Seven-day services, patient-centred care and EPIC – unintentional research

Ward M4
The view from the bed…

Oh dear, I really hadn’t expected to do research at the pointy end of 7DS, but an unscheduled trip to Addenbrooke’s in Cambridge on Saturday night provided that very valuable, ‘lived experience’ that you’d be happy for someone else to bring to the meeting.

Ambulanced in with severe upper abdominal pain, and with a long history of surgery for renal cancer (including a Whipple’s in early 2011), the prospects of discovering a) secondaries, b) bleeding and c) an adhesion-related obstruction, were daunting to say the least. A blue-light entrance on a Saturday evening, just a week into a massive and ambitious conversion to a total-hospital e-system, didn’t exactly fill us with dread. But you wouldn’t have hand-picked the timing.

So, with 48-hours as an in-patient, how did Addenbrooke’s stack up on these burning issues? Let’s look at EPIC, seven-day services, and patient-centredness.

EPIC

First, EPIC. Addenbrooke’s had switched, overnight, to a paperless electronic system almost exactly a week before. We were met at A&E by a nurse standing behind a tall, wheeled computer (I’ve just learnt that these are COWs, computers on wheels). She greeted my ambulance team calmly, and the other four that arrived within a minute. We were all logged in within five minutes, and most patients were dispatched to bays. Waiting for a while on a trolley, I watched as orange-armbanded floorwalkers and ‘super-users’ helped on the spot with small queries from staff as they logged histories and other info. Other glitches were logged (and apparently are addressed very quickly). All data from obs was bluetoothed via the handheld ‘Rover’ units into the system automatically. There honestly wasn’t a piece of paper in sight.

Once I was on the ‘majors’ assessment ward, throughout the night staff accessed blood results, histories and CT reports directly from the datapoint in my cubicle.  And for the rest of my stay, I was impressed! Staff were still familiarising themselves with the system and, when asked about it, some staff rolled their eyes and cited ‘early days’, while others were emphatically positive that the system is already making a difference. Meds, test results, prescriptions, doctors’ notes –   everything was to hand in a single place. Staff across the hospital can access records remotely. An insulin-pump educator who came up from the diabetes clinic on Monday had been keeping an eye on my blood glucose levels all day!

Verdict: a gob-smackingly ambitious project, well executed, and brilliantly project-managed. Steady and holding.

Seven-day services

You wouldn’t volunteer do go into A&E on a Saturday night. But Addenbrooke’s 7DS performance was pretty impressive. I was triaged, assessed by two different medics, and moved to ‘Area B’ in short order.  The place was busy, but the atmosphere was calm and organised. At midnight I was sent down for a CT scan (more of this below), so no issue with diagnostics. At 3am I had a long-ish conversation with a doctor, and we concluded, amongst other things that I’d be admitted, and that they ‘get me somewhere more comfortable’ asap. I was moved to a ward at about 4.40am, and dealt with there by nursing staff who couldn’t have done more to allay my anxiety, or to make me more comfortable. Through the little that was left of Saturday night/Sunday morning they were very attentive with obs, particularly with blood-glucose monitoring.

Of course, we expect A&E to be fully girded and running. But still the level of staffing, the availability of tests, and the attentiveness of staff was impressive.

Sunday saw more diagnostics/tests, with an x-ray at tea-time (no tea for me, mind!). This time the results were s-l-o-w getting back, and it wasn’t until 9.30pm that word came that ‘the gastrografin had gone through’ and I could eat something. The ‘missing meals’ service produced a lasagne at about 10.15pm, which I sort of fell into. Hadn’t eaten since Saturday brekky. It went down a treat, and I thought that wasn’t bad for late on Sunday night.

Sunday was also impressive for the attention that nursing staff paid to my iatrogenic (T1-ish) diabetes. Hospitals generally don’t have a great history of dealing with diabetes in in-patients, particularly where the patient has been admitted for non-diabetes related reasons. I was sceptical about the staff’s ability to manage my diabetes, and actually handled my own insulin administration throughout my stay. But we did the BG testing between us, and at night they were brilliant, actually, and came every hour or two to check it.

Verdict: diagnostics, care, timeliness and staffing were pretty damned good.

