I was listening to radio 5live on the drive home from work yesterday afternoon and they were interviewing Dave Brailsford, the man who is the head of British Cycling about the absolutely phenomenal achievement of the track team in Beijing (7 gold medals from 10 events so far!). Dave was explaining how the cycling team had gone about targeting every single aspect of the performance of the riders and the bikes and really left no stone unturned in their meticulous preparation. The quote that he came up with was “In order to improve things by 100%, you need to improve 100 things by 1%.”
This struck a cord with me and my work in the NHS. The NHS has far, far more money than British Cycling (in fact, the entire annual budget for British Cycling would run the NHS for about ten hours) but in 2008, we are struggling to provide the sort of world class service that we aspire to. It’s a little allegorical to what I wrote about the real difference between ICU and ward care.
I’ve been reading the posts of Dr Jane Doe over at Two Weeks On A Trolley with great interest. She’s been pointing the inefficiencies in the Irish Healthcare system (for Irish, read British because, at the front line, the two systems are pretty identical) and how these inefficiencies directly compromise patient care. She also writes about how the healthcare system down under copes with exactly the same problems in a much better, faster, more efficient and cheaper way. You really should read her posts, they’re fantastic.
I think part of the problem with the NHS is that nobody listens to the people who actually deliver the service. Actually, it’s not even that nobody listens, nobody evens asks the questions. Nobody wants to hear our ideas about how we can make the service better, and that is one of the most frustrating things.
Anyway, this post isn’t meant to be just another “The NHS is crap” whine, I actually wanted to write something constructive about how I think my area of specialty (anaesthesia) could be improved. Here are my top 5 ideas:
1. Get rid of the anaesthetic room.
The anaesthetic room (AR) is an anteroom right next to operating theatre. Patients coming in for surgery come into this room where we anaesthetists give them their general anaesthetic before moving the unconscious patient into the operating room (OR). From day 1 as an anaesthetist, I’ve always thought that this was really pointless. The hardest part of a general anaesthetic is the induction. This is the time where the patient is the most unstable, and as a result, this is the time that the patient is the most vulnerable. To me it seems really odd that, at the time where the patient is most at risk, we have to disconnect all our monitoring equipment and then move the patient into the OR and then drag the (sometime quite hefty) patient from the trolley onto the operating table. It’s all totally pointless and unnecessary. It puts the patients at risk and it puts the staff at risk too from having to drag unconscious people around. It would make much more sense to have the patient walk into the OR and then we give them their anaesthetic on the operating table – in fact this is exactly what we do if we feel the patient is a particularly high risk (e.g. emergency AAA repairs).
2. Automatic Doors
As I said above, we anaesthetist spend a lot of time moving unconscious people around. We go from the AR to the OR and from the OR to the recovery room. Some times we have to go through three or four sets of double doors wheeling an unconscious person on a trolley. We do this several times a day. Having to open doors and hold them open when we’re transferring patients is a pain in the arse. Can we not have automatic doors in theatres? If not fully automatic, then at least the type that open when you push a button. It makes sense. They have them in just about every high street store, can we not have them in the NHS?
3. Printouts
During an operation, we anaesthetist keeps a record of the patient’s vital signs. Every five minutes, we’ll write down the patient’s blood pressure oxygen saturations etc… etc… Whilst this is no big chore, it surprises me that the highly expensive anaesthetic machines just can’t print all this information out for us. Surely it can’t be that difficult?
4. Use Wireless Technology
I can sit and type this on my laptop and publish it to the internet using no wires at all. Bluetooth means that we can connect our mobile phones to our fridges if we so desire. As an anaesthetist, I spend a lot of my time untangling the patient from the wires and cables of our monitoring devices. The ECG leads, blood pressure tube and sats probe will inevitably get wrapped around or caught under various parts of the unconscious patient. We should be able to have ECGs, BP cuffs and sats probes that connect to the anaesthetics machines wirelessly and get rid of this problem.
