Why aren’t hospitals better at communicating? The founders of Careful say the problem is not the old cliché about doctors being good at treating patients, but hopeless at talking to them; rather, most hospitals simply lack a system to ensue information flows freely.
Careful aims to put that right. Its technology focus on handover moments in hospitals – that point when responsibility for a patient’s care moves from one professional to another. This might be when one doctor goes off-shift, for example, or when the patient moves to a new team – from the emergency department to a ward, say.
In most hospitals, handover today depends on a bunch of inefficient and informal processes. Doctors depend on everything from handwritten notes to WhatsApp messages to ensure their colleagues get the information they need to continue treatment and care. They create their own spreadsheets manually in order to keep track of patients and what needs doing.
It’s a system that is inefficient, expensive and, most seriously of all, unsafe, says Dr DJ Hamblin-Brown, Careful’s co-founder and CEO. He is speaking from personal experience – his own career in emergency medicine, but also from a chastening personal experience. “My mother almost died because of an error at handover made during a hospital stay,” he explains.
The research supports him. World Health Organisation statistics suggest 15% of all hospital expenditure is wasted on adverse events that happen to patients – and that 80% of these are due to poor handover. Hospitals and healthcare systems are plagued by delays to patient care, because no-one has a clear view of what the patient needs next, and when. “The systems we’ve built for handover are completely inadequate,” says Hamblin-Brown. Even leaving the hospital takes too long; delays with discharge are common, blocking much-needed beds.
Digitisation is taking place in healthcare, Hamblin-Brown concedes, with many countries now moving to make greater use of electronic medical records and similar technologies. But these don’t support handovers properly; they provide a backwards-looking view of care delivered to date, rather than simple task-based information about what patients need next.
Enter Careful, which claims to provide “a constantly updated, holistic view of every patient’s plan of care to ensure their safe and frictionless movement throughout their health journey”. It’s a digital health platform through which care givers can very quickly check on each patient’s status – the treatment and care they have received so far, plus the plan for their ongoing care that now needs executing.
The platform can be integrated with hospitals’ existing systems, and accessed via smartphone, tablet or desktop PC. But the key is to give doctors and nurses a much simpler and more holistic view of each patient, with clear details of who needs to what and when. That way, each patient should move through the system efficiently and safety. “We are trying to create a forward view of care,” Hamblin-Brown adds. “It has to be really simple.”
The platform is already attracting significant interest, with hospitals in the UK, the Middle East and China having begun trials and implementations. Careful has also begun discussion with US healthcare providers. “We can be up-and-running in any hospital, clinic, or care home in a matter of days,” says Hamblin-Brown.
In the first instance, he adds, the key is to win support from physicians, building scale by showing them how Careful can make their lives easier. But in time, that will give rise to a second opportunity – giving patients access to the platform too.
“Most care is delivered outside of hospitals,” points out Roohi Hamlani, Careful’s co-founder and head of patient participation. Patients are discharged from hospitals but then often need further care; they must attend follow-up appointments, for example, take medicines or complete physio assignments. Family members are often called upon to help.
The problem experienced by many patients is they don’t get much help or guidance with this. Their discharge notes are often full of medical jargon. As care continues, they don’t get updated advice, and there is no central point of record-keeping. “The burden of responsibility falls entirely on the patient,” Hamlani says.
Giving patients access to Careful would resolve these issues, she adds. It would provide a one-stop-shop for all the information patients need about their ongoing care, as well as for other care givers, whether these are professionals such as nurses or physios, say, or friends and families helping out. In a world where chronic disease is on the increase, and where the proportion of the global population accounted for by elderly people more likely to need ongoing support continues to rise, this could be crucial.