Sir, – While some of my medical colleagues will probably take a sceptical view of strategies to treat patients at home using remote monitoring and electronic consults, I believe this is an idea suited to the present and essential to the future (“Patients to be treated at home in virtual wards”, News, December 4th).
In the 1990s, oxygen saturation probes, which gently grip the finger tip and thereby measure heart rate and blood oxygen levels, came available in Ireland. They were expensive and finicky, and limited to very few operating theatres. They can now be bought for under €10. Automated blood pressure measuring devices are similarly readily available. Meanwhile advances in data recording and transfer between locations are legion and have transformed our lives in various ways. There seems little need to be admitted now for the monitoring of physiologic parameters.
A major challenge facing elderly patients during hospital admission is that they often become disoriented. An unfamiliar environment, the constant examination by a sequence of staff members, noise at all hours and being encouraged to stay in bed, disrupt daily routines. This can generate confusion which leads to sedation that, despite the best pragmatic intentions, often exacerbates that confusion. By necessity, hospital floors are hard and falls there often prove injurious. Familiar home environments with carpets are more forgiving. Simply accessing a hospital typically requires running the gauntlet of a casualty ward, which entails the risk of catching infectious diseases from other patients. Given the ageing pattern of the Irish population, with people older than 80 a rapidly growing demographic, such new strategies are timely and necessary to minimise these risks.
Finally, it’s important to note that not all such courses of treatment will be successful. The same is true of hospital admission, as some patients don’t survive. Most people when asked would prefer, given its inevitability, to die in their own bed rather than in a hospital one or surrounded by strangers. In totality, strategies of this sort should reduce upset to many patients, avoid the need for much medication, curtail costs and limit some liabilities to the State, and I applaud the initiative. – Yours, etc,
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BRIAN O’BRIEN,
Kinsale,
Co Cork.