Is There A Need for a National Anticoagulation Service?
Like many people in this country, I’m on Warfarin. This means that I have a blood test every week or so and answer a few questions about how you are getting on and if you have missed a dose. The hospital managing your anticoagulation service, then does the analysis for your INR and calculates your daily dose and date of the next test. If there is a change in the dose, you are told immediately by phone, usually within twelve hours of the blood test. On the next day, you get a letter from the hospital confirming the dose and giving the date of the next test.
I have found that one of the subsidiary effects of my stroke, is a need to solve problems and design systems that work. So after the problems with the phones last week, where if there had been a dose change, they wouldn’t have been able to phone, I got to thinking about how the service could be improved.
So what problems can I see?
- For me giving blood for a test is very easy. Although I am right-handed, because of my gammy left arm, I prefer the test to be taken out of my right arm. A week ago, they took blood in the hospital on the Friday and then I had another test on the Monday for the Warfarin. It was no problem at all. But my late wife, C, found giving blood for a test almost impossible. So we’re all different.
- The letter I get for each dose, is one of those awful NHS letters, that because of my hand, I find very difficult to open. Or I would, if I didn’t have a very good pair of scissors! There must be many on Warfarin, who have much worse hands than me!
- I live in the countryside and I have the blood test either at the GP surgery or at my local hospital. As I can’t drive, this means I have to make sure on test days, my driver comes in. It’s not a great expense and I usually do all my food shopping at the same time, but it could difficult for those who have to go to the local hospital, where transport is difficult.
- Perhaps my biggest problem, is that I travel a lot and might not be in the right place for a test. I can have them a day late, but I like to be precise in getting my dosage right! This travelling might also mean that I don’t get the letter until a few days after the test. This doesn’t matter as regards the dosage, but knowing the next test date might be important.
So what is available to improve the excellent service, I get from the NHS. And in these times of austerity, could a service be designed that was not only failsafe but cost less to run?
There are machines now to self-test for your INR, just like diabetics test for the amount of insulin they need. I used to think that this might be the way to go for me, as I’m pretty tech-savvy, but the machines aren’t cheap and it means that when I travelled, I’d need to take it with me. I’ve tried hard to avoid carrying excess baggage for years and now that I’m not as strong as I was, I don’t want to start adding to it. And my gammy left hand might drop and break it!
On the other hand, these machines only take a pin-prick of blood. So would they be much better for people like my late wife?
Technology has also moved on in the fields of communication and I now am reminded of my hospital appointments by SMS message. So there must be ways that technology can improve the service!
So what could a service look like?
I have said in the title to this post, that it might be National, but that might bring in other problems, like Data Protection. Incidentally, I don’t bother about that for my health records, as anyway most of my problems are already available to everybody in this blog.
Like now it should be based on a network of testing stations. There could be two sorts; ones that worked as now and sent the blood samples to the hospital and others that worked using pin-prick style machines, which give a direct INR reading. In the case of the simpler systems, all it would need would then be to enter them into the Service through a web page or even by phone to the hospital. Obviously, various routes could be allowed, so that patients who might be confused, weren’t upset.
The advantages of multiple testing stations are that you can go to the one that is most convenient. Suppose too, that pharmacists were licensed to do the test, so that you could do your test when you went to the shops. It would be much easier for me to go to Boots in Newmarket, than have to go all the way to the West Suffolk Hospital, because the blood nurse at the surgery was too busy or on holiday.
Multiple testing stations would also mean that, when I was travelling, all I’d need to do was find an accredited testing station.
As the testing stations would get your INR almost instantly, once it was in the Service, the results would be immediately available.
But it is in the distribution of those results that the greatest improvements can be made. We have five basic methods of communication; letter, e-mail, phone, mobile phone and SMS message. You should be able to choose how you want to be told and all of them can now be done automatically. I would take an SMS message with a letter for backup.
I elieve that properly designed such a system would work very well. The problem with it would be that some anti-coagulant departments in hospitals would no longer be needed. So what would the Unions have to say on that one!
Would a Private Firm Ever Buy Anything with Something Like PFI?
It’s grim reading about the problems the NHS is facing over bloated PFI deals.
No-one with any sense would ever have locked themsaelves into such deals. I’m sure people like Tesco have probably used design, build and maintain for stores and depots, but they wouldn’t have ended up paying six times the cost of the building. They’d have also used standard designs to save building costs. I bet each hospital is very different.
The problem is not with PFI, but with the politicians, civil servants and administrators, who pushed these deal through. In a banana republic, I would be smelling the pungent smell of bungs, bribery and favours. But here it’s just bad economics and incompetence. And who was in charge of the country’s finance at the time? So add this to a list of his big mistakes, like pensions, banks, renewing Trident etc. Gordon Brown must rank as the worst Prime Minister any country in Europe has ever had. let lone the UK!
At Last Some Good Health News!
I went to see the cardiologist yesterday afternoon. It was the sort of doctor’s visit that we all like!
