Systems engineering in healthcare - a personal UK perspective.

Increasing demand and growing complexity of the delivery of healthcare is associated with worsening performance in safety, delivery, quality and affordability. Systems engineering (SE) is an established body of knowledge that is widely used outside healthcare in domains such as aerospace and communications. Healthcare represents a complex adaptive system (CAS) and a combination of 'hard' and 'soft' systems engineering techniques have been successfully combined and piloted in primary, community and secondary care improvement projects as part of an emergent programme for developing embedded NHS capability in healthcare systems engineering.

Systematic kidney disease management in a population with diabetes mellitus: turning the tide of kidney failure.

Problem: A significant proportion of patients with diabetes mellitus do not get the benefit of treatment that would reduce their risk of progressive kidney disease and reach a nephrologist once significant loss of kidney function has already occurred.

Design: Systematic disease management of patients with diabetes and kidney disease.

Setting: Diverse population (approximately 800,000) in and around Birmingham, West Midlands, UK.

Lower limb acute compartment syndrome after colorectal surgery in prolonged lithotomy position.

Purpose: Acute compartment syndrome in patients undergoing prolonged colorectal procedures is uncommon but can have catastrophic consequences for the patient with the development of metabolic acidosis, myoglobinuric renal failure, Volkmann's contracture, limb loss, and death. The potential to produce long-term disability in a patient has important medicolegal implications, particularly if the complication is avoidable. Why only some patients develop acute compartment syndrome is not fully understood.

Digital photography in wound care.

Many nurses caring for patients with wounds do not have access to a medical photographer and have attempted to capture wound images as an unambiguous record of wound status. This often forms part of an initial wound assessment and is used throughout the treatment programme.

The identification and diagnosis of malignant leg ulcers.

Leg ulcers are predominantly managed by nurses working in primary care. One audit has suggested that 34 per cent of leg ulcer patients receive treatment without a documented diagnosis (Moffatt and Harper, 1997). Malignant leg ulceration is an uncommon condition but several recent reports suggest that its prevalence is increasing (Taylor, 1998; Yang et al, 1996).

Telemedicine: a new model of care.

An estimated one per cent of the population will have a leg ulcer and prevalence increases markedly with age (Angle and Bergan, 1997). At any one time it is estimated that 100,000 patients have open leg ulcers that require treatment. This treatment is mainly repeat dressings over extended periods of time, carried out by community nurses.

Telemedicine: an innovative way of managing patients with leg ulcers.

The optimal management of patients with leg ulcers requires a multidisciplinary approach, with contributions from both community and hospital specialists to identify, investigate and treat the underlying causes, provide patient education, assess healing and dress the wounds, monitor outcome and prevent recurrence. However, current practice is impaired by the limited communication between community and hospital specialists. There are inconsistencies in methods of transferring and updating patient records between the hospital and the community, and this can lead to confusion over the diagnosis and appropriate management.