- Smart Healthcare, Wednesday 17 June 2009 09.00 BST
Day 157: During my recent week-long stay in "Fastrack Hospital", I suffered from a minor system failure. Not primarily a computer failure, but a communications failure between doctors, nurses, the pathology lab and the computer.
I hesitate to mention this, as there were many people in the ward who were really ill, and what happened to me was little more than an inconvenience. However, my grumble seemed to me a microcosm of some of the things that are wrong with system design in the NHS.
I was to get an hour-long drip of a powerful antibiotic in the morning and at night. I would go home during the day, and spend the night in hospital. But I had to have a blood test each morning, to check that my blood stream could take the antibiotic.
The trouble was that the nursing staff did not know how long the pathology lab would take to process the blood - anything from one to three hours - and whether the doctors could be accessed to give the OK that the drip should go ahead. As a result, the time of my intravenous injection slipped day by day, and I couldn't go home until about 3pm. It became hardly worth going home at all.
The process started when the phlebotomist did his round taking blood at around 11am. He was admirably careful. But it worried me how long he took to write the details on the many phials; a fiddly process which demands clear minuscule hand-writing, and absolute accuracy. His visit to the ward lasted nearly an hour. Whenever I have had my blood taken, I have asked myself how this manual transcription can be avoided, and my mind has boggled.
At Smart Healthcare Live last week, I found a solution, a stand flogging an application for phlebotomists, combining a mobile clinical assistant with a bar-code printer that clipped onto a belt. No more microscopic handwriting. The barcode was stuck onto the phial. The suppliers claimed that the application cuts down the recording time by 50%. And the barcode, being electronically readable, could be useful in the subsequent processing of the blood. Which a manual transcription on the phial would not. When I think of the number of blood tests I have to go through every month, I wonder why trusts have not adopted such an elementary techno-aid decades ago.
I used to grumble every day to the doctor on the ward round about my later and later release from the hospital each day, and he or she would promise to ask the nursing staff to speed the process. One nurse commented "what do the doctors know about what actually happens when we are dependent on another department". The nurses seemed to take the attitude that because the lab was unpredictable, they, the nurses, were in the hands of forces beyond their control, and therefore powerless to help me, the patient.
This seemed to be an echo of what Gerry Robinson found in his attempts to sort out a hospital trust three years ago: that there was a feeling among nurses, consultants and administrators that "the system" inhibited any improvement. When NHS staff feels that they are powerless to improve patient care because of "the system", then we should start worrying about how any NHS IT system can develop.
In a previous life, I used to sell project management software, which told me that the critical path in this process was the time spent in the lab. I wish that a training in project management for both doctors and nurses was obligatory, so they would recognise how processes can be slotted together. It could save the NHS a lot of wasted time and money, and the patients like me a lot of grief.
After two hours of waiting for the blood samples to be processed, the nurses on the ward had to interrogate the computer continuously to find the result, when they should have been soothing my fevered brow. I would have thought that a bit of push technology could have been appropriate here, such as an alarm going off on the ward's work-station to say that my blood had been processed. Then the nurses would not have had to call up the screen continuously.
Worse still, I discovered one day that the lab had failed to key into the computer that my blood was ready, and the nursing staff only found out by telephoning the lab, when I got stroppy with them. This seemed to me a sloppy system, which could do more harm than good because it was not properly operated.
Again, I apologise for bringing all this up. There was nothing life-threatening about the defects I have described. Everybody else on the ward was very ill, and humbled me by their stoicism, whereas I was just a day-tripper on the ward, and my treatment had, rightly, a low priority.
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While at Smart Healthcare Live, the Patient from Hell questioned Martin Bellamy, head of NHS Connecting for Health. His question, and Bellamy's answer, can be heard from 19:10 on the online recording of this session.
