COVID-19: opportunity to improve, in the guise of a crisis

TIMES of great crisis have historically seen advances in health care systems and technology. “Necessity is the mother of invention”, as they say.

Wars have led to improvements as diverse as triage (sorting casualties by urgency) and surgical techniques. Previous respiratory virus pandemics have led to advances in testing, improvements in hand sanitation, greater use of personal protective equipment and reduction in activities that spread droplets, such as nebulisation of drugs.

We are now in the midst of another such opportunity in the guise of a crisis. The way we act now, and the way we organise and deliver our services, may not only influence current events but may also shape the future. If necessity inspires us to streamline and target services to where they are most beneficial, why would we want to go backwards after the crisis is over?

One such change we are now seeing is the expansion of telemedicine – where a provider offers a service at a distance. This can be done by telephone or using one of a range of audiovisual tools. The practice has been developing for some time for the delivery of critical care and psychological services to isolated areas. More recently, it has expanded to the provision of accessible acute care.

Although telemedicine was initially developed for accessibility and convenience, the service is shining in these times of infection risk. We can easily see, then, that sitting in a crowded waiting room with other sick people or having to leave home to be assessed and treated, for example, are best avoided at any time. This is especially so during any winter viral season – not just while a novel coronavirus is circulating.

Many of us already live in a digital world, and our children even more so. This winter, grandparents are connecting with grandchildren online, children are meeting classmates on their devices and adolescents are chatting and exchanging images the way they already did – electronically. It makes sense, then, to use the same familiar interfaces for health care provision.

The most important opportunity for change, however, is not limited to the technology.

We have been handed an opportunity to rethink the way symptoms are assessed and treated and the way we assess and handle risk. We can return to good clinical practice – empathetic listening, rational assessment, good explanation and shared decision making. We can dispense with the reflex “just in case” test or referral and replace it with an agreed plan to assess progress. We can wait, watchfully, for symptoms to develop or resolve, and adapt our plans as symptoms evolve.

We know we can do this – we are doing it now.

Rethinking the way we use acute care services – such as hospital emergency departments – can reap benefits all round. For the elderly, exposure to the currently circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be life-threatening, but so can exposure to influenza. The ability to be managed at home – including in residential aged care – can avoid the confusion and distress that comes from unfamiliar surroundings and being poked and prodded by strangers. The missed meals, the cold air-conditioning, the noise – all of these can be disruptive to the frail elderly. When emergency care is needed, however, providers can be reassured that other alternatives have been exhausted.

The same benefits can flow for families with young children, who can be assessed in their own home rather than dragged into a scary, unfamiliar environment. No need to separate the parents or find care for other children, unless transfer to hospital is absolutely necessary.

We have the chance to enter a new phase. We can combine the best of human understanding with the best of communication technology.

To do this, we need to move from a risk-averse, “need it solved now” mind frame to an understanding that symptoms and diagnoses evolve, and that agreed plans need to evolve too. Keeping in touch is easier than ever. Let’s not lose this skill when COVID-19 is no longer front-of-mind.

Dr Sue Ieraci is a specialist emergency physician who has worked for 35 years in public hospitals and now works in telemedicine.

 

 

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.