Patient-centredness

On the way to my CT scan, just after midnight, I remembered that in just two weeks I was due for my regular, 6-monthly thorax-abdo-pelvis scan before seeing the Oncologist, and it occurred to me that it wouldn’t be sensible to have half my trunk scanned now, only to do it all again in two weeks (I’m running at 40+ CT scans, I think). So, slightly dubiously, I asked the reasonably-hard-pressed radiographer whether it would be possible to do that whole scan now, rather than do just part and have to repeat it in a couple of weeks. It threw him for all of five seconds, then he went off for a few minutes and returned with a ‘Yes, we can do that.’ It would have been a lot easier to point to the request, nod at the queue, claim he was following orders, and fob me off. But he appreciated my concern, and took the time to make this possible. Points.

At about 3am on Sunday morning, still in A&E, in discussion with the doctor after my CT result had come through, he talked about suspending my insulin pump and putting me on a ‘sliding-scale’ glucose drip to manage my BG levels while I was being ‘starved’ (to address what he’d conclude was an adhesion-related obstruction). I demurred: I’m very insulin-sensitive, and was worried about the check-and-correct approach that would be involved. As an ‘expert patient’, I know that I can manage my diabetes better than anyone else can so, unless I was going to descend into a state where that wasn’t possible, I wanted to hang on to my pump and controller. We talked for maybe 20 minutes about the options, and exactly how we’d manage them, and in the end agreed between us to go with me being pump-boss. I was hugely impressed by this attitude, and by the subsequent support I got from ward staff.

I knew that the recently-formed Diabetes Clinic’s Outreach Team would become aware of my being on the ward, and would probably get in touch (as well as monitor my BG remotely!) at some stage. I also knew that an on-call Diabetes consultant was about. It is a shame then that, with my BG dipping a bit through Sunday, my suggestion that we have a word with the consultant (a pump specialist, as it happens) was met with some reluctance by the nursing staff. In fact, the nurse went off ostensibly to speak to him, and looked embarassed later on when I asked about it, and said that she’d decided not to. She’s entitled to change her mind, of course, but I’m entitled, I think, to know that she has. I still think it was a wrong decision. This situation was exactly the sort of scenario for which he was present in the hospital.

Verdict: mostly, really very good. Impressive, actually. With just a little bit of work to do in parts.

Overall? I’m pretty damned grateful to have Addenbrooke’s not-quite round the corner. (Other hospitals are available.)

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9 thoughts on “Seven-day services, patient-centred care and EPIC – unintentional research

    1. Ha ha. Thanks very much, Sheila. That’s very encouraging. Yes, I’m hoping that subsequent ones will be based less on first-hand experience and more on, yer know, informed conjecture. But it was such a full-on experience (and frightening, actually) that I wanted to capture it, while it was fresh.

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      1. That’s interesting. Your post is so measured in its tone that I didn’t pick up on your fear. You come across as extraordinarily rational in very stressful circumstances. Probably because you have such a proactive and well-informed interest in patient care. Perhaps a follow-up post could talk about the fear aspect (on the grounds that it would be as helpful to the audience for your writing & insights).

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      2. I was wanting to concentrate on the 7DS issues and the rest. I may well post about the emotional aspects. They were huge, in fact. I was surprised at how much I DIDN’T want to go the surgical route. Afraid of not waking up, based – fairly reasonably – on previous experience!

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  1. Very detailed. Thank you.
    For the non computer oriented that might be wondering what floor walkers and super users are. They are computer backup people watching how a new installation is working and are there to sort staff queries and any software problems on the spot, and improve the system as they go.

    That aside a friend of ours recently had a detached retina and unfortunately for him there was NO weekend eye clinic or Retinal surgeon available anywhere in the UK. He has lost the sight in one eye and now cannot drive ant the fact he is a full time wheelchair user life is very difficult. A totally different side of 7 day NHS!

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  2. Welcome to the Bloggerverse! Really great first post so look forward to reading more.

    I think its hugely valuable to capture this kind of experience and I hope that the folks at addenbrookes appreciate it. I also think its important not just to capture the negatives and I think the balance you have put in this piece is brilliant.

    It must have been hugely scary though so am sending a virtual hug – I hope you are feeling better now C.x

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    1. Thanks for the hug. I’m a lot better, although ‘not quite right’ with food still getting ‘stuck’* very high up under my ribs. Very uncomfortable, although not the terrible pain that caused the trip to A&E.
      I’d been intending to do a blog for ages, but hadn’t got round to it, and this spurred me on. I was trying to make it about the hossie, rather than my personal experience (which was, frankly, terrifying), but I’m hoping that future ruminations will be about the progress we’re making with various initiatives, rather than ‘reports from the front’. It’s really nice of you to enthuse. Hope to see you soon. xx
      * Jargon 🙂

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