In 1863, decades before the invention of the internet and almost a century before the inception of the NHS, Florence Nightingale was quoted as saying the following:
“Uniform hospital statistics would enable us to ascertain the relative mortality of different hospitals as well as of different diseases and injuries at the same and at different ages...”
In saying this, Nightingale pre-empted what could only be made possible through the use of IT; Hospital Standardised Mortality Ratios that collate data across a wide range of indicators to flag up those hospitals where, effectively, more people are dying than in others.
This complex analysis has taken decades to define and is still subject to scrutiny every year when the HSMR report is published. But while complicated measures such as the HSMR are carried out, the NHS frequently appears daunted by the thought of utilising technology in even the simplest way.
Not an IT system. A tissue.
Just two months ago, I had the misfortune to experience first hand the huge and unnecessary gap in NHS IT in the 21st century when a close relative was admitted to a cardiac unit.
Even though the trust was well-known for its implementation of an electronic patient record system, and even though it is considered to be, in many ways, leading the way in healthcare IT, this was how I found my relatives vital signs being recorded:
It does not take a genius to see that this is not a computer. It is not even a standardised, well formatted piece of paper, used to record crucial statistics following a serious procedure. It is, in fact, a paper towel.
A paper towel that easily creases to make it difficult to read what is written on it. A paper towel that can easily be mistaken for rubbish and thrown away. A paper towel that can almost certainly not be used to feed information quickly and accurately into a computer to be analysed in real-time for anomalies.
In this instance, the name of my relative was spelt incorrectly, even though it was written clearly above their bed. This entire process left significant room for transcription error and misinterpretation.
What’s more, this did not appear to be a one off, in fact the nurses, clearly busy, hurried from patient to patient writing down their vital signs in the same way.
Similar stories abound
There are hundreds of stories like this and each person that has come into close contact with the NHS probably has their own account.
When I shared my story with a close friend, she horrified me with her own encounter with the health service just a few weeks earlier.
Her two week-old baby was urgently readmitted to hospital, due to complications. The picture above shows the insertion of a cannula into the baby’s arm.
There is a date written on a bandage on the side to indicate when the tube was inserted, in order for it to be changed at regular intervals to avoid infection.
This is a seemingly sensible thing to do; but only if this information is also recorded elsewhere. If this information was rubbed off or made wet, serious issues could arise; guesswork could begin as to when the cannula should be changed. The whole process could be made so much safer and more effective when supplemented by IT.
It’s about more than technology
These examples show that while data, computer systems and technology can be complex, some of the biggest issues in healthcare are caused by the simplest things.
And evidence shows that we cannot afford to make mistakes or take risks on even the most trivial of actions.
Preventable medical errors are proven to cause around 98,000 deaths in the US per year alone, that’s more than the total deaths from motor vehicle accidents, breast cancer or AIDS combined.
This has been recognised since at least 2000, when the Committee on Quality of Care in Medicine in the US published ‘To Err is Human: building a safer health system’, To Err is Human: Building a safer health system.
This prompted the UK’s chief medical officer, Professor Sir Liam Donaldson, to publish his own report, ‘Safety First’, arguing that the NHS needed to take a far more consistent approach to eliminating errors, drawing on other industries in which safety is paramount.
Moreover, patients are increasingly EXPECTING technology to make healthcare safer. A recent research by IPSOS, found that of 1,000 people surveyed 68% said that as the medical field continues to adopt technology, medical errors should decrease.
Simple measures like entering the information on the aforementioned cannula or paper towel into a computer system at the point of care, electronically producing task lists to ensure the correct person is allocated to carry out checks or activities, and alerts to highlight issues or anomalies could significantly lessen the possibility of errors being made or complications being missed.
Yet both of the hospitals where these photos were taken are considered to have advanced health IT systems in place.
It would be easy to say ‘implement technology, it will solve the NHS’s problems’; but that is clearly not the task at hand.
Instead, we need to make access to the relevant patient information much more easily available. Technology needs to be uncomplicated with the correct training, attitudes, processes and leadership in place to help the end users.
The nurses at such organisations are doing incredible jobs, working under extreme pressure to balance the increasing demand by patients with often a reduction in budgets and resource and finding ways to cope with this, even if it does entail writing on paper towels to save time and money.
Florence Nightingale had the foresight to see the benefit that healthcare IT could bring more than a century ago, so we now have the opportunity to make this reality. The more we make patient information transparent and easy to understand, the more chance of care being provided in a quick, safe and easy fashion.
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