International approaches to improving emergency care

Our recent roundtable on improving emergency care brought together international senior stakeholders, experts, and thought leaders from countries across the globe, including the United States, Spain, New Zealand and the United Kingdom. 

improving emergency care
Chair of our roundtable series and former NHS Confederation Chief Executive, Mike Farrar, shares his key takeaways from the conversation to inform our understanding of international best practice for improving emergency care.    Across the globe, countries are still feeling the strain on healthcare systems brought about by the COVID-19 pandemic. Many people were denied treatment due to COVID-19 delays, and now there have been big political pledges to get people back into care and reduce waiting times.  Our ability to improve care delivery must first focus on managing urgent and emergency care. This way, we can ensure that we are best utilizing hospital capacity and staff to bring in people for planned treatment. Unless we get our emergency care system right, we are going to continue losing capacity day in and day out.  Our focus must therefore turn to the way in which we provide these services. There is a terrific opportunity to use technology, such as the application of digital innovations, to improving emergency care.   

Healthcare systems across the globe are strained in the wake of the pandemic – and this is significantly impacting emergency care

Countries across the world are facing similar but distinct challenges following the pandemic. In the United States, the healthcare system was stressed by the pandemic, and it highlighted the clear need to improve emergency care systems. Leaders are now considering other ways of treating patients to free up hospital beds, such as on-scene or at home. For example, remote patient monitoring is increasingly used to monitor and manage patients with long-term conditions. Across the US, similar technological innovations are used to free up hospital capacity whilst simultaneously reducing workforce burnout. In the Asia-Pacific region, New Zealand faced an omicron wave later than most countries following stringent COVID-19 measures. Compounding this, now in their winter season they are seeing an increase in outbreaks of seasonal viruses. Due to their geographical distance from Western suppliers, they are frequently at the end of long supply chains which can cause shortages.  European healthcare systems were similarly stretched by the pandemic, but healthcare as a priority has been forced off policy makers’ agendas. The war in Ukraine and the cost-of-living crisis is now taking precedence, causing funding to be directed elsewhere.  The United Kingdom saw patient demand plummet during the pandemic because people were encouraged to avoid using the NHS and did not follow up with illnesses. A series of severe COVID-19 waves impacted hospital capacity as well as staff sickness levels, with absentee rates remaining above average even now, more than a year later. Healthcare professionals are exhausted from these last few years and are more frequently taking shorter hours, early retirement, or simply leaving the profession entirely.  Across all regions, the knock-on impact of stressed healthcare systems is the migration of work and demand from primary care to ambulance services and emergency care. There is a shift in how patients are seeking help due to primary care overload. However, emergency departments are not appropriate for dealing with all patients, and the delivery of urgent primary care and emergency care is rarely compatible within the same system.    

Approaches to improving emergency care should be grounded in data and supported by technology

Worldwide emergency care requires redesign – and the starting point for transformation is to apply our understanding based on the data that we now have. Data can help us better understand the current demand for emergency care to improve our ability to predict and prevent.  Let’s take the example of patient safety in dispatch queues, waiting outside ER. We need a better way of stratifying and prioritizing patients. There are far too many patients presenting with shortness of breath and chest pain who have escalated to cardiac arrest whilst waiting. Once the first triage has been completed, we need specialist physicians to evaluate likely risk based on a range of things (e.g., co-morbidities). We need data to do this work, and with data we could transform the safety of patients.  Although leaders are optimistic about the opportunity data presents, questions remain over how well we are capitalizing on these insights currently. It is a case of going back to basics and using the data we have now to inform systems; for example, using data to inform basic quality management techniques would go a long way to solving simple workflow problems.  The technology is advanced and is already supporting hospital and workforce resources. For example, virtual wards and wearable pulse oximetry devices are seeing success in reducing hospital occupancy. Telehealth also remains a big player in the future space of safely delivering care, and success is already being seen in rural health in Australia. In this way, data and technology can give a real advantage with managing an emergency event. With telemedicine presence, we can have people provide support, advice, and intervention even when they are not there.   

Leaders need to be innovative, take risks and focus on education to drive transformational change on a global scale

Healthcare systems across the world are often hampered by a fear of innovation due to the systems’ tendency to maintain the status quo and the lack of management and clinical bandwidth to facilitate change. Systems are unavoidably bureaucratic, which makes changing procedures challenging. However, the state of international emergency care is not going to improve without radical redesigning and transformation at a system-wide level. For this to occur, leaders must take risks and embrace technology.  Technology can help with the redesign of services by connecting departments, bringing remote but accurate diagnosis into play, and reducing our emergency service challenge. As it stands, emergency services typically focus on physical health and a lot of mental and social health problems are dealt with elsewhere, and by default sadly by criminal justice systems. In the redesign of services, we need to think about what emergency care should look like and how to prevent urgent care problems arising. But when they do, we know that technology and services can connect multiple sites and address multiple complex issues, including mental, physical, and social health.  The narrative about emergency care and its importance in how it impacts the flow of patients and demand flow is crucial, but to date we do not have this narrative positioned strongly enough. It is important for leaders to set out this story to inspire change and crucially, involve and engage the public in this change. Unless we do this, it may be impossible to promote the uptake of technological approaches and consequently we will fail to improve outcomes for people, avoid deterioration or catch up in terms of health status.   

Next steps

This roundtable discussion highlighted the similar state healthcare systems across the world are in. Countries are not facing post-pandemic problems in isolation; health and emergency care systems worldwide are facing major challenges with profound consequences. Something must change, and this has historically been difficult to achieve in healthcare. Leaders know something different must be done and the same model of care cannot persist. The good news is that the best innovation and change often occurs when situations are significantly difficult.  Technology underpins a large part of the solutions to the challenge; however, it needs to be more people- and patient-centric. It must make life easier for staff & patients. As always, our role is to deliver excellent care and save lives, but we must first align our processes, barriers, and funding to enable the adoption of new technologies.  Our series of Visionable roundtable events are an ideal opportunity to facilitate discussion among leaders and drive forward our understanding to make developments in our collective response to the digital transformation of health and improving emergency care.   

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