I am back in the mysteries of the NHS again, this time visiting an elderly close relative. Hence not much blogging of late.
Back in 2014:
The information management problems for hospitals are formidable. At each stage more and more information about each patient is collected, noted down, and then has to be put somewhere useful. Different people need some of this information but not all of it. Crawf Minor tells me that his University medic friends are aghast at the way that hospital doctors are now trapped by their iPads. Ward rounds are taking longer and longer as more and more information on patients is sent ‘efficiently’ by wifi to the doctors concerned, who then need to read it all. Except when the wifi signal is not powerful enough to reach the doctor in the ward, when things get stupid.
All this information of course comes in myriad forms and sizes. Some of it is noted down by nurses and doctors taking simple tests and asking questions. Some will be printouts of scan or test results (numbers, text and images). There is no easy way to standardise all this to make it easy to use (including by meaningful prioritising), not least because the medical technology keeps changing and new ways of presenting information keep being invented.
While all this is going on, actual processing of doctors’ and nurses’ shifts happens, so the ‘information decay’ problem appears: the more people dealing with a patient, the more each person has to spend time reading up on where matters now stand.
No sign of any such fancypants Apple technology in the two wards I’ve been visiting in sizeable Hertfordshire hospitals. Nurses pull out scraps of notes from their pockets when you ask them what is happening next.
That said, once again I am struck by the sheer complexity of what is happening. A nurse comes round with a large suitcase-size metal box on wheels, full of different boxes of pills. Imagine the audit and practical supply-chain challenges of keeping that large box filled with the right pills, and making sure that the nurse gives just the right combination of pills to just the right patient at just the right time. Then recording what’s happened in a way that the next shift and the wider system as a whole can understand it.
Some effort is made to give patients a good choice of meals. What comes round often bears some resemblance to what they asked for (insofar as any patient food wishes can be extracted from the patients themselves – not an easy job in many cases), and is just about edible.
Above all, I am humbled by the diligence shown by the nursing staff as they try to keep their designated batch of elderly heavy wheezing largely immobile patients clean and tidy. All the more so when so few of them appear to be native Britons. Maybe it should be called the UK International Heath Service. One African male ward orderly told me how he came from a large Nigerian family: his father was a king in Nigeria and had had 20 wives, a policy that (he sighed) had proved too expensive for the family as a whole.
It’s a sobering thought to look at the expensive honourable care being given to old people in our society who long since stooped contributing much to the common weal other than tenaciously staying alive. Eeek. That’s me in 1000 weeks or so, if I live that long! How long will it be before the costs overwhelm the ability or willingness of the taxation system to cope? What are the intergenerational and other ethics of this situation?
No-one has the faintest idea. But the way forward has to lie in technology, robots and greater organisational flexibility.
Somehow. Or not.