Helping hospitals manage emergency department congestion

Paul, you’ve developed a wonderful tool to help doctors give their patients the care that they need to help hospitals manage their workload and to help patients get the care that they need when they need it. Please tell me about your product.

Okay, it’s a product that we developed and designed to address specific problems within the healthcare industry but predominantly within the UK.

The first problem we looked at was Accident and Emergency congestion. There were massive problems with just the sheer volume of people coming in. Our application gives doctors the tools to get and gain early visibility of the volumes of people coming in so that they can start making sort of proactive steps towards solving the problem rather than just watching it build and then trying to cope. It uses a triage type system.

Then a doctor can say well we’ve got eight level one and two level three’s, let’s move the level three’s to somewhere else and concentrate on level one’s. It also provides that sort of visibility to other hospitals as well. It sort of brings hospitals together in a virtual sense. They all start working together as a single cohesive unit.

One hospital can see that another has capacity and instantly start suggesting that patients go to the nearer hospital rather than having the extended waiting times that they’re currently enduring in that location.

The second problem we addressed was where patients have stayed in hospital, say for something like a hip replacement and they’re fit to leave hospital but they need some additional care, and they’ve been unable to locate a bed, so there’s no choice but for that patient to remain in hospital, occupying an acute care type bed for no actual medical reason.

It’s referred to in the UK as bed blocking.

“In the UK, that sort of emergency ward tariff is costing the NHS about 710 million pounds a year.”

It costs an enormous amount of money for both health and social care. Our application also addresses that by allowing both health and social services to work in collaboration. It shows these delayed discharges in real time so the moment one happens, you can be on top of it rather than waiting for let’s say weekly figures to come out. This should be a massive reduction in the costs and of time lost there.

Thirdly, we’re starting to experience quite a few major incidents in the UK. Our application is specifically designed to link or to be able to coordinate multiple Accident and Emergency Departments from a single location.

In the case of a major disaster whether it be an explosion or a building on fire, and you need to move a large number of patients or a large number of casualties, you can coordinate beds across multiple hospitals from this single web interface.

Can you explain the difference between our normal structure, where everything is based around the individual patient records, and your system, which coordinates all the hospital beds across the country.

Paul Rylance

Historically, most health systems are what we call ‘hospital centric’. All the records for patients are kept in the one or two hospital. We’ve taken a different approach.

We’re not focusing on individual patient records. We’re focusing on beds and bed capacity across the country. We’re not looking at the health system from a hospital centric point of view. We’re looking at it on wide geographic, city-centric or maybe even region centric point of view. Consider the case where you have a patient from the opposite side of the country that’s fallen ill, but they need medical or social care. Our system would be able to gain visibility of medical or care home beds hundreds of miles away, and see the capacity in real time.

We’ve removed that sort of road block. At present we can only see all the beds in our own hospitals. It’s not dynamic enough, I don’t think, for the modern health challenges that I think a lot of countries face.

We can make our application to a wide range of care professionals, like ambulance services. Straight away, they would get to see what the current status of hospitals are, in and around their immediate area. This will stop them taking somebody with a critical injury to a hospital that’s already struggling with capacity.

This is the first step in the visibility process. The ambulance crew have got a fighting chance of getting a critically ill person to a hospital that has capacity and therefore the reduced waiting times and instant availability of care. If the situation changes in between the ambulance driver leaving the pickup and arriving at the hospital, then clinical staff can use our system to locate the nearest appropriate type bed.

If let’s say for argument’s sake somebody wants an Intensive Care bed. It would take no more than two seconds to locate every available ICU bed within an entire city. You could get the person who needs that bed redirected really quickly.

Right, that’s wonderful because we simply don’t have that at the moment.

We did a lot of research here. We sort of collaborated with A and E consultants, A and E doctors, heads of service and listened quite closely to the problems they’d been explaining. Then we specifically designed our solution around addressing some of their key issues.

Paul what is your background? What sort of work have you done to bring you to this point?

I’m from a technological background, with about 17, 18 years experience. I’ve helped companies find the right solution so their customers can easily rent a car, manage an office or shift manage high volume of products around the world, via a web interface.

Right, that makes a lot of sense. Now I can see you’ve taken from a commercial and a tech background and put your skills and knowledge into the health industry.

Yeah and our CEO thankfully she has got so much experience in both health and social care. It’s a great partnership because we’ve got the technological world meeting the health and social care world in a practical sense.

What sort of skills and knowledge has she brought to your company?

I can use London as a prime example. There are over 30 hospitals in London and they’re operating at quite a high capacity. There maybe a time where, let’s say in central UK has a patient arriving with a very specific injury. For example a neurological injury, and they may need to be airlifted to a neurological specialist. Well, without system they can get a visibility of where the nearest bed is available for that particular expertise. That could by today’s standards take 25 minutes on telephones and emails trying to …

Longer. Much longer…

I’ll take it from you. We’ve designed our system to be used by every health care professional. GP’s can look online and decide which hospital they will refer their patient to, based on where beds are currently available.

