I took a phone call from a patient’s son some months ago. His Dad, Edward, had recently spent 24 hours in our hospital and whilst all members of staff had been kind and helpful he had a few issues he wished to discuss with me. Edward is 83. He had a heart attack 3 weeks ago and has ongoing chest pains. He has Stage 4 Chronic Kidney Disease (about 20% function) and leukaemia. Sadly this last is not amenable to any treatment.
In short Edward has multiple long term conditions and is dying from his leukaemia. He still has a reasonable quality of life and, with his family, has discussed clearly what his wishes for the future are. His GP has entered all of this into his eKIS or Electronic Key Information Summary which can be accessed by all healthcare professionals though the ECS, Electronic care Summary.
So when Edward got sudden onset severe chest pain last week the sequence of events was a surprise to him and his family. Paramedics were called and when they arrived they did an ECG. They then proceeded to fax this to the Golden Jubilee Hospital in Glasgow and discuss his case with the team there. All the time they did this Edward’s son was quietly explaining that this was not necessary, his Dad did not want this level of intervention and that this detail was all available on eKIS. The paramedics had not heard of, and were unsure how to access, eKIS. They apologised for this and took Edward to Dumfries. At least he did not have to go to Glasgow!
On arrival on the Emergency Department the same thing happened. Nobody knew what eKIS was and how to access it. I’m afraid this was replicated in the medical assessment unit. The following day, after Edward had been assessed, he was deemed fit for discharge – a blood transfusion had sorted his anaemia and angina. The first the family knew was when Edward phoned them to tell them. “And” he added “I can now drive!” He was delighted as driving is very important to him.
When Edward’s son arrived, a little surprised and anxious, he discovered that the team, who still had not accessed the eKIS, did not know that Edward had had a heart attack 3 weeks prior and hence couldn’t drive, had not contacted the palliative care team (outlined in eKIS on any admission) and had not really thought through his discharge. “Its not very Holistic” was his understated comment to me. It all got sorted and Edward got home (although a little aggrieved that he couldn’t in fact drive) and neither he nor his family wish to complain but they want to understand why eKIS seems to be a mystery to the Scottish Ambulance Service and most of secondary care.
So what is eKIS? If you click here you will get access to a useful ‘FAQs” about eKIS. You can also read Neil Kellys blog “The KIS of Life”, published on the 14th of February 2014, here. Very simply eKIS is an electronic handover. GPs, in consultation with patients and their families, can enter details about DNACPR, treatment escalation and goals and priorities for the future. The idea is to prevent things like unnecessary trips to Glasgow or, if arriving at the ED in a collapsed state, CTs or endoscopies or trips to theatre. Basically it’s an attempt to communicate a patients wishes to all who care for them. Not much use though if no-one looks at it.
Its important for us all to be aware of eKIS. Not just those of us at the front door. If I review a patient in a clinic or on a ward round and we discuss issues about the future and decisions are made then I should communicate this to the GP and ask for it to be included on their eKIS. I confess I am not very good at this but hope that this story will significantly improve my communication efforts. I must also confess that I did not have a password for ECS when I heard this story but I have remedied that.
It’s almost a daily mantra in my life – “it’s all about communication”. So many small (and not so small!) things go wrong because of poor communication. eKIS is an excellent tool aimed at reducing communication errors. Let’s not be like Peter Pan and keep it hidden, let’s use it.
Postscript: Sadly, since writing this blog, Edward has died. He had a number of admissions to hospital following the one outlined above and had similar problems with communication however died peacefully in the Alexandra Unit.
Ken Donaldson is a Consultant Nephrologist and Associate Medical Director at NHS Dumfries and Galloway