For hospital doctors in the NHS, this might sound like an oxymoron! Usually, hospital IT is frustrating, laborious and doesn’t provide what you need.
Last week, in the Orthopaedic operating theatre, the following scenario arose:
The patient has just arrived into my anaesthetic room and was being checked in by the Operating Department Practitioner (ODP), who said to me, ‘Have you seen the ‘Group and Save’ result for this patient; there isn’t one in the notes?’
A bit of background: the patient was about to undergo major orthopaedic surgery, a total hip replacement. It’s not unusual for significant haemorrhage to occur during such surgery, so I, as the anaesthetist, must ensure that we can give a suitable blood transfusion should that be necessary. This means that a particular blood test, called a ‘Group and Save’ (meaning, identifying the blood group of the patient and saving the serum so that suitable blood can be dispensed at short notice by the Blood Bank), should have been done pre-operatively. If no ‘Group and Save’ is available it could mean:
- One’s not been done
- It’s been done, but the result’s not available
- It’s been done, the result’s available, but the paper result form is missing
If it’s not been done, what do I do? I could:
- Send the patient back to the ward; it’s not my problem!
- Bleed the patient again myself, write out a paper request form, send to blood bank and wait for the result (probably about 1 hour delay)
- Try to find out electronically if the result’s available
So, I said to the ODP, ‘Can you access the PAS?’ The Patient Administration System (PAS) links to the Pathology Department’s system, so if the result’s available it should appear there. He said, ‘No’! Not all staff are allowed to access the PAS, so even though it would make sense for him to access the PAS, his role-based access doesn’t give him the necessary privileges, even though he can phone the Blood Bank and get the results verbally!
Just as I was thinking whether I could risk proceeding with the operation whilst I sent the blood test off, the ODP said, ‘Oh, there’s an icon on the Theatre Management System for ‘ICE’ (Integrated Clinical Environment); that’s new!’ Neither of us had seen this before. He clicked it, and to our amazement and delight, the correct patient’s blood results appeared (context-sensitive), showing that the ‘Group and Save’ had been done and was available! We could happily proceed with the surgery, without using any more paper! Result.
- Hospital IT systems can delight workers
- It is possible to work paperlessly
- Why don’t IT departments communicate with frontline clinical staff?
- How can a patient travel so far down a pathway without essential information being known by those who need to know it?
- Why don’t we train staff how to use systems that could be of use to them?