This week, I had an adventure visiting local hospital A&E. With most parts of my body still working well, I was curiously watching the operations there and the following are my notes and thoughts. It might not make sense at all but it might be interesting to share……
At A&E, soon after a few checks, I was sent to Clinical Decision Unit (CDU), where patients need to be watched, checked and wait until a duty doctor can make a decision on their cases. Normally this should take a few hours or more as the decisions are made based on some test result come out. And a decision could be taking more tests based on the results. My case fell into the latter scenario and I was there for totally 36 hours.
During the time, I was regularly checked by nurses on body temperature, blood pressure etc. I was also given pain killers regularly based on my feeling of the pain. There are about 30 to 40 patients in two large rooms with beds and a waiting area with seats. I believe there are about 10 staff at one time, including nurses, managers and doctors. To take care of every patient by different nurses and doctors, the operations in general are quite efficient and smooth, how do they do it?
Every patient is allocated a bed, a folder with a bed number, which has all the medical information, different forms, doctor and nurses’ notes, test reports etc. A doctor or a nurse have to take care of multiple patients and a patient will be taken care by definitely more than one nurse or doctors. During the time I was there, my case has been reviewed by three doctors and I have been taken care of by seven different nurses. Every time, different nurses come to me, asking my name, my date of birth before he or she conducted any action, such as taking blood for tests or giving medications.
There is a big screen in the room, showing the patient and their medication measures which I cannot fully understand but I believe that screen show an overview of the Unit, the capacity, the progress etc. If some patient needs to be sent home by an ambulance, the Unit manager will arrange the transportation. Every so often, we can see the patient were sent in on a medical bed by a crew of ambulance and the duty manager of the Unit helps to arrange a slot for the bed. Patient sent from the A&E room should sit in the waiting area first to wait until a bed is available. The managers also take care of the staff who are responsible for food and clean the bed.
The interesting moment is the doctor review time and how they make decisions. This could happen case by case or by a routine review in the morning or evening. When all the results come back and check-up completes, a doctor will review the case. In the morning session, the doctor came with trainee doctor and his medical student. They discussed each case based on the information of patients’ folder, talk to nurses and then talk to the patient. I believe this is very much evidence-based decisions as the doctor will discuss the patients’ symptoms, the test results and the decision, which could be more time to watch and monitor, more tests to do or discharge from the unit. They also will ask how the patient feel and see if they can help in any way. All sounds not that hard if the symptoms are not life threatening and most of the time the patients got discharged with assurance as every test results show the body is reasonably function well.
At this point, you might wonder why I am interested in this? What is my point?
Let us compare this operation to a live defect fix scenario in a software development team. Dealing with live defect is like working at A&E. A system with live defect has to be fixed or a work around has to be applied by a developer at a limited time. Sometime the defect can be fixed quickly but sometime the defect takes ages to investigate. The live defect fix process is not as smooth as the Clinical Decision Unit. Most of the time, we will see following scenarios:
- Sometime, the systems are too poor to be fixed. This kind of systems are often called Legacy. I don’t know why this beautiful word is used to describe something going to be dumped soon. Often it is quite difficult to fix a live defect of a legacy system as the technology is outdated and nobody really knows what is going on inside.
- Sometime, the investigation can be time consuming as the developer need to reproduce the live issue in a development environment and sometime it is quite tricky to do so.
- It is quite common that one system can only be fixed by one or two developers as they have all the knowledge and it will take too much time for others to do the same job.
- It is also quite common that a live defect fix can trigger another defect as the quick fix applied with time pressure might not be technically sound and often it overpasses a development pipeline because of time constraint.
Compare to the CDU, the systems with live defects are like patient registered in A&E. The developers are the doctors, we have managers to take the defect in but no nurses to do the check-ups or specialists to do all kinds of tests, or analyse the results, such as blood specialist, heart specialist or radiologist to look at the X-rays etc.
There are more differences comparing the live defect fix with A&E operations, see the following:
- No nurses
- No routine tests
- No specialist
- The system cannot talk
- The systems are all different comparing to a human body