Sunday, November 16, 2008

Canberra Health System First hand Experience

Last week I attended a talk on ICT in Health Delivery in the 21st Century by Ian Bull from ACT Health. Less than forty eight hours later I was experiencing that system first hand having been taken by ambulance to Canberra Hospital. This is a brief note to thank those involved with my treatment, reassure all that I am reasonably well and describe the experience for others.

At about 11:30 am on Thursday 13 November I started to feel unwell. I was due to attend a second video conference with ACS Green ICT in the Canberra CBD . However, as I bent down to unlock my bicycle to ride it to the video conference room I felt dizzy. I relocked the bicycle and walked back to my office at ANU. Some time later I was found by the Department of Computer Science staff in an incoherent state and an ambulance was called.

After treatment on site, the staff helped move me down to the ground floor to the ambulance. This was a slightly undignified exit as, due to the small size of the lift, it was easier to have me sit on my office chair and be pushed along backwards. I helped propel myself with one foot, but had to be told to stop doing this when we got into the lift.

The ambulance ride was surprisingly uncomfortable: I seemed to feel every small bump in the road and my dizziness made every corner seem very sharp. During this time I could hear the staff communicating by two way radio with the Canberra Hospital emergency department. I was given an aspirin to thin my blood (it tasted like lemon, which worried me until I was told it was lemon flavoured aspirin).

At the hospital I was checked by a triage nurse just inside the door and within what seemed less than a minute pushed through to the intensive care section of the causality department. I was helped from the stretcher to a bed in a small one bed room.

At this point numerous people when through a well rehearsed routine asking me questions, reporting to each other what was known, recording details. My body was covered with what appeared to be dozens of sticky electrodes for an ECG (the staff apologising that the electrodes already attached in the ambulance where not compatible with the hospital system). After a time I was hooked up to a machine which beeped annoyingly and left for what seemed a few minutes.

I must have dozed off and when I awoke it was late in the afternoon and I felt completely better. It was a little embarrassing to find myself awake, apparently completely well and occupying what was clearly a very expensive medical facility. I was reassured that was okay as they needed to assess me (my first inclination was to get up and walk out).

For the next twelve hours I would be asked repeatedly my name, date of birth and if I knew where I was. This was annoying, but I realised after a time it was to check if I was mentally okay. Before being allowed to stand up I first had my blood pressure checked sitting and standing. Then I was asked to close my eyes and move my limbs various ways to check I had balance. Several times I had all joints tapped with a rubber hammer and reflexes noted, poked with a blunt pin to check for sensitivity, had my eyes checked for responses.

Fully conscious, I seemed to be the least unwell person in any of the sixteen or so beds (which were occupied most of the time). I even seemed to be healthier than some of the staff. My bed faced the nursing station in the centre of the room (arranged so the staff there could observer every bed. What first got my attention was that there were two large computer screens which they consulted over ever now and then.

There was a confusing array of different uniforms worn. I was asked if I had been seen by a doctor and realised I had no idea which were the doctors (almost everyone had a stethoscope). The general rule seemed to be that the more uniform-like the clothing worn, the lower status of the staff, with the consultant doctors on the top of the pecking order having no uniform.

Everyone there seemed to know what to do except me. However, just when I question would occur to me, such as "do I get something to eat?", someone would appear and ask if I was hungry. Some aspects seemed less organised. Several times someone would say something was going to happen, then leave, someone else would then come in and ask what was happening, whereupon I would explain I was being sent for some treatment. At one point I had difficulty convincing a nurse (by this point I had worked out the people in bright red tops were the emergency nurses) that I had just had my blood taken and there was no need to do it again. Most of this questioning was genuine, but I suspect some was to check on my mental state without the tedium of asking where I was again.

After a few hours, a couple of visitors, and some phone calls to reassure people I was okay, the novelty started to wear off. While I was in a room of my own I could still hear the discussions around me and of the same questions I had been asked being asked to new arrivals. There were also cries of pain and coughing indicating people in a far worse state than my own. Feeling completely well, it was frustrating to be tethered to a bed by heart rate and blood pressure monitors. I had to be unplugged by someone each time I wanted to get up.

Having a
Computed tomography (CT) scan turned out to be a much less scary experience than I was expecting. Laid on a motorised bed, my head was moved into a doughnut shaped device. This was like like putting your head into a large front loading washing machine (I could see part of the mechanism rotating trough a transparent window).

