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Le spécialiste et la continuité des soins

Le spécialiste et la continuité des soins. Durbuy, 01-06-2012 J.A. Gruwez. Code de déontologie médicale belge:. « Quelles que soient les circonstances, la continuité des soins aux malades doit être assurée  ».

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Le spécialiste et la continuité des soins

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  1. Le spécialiste et la continuitédes soins Durbuy, 01-06-2012 J.A. Gruwez

  2. Code de déontologiemédicale belge: « Quelles que soient les circonstances, la continuité des soins aux malades doit être assurée ». « La continuité des soins n'a de valeur que pour autant qu'elle influe sur les résultats des soins, la prévention ou la réduction des infirmités physiques, mentales ou sociales, la satisfaction des patients et le coût des soins » J.S. Gonella et M. W. Herman J.A.M.A. n° 243 (4) de 1/1980 (352-354)

  3. Le spécialiste et la continuité des soins • Introduction • La relation médecin-patient • La technologie de l'information et de la communication dans la continuité des soins • La main d'œuvre médicale • Exode et immigration des médecins en Belgique • Sondage : perspectives pour les jeunes - les gardes • Les transferts de données des gardes hospitalières • La limitation du temps de travail • Les urgences • Conclusion J. Gruwez 01.06.2012

  4. T E A M TogetherEverybodyAchievesMore

  5. Great Expectations :the 21st century health workforce "...it is clear that we are evolving into a shortage of physicians, especially specialists, and that primary care will increasingly be done by nonphysician clinicians" George F. Sheldon (The American Journal of Surgery 185 (2003) 35-41)

  6. Health Care TechnicianSurgical Physician Assistant Physician Assistant J.P. Dercq, 2002 KUL Katholieke Hogeschool Leuven Dpt. Verpleegkunde en Vroedkunde

  7. >110 hôpitaux généraux adhéreront à un hub en 2010-2011 9

  8. Electronic Medical File Exchange between On-Duty Care Providers and the Attending Paediatrician : a Belgian Paediatric Pilot Project 1Department of Paediatrics, Universitair Kinderziekenhuis Brussel ; 2Department of Surgery, Université Catholique de Louvain – Medical School at Mont-Godinne University Hospital ; 3Department of Biostatistics and Medical Informatics , Vrije Universiteit Brussel ; 4Department of Health Informatics and Medical Statistics, Ghent University M. Deneyer1 , S. Hachimi-Idrissi1 , L. Michel2 , M. Nyssen3 , G. De Moor4 , Y. Vandenplas1 Acta Chir Belg, 2012, 112, 116-120

  9. Benefits of the project of PCF-EXEM Consult is always and everywhere possible Availability of objective health information Availability of coordinates to be able to inform legal representatives Feedback to the attending physician Administrative simplification Cost saving by centralising the reporting Tracing of « dark » diagnosis by joining informationsuch as child abuse, Munchausen by proxy

  10. Sign-out Handoff (debriefing) Patient Information + Responsibility Transfer Vidyarthi et al. J. Hospit. Med. 1, nr. 4, July-August 2006

  11. Bibliography Handoffs – Sign-out • Managing discontinuity in Academic Medical Centers : Strategies for a Safe and Effective Resident Sign-out Arpana R., Vidyarthi et al.Journal of Hospital Medicine, vol. 1, nr. 4, July/August 2006, p. 257-266 • Handoffs in Teaching Hospitals : Situation, Background, Assessment and RecommendationLia S. Logio, MD, et al.The American Journal of Medicine, vol. 123, nr. 6, June 2010, p. 563-567 • Discontinuity of care: Further Thoughts on Standardized ProcessesKyle B. Enfield et al.Journal of Hospital Medicine, vol. 2, nr. 2, March/April 2007, p. 115-117 • Author ReplyArpana R., Vidyarthi et al.Journal of Hospital Medicine, vol. 2, nr. 2, March/April 2007, p. 116-117 • Avoiding Malpractice Risks in the Patient Handoff Mark E. Crane Medscape Business of Medicine, WebMD, LLC

  12. Experience with Faculty Supervision of an Electronic Resident Sign-out SystemChristopher Nabors et al.The American Journal of Medicine, vol. 123, nr. 4, April 2010, p. 376-381 • Impact of Resident Workload and Handoff Training on Patient Outcomes Stephanie K. Mueller et al.The American Journal of Medicine, vol. 125, nr. 1, January 2012, p. 104-110 • A Bridge too Far: A Critique of the new ACGME Duty Hour Requirements Joseph S. Alpert et al.The American Journal of Medicine, vol. 125, nr. 1, January 2012, p. 1-2 • Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safetyAlexander B. Blum et al.Nature and Science ofSleep 2011: 3, p. 47-85

  13. Stratégies spécifiques pour l’efficacitédes transferts (NASA – Centrales nucléaires – Industrie des chemins de fer) • standardisation de l’information • s’assurer que l’information est à jour • la limitation des interruptions • un échange face à face verbal structuré et écrit • Intégration d’outillage électronique • Action concertée (Team-work)

