Nicola's Profile

We have had some great success in reducing length of stay for elective surgical patients.
The most effective method has undoubtedly been setting very clear expectations with the patient, in advance of surgery. At pre-assessment, they are told specifically which day to arrange transport home, and everything from the day of admission is geared towards this discharge date. All documentation is clear, the nursing staff are briefed, the consultant plans accordingly.
Of course if there are clinical issues, or if the pathway changes, the patient would always be kept in. But we have found that when the patient is aware so far in advance, they are very keen to stick to the discharge date, and we don’t get many who request to stay longer.
One issue we’ve had is insurance companies when pre-authorising surgery, writing to the patient saying they are authorised for a set number of days, which is often more than clinically required. Changing patient mind set to something lower than what has been approved is tough!

Telemedicine is something that I think is vastly under-utilised. I am about to embark on an Orthopaedic project between Europe and the Middle East which will be heavily reliant on Telemedicine.
One aspect I am interested in exploring is how Telemedicine “consultations” between patient and physician will be funded by insurers – I would be interested to hear of any health systems who are using this method effectively in place of face to face consultations.

That’s a really great idea, and one I think the organisation would support. I will give it a go!
Thanks for your feedback.

What are the current barriers to reducing communication time? As you say, the technology is there to have results almost instantly.
I agree that one stop clinics are a great way to reduce the “waiting” – and patient’s expectations are managed very effectively.

An issue I have experienced in the past has been the method of communicating results. Historically this has been done by post, adding days to the wait. The results also sometimes went from hospital physician, to primary care, then the patient contacted to make an appointment to come in for their results, often adding another few days to the wait (at the same time the patient knowing the results were likely bad news as they had been called into the doctors surgery…). How can we use modern day technology better? Although it wouldn’t be appropriate for patients to receive instant results by email, without some form of physician involvement, how can medical professionals utilise technology better? I have seen effective use of central systems where different agencies are able to access a central system for results. This cuts down the “chasing of results” scenario, and enables communication to the patient quicker.

I agree that given today’s technology, same day results should be possible now, not a thing of the future!

This is an interesting one, and a difficult one to find a “one size fits all” approach.

1. I have seen effective implementation of training courses which teach the staff member to spot early warning signs of safety threats. These include role play scenarios, and literature relating to how to manage difficult situations. Role playing scenarios really helped staff to feel confident in dealing with the unknown, and having group sessions to discuss “what could you have done differently” was useful. Also getting staff to help design layout of rooms/kit – especially when lone working, so they feel safe that if anything happens, they feel comfortable in their surroundings. Of course this doesn’t account for staff working out in the community, which is much more difficult to plan.

2. Having discussed this issue with staff before, the resounding feedback has been that they feel there is pressure to return to work very quickly after an emotionally challenging situation. Sometimes little or no support is offered, especially if the staff member “looks fine”. Maybe access to support groups, counselling etc – in work time, should be promoted more. Maybe mandated time off? Regular follow up with the manager, or an HR person, on a “keep in touch” basis?