What do we need from technology to improve patient flow? A day in the life of a frontline clinician
For those who don’t know me, my name is Dr Constantin Jabarin and I’m the International CMIO for Altera Digital Health. I’ve had the pleasure of being at the company for around three and a half years and as my title suggests, I’m also a practicing emergency medicine doctor at Gloucestershire Hospitals NHS Foundation Trust, which happens to be one of Altera Digital Health’s clients and where we use Sunrise™ EPR clinically.
As an A&E doctor, I see patient flow problems first-hand. In August this year, NHS England figures showed just 58% of patients at Type 1 A&E departments, and 71% of all emergency patients, were admitted, transferred or discharged within four hours. This is a long way off the four-hour target of 95% of all patients.
Unfortunately, issues of delayed transfer of care and poor patient flow are a reality for every hospital. However, it isn’t just a hospital challenge—it’s an ICS-wide issue that must be tackled at the root cause. Alleviating bottlenecks that negatively affect patients’ safety, experiences and outcomes is critical.
In this blog, I will share some insight into my role and the impact technology has on patient flow. I’m writing this retrospectively having just finished my second ten-hour shift in two days.
What is it really like to be a doctor in the NHS?
As we approach winter and the flu season head-on, naturally we see an influx of patients visiting hospitals. Pair this with continued COVID-19 pressures, and doctors are stretched thin.
Many of the issues we face in acute hospitals are a direct result of the long-term under-resourcing of social care. The pressure is high, and I feel for my full-time medical colleagues; I only work clinically a couple of weekends a month, but for those two ten-hour shifts over a weekend, I experience the pressure, too.
After I left my second shift, following a long weekend, there were many more patients than the department is designed to cope with.
Starting my shift
When I arrive, it’s all-hands-on-deck, and I must be fully “in the zone” from the moment I arrive until the moment I leave. In the time I’m treating patients, there is a lot to do. I must examine them, write their notes, request diagnostics and refer them. All done while advising junior doctors and nurses and waiting for a phone to be answered if I’m trying to talk to someone in another part of the hospital.
As a clinician, what do I need from an IT solution?
I need the solution to be fast. Doctors simply don’t have the time to wait for applications to load—our priority is with the patient and we need solutions to work seamlessly, regardless of the machine.
In our personal lives, we’re used to technology and software that is seamless and user-friendly. These attributes make technology easier to use. If a solution is efficient and easy to use, it’s one less thing a doctor in an A&E department has to worry about.
From ordering, to requesting, to writing notes, systems must provide as little obstruction and distraction as possible. You need to be able to get to where you want with your common actions repeatable, as quickly as possible.
Today, for example, I was using a mobile and a laptop on wheels—which was very effective—simply because the room I was in is a temporary room where we assess and take handovers, with no space for a desktop.
Seamless access to data
During my shift today I treated an elderly man with dementia who often liked to go for walks, except this time he didn’t come back. The police were looking for him all day and eventually found him at the bottom of a ditch in the middle of nowhere. I first listened to the patient’s story from the police and then from his daughter, as I wanted to see if there was anything else we, as healthcare professionals, needed to know about him, in order to treat him effectively.
After considering the gentleman’s condition and making decisions about his onward treatment, I recorded all the information I was given in Sunrise so that other people in the hospital and wider health system can see his history. When doing so, time is of the essence, as I constantly need to see the next patient; I don’t want to have think about opening multiple systems or tabs to record what I need to.
Any solution we use must be able to pull in information seamlessly to enable me to make the best assessment quickly.
Ease of use
At the same time, I begin treating another elderly patient that’s just arrived. Initially, it appears the 90-year-old has suffered a minor fall, as she was found on the floor in her home, complaining about pain in her knee, even though she was actually pointing towards just above her knee. I examined her, captured the information and requested my investigations.
Once again, all of this needs to be done without me having to spend too much time thinking about the process of entering, recording and receiving this information. It needs to be done as quickly as possible so I’m able to get back to the patient.
The patient’s X-ray revealed she’d broken her femur, which was complicated by the fact that the patient already had a metal rod that went down the middle of the bone. This was due to a previously broken knee. This time she had broken her femur in a very tiny part of the bone with no metal work.
It was my responsibility to make referrals, discuss the case with the orthopaedic team and then explain to the patient’s family that while the injury is fixable, the surgery carries significant risk for a frail 90-year-old.
Afterwards, I recorded all this information in Sunrise so that other people in the hospital and the wider health system can see the history of the patient. Time is always of the essence as I need to see the next patient.
Next I saw an elderly lady who had been sent home from hospital two days prior. She seemed very unwell with what I suspected was a large lymph node in her bowel. The bowel had twisted and needed surgical treatment. I examined, then updated my notes, contacted the surgical team and organised a scan. At this point, multiple users in the hospital needed to access the patient’s record.
To deliver quality care, clinicians rely on the electronic patient record to provide the right patient information at the right time. IT is the critical system that underpins the entire running of a hospital, and we need it to support us like we do our patients.
More hospitals are starting to realise that patient flow is the key to creating a better experience for both patients and staff members. If a hospital can’t get patients in and out in a timely manner, then bottlenecks will only worsen, resulting in further lengthy waiting periods. A hospital’s success depends on its ability to move patients through quickly so it can keep others coming in.
To learn more about how Altera is helping streamline patient flow, download our eBook, “Top 5 ways to improve patient flow for UK hospitals and ICSs.” Download