Back in my comfort zone??

Today has been a very stimulating day clinically. My first meeting was at the Eye Centre with the Chief Physician Anja Tuulonen. She was recruited to come and work at Tampere and was given the tasks of focusing and developing eye care services for the area. The eye care centre is part of a building shared with the patient hotel - more about that later! Anja has a very realistic philosophy that is shared by her staff - "Demand will always exceed resources" and therefore "we cannot and should not try to serve everything to everybody" and that more care does not always mean better care. She thinks that doctors and nurses should be taught health economics. For her the focus is on treating those who are in the greatest danger of losing their sight. She has a radical view of the role of nurses compared to what I have so far met. She thinks that the nurses in her unit should be taking on some of the doctors roles so that the doctors are freed up to do more complex and challenging work. She is trying to set up patients being able to check their eye pressures at home rather than having to come into eye clinics for this. The recent treatment for age-related macular degeneration of injecting into the eye is now being done by nurses in the unit and they are currently seeing about 20 patients a day for this. They are also using the cheaper drug (Avastine) for this - this is off licence as it is only licensed for colo-rectal treatments, but their results are the same as the more expensive drug. It was refreshing to see her vision and philosophy.

My next visit was to the Acuta (A&E). I met with the head nurse Anu who told me about nurse prescribing. There are 2 nurses from the Acuta doing this course at Tampere, which they started in September. The first course started in Jyvaskala 6 months previously. The course is only running for primary care nurses - some of the Acuta nurses come under primary care. At the Acuta there is the equivalent of a walk-in centre, although patients can be referred there and there is a nurse-led service which runs in the evenings and at weekends. The patients are triaged by a nurse and there is a strict protocol of which conditions the nurses can see and then which drugs related to these conditions they will be able to prescribe once they have done the course. There is much more encouragement for nurses working in the smaller hospitals and remote areas to become prescribers as these areas struggle to recruit doctors. However, at Tampere, the doctors are less keen. This is partly as they feel threatened but mainly because although they are salaried they also get paid per consultation so they want to see the patients!

Anu then took me on a tour of the Acuta - there is the walk-in part then there is the equivalent of a minor injuries unit and then what I would call a typical A&E department. What was very strange for me is that most of this comes under primary care and so has a completely separate budget to the hospital. So in one area there are 2 treatment areas - one for primary care and one for secondary care each with it's own equipment even though they share the same room. When patients come into the A&E they are assessed and then they have to buy in the necessary specialist services from the hospital! They do not have Emergency Nurse Practitioners at all, their nurses do not suture, order x-rays. In the plaster room there are separate technicians who are highly skilled in all types of plastering, they also x-ray and then provide the necessary equipment.  Interestingly they use a Swedish software system to track their equipment - it all has a bar code and this is entered using a bar code scanner and this then records in the patients electronic notes so that they now do not lose their equipment. They have a total patient throughput of about 90,000 a year. It was great to talk with some of the nurses and one of them was very keen to show me their area for violent patients. This consists of "cells" away from the main patient area. They have camera and little equipment to prevent self-harm and are also used for certifying death.

I then met up with the TAMK university group again. We had lunch together at the patient hotel and were then shown around the hotel and had a presentation. The hotel is run by a Norwegian company Norlandia care. They run the hotel - it is the first of its kind in Finland. They are now moving into nursing homes and child day care centres. Their strapline is CARE - Competent, Ambitious, Respectful, Energetic. They have started the hotel with the view that for about 30% of patients they do no need to be in a hospital bed. For example pre-operative patients, those having daily treatments, examinations and investigations, rehabilitation, after childbirth, outpatients, education programmes and relatives. The rooms are charged to the patient at the same rate as they would be charged for their hospital bed - 32.5 euros. Of course the true cost of a hospital bed is about 500 euros a night so it is considerably cheaper for the hospital to put patients in here than in a hospital bed. There is 24 hour nurse care. the hospital remains responsible for the patient and their treatment. Patients can choose to stay there too but then they would be charged the full rate (a bout 84 euros a night). It is a very different concept and one that has only been running for 4 months so they do not have any figures yet. It is probably particularly well suited to a country like Finland where patients have to travel large distances for health care. I was not too sure but maybe that is because it is such a different way of viewing healthcare and a new venture working in partnership with the hotel trade. The hotel can be used by anyone so it is not only for patients.

A typical room in the patient hotel

The view of the forest form one of the rooms

the sauna!

The view of the hospital 

We then went back to the eye unit and had a tour round. For some of you, you will know that eyes has never been my strong point - hence the title of this "back in my comfort zone" with a "?"! The unit moved in when the building was finished about 4 months ago but it was planned on the LEAN principles [Lean is basically about getting the right things to the right place, at the right time, in the right quantities, while minimising waste and being flexible and open to change].

One of the operating theatres

The hotel and eye clinic reception area

After that I said goodbye to my colleagues on the TAMK programme and went to my office. I ahd great fun tyring to get onto the computer - the directions are all in Finnish! I then couldn't find the @ key - I had to go to reception and ask - it was by the number 2 and I had to press Alt Gr to access it!!!

My office

Note the Finnish keyboard - far right extra letters!!

On my way back to my flat I took a picture of my block. I live in the Kissanmaa area - which translates as "cat country"! The street is called Kissanmaakatu (cat country road / street) and so there are cat pictures on my block and on each floor:

My block - number 22

My flat door and it's cat!

I have now caught up with my blog so shall relax for a bit before Pirjo picks me up to go to Frisbee golf with her son Vilpo! Tomorrow I am meeting Dian and Lorraine at 8am (they have to leave at 6.30am) to travel to Helsinki. We shall then catch a ferry to Tallinn in Estonia and spend the night there. We then have our mid-evaluation meeting in Helsinki so I am not sure when I shall next be blogging. I am sure it will be an adventure!!