Patient care pathways | Process would see doctor assess patient and hand off to next specialist to continue treatment
In an ideal world, patients would go to a hospital, change into a gown and all the physicians and specialists would then come to them, says Neil Fraser.
That scenario isn’t so far off, the president of Medtronic of Canada Ltd. told a recent Regina Chamber of Commerce meeting.
It would also be a boon to people from rural and remote areas who have to travel long distances for appointments and treatment, he added.
Medtronic, one of the largest medical device companies in the world, is best known for devices such as insulin pumps and pacemakers. However, Fraser said its role is changing as it works with health-care providers to provide patients with better access to technologies and devices.
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The company formed a “hospital solutions” team several years ago to help make those improvements.
Fraser said the process has been implemented with great success at Maastricht University’s hospital in the Netherlands. The facility has 750 beds and more than 100,000 cardio-vascular clinic visits a year.
“Before this project started, a patient might have to visit the hospital seven times to visit different departments to get the diagnosis and treatment required,” Fraser said.
The hospital, with Medtronic’s help, initiated 70 projects to establish patient pathways and create efficiency.
“They literally redesigned the whole hospital so that all of the specialists involved in cardiac care were in one central area,” he said.
Fraser said the patient experience greatly improved. Seven visits were cut to just one.
“During that appointment, the patient would check in once, change once and the doctors would come to the patient in a very organized way,” he said. “The hospital realized about $6 million in annual savings, representing a seven-fold return on investment.”
Treatment can be remotely monitored, which also reduces return visits.
Fraser said patient pathways are critical to the entire process, and Sask-atchewan is working to establish them for different types of conditions.
He said the pathway alleviates the bottlenecks of patients who aren’t the right candidates. For example, a patient who doesn’t need to see a surgeon might see one anyway because of the way the system is currently set up.
He used the example of low back pain to describe how a pathway is forged. The person in pain goes to a primary care doctor, who assesses whether it is acute pain that could be managed by medication or chronic pain that requires another action.
“Is it a mechanical problem that might require surgery? Is it a medical problem that would require pharmaceuticals or other forms of intervention?” Fraser said.
“How do you get from primary care to maybe tertiary care and then out of the system and back home?”
He said there could be as many as 500 patient pathways, and the province has established 10 or 20.
“I think Saskatchewan’s patient care pathways are accelerating the appropriate use of technologies, and what was happening before is that patients would get stuck at the primary care level,” Fraser said.
“Doctors might put them on a medication, which is suboptimal, when they really should get a more advanced treatment. So it’s part of educating primary care people through these appropriate care pathways.”
Lean is also part of this process.
Medtronic uses the management system in its own company and applauds the Saskatchewan health ministry for implementing it as part of this new approach to health care.
Fraser said Medtronic staff cut an 18-month backlog by using Lean Sigma to manage explanted cardiac devices.
“Lean is not a panacea because you have to start with the right process,” he told the meeting.
Fraser said Saskatchewan has taken a bold step and understands what needs to be done to make a dramatic improvement.
“They just need to make sure that what they’re making Lean is an appropriate process,” he said in an interview.
“You can’t have Lean without studying the patient pathway for optimal care and outcomes. Put the two of them together and you’ve got something.”