Right, that’s excellent.

Yeah, traditionally I guess you guys just call a hospital, and you have no visibility of whether they’re struggling or not. Of course the person on the other hand knows they haven’t got capacity. It’s just a fruitless conversation. Where as our solution gives everyone the initial heads up. It stops that sort of ‘cold calling’ approach. Wouldn’t it be great if you did know where every available bed was in real time all the time?

Yeah, it would be absolutely wonderful. As an ex nurse I can tell you it’s not nice for the patients to be piled up in emergency departments. Hospitals get fined a lot of money if they go over the four hour period. Everybody gets very stressed. It’s not nice for anybody. If people could be somewhere else that will be much better for everybody.

In the UK, that sort of emergency ward tariff is costing the National Health Service about 710 million pounds a year. That’s not only is that a significant amount of money, but you’ve got to realise that people are waiting a long time, and the predominant reason, is a lack of available beds. If people could see where beds are available, the lower triage score patients could actually go to a walk in centre. But if people don’t have the visibility of available beds, they can’t make good decisions.

When somebody turns up to A and E, let’s say with a bee sting or a broken finger, they can look up beds in real time and say, there’s a critical care centre not three miles away from here that has a current waiting time of 20 minutes. I’ll go there instead of waiting here for four, five hours plus. We’re focusing on that one already.

“I’m from a technological background, with about 17, 18 years experience. I’ve helped companies find the right solution so their customers can easily rent a car, manage an office or shift manage high volume of products around the world, via a web interface.”

Also, many people in emergency have actually come from nursing homes and care homes and disability services. Those staff aren’t normally included in the hospital bureaucracy, or given the right tools to manage their clients.

Yeah, I’m not suggesting that it’s some nirvana because the health and social care industry is an extremely complex environment. We’ve looked at these big pain points and we’ve tried to address them in the most pragmatic manner that we can. We’ve got the tool readily available on the internet as a demo for evaluation. People can have a look at it, if they’re interested they can contact us. We can give them a specific log on to perform certain function then they can see the tools that are available and they can also offer feedback, to say well this can be done better or this is exactly what we need.

I’ve already spoken to an A & E doctor in the north of England who’s said regarding this visibility of available beds just in his own hospital because they’re spread over a very large geography. He said this would just be so great to have our system, just to get visibility of beds in our own hospitals.

How far advanced are you in terms of getting the bureaucrats to accept this? Yeah, okay pause for laughter, we all know what bureaucrats are like…

Well we’re trying to actively engage with both health and social care, which in itself is quite difficult to do, and trying to talk to them in a joined manner is doubly difficult. We’re taking those initial steps, as I say thankfully we’ve already got a product. We’ve gone beyond the concept. We’ve got something that’s fully functional for them to look, feel, have a play with which I think is a massive step. Yeah, it’s early days at the moment and hopefully we’re talking to the right people.

Are you looking outside the UK? Have you approached other people? Have you been to Australia for example?

We haven’t been to Australia yet, no. We have got them sort of on the radar so to speak. We’re also looking at countries like Japan that has a similar sort of set up to the UK. Any country really with a national type health service. If there’s definitely if there’s capacity within Australia for use of this product then I’ll be more than happy to engage with people.

If people are interested they just need to have a look at your website, you’ve got a slideshow explaining how it works. And if people get in touch with you, you can give them a live demo.

Absolutely, and if they’ve got any questions, my advice is to look at the presentation first, and we’ll include a link to that with this interview but to look at the presentation first. That gives a nice overview of the features and functions that we have. Then when you’ve identified an area that you think is of particular interest, then you can contact us. We can give you that discreet level access to the application. If somebody’s looking for how would you manage these multiple hospitals in a major incident environment, we can give them that type of log on and they can have a look at it.

Well once again I’m really delighted to be talking to somebody who’s got a practical solution to one of our many health industry problems. Having been a nurse in places including emergency departments and seeing chaos, waiting times, confusion, unhappy people, unhappy doctors, unhappy nurses I would just love to see this problem resolved. Your software sounds fantastic to be honest.

I guess it’s also removing issues with bureaucrats, available beds, with clinical staff often caught in the middle. Without system everybody knows what beds are actually available. We have a statistic built within our application, that will show you on a day by day, month by month basis, the volume of available beds compared to the volume of patients.

This will stop any arguments about ‘you’ve got beds but you’re just not using them’.

Thank you very much for coming on the show and I look forward to hearing you going from success to success.

Thanks very much Delia, likewise.

© Wikihospitals July 2017.