Tuesday, 11 October 2016

Theatres can be surprising. As I discovered on a hospital project

Avoiding the avoidable is an excellent goal. But sometimes healthcare, including acute healthcare, is simply unavoidable. Not all the people walking into Emergency Departments are ‘walking wounded’ or ‘worried well’ who can be sent home with instructions to see their General Practitioner in the morning. Some really need hospital care and have to be admitted.

However, avoiding the avoidable doesn’t stop at the hospital bedside. Work still needs to be done to make sure that even within a hospital stay, the care delivered is precisely what the patient needs, and no more. In that context, initiatives that I’ve mentioned before that focus on discharge planning are important: from the moment of admission if not before, work needs to be put in place to discharge the patient as quickly as possible:
  • The patient should not have to stay longer in hospital than they need to just because test results are not available
  • If necessary, doctors have to review the organisation of their work to ensure that all the necessary paperwork, including prescriptions, are signed and ready in time for a prompt discharge
  • Where hospitals have to ensure that a patient is discharged to an environment with adequate care, all the arrangements should be in place beforehand
That’s the surest way of avoiding unnecessary hospital care: get the patient out of hospital and no longer incurring the elevated costs of nursing, medical care, tests or hospital drugs, to say nothing of surgery.

Even while in hospital, we can take action to avoid resource wastage. That’s where good information services come into their own again. Sometimes, they don’t even need to do anything exceptionally clever: they simply have to report in a clear and undeniable way on what’s going on in the hospital.

Often, that kind of reporting does just one of two things, both useful:
  • It may confirm what everyone knew, or at least suspected, but couldn’t prove
  • It may surprise people who hadn’t anticipated that the problem would exist
Occasionally, the same piece of information may confirm one person’s suspicion and surprise another. That happened to me when I was working, many years ago, on a reporting system for theatres (as we quaintly refer to operating rooms in the UK) in a major acute hospital. Theatres are hugely costly, both in the amount of capital they require – not just for building space but also for equipment – and in their running costs, requiring large numbers of highly-qualified staff in relation to the numbers of patients. It’s no surprise that many cost-containment initiatives in hospitals make a specific point of working on cutting unnecessary theatre costs.

One of the costliest areas in a hospital
so no bad place to look for economies
The project was fun because we set up a live link between our reporting system and the theatre management system. That meant we could see what stage of an operation any one case had reached: arrival in theatre, start of anaesthesia, first cut, last stitch, out to recovery, return to ward.

I appreciate that’s only fun for a geek who’s got too used to working on retrospective reporting systems, as I was: to me, it was exciting to be able to follow individual cases in near real time, as the theatre nurses entered information on their own system.

The real surprise came, though, with one particular report. We hadn’t been second-guessing the users at all, but building reports only as they told us they wanted them, using information they’d asked to collect. One of the reports, however, struck me as singularly dull. It simply showed the number of cases when the patient had been due to have a general, regional or local anaesthetic, plotted against which type of anaesthetic was in fact administered. The report looked something like the fictitious example illustrated (from memory – please forgive any implausibility it contains).

Anaesthetic report: I couldn’t see what was so exciting about it
The Medical Director of the hospital was also the head of anaesthetics. He looked at the report and immediately crowed with delight.

“That’s what I thought!” he proclaimed triumphantly.

I looked again at the report. I couldn’t see anything inspiring in it.

“Look at all those times they asked for a regional or general anaesthetic and ended up using a local! What a waste of an anaesthetist’s time, standing by to administer the anaesthetic, without being required.”

Suddenly the report made sense, as did his reaction. And I made a mental note: don’t imagine you know everything a reporting system should do. Talk to the users, learn what they want, and you may come up with something that will surprise you and delight them. 

Particularly if it highlights an area of waste that can be avoided.

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