It can sometimes be difficult to understand what coordinated care actually means. At its simplest, it means the sharing of information about a patient between different health and social care professionals. In other words, ‘the left hand knows what the right hand is doing’.
A personal example:
My elderly father died in Feb after spending the last 12 months of his life with increasing dementia. Towards the end of his life, my sisters and I discussed his end-of-life care. We decided that, should he suffer a cardiac arrest, or deteriorate suddenly, then his carers should not initiate any emergency procedures, such as phoning for an emergency ambulance to take him to hospital. Notwithstanding these clear, documented and agreed decisions, when he deteriorated agonally, one of his carers phoned for a doctor. This doctor was provided by an out-of-hours service, who didn’t know my father. The doctor instructed the carer to phone ‘999’, which she did, despite the end-of-life directive. When the ambulance crew arrived, they were told of the directive, but felt obliged to take him to hospital. He died shortly afterwards in the hospital, where he was known, and no further medical interventions were done.
Unfortunately, the doctor who saw him in A+E went off sick himself the next day, so we couldn’t get a death certificate from him. Moreover, as the hospital was in a different county to my Dad’s residential home, the Coroner wasn’t able to progress the death certificate either. My Dad’s GP couldn’t sign the death certificate, even though he’d seem him within the last 2 weeks (the legal requirement) as the death had occurred in another county. Eventually, another doctor in the hospital agreed to sign the death certificate, as he’d seen my Dad the previous week.
The result was that my Dad was subject to unnecessary and unwanted medical treatments, the family felt their wishes had been ignored, the residential home felt they’d failed, the ambulance crew had a wasted journey, and the State had wasted tax payers’ money. In short, a complete service failure due to lack of co-ordination.
Two separate articles in the BMJ this week highlight the conflicting evidence regarding technology in providing integrated care for patients (see attached). The first describes no reduction in costs from a telephone coaching intervention, in fact, some evidence that it increases hospital activity. The second describes a successful solution for dying patients.
The key to success is a personalised care plan that is accessible by everyone with a legitimate interest and, most importantly, actually implemented.