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| Dr J Sivakumaran |
Technology plays a very important role in hospitals. Though it is no substitute for a doctor’s expertise and a nurse’s healing touch, technology does play a very vital role in enhancing the quality of care and treatment of patients. We are familiar with telemedicine, health alerts on SMS, archiving of digital images, hospital billing, financial applications, physician billing, electronic medical records etc.
There are many more technological developments taking place. Let’s take a look at some of them that are interesting and beneficial to patients:
e-ICU
An ICU setup will consist of patient beds, monitors/equipment, trained nurses and at least one intensivist per shift. Most of the bigger hospitals manage to get nurses and doctors, but smaller hospitals/nursing homes/peripheral centres do not find it easy to have a full-fledged ICU setup. Patients who need to be under ICU care are being referred to the nearest best hospital of their choice, depending on how much the patient can afford to spend. By adopting e-ICU, the smaller hospitals can run an ICU department, without having an Intensivist and trained ICU nurses.
A tertiary care hospital is hooked up with smaller nursing homes and peripheral centres where they have patient load but do not have ICU specialists on board. The tertiary care hospital will have a command centre equipped with few servers and bigger monitors/terminals, where the readings of different patients from different hospitals are displayed. The command centre will monitor the patients of other centres, 24×7 through a communication network. The smaller hospitals can have only an on duty doctor/nurse, who can understand the instructions and directions from the intensivist to administer the medicine/carry out procedures. These hospitals will be equipped with high resolution cameras attached with movable carts. While the vital parameters are being transmitted to the command centre continuously, the intensivist at the tertiary care centre can get connected to the other hospitals, at the click of a button. If at any point of time, the intensivist wants to see the patient to observe something, the movable cart will be kept by the side of the patient at the referred hospitals and focussed on the desired position. By having the history of the vitals and physical observations, the intensivist will be able to take an appropriate decision. The tertiary care centre will be paid on a per bed per day basis by the referring hospitals.
Hybrid operation theatre/ room
Suppose a patient needs both stenting and bypass surgery, the patient has to get into cathlab for stenting and has to be shifted to an operation theatre to undergo bypass surgery. This prolongs the stay of the patient, entails his frequent movement, thereby increasing the overhead budget of the hospital and a resultant increase in the patient’s bill. Assume that if the theatre is attached with a cathlab, the physician and the surgeon will work as a team to undertake the respective procedures in the same setting; thereby immensely benefitting the patient.
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Hybrid Operation Theatre/ Room
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These theatres are called Hybrid Operation Theatre/Room. It is a minimally invasive approach combining the features of a cathlab and a standard operating theatre room with state of the art imaging facilities. In hybrid OT, both physician and surgeon work as a team. If, during the diagnostic procedure any complication arises, the patient could be operated upon immediately, without any loss of time. Surgeons can take real-time decisions during surgery. This is very useful in specialties like cardio, neuro, ortho and trauma cases. The hybrid theatre will be highly beneficial for a trauma patient who requires procedures from multiple specialities where diagnostic images are needed frequently. Hybrid minimally invasive approach is very cost effective, avoids unnecessary transfer of patient from one place to another, reduces medical errors, decreases hospital stay, facilitates faster recovery, yields better outcomes, enhances patient safety, aids better utilisation of resources and enhances efficiency.
Reducing medication errors
Medication error ranks amongst the top 10 reasons for mortality in the world. In India, these errors are not declared and shared due to a lot of extraneous factors, not related to the patients’ well-being in the least. However, using technology errors could be effectively kept under control. The medication management activity can be broadly classified into the following four steps:
- Prescription by doctor: Medication errors occur due to illegibility of handwriting, non-mention (remembering) of drug reactions, not taking care of drug-to-drug reactions, dose, route, dosage form etc., in the physician’s order. A computerised physician order entry (CPOE) with integrated information system will overcome this problem.
- Transcription: When manual orders of the doctor are transcribed by the nurses or assistants, due to illegibility, chances of errors are high. But if the order is through a computer, this problem could be taken care of.
- Dispensing: Errors happen during the dispensing of medicines and drugs due to volume of work. To overcome this problem, automated dispensing cabinets (ADC) could be installed. ADC cabinets are robots which can dispense any volume of prescriptions accurately and at a faster rate.
- Administration: Errors occur at this stage if the right patient is not given the right medication with the right dosage. The bar code of the medicines and the patient ID need to be reconciled and electronically matched before administering the medicines. If any mismatch is found between physician’s order and medicines, the system would raise an alarm so that errors could be avoided.
Disadvantages/ challenges of technology
Technology has several advantages but it is not without its share of challenges as well. The prime challenge is the capital investment. Many of these investments will not have tangible benefits but indirectly help the hospitals in delivering quality healthcare. The main challenge is to convince the stakeholders on the advantages of technology for 100 per cent compliance. Though ADC robots are efficient and faster, the manual system also should be in place as a stand-by. In case the robot is having any technical problems, then the entire hospital system will come to a halt. How many hospitals can afford to have diagnostic machines inside OT and a hybrid OT? Regular patients cannot be diagnosed in a sterile area like OT. Being heavy in size, it cannot be moved from one place to another frequently. In the final analysis, the machines will be underutilised, if sufficient patient load is not there. Though hybrid OT will benefit patients and many lives could be saved, the viability of the project would always be the most supreme consideration before capital is committed for such investments.
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