Friday, 10 June 2011

View from the front line. Finchers takes research to the next level...

It wasn’t in the masterplan, but I experienced a good chunk of the NHS patient pathway this week as I was admitted to an NHS hospital via an out of hours GP service and Accident and Emergency Department (A&E). A testimony to this obsession for writing about healthcare was clearly apparent as my close friends and family, without exception, all said – ‘you’ll get some great material for your blog’ when they heard of my incarceration.

I shall spare you the gory details but I am now home, the walking wounded, not necessarily richer, but definitely not poorer for the experience.

there is indeed sumptuous fodder for a healthcare blogger as an NHS inpatient. None of it particularly shocking, mainly reaffirming of my current viewpoint actually. Today’s commentary is a summary of all that was good about my experience and I shall add some postings over the next few days on areas where ‘could do better’ would be the score on an end of term report. These areas (probably no surprises) will include Communication, Accountability, Time Management and Waste.

For the past two years all my time spent in hospitals has been in an official capacity, skirting around the edges of the actual patient experience. This time as an inpatient, my first since becoming a blogger, was particularly fascinating as I tried to view every nuance of the service and the people who provide it from an independent, detail-thirsty and hopefully objective view-point.

My whole experience was, on the whole, highly user friendly and possibly life-saving. I received timely, appropriate, and in the main, well delivered care throughout.

I know that I am lucky to live in an affluent area with good GP access, who happen to have an excellent out of hours service. Without going into too much detail, my GP himself ended up seeing me out of hours and immediately phoned the hospital who advised that I should be admitted.

Time from my phone call to out of hours service to seeing GP: 20 minutes
Time from GP assessment to referral: I minute

Note to Mr Lansley: (UK secretary for state for health). This is what GPs do best. They know a patient’s history, they provide front line advice and triage and they refer if appropriate.

Within an hour of arriving at the A & E department, I had been thoroughly investigated, diagnosed, treatment started and the search for a bed had begun. The clock started ticking and I was fascinated as staff made frantic phones calls and juggled names on boards, reminiscent of the archived news reports of naval ships being manoeuvred across a board in the planning rooms in bunkers under Whitehall during the Second World War. And hey presto – with just 3 minutes to spare, I was whisked to my duly allocated ward, with the A & E target intact. Money saved for the Hospital Trust and a patient happy to be admitted without too much delay. (The target is: decision for admission to patient reaching hospital bed – 4 hours)

Time from admission decision to reaching allocated hospital bed: 3 hours 57 minutes.

Note to Mr Lansley Targets work. I would probably have had to wait many more hours for a bed. The four hour window was constantly on the A & E staff’s mind

The four-bedded bay on the ward was well equipped, light and airy. It was spotlessly clean, not particularly well run, but care was delivered as needed. I was surprised not to see a pharmacist, especially as I was a medical, not surgical patient. But I was cared for and assessed by at least two consultants a day, several junior doctors, many nurses and an army of healthcare assistants. I shall talk more of this in another blog as it appeared to be a case of many hands not making light work…

Note to Mr Lansley: You are absolutely right, efficiencies need to be made in Hospitals. But the existing core services and infrastructure in many, many cases are very good. Restructure, reform and reconfiguration is a drastic way to provide improvements that could be achieved through sensible pathway mapping, realistic and unambiguous service delivery targets and minimum capital equipment requirements. Improved recruitment processes, communications training and ongoing professional development are badly needed. And most important of all, a good old fashioned time and motion exercise to assess how manpower is being used would be money much better spent than changing the commissioning process.

I was given over £1000 ($1600) worth of medication during my three day stay. My take home drugs would have cost around £200 ($320). The food and facilities were excellent. A wide choice of menus, regular tea and coffee rounds, clean sheets and towels every day, fresh water delivered to your bedside twice daily – pretty much like a good basic hotel. If I hadn’t been treated promptly, this blog would have told a very different story, with far reaching effects for my future health. This particular patient is due to make a full recovery.

Cost to patient for all these services including medical consultations and nursing care, x-rays and blood tests, medication, accommodation and food: £0.00

Note to Mr Lansley:  Bless the NHS!


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