Blood works bet­ter in colour

Some of the an­swers to solv­ing our pub­lic hospi­tal woes could be star­ing at us right in the face. Kel­lie Bis­set re­ports

The Weekend Australian - Travel - - Health -

IF you were hav­ing a heart at­tack, what’s the like­li­hood you’d want to spend up to two hours longer than nec­es­sary ly­ing on a hospi­tal trol­ley wait­ing for your ur­gent blood test re­sults to come back from the lab? Zero, un­doubt­edly. But for one in seven pa­tients, un­nec­es­sary pathol­ogy test de­lays are just one of the grim re­al­i­ties they ex­pe­ri­ence in over­stretched hos­pi­tals across the coun­try.

Th­ese de­lays aren’t just in­con­ve­nient — a pro­por­tion will re­sult in se­ri­ous ad­verse events that could have been pre­vented.

Re­search shows that over­crowded emer­gency de­part­ments are un­safe places to be: you’re more likely to die if ad­mit­ted to hospi­tal via an over­crowded emer­gency de­part­ment than if you front up at one that’s not so hard-pressed.

And while de­bate rages na­tion­ally over how to fix ‘‘ ac­cess block’’ — where pa­tients queue up in emer­gency be­cause they can’t get an in­pa­tient bed — a grow­ing band of health ex­perts is push­ing to cut through the noise and get back to ba­sics.

The an­swer, they say, is not about sink­ing more dol­lars into a sys­tem in­sa­tiable for funds.

It’s about re­design­ing the way our hospi­tal sys­tems work — and some­times the so­lu­tions can be dis­arm­ingly sim­ple.

Bris­bane pathol­o­gist Andrew Francis thinks he’s hit upon one such so­lu­tion.

Sick of watch­ing pa­tients suf­fer from pre­ventable de­lays, he has de­vised his own way of stream­lin­ing the sys­tem.

The re­sult is FASTPaTH, a re­design of the pathol­ogy process in hos­pi­tals that sees ur­gent sam­ples col­lected in colour-coded red tubes and bags.

This means that ev­ery­one deal­ing with the sam­ple — from the wards­man de­liv­er­ing it to the lab staff pro­cess­ing it — knows it’s pri­or­ity one.

A trial of the sys­tem has shown it re­duces the time pa­tients spend in the hospi­tal emer­gency de­part­ment by 20 to 30 min­utes.

And that time sav­ing trans­lates into big dol­lars.

In Queens­land, where FASTPaTH has been rolled out across 19 hos­pi­tals, the sys­tem has the po­ten­tial to see an ex­tra 500 pa­tients a day treated statewide.

That’s an ef­fi­ciency of about $35-$40mil­lion a year — and one that Francis, di­rec­tor of pathol­ogy for the Prince Charles Hospi­tal Lab­o­ra­tory Group, thinks could be repli­cated in other states.

Aus­tralian hos­pi­tals on av­er­age fail to de­liver ur­gent pathol­ogy sam­ples on time in 10-15 per cent of cases, ac­cord­ing to the Aus­tralian Coun­cil on Health­care stan­dards.

But in some state pub­lic hos­pi­tals the fail­ure rate is much higher, with 55 per cent of pa­tients not get­ting their ur­gent pathol­ogy re­sults within the hour ex­perts agree we should aim for.

In­ter­na­tion­ally, fig­ures for OECD coun­tries show about 30 mil­lion ur­gent blood test re­sults per year are de­layed un­nec­es­sar­ily. And Francis says this trans­lates to a min­i­mum of 300,000 peo­ple per year suf­fer­ing se­ri­ous con­se­quences as a re­sult.

‘‘ That’s the equiv­a­lent of 10 jumbo jets a week fall­ing out of the sky,’’ he says.

‘‘ We have al­most three years of data that has ev­i­dence to show [this sys­tem] is sim­ple and sus­tain­able. We have a duty of care to pa­tients to of­fer best prac­tice.’’

Francis, who as a private in­di­vid­ual has been granted an in­no­va­tion pa­tent for his work, has also in­cor­po­rated other fea­tures, such as a method of track­ing ur­gent sam­ples, so the lab can check on de­lays.

And he’s not the only voice urg­ing a re­think of sim­ple hospi­tal pro­cesses as the key to mov­ing pa­tients through the sys­tem more ef­fi­ciently.

A Re­design­ing Care Pro­gram at Flin­ders Med­i­cal Cen­tre, led by epi­demi­ol­o­gist Pro­fes­sor David Ben-Tovim, has turned the hospi­tal’s for­tunes around by map­ping pa­tients’ jour­neys through the emer­gency de­part­ment and fix­ing the pit­falls they found along the way. The re­sults have been im­pres­sive. Since the project was launched in 2003, the hospi­tal has gone from hav­ing the state’s worst per­form­ing emer­gency de­part­ment to be­ing one of the bet­ter per­form­ing hos­pi­tals, de­spite a 50 per cent in­crease in ac­tiv­ity. It has saved 10,000 bed days by re­duc­ing the pa­tient length of stay and it has im­proved re­cruit­ment and re­ten­tion of med­i­cal and nurs­ing staff.

Ben-Tovim says it wasn’t un­til the emer­gency de­part­ment team — from the cler­i­cal staff to the head of de­part­ment — got to­gether to map how pa­tients ex­pe­ri­enced the sys­tem, that they re­alised how con­fus­ing it was.

‘‘ It was a very pow­er­ful process — we stood back and saw what a mess we had got into with­out re­al­is­ing it.’’

In its bid to re­design care, the Flin­ders team adopted the prin­ci­ples of ‘‘ lean think­ing’’ — a con­cept orig­i­nally de­vel­oped by Toy­ota to stream­line its man­u­fac­tur­ing pro­cesses.

The pro­po­nents of lean health­care say it’s not about cost cuts, but about im­prov­ing things step by step.

At Flin­ders, the re­sult of map­ping the emer­gency de­part­ment jour­ney led to a ma­jor change in how pa­tients were dealt with. Those with life-threat­en­ing con­di­tions were still given im­me­di­ate pri­or­ity. But the rest of the pa­tients were di­vided into two streams: those the ED could treat and those who needed to be ad­mit­ted. Each group was dealt with sep­a­rately and pa­tients were treated on a first­come, first-serve ba­sis.

Ben-Tovim says the change worked on the day it was in­tro­duced, didn’t cost a cent, and the lean think­ing phi­los­o­phy has since been in­tro­duced right across the hospi­tal.

Ac­cord­ing to Pro­fes­sor Ju­dith Dwyer, the Flin­ders project is a bea­con for other hos­pi­tals want­ing to achieve sus­tain­able change.

Pic­ture: Tony Phillips

Crack­ing the de­lay code: Bris­bane pathol­o­gist Andrew Francis and lab­o­ra­tory man­ager Katy Mar­shall us­ing the colour-coded sys­tem he de­vised

Newspapers in English

Newspapers from Australia

© PressReader. All rights reserved.