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