Forget S.P.E.C.T.R.E, Mr Bond – S.L.O.T.H is the enemy!
In the 1930s, people avoided hospitals because of high mortality rates. Today, they go to hospital a lot although evidence suggests it is still bad for us.
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Treating people in the wrong place is expensive and potentially fatal
80% of people want to die at home. But only about 12% actually do. Why hospitalise these kinds of patients? An overloaded system no longer works well, eg 90% of English hospitals are working over capacity and report a negative impact on patients. Too many old people can be observed waiting in the emergency department, and the ultimate benefits of hospitalisation of people in the last years of their lives is questionable!
Emergency Department as barometer for healthcare systems
SLOTH* creates chaos by increasing:
- the chance of dying in hospital (rises by 20% after a wait > 12 hours)
- the length of stay by 1-3 days
- the chance of errors and litigations
Henry Ford was told people want a faster horse – resistance to innovation. But proven technology could revolutionise healthcare for patients. Agility is required and fear needs to be overcome, eg most GP practices don’t offer online video consultations for liability-related fears.
Solutions to chaos
Focusing on pre-hospital practice will drastically reduce hospital admissions and crowding, eg ambulance services have an unprecedented range of technological skills at their disposal; but some dispatch systems are based on 40-year old models. Better systems fundamentally change the way you work and the quality of healthcare for patients.
Scotland: A test tube of European healthcare
The Scottish Centre for Telehealth and Telecare (SCTT) has many examples of promising projects that could be scaled to other small and rural nations. Unfortunately only 20% of projects are adopted, eg patients can now enter virtual waiting rooms and be seen by a clinician.
The SCTT is focusing on platforms, such as a community health index to follow patients and determine clinical outcomes. Using four decades of data from ambulance services, 40 protocols have been downgraded to less urgent responses, freeing up ambulance time.
Taking diagnostics to patients reduces hospital workflow dramatically:
- A trained person in the Western Isles does a CAT scan, transmitting data to Aberdeen for a consultant to decide if thrombolysis is needed.
- Blood tests (eg Troponin) done in the back of an ambulance rule out up to 70% of known STEMI’s.
- Video conferencing cuts hospital transmissions by half.
- Experts focus on calls from paramedics and GPs and data analysis (90% of cases are likely to be normal).
What might quality prevention look like in the future?
- Passive, integrated monitoring, eg toilets monitor urine and stool, new sensors for Fitbit linked to incentives, Wii Fits-based competitive physio to increase motivation. Effectiveness will depend on creating platforms to collect data and provide clinical access should medical intervention be required.
- Increased self-screening, eg colon capture (a device is swallowed which photographs the colon, transmitting the image); could beat colon cancer within the next ten to twenty years; particularly if a chemo tope and toxic agents are tethered to the capsule.
Patients are getting a rough deal in most health care systems today. Telehealth and telecare have the potential to improve patient health and wellbeing by strategic resource management.
* Using the James Bond reference Ferguson said, instead of SPECTRE, the enemy is SLOTH, (Secret League Opposed to Health). Their mission: to kill people by doing nothing. Their weaponry: CHAOS (Chose Hospital Admissions Only Solution).