  14. Conclusions for managing discontinuity • Sign-outs part of current landscape of (teaching) hospitals • Hospitals are mandated to develop standards and systems to improve sign-out • Allocation of resources, individualization, intensive training, ongoing evaluation • Patient safety at the forefront Vidyarthi et al. J. Hospit. Med. 1, nr. 4, July-August 2006

  15. “The way residents transfer patient care information reflects the culture of the institution” Managing discontinuity in Academic Medical Centers A.R. Vidyarthi Journal of Hospital Medicine Vol. 1 / nr. 4 / July/Aug. 2006

  16. La main d'œuvre médicale 01.01.200831.12.2010 Méd. spéc. 22.890 25.012 Méd. gén. 14.54914.678 Tot. 37.43939.690 Fem. 12.425 = 33,2 % 13.989 = 35,245 % Cand. spé. 3.273 3.387 Cand. gén. 510 572 Tot. 3.783 3.959 Méd. 41.192 43.649

  17. Prof. Dr J.A. Gruwez12.11.2010

  18. 20

  19. Emigration - Immigration Belges  Etranger 2008: 281 (spécialistes)2011: 254 (spécialistes)526 (généralistes) 780 Etrangers  Belgique 210

  20. Sondage de la profession(hom.: 19, fem.: 2, Fr.: 6, Nl: 15)(chir.: 14, autres spéc.: 7) • Nos jeunes spécialistes auront difficile à trouver une bonne place? • Y-a-t-il pléthore dans la profession? • Nos jeunes spécialistes iront à l'étranger? • Avez-vous modifié votre système de garde après la loi sur le temps de travail? • Est-ce-que le transfert des données est devenu plus strict?

  21. Résultats

  22. […]57. EWTD compliance – Towards 2009 J Lowry, J. Cripps. Ann R Coll Surg Engl (Suppl) 2006; 88 : 262-26358. SHO clinical exposure following the introduction of an EWTD-compliant shift system. HK Khan, MI Trotter, H Hathurusinghe, W Raut, F Wilson. Ann R Coll Surg Engl (Suppl) 2006; 88 : 238-23959.EWTD developments. H. Phillips, J. Cripps. Ann R Coll Surg Engl (Suppl) 2004; 86 : 190-19260. Working Time Changes: A raw Deal for Emergency Operative Training. SV Gurjar, AJ Mclrvine. Ann R Coll Surg Engl (Suppl) 2005; 87 : 140-14161. An EWTD-compliant shift rota decreases training opportunities. CD Marron, CK Byrnes, SJ Kirk. Ann R Coll Surg Engl (Suppl) 2005; 87 : 246-24862. The EWTD and retirement intentions. J Lowry, J Cripps. Ann R Coll Surg Engl (Suppl) 2005; 87 : 272-27463. ASiT (Association of Surgeons in Training) opinion on the EWTD. May 2006[…] Liste Bibliographique concernant le temps de travail en chirurgie. 63 références.

  23. Matt FreudmanPres. BOTA (Brit.Orth.TraineesAssoc.) Oct. 2005Survey: 1300 Junior Surgeons 90 % training diminished82 % time in theatre decreased75 % contact with trainer fallen84 % continuity of care f. patients suffered58 % quality of care worse47 % quality of life worse

  24. P.J. Wraighte, D.P. Forward, P. Maining … implying a decrease in the quality of training opportunities. Other implications include a reduction in trainer-trainee interaction, LACK OF CONTINUITY OF PATIENT CARE and a negative effect on trainee well being and quality of life. Ann. R. Coll. Surg. Engl

  25. Lack of rest does not affect residents' surgery outcomes Emma Hitt July 29, 2010 Journal of Surgical Res. (80 hour workweek 2003)

  26. Prof. Dr J.A. Gruwez12.11.2010

  27. Lack of rest does not affect Residents’ Surgery Outcomes Azezou Yaghoubian, L.A. Med. Center, Torrance 80-hour workweek (2003) + 5 hour rest period after 16-hrs shift (recommendation ACGME) Retrospective review of laparoscopic cholecystectomies and appendectomies July 2003-March 2009 comparison 2.908 lap. cholecystect. by Surg. Resid. 1.726 appendect. 6 AM – 10 PM 10 PM – 6 AM NO difference in morbidity and mortality!

  28. Spoedgevallendiensten in de ziekenhuizen in het Vlaamse Gewest (19.05.2015)

  29. Médecine d’urgence • 142 services d’urgences spécialisées • Besoins en spécialistes de la médecine d’urgence: 750 • Formation annuelle de spécialistes en médecine d’urgence ± 20 • ➚ L’attractivité (?!)

  30. Conclusions Continuité des soins : …… • Multitude de problèmes • Transborder medicine – Médecine à travers les frontières • Listes d’attente – Délais de traitement • ………… MERCI POUR VOTRE ATTENTION

  31. “Belgische gediplomeerden blijven België ontvluchten” Certificaataanvragen voor emigratie Nieuwsbrief BVAS-VAS maart-april 2012

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