R is back in hospital. I am writing this, as R sleeps, to a non-stop soundtrack of “The Big Bang Theory”, courtesy of the teenage boy in the opposite bed (please let it stop soon).
It was a planned admission this time, which is something of a novelty. But it’s been far from straightforward getting this far. Clinical care, as always, has been good. When your child has a complex health history, it seems that you are spared, by and large, being treated by junior doctors: for as long as I can remember R’s care has been delivered by consultants, regardless of the specialty (the unfortunate exception to this is A and E where there is a tradition of using junior doctors as canon fodder).
This high quality of care contrasts sharply with the administration procedures in place to support it. In particular, it seems that the (new and hugely expensive) computer system at R’s hospital is seriously flawed. R’s current admission required coordination between a number of specialties. This proved almost impossible to achieve. Letters from one specialty to another do not appear to be flagged up by the system for action by the consultants involved. It was me that had to coordinate things in the end. One specialist was informed this morning that R was a no-show by the day surgery unit. That she had been admitted to a ward several hours earlier surely ought to appear on the hospital computer system but apparently it doesn’t.
From where I’m sitting, it would appear that the problem lies in procedures which assume a linear – and predictable – patient journey. Patients with complex needs may be a minority group but they account for a disproportionate number of hospital appointments and admissions. A system optimised for this group would work for all patients. The fault lies not with programmers, I suspect, but with the administrators and managers who commissioned the software. Who did they consult? Not me. Had they asked, I would have also suggested that every patient record have a front page listing all the current diagnoses and medications and involved specialities; that it would be impossible to close a record without this being updated; that all new prescriptions be automatically shared with the GP. But they didn’t and it doesn’t.
Things went ok today in the end and R is recovering well. But it could all have been so much better.