Well, I guess they feel that my idea is the best.

It also comes with a five figure funding to fulfill my idea. So, more work to be done.

Optinuum is run by a group of like-minded healthcare professionals who are passionate about transforming homecare as an essential link in the healthcare delivery system, if not the very core foundation of the entire healthcare system.
We exist to help and enable patients who need to recuperate, have chronic conditions, or face the end of life, be cared for at home.

Home Care, the important link

Home is the best place for patients who are sick, recuperating, or have chronic conditions that can be managed at home.
However, it is natural for families and caregivers to experience some uncertainty or stress when caring for their loved ones at home.

As a result, many patients are sent to hospitals or nursing homes, many which can be costly, and with long waiting times.facing a shortage of beds and staff and charge hefty fees.

In truth, for most non-critical cases, patients can be cared for at home, and it is the most ideal solution if there is an adult at home to assist.

Why Home Care?

1. Many patients would like to convalesce in the comfort of their own home, to be in familiar surroundings. It improves their well-being emotionally and physically. For end-of-life patients, being at home lets them live their remaining days with love and diginity.

2. Home care allows the patient to have one-to-one attention from the caregiver, unlike in nursing homes or hospitals where staff may have many patients on hand.

3. Home care is the most cost-effective solution for families in the long term, compared to nursing home or hospital charges.

How We Make a Difference

We provide caregiver training and support, as well as a platform for caregivers and families to interact, so as to empower you with the right skills, knowledge and confidence to take care of you loved ones confidently.

We teach you how to take care of your loved one

Our unique training programs let the caregiver understand the patient’s medical condition and needs, and anticipate changes along the way. Caregivers learn to record, monitor and observe the patient’s progress, and to communicate closely with the patient’s doctor.

Our programs are conducted in short modules, so that caregivers need not be away from their patients for long periods of time. The modules are tailored according to the needs of the patient.

We take care of you, the caregiver

We understand the stress and anxiety that you as a caregiver may go through in caring for a patient on a daily basis.

That’s why we provide you the vital training, supportand friendship to see you through. Most importantly, it is easy to stay in touch, update, and talk to us. You can also join our support network of caregivers and families to share ideas, seek support or mentor others.

Optinuum aims to make home-care a viable option and to provide families with a seamless care solution after the patient is discharged from the hospital.

Call us today at 81967435 to find out more about our programs.

Singapore General Hospital, KK Women’s and Children’s Hospital, Tan Tock Seng Hospital and National University Hospital were presented the Stage 6 EMRAM Award by US-based HIMSS Analytics.

The firm provides international benchmarking for electronic medical records systems implemented in healthcare institutions.

Speaking at the award presentation, Permanent Secretary for Health, Yong Ying-I, said the growing sophistication in IT enables the hospitals to reduce medical and administrative errors as well as time savings, which help keep healthcare costs in check.

The goal is to reach Stage 7 – operating in a fully paperless environment.

In the United States, only 3.5 per cent out of the more than 5,200 hospitals tracked by HIMSS Analytics have achieved Stage 6 recognition for implementation of the electronic medical record.”

My question to this is, where is the proof of reduce medical and administrative errors as well as time savings? How does it translate to better healthcare outcomes, especially those not related to medical errors?

Intravenouse treatment at home

This is the trend of his haemoglobin from January to April 2011 :

24th January – 7.8 g/dL
9th Match – 8.4 g/dL
28th April – 12.1 g/dL

Total improvement in haemoglobin level is 4.3 g/dL.

This is the breakdown of costs to for this cycle of care :

Cost of IV drug – $240 for 10 vials of iron-sucrose
Cost of IV accessories – $440 for IV accessories
Cost of IV procedure done by nurses in the hospital’s outpatient clinic – $500 ( Cost by doctors’ home visits is approximately $2000 ) ( I practically did it for nothing for my father-in-law )
Cost of transport to the hospital and away from work for caregiver (dependent on type of transport and caregiver’s work) ( omit this if procedure is done by home-visiting doctors ) – $4000 ( taking my type of transport and work as an example )

Total cost ( if procedure is done in hospital ) – $5180
Total cost ( if procedure is done at home ) – $2680

So cost-effectiveness of intravenous iron-sucrose medication to improve haemoglobin level in my father-in-law was :

5180 / 4.3 = $1205 per 1 g/dL increase in haemoglobin if procedures performed in hospital
OR
2680 / 4.3 = $623 per 1 g/dL increase in haemoglobin if procedures performed at home

So overall, the family is happy with the results of the intravenous treatment. The question is, at what patient’s comfort and cost?

