How to utilise the technology that can transform urgent care
Technology that could revolutionise care has already been developed, so how do we roll it out to all of the NHS, ask Jim Parle and Terry Young.
Friday evening at accident and emergency in the city, and things are getting busy. At the heart of the hive are a dozen cubicles surrounding the nerve centre. It is a place to which A&E staff return repeatedly, updating notes, adding arrivals or removing the names of those discharged or admitted to the main hospital.
Each staff member glances regularly at the wall-mounted display showing a set of predictions. This system keeps estimating how long patients will be in A&E tonight.
The display turns amber when the average predicted stay exceeds 90 minutes. Red identifies patients heading for the two-hour mark. Later this evening the display will turn amber and the consultant in charge will spend five minutes running three pre-set scenarios through the model.
These include an option to redirect some of the anticipated demand. Then the consultant will choose how best to manage the crisis that will not happen tonight: it has been six months since any patient stayed for more than two and a half hours.
As each patient arrives, a sophisticated software system is already sifting through records and GP-generated predictions, capturing the provisional diagnoses of the consultant-led front-of-department team and feeding this information into the model that drives the prediction display on the wall. The system is also using this knowledge to signal to the wards about likely admissions and discharges over the next few hours.
Two hours ago, every feeder GP practice submitted its estimate of how many people in its catchment are likely to pitch up as emergency admissions – every day for the next nine days.
Two decades ago, people were worried about the European working time directive and the loss of resources it represented as junior doctors and others had to cut their on-call hours.
Today, in 2030, the NHS delivers better care than ever before, and staff numbers have stabilised well below 2010 levels. Also, three-quarters of the workforce now choose their working hours through an online negotiating service…
Leaving the future for a moment, will it take until 2030 to deliver such a service? By 2030, care will have to look very different – we will not have the staff to manage burgeoning demand. And most indicators suggest that we are travelling in the direction of using data intelligently to predict and manage demand. The key question is: how fast?
The good news is that almost all the technology needed has already been developed in some form and has been used successfully somewhere. Increasingly, doctors, nurses and healthcare managers are turning to models and simulations to get a handle on care management.
For example, Stockport Primary Care Trust noted a rise in GP referrals to hospital after the introduction of the new “free choice” system for patients. Scenario Generator, a modelling package, traced and analysed the routes patients were choosing. The management team found a way to ensure that 97 per cent of patients received an appointment within 28 days and that nobody waited more than 37.
Another example is the development of electronic case management systems in hospitals that are allowing centralised, real-time surveillance of patient wellbeing. The system is proving to be a boon to infection control, because it monitors and produces real-time reports on many of the early indicators of infection outbreaks.
Introduction of such a system to Portsmouth Hospitals Trust has resulted in large reductions in outbreaks of the highly contagious norovirus or winter vomiting bug. The average number of outbreaks was running at about 20 a year but, since introduction of the new system almost two years ago, there has been just one identified infection outbreak.
Strides are being taken to risk-stratify patients, especially those with long-term conditions. For example, The Southampton, Hampshire, Isle of Wight and Portsmouth PCT cluster will commission £3bn of care a year. It has gathered tools from sources as diverse as the Johns Hopkins Bloomberg School of Public Health, McKesson and Experian to predict and procure what is needed.
These examples reveal a new generation of doctors keen to rewire their healthcare world. A systematic push is now needed to integrate what is happening and to roll it out nationally. This will mean drawing our knowledge companies into healthcare in a new way.
But can change in the NHS be speeded up? The Cumberland Initiative is an attempt by a group of research academics with strong healthcare credentials, working with clinicians and knowledge companies, to bring the NHS version of this change into reality – perhaps a decade earlier than it may otherwise take. A faster, more strategic approach could save billions of pounds and improve many lives.