“In the past, there was little information on what is the golden period of saving stroke patients,” recalls Dr. Visit Vamvanij, Director of Siriraj Hospital in a recent interview with Hospital Management Asia. “Right now, we knew from literature, we could make life-changing interventions within 4.5 hour after the onset of a stroke. With the information, we often raced against time to get CT scans, diagnoses and medications ready within the next 60 minutes”. However, after several years of following the protocol, Siriraj Hospital, one of the finest of its kind in the country, was not satisfied with the result.
When a patient started to experience some symptoms, they needed an ambulance to take them to the hospital. Traffic, unexpectedly played a crucial role in some incidences especially in a busy city like Bangkok. “Sometimes, by the time a patient arrived at the emergency room, two hours had already passed. As a result, some of them would lose the chance to receive the treatment they needed,” adds Dr. Vamvanij. “We later discovered a mobile strategy from past studies and decided to introduce portable CT scanners on ambulances. So, patients could receive their CT scans and have those images transferred while on the way to the hospital. This allowed physicians to make critical decisions before the patients arrived”.
Dr. Vamvanij said this was a vivid example of integrating technology into existing processes to make real improvement and achieve clinical effectiveness. Dr. Vamvanij believed clinical effectiveness is inseparable from Siriraj Hospital because it is not only a healthcare facility but also a medical school. “Over here, we have several value propositions to the society, our stakeholders, patients and their families, as well as the payers, which include the government, social security, and private insurance companies. We are expected to deliver the best clinical outcomes and care for them,” Dr. Vamvanij explains.
“We also need to ensure our treatments, medications and everything we provide are cost-effective and have the best values. This is why we treasure evidence based medicine and not blindly following cutting edge technologies and innovative treatments. We need to have evidence and data to back up our considerations. We need to ensure our medical students are receiving professional trainings. After all, the public trust us to do our best”.
As a healthcare leader and hospital administrator, Dr. Vamvanij is committed to support his fellow physicians and care teams by making sure hospital operations are smooth and organised; a formal feedback loop is in place to analyse and better the overall performance, and most importantly, harnessing access to the most updated information to keep the care team “smart” at all times possible.
“In the old days, when physicians encountered conflicting diagnosis or treatment decisions, we often have to fight it out. If we met with difficult cases or wanted to know what were the solutions to some particular challenging problems, we have to go to the library to do some research. It was common to wait for a day or two or a week at times to retrieve and read the requested research paper. Today, things have changed,” Dr. Vamvanij says.
We have clinical decision support tools and point-of-care medical resource like UpToDate® which provides an extensive collection of medical and drug information for members of the care team in different medical subspecialties and seniority. For medical students, since it is impossible to teach them everything in actual clinical setting, they can turn to UpToDate® for additional details to beef up their learning. For practitioners, UpToDate® is a “one stop shop” for diagnosis and treatment recommendations where they can clarify their queries in the most efficient way.
“For senior physicians like myself, who graduated from the medical school 40 years ago, the knowledge that I have learned had advanced so much that some of them might not be relevant anymore. Besides, we are too busy to re-read and memorise all the new knowledge and research findings that are emerging every day. Thus, UpToDate® is ideal as we have something in hand which we can quickly check and refer to when we run into issues. It’s brilliant,” Dr. Vamvanij adds.
Nonetheless, Dr. Vamvanij warned we should not take technology for granted. The medicine and healthcare community needed to explore a new technology beyond what the vendor said and what the newspaper had reported. “We needed to assess the rationale behind using these technologies. Why do we have to use them in this treatment? What are some of the advantages this is going to bring and what can we achieve using this technology? We always have to weigh the risks and gains and go back to the literature to study everything in details”.
Dr. Vamvanij cited robotic surgery as an example. He said more than 10 years ago, the procedure was deemed superior to standard surgery but before Siriraj Hospital could adopt it into their workflow, they needed to carefully assess its efficacy. “We did risk management and ran some small pilot projects involving a small group of patients to review the system. It was only after these tedious processes, we began to learn, analyse, and extend the scope of the technology. At the moment, we have four or five such robots in the hospital. I guess the same principle would apply to any new technology”.
This is probably why he is confident letting his care team to use UpToDate® as it is an authoritative channel of clinical information, updated daily following a continual comprehensive review of peer-reviewed journals, clinical databases, and other resources, by more than 7,100 world-renowned physician authors and editors. “Medicine is often about teamwork, we need the whole team to be on the same page and knowing what is going on,” Dr. Vamvanij says. “We need to learn together from new cases, new data, latest advancement to improve our overall effectiveness. Thus, it is important to have information and allowing the information to flow across the team”.#
An evidence-based clinical decision support solution used by more than 1.7 million clinicians in 190+ countries to make important day-to-day clinical decisions, UpToDate is the only resource associated with improved patient outcomes and hospital performance, and studies show that clinicians who use UpToDate change their decisions 30 percent of the time. More than 6,900 world-renowned physician authors, editors, and reviewers use a rigorous editorial process to synthesize the most recent medical information into trusted, evidence-based recommendations. Every day, clinicians view topics covering 25 specialties over 1.5 million times.
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