Lack of cooperation between stakeholders, anticipation of discharge procedures and coordination of the patient journey: These findings in 2018 helped explain why the average length of stay for patients within the surgical department of the Beijing Hospital Outpatient Center was so high. From LOS National. “So we questioned the formalization of the coordinated patient journey, with the goal of reducing MSD while meeting patient expectations”During the nursing fair, Olivier Lingan, senior health director in charge of the medical-technical pole at Beijing Hospital, said.
In January 2019, the team selected the Nurse Assessment and Education (INEE) training. “Its job was to organize appointments with patients, right after they met with the anesthesiologist, to send them more information, assess their needs and their level of dependency in order to start and better organize their output”Olivier Lingan explained. Two tools were preferred: the Prado’s take-home service and the ViaTrajectoire, which offers personalized guided assistance. To start this new mission of INEE, three specialties were targeted: total artificial knee in orthopedics, prostatectomy in urology, and colectomy in visceral surgery.
The team also created a monitoring tool based on an Excel table where INEE entered the patient’s reason for arrival and start of discharge, before sending it to executives at the time of patient admission to hospital. “This solution made it possible to anticipate the needs of the patient”The chief health official said. After seven months of the study, the team noted a decrease in MSD for three days in orthopedics, and two days in visceral surgery, but no change in urology. “We also noticed a bias because if our quantitative goals were to be reached, we had no idea, at the time, of doing a qualitative study with patients, Getting to know Olivier Lingan. However, no patient complained about our work. “
Create an organized patient journey
In parallel with this first experience, other management methods have been gradually deployed with outpatient surgery or establishment of surgical hospitalization at D0. “With these developments, we then thought about creating a patient’s path in surgery”Olivier Lingan said. This led to the creation of a bedside manager nurse position, a pre-admission surgical unit that brings all players into the same unit and the integration of the INEE Center with the pre-existing outpatient coordination nurse (Idec) on the route. INEE only saw patients with conventional surgeries, and Idec only outpatients, He completed. Therefore, the two stations were merged to receive all patients. “ From now on, three Idecs and a nurse bed manager are involved in the service.
“This new functionality allows us to reach all patients in order to meet their needs, Emily Trivedik, Idec in the department, also practices stoma treatment. I act as a liaison between the surgeon and the patient, taking over the entire course of his care with the latter in order to ensure that he fully understands the course of his stay in the hospital. “ You may also have to re-explain the surgical procedure and treatment results. I prepare for his admission to the hospital by making sure that all necessary examinations are carried out and reported to avoid delaying interventions. “ It also identifies any difficulties with the ViaTrajectoire while contacting the Executives to inform them of the items needed for proper patient care. All data is tracked in the patient file so that the healthcare team is also informed.
This anticipation of needs makes it possible to improve care and reduce hospitalization time. By launching post-operative care procedures in convalescent or private centers., Idec said, explaining that this organization has also been reassuring to patients and their families. Today, the team is satisfied with this successful course, but it does not close the door to other developments, for example, the implementation of remote consultations in nursing.
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