Using Telemedicine to Reduce NHS Waiting Times

I called NHS 111 at two in the morning two years ago. The sweet scent of a nearby magnolia coated the night air at the tail end of spring. It did nothing though to alleviate the severe abdominal pain I was experiencing. I needed help immediately. I had started some projectile vomiting and could feel my tongue get heavy in my mouth. I knew I was getting dehydrated.

?

The screening team on NHS 111 focused more on whether I was having chest pain, bleeding, or breathing. After what sounded like a decade and a half, they promised me an ambulance to take me to the nearest hospital in five hours. I would have had to wait five hours or be seen by a doctor. There was no guarantee either because, in A/E, cases are seen in order of priority. Vomiting ranks low compared to loss of consciousness or chest pain.

?

I knew though that I would quickly escalate from low to high priority if I was not seen immediately. See, I had just had a surgical procedure and was discharged from the hospital 72 hours before this incident. My vomiting and abdominal pain I believed were related to the procedure. I tried explaining that the best thing would be to link me up with a specialist who had either attended to me or knew the procedure I underwent. No sir, as long as I was breathing and able to speak, I could wait for five hours for an ambulance.

?

Being a nurse, I knew I needed intravenous fluids and fast as I had not eaten in over twelve hours. I could not keep anything down, not even water. My abdomen was also making a statement. I looked either nine months pregnant or like a balloon ready to pop up at the slightest provocation.

?

The last thing I did for myself was request for an Uber. The driver arrived and as I vomited into a plastic bag, I told him to please get me to the hospital where the procedure had been done and if I would have passed out, to rush in and ask the nurses at the emergency department to get me from the car. I even wrote down the procedure I had had on a piece of paper and a huge question mark on the complication I suspected and asked the driver to give that to whoever would take me out of the car. I could feel myself slip in and out of consciousness. I did my best to stay awake lest I vomit while unconscious. I passed out and yes, the complication I suspected was the diagnosis!

?

My story is the story of many patients across the United Kingdom. Our NHS services are greatly stretched. The triage system is outdated as it only tries to identify life-threatening conditions like cardiac arrest. The irony is that while the triage system aims to address what it considers life threatening i.e. chest pain, breathlessness, and loss of consciousness, it allows millions of cases to reach that very point of life threatening. When the system fails to capture deteriorating patients in the community, it then becomes reactive and not proactive. Suppose we do not address severe vomiting and abdominal distension 72 hours post-surgical procedure. In that case, we risk having to deal with a paralytic ileus if not a toxic megacolon, acute kidney injury, and cardiac arrest thanks to electrolyte imbalances. These are added costs to the already financially weak NHS system.

?

This incident spurred my curiosity about telemedicine as a solution to existing problems. ??If the world of healthcare is indeed digital, and I believe it is, then surely there is a digital solution.

?

?Here are some of the ways we can leverage telemedicine in the United Kingdom to reduce waiting times for patients and clear out Accident and emergency departments.

1)????? Set up telemedicine offices

Yes, we have to embrace these in the accident and emergency department. These are offices fully staffed with nurse practitioners and doctors. The aim is for patients to contact them after being referred by NHS 111. With telemedicine offices, the patient can phone them and be reviewed in real-time on video. This gives the nurses and doctors a real picture of what is happening to the patient. It also gives patients more agency over their own health and well-being.

2)???? Offer telemedicine to patients on discharge

Having worked in our NHS hospital wards, I have seen a growing number of failed discharges and this is due to largely, a lack of proper post-hospital follow-up. When patients are aware of the telemedicine option, then they have more confidence that doctors will follow them up in the comfort of their homes. This will help address things that easily slip through the cracks like reinstating regular prescriptions, arranging for a blood test after initiating new medication, and canceling old prescriptions among other factors. Telemedicine therefore becomes the safe gap between the hospital and the general practitioner.

3)???? Chronic urgent care telemedicine

As Britain’s life expectancy went up, so did the number of comorbidities that patients lived with. Therefore, we have people living for longer with chronic diseases like kidney disease, high blood pressure, diabetes, and heart failure to name but a few. These chronic diseases are to blame for frequent hospital admissions. Our District Nurses (Home Health Nurses in the USA) are stretched to the bone and cannot cater to everyone at the same time!

?

The chronic urgent care department is a one-stop shop where patients can call, and get e-consultations and video reviews. This helps us determine whether they need to come to the hospital or we can send a doctor or a nurse over to them if need be. Perhaps all they need are medications to prevent their chronic condition from exacerbating. ?

The above are only three ideas. There are other ways in which we can utilize telemedicine in the NHS to cut the cost and also improve patient outcomes. Arguments though, can be made that the use of telemedicine will only favor the literate and the tech-savvy. This is a valid observation. Nevertheless, telemedicine, if properly utilized has the added advantage of translation into different languages and simplification of medical jargon. In addition, as more and more people take up digital solutions to traditional medical problems, it then frees room and time for patients to whom this is not a viable option to physically be reviewed in accident and emergency rooms on time.

?I am a believer that this is the future of medicine and nursing as we know these two. We can adapt to the changes as the NHS or we can perish and play catch up in a few years, at an added cost.