Re: https://www.hifa.org/dgroups-rss/what-changes-when-generalists-are-respo...
Dear Viengchan,
You write:
'In practice, this changed how risk was detected. Subtle but consistent blood pressure rises, early neurological symptoms, or small changes in a mother’s condition were more likely to be noticed and addressed before escalation. These were often patterns that did not trigger formal chart alarms but became clear through repeated bedside assessment.'
For me, this is part of the routine in-hospital monitoring process and why 4-hourly (or more frequent, as needed) routine observation (eg BP, pulse, temp, relevant signs/symptoms), typically by nursing staff, is so important. Was this not part of the routine care before the changes were made?
You note 'generalist doctors' and 'specialists', whereby generalists were responsible for continuity of care across shifts. Can you say a bit more about this? Do you mean that generalists were available much more often than specialists? It's been a (very) long time since I was a hospital doctor, but typically nursing staff were available to, and observing, patients 24/7, whereas doctors would be present on each ward only for relatively short periods.
There is currently debate about staffing models in the UK NHS, with calls by some to bring back the 'firm system' whereby a team of doctors ranging from house officers to consultant would be responsible for the care of each patient, rather than each patient moving from doctor to doctor, shift by shift. This gives more continuity. Perhaps the incremental changes you refer to are most likely to be missed by incoming doctors who have not previously seen the patient?
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org