The study, in April’s Health Affairs, echoes two reports issued in November 2010 that showed rates of adverse events hovering near 25% among hospitalized Medicare patients nationwide and at 10 North Carolina hospitals.

In a survey released March 31, patients are scared of medical mishaps. Nearly 60% of adults polled by the Consumer Reports National Research Center believe medical errors are common in hospitals, and nearly half said serious harm is common. Nearly 80% of patients said they feared contracting an infection in a hospital, 71% were worried about medication errors and 65% were scared of surgical mistakes.

The vast majority of the adverse events identified in the Health Affairs study — 93% — required medical intervention but did not permanently injure or kill the patient. Most were medication-related or nosocomial ( hospital-acquired, ie inadequate staff hygiene ) infections.

The NEJM study said 63% of the adverse events that reviewers identified could have been avoided.

Day Surgery Facility Charge $ 53.27
Consumables $ 218.74
Laboratory Investigations $ 269.00
Non Standard Medications $ 12.04
Standand Medications $ 28.32
Renal Dialsys (Peritoneal) $ 30.00
Minor Surgical Procedure $ 66.00
(Ligation of 3 internal piles)
Surgical Procedure $ 1,425.18
Gastroscopy Consumables Package $ 80.80

Total Charges $ 2,183.35

One will think that this is a reasonable amount for the intervention that he went through, and I agree. But the care cycle does not end there.

My father-in-law subsequently suffered a complication from new oral medications that he was discharged with after the intervention. This required a medical professional ( in this case me ) to step in to mitigate the problems. The prices here are an estimate as I obviously did not charge my father-in-law.

2 Home Visits ( one at 5am ) $ 400
Intravenous Dextrose drip for 24 hours $ 50
(provided caregiver changes dextrose bottles on their own every 6 hours)
Total charges $ 450

So the total cost is $ 2,183.35 + $ 450 = $ 2,633.35

The care cycle would end here if he was not admitted into the hospital through the emergency department. But for most families, the care cycle would have continued because they would not have a medical professional in the family to take charge of the situation arising from the side effects of those oral medications.

This method will be a good way to compare the value of any intervention by any healthcare provider to any patient. Only by comparing the total charges over the whole care cycle of a medical condition and its interventions can we truely choose the best for ourselves and our families.

I once had a patient who like him had a laryngostomy in the general ward, whom I happened to chance upon during my break to appear extremely drowsy. I immediately sounded the alarm, got the crash cart and at first tried to bag her through her laryngeal tube, but the bag was hard as stone! I immediately removed the laryngeal tube to place an endotracheal tube through her mouth for resuscitation. We got her oxygen saturation up and she was brought down to the ICU, but eventually passed away a couple of days later. The reason for her collapse was found to be a mucus plug which I found lodged in her tube! I brought this up to the attention of the nursing staff in charge, but till the end of my rotation in this hospital, I did not get any feedback on the outcome of this case.

So after reading his short story, I totally believe that what he has gone through is true.

Here is his story as told HERE.

By Itzhak Brook, MD, MSc

As an infectious diseases specialist for over forty years, I was not aware how common these errors are until I became a patient myself after being diagnosed with hypopharyngeal carcinoma. My initial cancer was successfully removed, but a local recurrence occurred twenty months later. I underwent pharyngo-laryngectomy with flap reconstruction after attempts to remove the cancer by laser failed.

Although the care I received was generally very good, I realized that mistakes occurred at all levels of my care. I am sharing my personal experiences about the medical and surgical errors that occurred during my hospitalizations at three different hospitals. My inability to speak after surgery made it difficult for me to prevent all of these mistakes. Fortunately, I was able to abort many of them.

