University Hospitals Birmingham Trust wants to curb A&E visits and outpatient appointments
When all other medical care options have been exhausted, a person can still turn to the Accident and Emergency Department (A&E) for urgent medical attention at any time of the day or night. Tony Blair once described the A&E department as the “shop window of the NHS”; however, is the current window display as engaging as we’d like it to be?
In my own experience, the last time I visited an A&E department, my daughter and I waited more than 5 hours until an overtired doctor eventually saw her. Back in 2004 in Briefing Paper Number 07171, 16 October 2018 on NHS maximum waiting times standards and patient choice policies, the NHS pledged “a maximum 4-hour wait in A&E from arrival to admission, transfer or discharge”which has since become a benchmark for A&E performance in England. In 2004, 98% of patients were expected to spend a maximum of 4 hours in A&E but this was reduced to 95% in 2010. As the night progressed, and as our discontent grew, I wondered whether there was a more efficient form of care delivery and if this is really the type of poster child we want?
Better online than waiting in line
Using information and communication technology (ICT) to render service delivery more convenient and consumer friendly has become ubiquitous in most industry sectors and has subsequently changed both caregivers’ and patients’ expectations on how healthcare should be delivered.
In an article reported in The Guardian on 24th May 2019: “NHS to sign up patients for ‘virtual’ A&E in tech revolution” , the University Hospitals Birmingham (UHB) trust announced that it had decided – “to push through radical changes that it hopes will transform how hundreds of thousands of patients a year receive NHS care and treatment” – by encouraging patients to use digital technology. In concrete terms this means that UHB wants to reduce the number of A&E visits in addition to outpatient appointments. The strategy to achieve this objective strongly focuses on the use of ICT.
Online A&E and virtual consultations
UHB plans to introduce an artificial intelligence triage that encourages patients to take a 2-minute online assessment of their symptoms prior to going to an A&E to establish the necessity of such a visit in the first place. In this way the hospital hopes to filter out those 30% of patients with minor ailments it deems as “avoidable attendances” to ultimately curtail queues in the A&E department. “Using a chatbot powered triage system could reassure patients that they do not need any medical attention or advise them to see a GP or pharmacist instead” – explained the trust’s chief executive, Dr David Rosser.
Under UHB’s envisaged scheme the word “outpatient” takes on a new meaning: To scale down the number of outpatient appointments UHB plans to establish virtual consultations keeping patients “physically” out of the confines of a hospital. Rather than seeing a doctor in a clinic, patients will use a mobile device to talk to a caregiver. “We think that we can get 70% of our 2 million outpatient appointments on to this way of doing things within 2 to 3 years,” Rosser counters. Patients choosing that option would be managed entirely online and not be physically assessed, states the article.
Is the future online?
If everything goes to plan, care delivery in Birmingham will be less “touchy feely.”
Rosser expects that the “way patients access and receive healthcare in Birmingham will be unrecognisable in 5 to 10 years’ time, with technology playing a hugely enhanced role”. First experiences with a virtual clinic for liver problems in Birmingham are promising so far, supporting UHB’s vision of a “massive expansion” of such clinics in future to cover all medical specialties.
There is a lot to be said to facilitate access to care by employing ICT: Using triage services prior to treatment in order to reduce unnecessary visits to the doctor saves resources, costs and anxiety. One of the leading companies in the field in Europe, Swiss telemedicine company Medgate, has been very successful in triaging people over the phone for more than 20 years. The same can be said for its virtual consultations. And after more than a decade of virtual visits, Medgate created its own clinics for those cases where physical assessment is necessary in a strategic move to provide an end-to-end service to its customers.
However, it has taken them some time to establish trust amidst patients. Furthermore, doctors had to be specifically trained for the new types of encounters considering that it differs from the way they were originally trained to deliver healthcare. From Germany, where telemedicine has been practiced for just over 1 year on a larger scale, we have learnt that it is often doctors, not patients, who find this form of practicing medicine unsatisfying.
Balancing online and on-premise consultations
For virtual care to succeed, it is fundamental to create an environment in which both caregivers and patients feel comfortable. It is about striking the right balance between online and on-premise healthcare delivery. This will take time. Starting small has proven useful, taking on board feedback on what works and what doesn’t on both patient and provider side is essential. UHB’s vision to conduct about 70% of outpatient appointments online within a 2 to 3 years’ time frame might need to be revised down in light of user experience and patient outcomes. But it is heading in the right direction. At the time, my daughter and I would have opted for an online triage service that probably would have allowed us to sleep peacefully at home and see our GP the next day.