He indicated that he had reviewed my X-rays ans scans from Addenbrookes and then asked me how I was getting on with the Warfarin. It has not been a problem for me and the anlysis at West Suffolk Hospital has gone very smoothly and professionally. He then said that the Warfarin should protect me from another stroke and that the leak in my heart valve was moderate and probably should be OK for ten years. As he knows, I’m a technologist, we talked a bit about how software and techniques are improving for a few moments. After the chat, I felt that if I did need an operation it would be a lot less serious than the ones my Mother-in-law had thirty years ago.
He then said that I should come back and see him in six months.
That last point really cheered me up!
Between Life and Death
This program on BBC1 last night, was not the sort of television I usually watch, as I jokily say I’m allergic to hospitals. I suppose, that as I’ve seen the inside of them so much in recent years, what with the death of C and our youngest son, and now my strokes, it is quite understandable.
But for some reason, I didn’t turn the program off last night. Partly because it was Addenbrookes, I suppose and I do have a respect for the place after what they have done for my family. I’ve also played tennis with several of the doctors and know the cutting-edge ethos of the hospital, which is pushing the boundaries of what is possible.
In the end I found it very uplifting and almost supportive of my recovery, albeit from a very minor problem to those shown in the program. I could relate to all the people in the program on various levels, as a scientist, a father and a patient.
If there is one lesson we should all learn from last night’s program, it is that we shouldn’t stop funding units, such as this at Addenbrookes, in these times of austerity. You can’t put a price on human life and with this units, there must be much they are learning that can be applied across the NHS and the wider world. There are also other lessons to be learned by us all and let’s hope that someone, who watched the program last night, is moved to improve his behaviour or driving skills, so that he avoids the need for going to hospital. That would be a positive benfit for everyone and everything.
We might all learn that human life is precious!
The Middlesex Hospital Lives On!
To me, two London hospitals hold pride of place in my mind, St. Bartholemew’s or Barts, as it was the local hospital, when we lived in the Barbican and the Middlesex, as our oldest and youngest sons were born there.
The Middlesex is now just a bricked and boarded-up chapel, surrounded by a vast deserted building site, as it has long been demolished to make way for a hotel and housing.
But something from the Middlesex lives on; the art. Or rather some of the most amazing pieces of Victorian art, that used to be in the hospital reception area.The paintings are now on display at The National Gallery until October. See more here on the BBC. The artist was Frederick Cayley Robinson. Note that the link points to a French entry in Wikipedia, as there is no English one! What does this say about our views on artists?
The Left-Handed Blood Test
As my left arm is the one affected by the stroke and because it was also broken in a bullying incident at school, I generally as for blood tests to be taken from my stronger right arm. Today, Today, I had my weekly Warfarin blood test in the West Suffolk Hospital in Bury St. Edmunds because I was going to Felixstowe and it was more convenient being on the route I would take.
Today though the blood was taken by a nurse who was left-handed. She took it from my right arm as normal and it was very pain-free. Not that I find having blood taken at all troublesome. Because she was the wrong way round did it help?
But I just wonder, if we never think how we take a blood test! But also I might be lucky, in that they never seem to hurt and all I have to show for them a few hours later is a tiny spot. C on the other hand, feared them and had tremendous trouble taking a test.
But it has to be said that some jobs may be better done, by someone who is left or right-handed. For years, my father said that to be a compositor, or someone who sets letterpress type, you had to do it right-handed. But then he hired a temporary comp, who was left-handed. There was nothing wrong with his work at all, but he was just a bit ungainly to my father’s experienced eye.
Addenbrookes TV/Phone System
I suppose beggars can’t be choosers, but it is not good. Cost is obviously an issue I don’t bother about, but whoever designed the system should be reducated. Wires get entwined with each other and the screens are distinctly user-unfriendly.
But my biggest gripe is that it doesn’t have BBC Radio 5 Live. I could at least get that through the Internet in Hong Kong. But there is no wi-fi on wards here. There should be!
Another point is that the Hong Kong system does the medical records too. But knowing a bit about computing in the NHS, I’m not surprised they got that one wrong.
Feeling Better
Ensconsed in Ward R2 at Addenbrookes and hopfully I’ll be really home in a few days.
Food is not bad and it’s much more relaxed than Hong Kong.
The Middlesex Hospital Chapel
Two of our children were born in the Middlesex Hospital; one on the day that Armstrong, Aldrin and Collins that Ap0llo 11 left for the moon.
It is now quite sad to pass the site of the former hospital, which has been almost completely demolished.
The Middlesex Hospital Chapel
There is just the chapel and one wall of the old hospital shown behind and to the left in this picture. The chapel is on the English Heritage at-risk list.
I only popped into the chapel a couple of times, but let’s hope that when the site is finally developed, that they allow full access to one of London’s little gems.
I searched Google and found this project to model the chapel in 3D.
The Anonymous Widower 