I realized that my surgeons had failed to diagnose the recurrence of my cancer in a timely fashion although they examined me periodically after my initial surgery. I had been complaining of sharp and persistent pain in the right side of my throat for seven months. The recurrence was finally observed by an astute resident who was the first to ask me to perform a valsalva maneuver (exhale while closing my mouth) during the endoscopic examination. This allowed visualization of the pyriform sinus where the tumor was located. I had wondered why my experienced surgeons never performed such a basic procedure. If they had done so earlier, my tumor (4×2 centimeters) would have most likely been observed and removed much earlier.

Subsequently, my surgeons, using laser equipment, mistakenly removed scar tissue instead of the cancerous lesion. A week after the surgery pathological studies revealed that the tumor was actually farther down in the pyriform sinus. This error could have been avoided if frozen sections of the lesion itself, not just its margins, had been analyzed in the operating room. Accordingly, I had to undergo an additional surgery to remove the tumor. The prior surgery made the repeated attempt more difficult because of swelling and post surgical changes at the surgical site.

I also experienced hazardous situations because of nursing errors. One day after my laryngectomy, while still in the surgical intensive care unit, I experienced airway obstruction and reached for the call button. It was not to be found as it had fallen to the floor. I tried to call the attention of the staff and, even though I was a few feet away from the nurses’ station, I was ignored until my wife luckily arrived ten minutes later. Without a voice, I was helpless in asking for assistance and was in need of air while medical personal passed me by.

A similar incident took place on the otolaryngology floor a week later when the nurse did not respond to my call to suction my airways. I had difficulty in breathing, as mucus in my trachea obstructed my airway. The nurse came to assist me only after fifteen minutes. I learned that she was on the phone ordering supplies during all that time. There were two physicians and several nursing assistants on the floor, yet no one responded. Incredibly, even on a ward dedicated to people with airway issues, there were many distractions that prevented physicians and nurses from paying attention to their patients’ immediate needs.

The most serious error after my major surgery was prematurely feeding me by mouth with soft food far too soon. Early feeding by mouth after laryngectomy with free flap reconstruction can lead to failure of integration by the flap. Only my persistent questioning brought this to the attention of a senior surgeon who discontinued the feeding after it had gone on for 16 hours. The error occurred because the order to start feeding was intended for another patient and was erroneously transcribed into my chart. I wonder what would have happened if I would not have continued to question the feeding and when (or if) the error would have been eventually discovered.

Some of the errors by nursing and other staff included: not cleaning or washing their hands, not using gloves when indicated, taking oral temperature without placing the thermometer in a plastic sheath, using an inappropriately sized blood pressure cuff (thus getting alarming readings), attempting to administer medications by mouth that were intended to be given by nasogatric tube, dissolving pills in hot water and feeding them through the feeding tube (thus irritating the esophagus), delivering an incorrect dose of a medication, connecting a suction machine directly to the port in the wall without a bottle of water, forgetting to rinse the hydrogen peroxide used for cleaning the tracheal breathing tube (causing severe irritation), not connecting the call button, and not writing down verbal orders.

All of these events made me realize that a hospital is the least safe place for patients. Most patients lack medical education and thus cannot recognize, let alone prevent errors in their care. My experiences taught me that a dedicated patient advocate such as a family member or a friend is desirable for all hospitalized patients. Fortunately, despite these errors, I did not suffer any long-term consequences. However, I had to be constantly on guard and stay vigilant, an exhausting task during a difficult recovery process.

Despite these experiences, I am grateful to all the physicians, nurses, and other health care providers who supported and cared for me through my difficult and challenging hospitalizations. I am sharing my experience in the hope that it will encourage better medical training, greater vigilance, and increased supervision and communication between health care providers and their patients. It is my hope that these will contribute to the reduction of errors in patient care and lead to a safer environment in the hospital setting.

Dr Brook is the author of the book: My Voice A physician’s personal experience with throat cancer.

The full report can be read HERE.