5. Bleeps
This is one that’s not specific to anaesthesia but is the bane of junior hospital doctors across the nation. The bleeps (or pagers) that we have to carry and use to contact each other have to be the most annoying and inefficient way of communicating ever invented. I’ve mentioned this before and the solution is for hospitals to have a mobile phone system rather than a paging system. Communication would be much better and things would get done faster because staff won’t have to sit around waiting for people to answer their bleeps.
This struck a cord with me and my work in the NHS. The NHS has far, far more money than British Cycling (in fact, the entire annual budget for British Cycling would run the NHS for about ten hours) but in 2008, we are struggling to provide the sort of world class service that we aspire to. It’s a little allegorical to what I wrote about the real difference between ICU and ward care.
I’ve been reading the posts of Dr Jane Doe over at Two Weeks On A Trolley with great interest. She’s been pointing the inefficiencies in the Irish Healthcare system (for Irish, read British because, at the front line, the two systems are pretty identical) and how these inefficiencies directly compromise patient care. She also writes about how the healthcare system down under copes with exactly the same problems in a much better, faster, more efficient and cheaper way. You really should read her posts, they’re fantastic.
I think part of the problem with the NHS is that nobody listens to the people who actually deliver the service. Actually, it’s not even that nobody listens, nobody evens asks the questions. Nobody wants to hear our ideas about how we can make the service better, and that is one of the most frustrating things.
Anyway, this post isn’t meant to be just another “The NHS is crap” whine, I actually wanted to write something constructive about how I think my area of specialty (anaesthesia) could be improved. Here are my top 5 ideas:
1. Get rid of the anaesthetic room.
The anaesthetic room (AR) is an anteroom right next to operating theatre. Patients coming in for surgery come into this room where we anaesthetists give them their general anaesthetic before moving the unconscious patient into the operating room (OR). From day 1 as an anaesthetist, I’ve always thought that this was really pointless. The hardest part of a general anaesthetic is the induction. This is the time where the patient is the most unstable, and as a result, this is the time that the patient is the most vulnerable. To me it seems really odd that, at the time where the patient is most at risk, we have to disconnect all our monitoring equipment and then move the patient into the OR and then drag the (sometime quite hefty) patient from the trolley onto the operating table. It’s all totally pointless and unnecessary. It puts the patients at risk and it puts the staff at risk too from having to drag unconscious people around. It would make much more sense to have the patient walk into the OR and then we give them their anaesthetic on the operating table – in fact this is exactly what we do if we feel the patient is a particularly high risk (e.g. emergency AAA repairs).
2. Automatic Doors
As I said above, we anaesthetist spend a lot of time moving unconscious people around. We go from the AR to the OR and from the OR to the recovery room. Some times we have to go through three or four sets of double doors wheeling an unconscious person on a trolley. We do this several times a day. Having to open doors and hold them open when we’re transferring patients is a pain in the arse. Can we not have automatic doors in theatres? If not fully automatic, then at least the type that open when you push a button. It makes sense. They have them in just about every high street store, can we not have them in the NHS?
3. Printouts
During an operation, we anaesthetist keeps a record of the patient’s vital signs. Every five minutes, we’ll write down the patient’s blood pressure oxygen saturations etc… etc… Whilst this is no big chore, it surprises me that the highly expensive anaesthetic machines just can’t print all this information out for us. Surely it can’t be that difficult?
4. Use Wireless Technology
I can sit and type this on my laptop and publish it to the internet using no wires at all. Bluetooth means that we can connect our mobile phones to our fridges if we so desire. As an anaesthetist, I spend a lot of my time untangling the patient from the wires and cables of our monitoring devices. The ECG leads, blood pressure tube and sats probe will inevitably get wrapped around or caught under various parts of the unconscious patient. We should be able to have ECGs, BP cuffs and sats probes that connect to the anaesthetics machines wirelessly and get rid of this problem.
5. Bleeps
This is one that’s not specific to anaesthesia but is the bane of junior hospital doctors across the nation. The bleeps (or pagers) that we have to carry and use to contact each other have to be the most annoying and inefficient way of communicating ever invented. I’ve mentioned this before and the solution is for hospitals to have a mobile phone system rather than a paging system. Communication would be much better and things would get done faster because staff won’t have to sit around waiting for people to answer their bleeps.
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