Archive for the ‘Hospital Management’ Category

The Age of Dr. Now!

In Emergency Medicine, Hospital Management on November 4, 2010 at 00:04

People don’t just buy what they need anymore, but what they want. That’s marketing. But a funny thing is happening in Emergency Medicine. On top of the real emergencies, many people start using the E.R. when it suites them. They go see the doctor, because they want to at that time. That’s how one week old contusions, four hour wounds and three month old back aches make it to the E.R. “I just visited my Mom here, and I thought, you know, it’s tuesday night, I’ve got nothing much going on, why don’t I go get that blurry eye checked out now? Saves me a second ride to the Hospital and I’ve got nothing to do right now anyways. It’s been four weeks now. It think. Might have been five. Can you refill my PPI prescription too, please? – Oh! Look at that guy bleeding! What? You’r taking him before me? I’ve been here for over an hour, and he’s just arrived! Nice Emergency Room you’ve got, Doctor!
And yeah, you know, it’s really bothering me today, and face it, I’ve got no where else to go now, Doc! You can’t refuse to have look at me, can you? Not in Europe Anyway.
And that’s kind of true. There’s no real alternative at that kind of time. No other doctor will see you. And you can’t say it’s not really bad without having looked at it. So they’ve got you between a rock and a hard place.
More and more, the population of the E.R. are people looking for Dr. Now.
I want a consultation with a doctor, and I want it NOW.
That’s right.
Can you imagine?


Safety Precautions for Patient ID checks during Critical Procedures

In Hospital Management, New/Converging Technologies on November 3, 2009 at 03:23
On October 22nd, an Antwerp Hospital mistakenly switched 2 male patients in the Operation Room. One seems to have had the others prostatectomy, the other got examined under anesthesia. The latter got his prostatectomy later, after it came to attention he still needed one.
One of  them had his name bracelet taken off  for an I.V. cannula placement. The nurse, so they now say, may have forgotten to put it back on.
This is something that cries for novel technology solutions.
It is painstakingly true, that almost no hospital in Western Countries of Europe can boast a system that can identify a patient with a system that makes the necessity for a cognitive interaction, during the process that is considered critical, obsolete or simply unnecessary.
There where people usually attribute a higher level of certainty  to the implication of human judgment in a safety procedure, it may well be that this human appreciation should be made before the start of any Highly Safety Dependent Procedure. The sheer knowledge of the existence of the possibility that several intricate processes may go wrong is sometimes enough to create a base line of stress, which in turn may ignite cognitive mistakes.
If a patient’s identity is crucial to the safety and further development of care processes, which it undeniably always is in a hospital, a separate identity verification should be considered as a necessary SEPARATE logged and verifiable procedure before the critical process begins.
During the different stages of the critical procedure (like an operation, an invasive test, or a examination under anesthesia) a verified identity is remaining attached in a procedurally indelible way to the patient. In our view, this may well be a specially designed sophisticated electronic identification, unique to the patient, and not removable.
This way, during the critical process itself, only positive appreciations or checks of a technological and preferably not (inter)changeable parameter can establish the identity of the patient.
It goes without saying that the checks should not be dependent on the reach of the attention span of one, let alone several singular persons, to allow  for mistakes to happen.
On the contrary, the technology should be automated, and  a report of the several automated checks, along with a report of the initial and original verifiable identity procedure carried out separately BEFORE THE START of the critical procedure should be reviewed and “signed” by the surgeon about to operate on the patient.
At this point in time, this methodology has been clearly defined and used in environments very different from hospitals. In factory production environments, logistic relay stations, railway solutions, airplane logistics, and in many other circumstances less strange to you than you may well think, this kind of adaptation is considered a normal part of the process.
Maybe we can learn from from our fellow humans in the field?
I sure know I would like to keep my private parts!

E.R. Process for Cars. Or the Other Way Around?

In Emergency Medicine, Hospital Management on August 6, 2009 at 18:09

Renault Minute
It is not clear to me why we systematically expect the people with the lesser emergencies to spend much more time in the E.R. than people who are severely sick or injured. It is both illogical an irrational. And it’s bad commerce too. As in the car dealership, in stead of being triaged and told I’ll have to wait long (until all the really very sick people have been treated), I’d rather be rapidly assessed and assured I can carry on driving the car a day or two without causing additional damage. Then they give me an appointment to get it fixed at a later time. No more waiting.
But I guess I can only get that kind of attention for my car. Not for my ankle…

The Transparent Hospital

In Hospital Management, New/Converging Technologies on June 17, 2009 at 00:08

I cannot believe the contrast between the advancement and convergence in medical technology on one side, and the ever so apparent overall lack of (medical) process management in most hospitals on the other side. I remember to have read (I believe it was Professor Ken Hillman from the Liverpool Hospital in Sydney, Australia) a remark about the structure of the medical force in a hospital being exactly the same as two to three hundred years ago. I can tell you, if many major companies are transparent (at least for their management), hospitals are as black as the night in most cases. Doctors simply like to just do their thing, and use the fact that just about EVERYONE needs a doctor every now and then, ads leverage for them to fight change, and much more so, to fight transparency.
Nobody wants doctors to spill their guts about everything they know about patient or even about what happens in a hospital. But is that a reason not to try to find efficiency and search for a shorter way to results in the way a hospital works? Apparently it is. And while doctors are keen to counter change, most of the time, they also like to maintain the power in a hospital. Because transparency, they think, exposes the leverage. And the loss of the leverage, means loss of control.

And doctors love to be in control. Granted, they do take responsibility for it, and control is essential, even if it needs to happen through back doors.
You have to understand that most of the time this does not affect patients to much. But it certainly affects how much people, space and money is needed to get something done, and get it done in time. And the more of these assets are under control, the more the process is under control. Simplifying the process, would neccessitate less assets, and mean a loss of control. And that, my friends, is something a not to small number of doctors do not want to risk loosing. But the nursing world is beginning to awaken, and so are the patients. So I am very keen to see how the white caped heroes of the castle will respond to the every day people acquiring more say in the matter bit by bit. People are opening their eyes, thinking over things they didn’t use to, and through “Social Networking, Collaboration, Participation, Apomediation, and Openness” to quote Gunther Eysenbach, are acquiring a different position in the process, aspiring for a role in this very process, in stead of only being the object of it.
God gave us Twitter with a Purpose. Let’s use it wisely.
This is bound to become interesting. Very interesting …