The ultrasound scan of my neck turned out to be less pleasant than I expected. This was used on my neck to check blood flow. The device is pressed on and an image displays on screen, with blood flow in colour. At the same time there is the sound of the blood flowing (something like a special effect from a low budget science fiction movie). The device had to be pressed uncomfortably, but not painfully, hard to my neck to get a clear image.

What was surprising was the speed with which tests were done. I expected to be moved to another building or at least another floor, but was instead quickly whisked around a corner, tested and then back again. One disconcerting part was the TV show in the imaging waiting area, which had advertisements for life insurance, will kits and funeral funds. I was well enough to see the humour in this, but it might might be disturbing for someone less well. Another unusual sight was the ceiling of the imaging area covered with black fingermarks, while every other surface was antiseptically clean. The staff explained that this marks were left by the electricians changing cabling.

Several times the staff would collect around the large computer screen with one operating a keyboard to scroll through a list, presumably reviewing the status of each patient. During one of these sessions, someone in a slightly scruffy suit (looking like the forensic pathologist out of an Inspector Morse episode) glanced over at me said something like "he looks well enough". I was then whisked out of the room and two beds down to a curtained area, it being explained that the room was needed for a suspected infectious patient. The next person to check my blood pressure looked a little confused as the chart for that bed said I was eleven months old.

As I had attended a talk on the
$165M project to produce integrated e-health standards for Australia, I took a particular interest in the computer systems used. Apart from the large screen used to manage patents there was a lot of ICT evident. Several of the staff were equipped with walkie talkies.

One quick change the hospital could make would be to turn on the power saving features of the large screen displays at the nursing station. These display a screen saver message after a few minutes which wastes power and is annoying to look at. The station has two displays side by side facing opposite directions. Due to the need for cooling, there was a sign on the back saying not to place notices there. This wastes a large area of the most important part of the room. A notice board could be bolted to the back of the display, leaving sufficient space for cooling. I noticed one doctor using the LCD screen as a lightbox, to examine x-rays. Perhaps the software needs a function which, at the push of a button, displays a blank white screen for this purpose.

The blood pressure and heart monitors were computer operated (it was disconcerting to have my arm constricted by an automatic blood pressure cuff every hour). But the various systems were standalone. While the devices at the end of the bed would record a sequence of readings from me over time, someone came with a paper chart to transcribe the readings.

The CT and ultrasound machines are computer controlled and produce digital images within a few minutes, but the output is turned into x-ray like transparency photographs which took an hour or so to get to the doctor (presumably this would be quicker or an urgent case).

My details had to be re-entered into each computerised device and checked. From the time I was first seen by the paramedic, my details were verbally relayed by radio, telephone, paper and face-to-face between numerous staff. ACT Health are to spend about $300M integrating these systems over the next few years (the ultrasound operator was looking forward to a new film less system arriving shortly). Apart from reducing the risk of errors, linking the systems up will reduce the cost of the processes and allow the staff to spend more time on the patients. However, linking up these systems reliably is a major undertaking.

While using the computerised equipment the staff also understood its limitations. Rather than just look at the machines, they would first look at the patent and see how they looked. This became comical at times, such as when the most important consultant was examining me but the pulse monitor was in the way. After some hesitation he unclipped it, then realised that it would sound an alarm within a few seconds if there was no pulse recorded. He handed it to his assistant who wondered what to do with it (considering handing it to the next person down in the pecking order). The consultant suggested he clip it to his own finger so the system would get a reading, but I suggested this would not be a good idea as the record of my heart rate recorded would suddenly change which might confuse someone checking readings later.

After about twelve hours in the hospital I was told I could go home. This was somewhat of a surprising anti-climax. I was handed a copy of a letter sent to my GP, with instructions on when to come back for an Magnetic resonance imaging (MRI) scan and what medicine to take and not to drive a car for a month (riding a bicycle is okay for some reason). There were no forms to sign and no mention of money (the cost of the treatment must have been significant).

Within a few minutes I was out the door. It was a bit difficult finding my way out as I had not walked in and I had never seen the outside of the building. I called a taxi and returned to the university where the last session of the Green ICT Symposium 2008, I had organised was taking place. As I entered I was greeted by a round of applause by the audience, who had obviously been told of my illness. This was heartening. I stayed for lunch with them and then went home to rest.

My thanks to the staff of the Department of Computer Science at ANU for coming to my aid, the ACT Ambulance Service and the Canberra Hospital. Also thanks to Senator Lundy, who chaired the symposium in my absence.

ps: Some might like to carry out a word analysis in postings to this blog, before and after 11:30am last Thursday, to see if I have recovered. ;-)

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