MICROBIOLOGY
problems in children… We set our systems up to think that everybody has more illness; and we design our systems and our devices based on a probability that the incidence is much higher than it actually is.”
He added that, “If you design a specific tool to be used on a specific group, then someone decides to use that tool on ‘all-comers’, it’s never going to be as effective. People start using things in ways that weren’t intended,” he warned. He went on to talk about triage and the decision to ‘not do anything at all’, giving an example of ‘infant one’ who has a temperature of 38.1 degrees and ‘infant two’ who has a temperature of 37.9 degrees.
Treatment pathways “Put your hands up if you think that these two children might get different investigatory and treatment pathways?” (Many in the audience responded positively). He pointed out that arbitrary thresholds (such as 38°C versus 37.9°C for fever) lead to significantly different treatment paths – despite minimal clinical difference.
“It is statistical nonsense that, on the basis of a 0.2 degree centigrade difference in temperature (which is outside the limits of a digital thermometer and an ear thermometer), that we would choose to do that. We continue to do it because the guidelines say: ‘if you are 38 degrees you are at risk, and if you are 37.9 degrees, you are not. Just mull on that.”
He highlighted the work of Professor Rick Body, a Professor of Emergency Medicine in Manchester, and went on to consider where clinicians draw the line in their practice – a CRP of 51 versus 49? White cell count of 23.4 versus 16.2? “You need to understand your own cognitive psychology, otherwise you’ll end up making mistakes,” he warned. Professor Roland went to discuss the relationship between clinicians, caregivers, and children, which creates a complex decision-making environment and adds to psychological pressures. “There are a lot of things that
caregivers bring to a particular consultation – their anxiety since COVID has gone through the roof. Ten years ago, I wouldn’t see children presenting with only one day of fever every day in our emergency department. We regularly see children now who have had 12 hours of fever. Add the pressure from parents to the limited information that healthcare staff have, and you can see how this becomes really challenging,” he commented.
While tools and testing guidance are 40
The impact of system flow problems in the NHS on critical care processes like sepsis identification was discussed.
important, they alone won’t solve the problem of overprescribing of antibiotics. Social, systemic, psychological factors and cognitive bias must be addressed, he asserted. Professor Roland outlined some
key recommendations for addressing key decision-making challenges across different stakeholders (see Table 1), pointing out that a comprehensive approach is needed, in order to have an impact. Technological solutions must consider the human factors in medical decision-making, therefore. “If you ignore the social or psychological challenges that staff and caregivers face, we are not going to win on this, because it’s not going to be a number alone that is going to save patients’ lives,” he concluded.
Importance of flow The discussion continued with a presentation by Dr Ed James, a Consultant in Emergency Medicine, at NHS Lothian. Dr James is also a National Clinical Advisor for Unscheduled care, working for the Centre for Sustainable Delivery – focusing on Pre-Hospital and Front Door delivery – and is currently supporting on redeveloping the Flow Navigation Service for NHS Lothian. During his presentation, he discussed how system flow problems in the NHS impact critical care processes like sepsis identification. He pointed out that the NHS in England, Scotland, and Northern Ireland is not currently functioning effectively and this dysfunction undermines the systems and protocols that were designed for efficient environments. He introduced the audience to
the concept of ‘Little’s Law’ and a mathematical approach to hospital flow. (Little’s Law is a metric for seeing the velocity of a process and allows you to see how many items are in the queue of a production. It can be applied to any industry.)5 Presenting some occupancy data
for a ward in Edinburgh, he explained that, on average, a general medical unit had around 60 patients, with only 52 beds. This led to patients being located “all over the place” – referred to as “borders”. Doctors have to undertake ‘jungle ward rounds’ – so called because clinicians have to seek out the patients. He revealed that they are aiming to
reduce and maintain length of stay in Medicine of the Elderly (MoE) to 14.9 days.
“Lord Darzi said that we need to
drop occupancy rates to 80% and that occupancy in the NHS is coming in at 100% in some areas... Pretty much every hospital manager and senior clinician will say that 80% is not going to happen. But we can be more subtle than that. We should be more subtle than that… and we can be a lot more specific. “We can say ‘all you need to do is
reduce your length of stay by 1.5 days’ – then it seems achievable. You can give a local team, a local challenge, with a local quality improvement project to attempt to do that. Alternatively, you can say: can you reduce your admissions by one patient per day? That was the approach that we took in Edinburgh – we reduced our admissions by 2.3 patients per day and saved 30 beds,” he continued. So, why does this matter?
Overcrowding creates a “Where’s Wally” phenomenon, Dr James explained. It
DECEMBER 2025
WWW.PATHOLOGYINPRACTICE.COM
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60
