People enjoy travelling to explore destinations or visit friends and relatives. Healthy travellers may catch a cold or acquire an infection. Most often, these travel-related illnesses are not serious. Medical travellers, or individuals that are travelling to receive healthcare outside their usual place of residence, often cross an international border to receive care while they are medically compromised. Travel for them is inherently riskier than the average tourist.
In search of a cure
Approximately two million people annually travel to receive medical treatment, i.e., secondary, tertiary, or quaternary medical care. In addition to these medical travellers, an additional 225,000 to 500,000 people travel for elective “lifestyle” procedures, often involving surgical procedures to non-hospital settings such as clinics. In general, approximately 5.5 million medical-related trips take place every year; about 0.2 per cent of all people who travel internationally.
When medical travel goes wrong
Medical travellers go from their place of residence to another destination location for treatment and then return home. The patient journey for these individuals may require that the home medical providers communicate with the destination providers to coordinate the care for the patient on the outbound and return journeys.
When patients change from one healthcare provider to another, these shifts are commonly referred to in the healthcare profession as “transitions of care”. Adding travel to the patient treatment plan increases the risk of miscommunication both in both documentation as well as clinical care. Because there are more handovers among providers, the likelihood of human error increases, generating more gaps in the transitions of care and increasing risk to the patient.
The peer-reviewed research into negative outcomes for medical travellers has focused on small numbers of people, cataloguing their complications. The reporting biases are that healthcare abroad is dangerous, a bad idea and that off-shore providers are less competent.
Regardless, it is clear that people will continue to choose to travel for medical care. Some negative outcomes are bound to take place, but there are steps that responsible healthcare providers can take to reduce the risks to patients travelling for medical treatment. A clear focus on post-discharge transitions of care can reduce the risk to patients, increase safety, and make international medical travel better for patients and providers.
‘Seven ways to defeat; first is failure to count’
There is no reliable information available about the frequency of sentinel events in medical travel. “Sentinel events” are those outcomes where the consequences to the patient are severe, and result in temporary or permanent harm, or death. In healthcare, the universally accepted measure of sentinel events is hospital readmissions and return visits to medical providers.
Returning to the scene of the care
Hospital readmissions and return visits occur everywhere. For example, the average readmission rate for US hospitals is 15.50 per cent, while in the UK, emergency readmission rates range from 12.5 per cent to 13.8 per cent.
Using these numbers, a conservative global estimate of sentinel events in medical travel is 173,000 (low) to 833,000 (high) with a “most likely” average of 442,000 per year. Sentinel events in medical travel may trend towards the higher side since many individuals travelling for care are extremely ill, have complex medical conditions, and are seeking tertiary or quaternary care – all high-risk factors.
Reducing sentinel events
Reducing negative outcomes has been investigated, notably in the US, where they represent an area of focus because of their financial consequences. Research shows that improving transitions of care significantly reduces hospital readmissions and improves outcomes. Too often, the people discharged from care are: Unable to describe symptoms and signs to watch for;
- Failing to schedule and complete required follow-up tests or visits;
- Cannot repeat proper medication/ prescription protocol, and;
- Unclear what to do in the case of adverse signs/symptoms.
In medical travel, there is no universally accepted standards for providers to use for post-discharge follow-up when patients return home. The healthcare providers in the home destination may not want to offer treatment to the patient, especially for complications.
Creating standards at the time of discharge can reduce the risk of complications. These well-established best practices include requiring “teach back” demonstration of learning about symptoms and what to be on the lookout for; providing the patient with simple, printed instructions in their primary language, and confirming that they can read and understand them. By adopting post-discharge follow-up with departing patients, healthcare providers can deliver better clinical outcomes, improve the patient experience, and burnish their brand as reputable healthcare destinations.
The value of a good follow-up
Sentinel events in international transitions of care are significant, generally not measured, and there does not appear to be much effort to prevent them. However, there are demonstrated standards of care in medical transitions that can be applied, and which would significantly reduce sentinel events and their associated costs, loss and risk.
As President of Stackpole & Associates, Inc., Irving Stackpole is internationally recognised in healthcare marketing, serving hundreds of clients on five continents. He holds appointments with European and US universities and a patent in digital healthcare technology from the USTPO.
References available on request.
This article appears in Omnia Health magazine. Read the full issue online today.
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