There are many clinical studies and outcomes published every month, and for me the interesting ones get filed away for future reference. However, once in a while there are studies that stay with you because of the sheer enormity of what they represent, especially if they touch you in personal way, and influence the very core of your belief about what is important.
It was about a year ago, and I had just finished talking to my wife on the phone. She wanted me to call my parents to check on them since my dad was running a high fever. I had been with them just 3 days before, as he had a corrective hernia surgery, and all seemed to have gone well. Apparently not… given the high fever he was running. My mind was racing as I did what doctors hate all of us patients these days for – assumed it may be Sepsis, and that immediately linked it in my engineering mind to an article I had just read and distilled as “every hour of delay in treatment with the right antibiotics decreased the chance of survival by 8% in the case of Sepsis”. With all due respect to the authors of the study
(https://www.ncbi.nlm.nih.gov/pubmed/16625125) that was my layman’s interpretation.
Apparently, he had been running that high of a fever for a couple of days, but like many dads, he didn’t want to bother me because I might be busy with work. In the back of my mind, I was adding the delay in hours… 48. I booked a flight home and asked them to call the surgeon immediately. 8 hours later I was home with them. The hospital had asked them to come in the next morning, 12 hours, to run some tests. It took quite a few phone calls and 6 hours later we knew it wasn’t viral. He had no obvious inflammation or pain at the surgical site, but we had to wait another 18 hours for the cultures to come back with the initial results which in this case were not conclusive.
It took constant follow up of the lab folks to document the results, and the nurse to get the information to the doctor once it was available. The standard protocol was to wait for an additional 24 hours of culture to be sure. The counter was already at 7X increased risk of mortality. Given the age as a factor, I ended up in a serious discussion with the attending physician, who ended up prescribing a dose of broad-spectrum antibiotics delivered via IV. Along with the fluids. I remember manually trending his temperature and blood pressure every hour and ensuring that the protocol prescribed by the physician was followed. It took 3 days as his fever gradually subsided, and it all ended well. Of course, the hospital bill was pretty detailed and accurate when he was discharged.
Being the CTO of the Clinical Care Solutions business at GE Healthcare, and responsible for driving Digital solutions to improve patient outcomes, the episode raised four big questions for me:
- In this day and age of connected devices, why are we still sending post-acute patients home the same day after surgery, without even basic monitoring?
- Why does it take all the follow-up for data that may be critical for a clinician to make the appropriate decision…especially when every minute and hour matters?
- Why does a family member of the patient have to keep track that the treatment plan is being followed?
- Most importantly, why have we invested so much more in ensuring the accuracy of billing, and making sure everything is documented, but not really much in what really matters in terms of caring for the patient, and delivering on outcomes?
I think it’s time we put the patient at the center of care and bring the digital revolution to bear on some of these problems.