January 25, 2024
Hospital capacity is quickly becoming one of the most visible issues facing the health system. Apart from anything else it’s one of the most reported on aspects of the current health crisis. We’ve heard about rising tensions in ED, we know that many ED departments are operating close to (or even exceeding) capacity but when phrases like “ambulance ramping” and “bed block” become common parlance we have surely reached an unprecedented level of visibility and public interest in the concept of hospital capacity.
Hospital capacity, like a lot of things, doesn’t get all that much attention until it starts to run out. We’re likely to see another flurry of headlines as winter approaches and the dreaded but highly predictable winter surge arrives (early no doubt). This surge happens every year, as surely as the tide goes in and out each day. But what people forget is that the high watermark is still relatively low when you take our ageing demographic into account.
By that I mean, Winter surges in the future (even 5 years from now) will be considerably higher than the one our hospitals experience this year. That’s because we have an ageing population and older people are statistically more susceptible to hospitalisation from winter illness. In 15 years, according to Statistics NZ, there will be 100k more people aged over 85 years in Aotearoa.
This simple diagram attempts to illustrate key actions that can impact hospital capacity and where precisely Spritely can help address the pressure on health services that our ageing population is bringing to bear.
Our population is growing and ageing at such a rate that it isn’t feasible to solve the capacity issue by adding more beds/staff That would of course help, but we can’t add them fast enough to keep pace with population.
When you consider that our ageing population will “naturally” drive up acute and non-acute admissions due, in part, to fall-related injuries and winter illnesses, you soon realise it isn’t easy to reduce admissions either.
As more people come to hospital and there are proportionately less beds to accommodate them, the only realistic way to alleviate pressure on hospital capacity is to minimise their length of stay and improve discharge services to reduce the chance of them being readmitted within 30 days.
Initially it makes sense to focus on the heaviest users of the health system, older people. Statistically they tend to be admitted more often, have a longer length of stay and they are also more likely to be readmitted within 30 days of discharge.
Supported discharge teams like HKTK in Hawkes Bay, START in Waikato, and CREST in Canterbury have been established specifically to reduce length of stay in hospital, reduce readmissions, and reduce healthcare costs for older people following discharge. Research (Parsons et al) has proven that these multi-disciplinary teams, which provide enhanced oversight of patients for up to 6 weeks in the community following discharge, significantly reduce patient time in hospital immediately prior to discharge and reduce time in hospital in the 12 months following discharge.
Less time in hospital for older people means more space for others including people who get admitted due to winter illness.
Like many parts of the health system, these multi-disciplinary teams will become stretched as hospitals need to perform more acute and non-acute surgeries on older people and more falls-related injuries occur each year.
SDTs must find a way to maintain service levels, protect hospital capacity and preserve cost savings, in the face of workforce shortages and an ageing population.
In 2023 the HKTK team trialed a new remote patient monitoring platform that was co-designed with older people in New Zealand. The platform, which is called Spritely, has proven to be very successful where other attempts at RPM have failed. Sym Gardiner was the project manager and evaluator in Hawkes Bay. This extract comes from his evaluation dated 07/12/23.
“The Spritely offering is very good overall. They have solved the major impediments to Remote Patient Monitoring that we have previously struck. Specifically:
1. There is no worrying about connectivity. The product comes with 4G data packaged within the cost and managed by the vendor. This has a strong equity and accessibility benefit.
2. There is no worrying about pairing Bluetooth. The vendor has developed and implemented a way that measurement devices do not need to be paired with the tablet. They just simply work. This is a
3. There is no worry about the device being used for other purposes. The tablet is locked down and is only usable for the remote patient monitoring.
The system saves the HKTK team a lot of time because it is very easy for clinicians and patients to use, has high patient engagement and there is virtually no technology burden on the service. This video created by Hawkes Bay hospital shows the system in action with clinicians and patients.
If any hospital or community-based health services out there would like to use this technology, please get in touch via our website www.spritely.co.nz