Med-Talking: Dr Chris Subbe, a very digital doctor
Dr Chris Subbe is a consultant in acute, respiratory and critical care medicine based at Bangor University. He recently collaborated with health giant Philips when testing its new ‘General Ward Systems’ vital signs monitoring package.
It’s never been more important for doctors and clinicians to work together with industry to develop new solutions, so Med-Tech Innovation sat down with Dr Subbe to find out what motivates him, and why he’s so passionate about healthtech.
Q: Dr Subbe, can you describe your average day in five words
A: Learning from patients, colleagues, students.
Q: What interested you in the medtech sector?
A: Health is our most precious good and working with patients makes me very aware of this. In order to improve the way that we work with patients we have tried very hard over the last few years to improve our understanding of how physiology works: what happens to blood pressure, heart rate, the speed of breathing, the level of consciousness and the temperature of patients if they become ill. What are early warning signs? How do we know they are getting better? And with the help of monitoring partners such as Philips we have now got a very good understanding about how these physiological signals behave and what they mean for the health of patients in and out of hospital.
At the same time the amount of data that we monitor has become really confusing. An average hospital collects each day as much data as an international bank. And for the human brain this amount of data is very difficult to synthesize into meaningful information that we can respond to. So while this type of data help us to understand, it doesn’t always help us to help patients. In fact we know that many adverse events in patients who are in hospital happen despite there being very obvious and documented signs that things are going bad. Four out of five patients who go on to have documented cardio-pulmonary arrests have documented signs of deterioration.
So this is where we need to think about ergonomics or as we would say today ‘human factors design’ in patient monitoring. We need to present complex and fast moving data about multiple parameters from multiple patients in a way that healthcare professionals, so doctors and nurses, can distinguish what is really really important, safety critical data and what is not so important, just noise at that time. For this we have worked with colleagues from the Helen Hamlyn Centre for Design at the Royal College of Art but also with Philips Healthcare to develop and test solutions where we are able to reduce cognitive load and help clinicians to make better decisions helping to deliver care matched to individual patient’s specific needs.
All this is really hard without technology: monitoring, analysing, filtering etc. And when we put that together we get amazing results. In our most recent study we managed to improve response to physiological deterioration and the way that teams worked together with a reduction of cardio-pulmonary arrest by over 80% and a doubling of the chance of patients who needed intensive care to survive their illness. The technology was the key enabler to change practices of communication and work patterns.
Q: What inspires you to go to work?
A: Every day something different! I am fortunate in that I work with some really inspiring people. I love looking after patients. I love working with my team in Acute Medicine, I love working with our Rapid Response team that looks after the sickest patients on the general wards, I love working with students and the discussions with them: we are working on new systems for communication and have just created some intriguing data on how teams work together when they look after sick rapidly deteriorating patients. To have all these things to look forward to at the beginning of the day is brilliant.
Q: What do you love about your job?
A: Lots of things! But there are two things that I like particularly: the first thing is the contact with people. And that is patients, nursing and medical colleagues, students. And then I love the ability to be creative in the research that we are doing. We are trying to find out what changes we need to make to create safer systems and I have really awesome partners with whom I work on this. Philips is my main technology partner in this. We are having very active discussions on what better systems need to look like, how we test them etc etc to provide the solutions that healthcare professionals and patients need for better health outcomes. One of our current collaborations with Philips involves the Early Warning Scoring system in the general ward mentioned. And I am working with colleagues from a couple of software companies to create better user interfaces, that is Tapa Health and Elidir Health. That is really creative work.
I am really privileged in that the Health Foundation is currently supporting me to explore how patients can be more actively involved in their care process by accessing their hospital documentation and made be add to it! That is again very creative and has brought me together with some very inspiring colleagues from other sectors of the health system.
Q: One thing you would change about it if you could?
A: I would introduce more hours into the day to fit it all in!
Q: If you didn’t do this job, what would you like to do?
A: I would love to go back to University as a student and study art and design. The way that what we use shapes our behaviour and how good design seduces us to do something in a certain way is really fascinating.
Q: What is the most important medical device ever invented?
A: The watch! The ability to count things against time is a key part of our understanding of illness. Simple but essential. Many other devices like monitors or machines to record the electrocardiograms etc. are impossible without the measurement of time.
Q: Can you name one thing you plan to do today that will have a positive impact on the sector?
A: I will write a blog about disruptive usage of technology to explain how patients could have greater control of their data in hospital and how this will transform the impact that technology can have! And I hope that there are partners in the sector who will help to make that reality.
About Chris Subbe
Dr Chris Subbe is a clinician working in Acute Medicine and lecturer at Bangor University. He studied in Germany, where he also completed his MD in Respiratory Pathophysiology. He has trained in England, Germany and Wales and has complemented this with work for Medecins Sans Frontieres in Angola and fellowships in France and the US.
He published the first peer-reviewed paper on Early Warning Scores and his research since focuses on collaborative working to create pragmatic solutions for practicing clinicians.
He is co-founder of safer@home, the first international research collaboration in Acute Medicine and the Crisis Checklist Collaborative as an international patient safety group.
He has also recently been appointed as an Improvement Science Fellow to the Health Foundation to examine the impact that patient contributions could make to safety in hospital.