On Wednesday evening I am coming back up the coast while the sun goes down over Anglesey. Three days of learning and reflection with the HealthFoundation’s Improvement Science Fellows in Cambridge. This is an annual get-together of specialists in Improvement Science now hosted by THIS institute. The careful analysis and development of new solutions for patient safety is at the heart of several of the programs that are being presented: Alleged allergies are stopping patients to get life saving treatments; new monitoring predicts when things will go wrong; and safety is moving from the hospital to the patient’s home.
Penicillin allergy anyone? Yogini Jani is running a program about this. The twist in her story is that she needs to find safer ways for morepatients to get Penicillin because Penicillins are really good for many lethal infections. Her challenge is that too many patients have got ‘Penicillin’ written into the allergy part of their record. Some might have been sick after taking Penicillin because their infection is really dangerous and made them sick, not because Penicillin made them sick. Some might have had another antibiotic, but Penicillin is a word that people remember. It is used as synonym for antibiotics. Like ‘Hoover’ for vacuum-cleaners. There is a lot of literature out there, some data hidden in existing record systems, but finding solutions to do this at scale is really difficult.
Are you safer@home? With a European working group we have tried to understand who is better off at home for the last four years: Patients with stable vital signs who are able to be cared for at home might be saved the complications of bed-rest in hospital. But home care might have its own challenges. Helen Hogan asked us to think about the safety complications of needing dialysis treatment at home. As patients get older or have an intercurrent illness family members step up to the plate to give the care that is usually provided by specialist nurses. Great for independence of patients. Occasionally challenging in the messy organisation of real life where we are all improvising to juggle multiple demands. Understanding the many varied ways how patients and families do this in their own home has the potential to inspire new ways to improve healthcare.
With safer@home we have recently re-analysed the data from the CURIOS@ study. In CURIOS@ we asked patients, their families and care teams why they thought that their readmission to hospital was predictable or preventable. In a quarter of cases patients had anticipated the need to come back in, and in some of these admissions they had tried to get this across to their care teams. A significant proportion of the patients who were readmitted had an increase of heart rate and the speed of breathing from their first discharge to their readmission. These are parameters that could be measured at home. Wearable technology allows to measure heart rate and speed of breathing every few seconds and could be used to alert to worsening in the condition of a patient. Heart rate monitoring can be done by smart watches and the speed of breathing can be measured by apps that can be downloaded for free to a smartphone. Patients might prefer to see this data first rather than having a healthcare professional look over their shoulder. And might make sensible decisions after talking to peers.
And then we have the grand-master of patient safety: Professor Charles Vincent. He has recently changed his focus from looking at safety in hospital to see what happens in patients own homes: as more complex treatments become available such as home dialysis and home ventilation there is also more scope to get it wrong: for patients to be too poorly to do the job on their own, ask a friend to help out and twist a button the wrong way …. Together with Helen Hogan, who is best known for a her work on preventable death, he is setting out a whole new field of patient safety.
There are common threads in safety research in healthcare:
If safety in health care becomes patient centred: what is the limit of where patient’s can get involved? Could some be too ill to contribute? Or is the limit where patients want to get involved?
What are your views?