Inno4 ageing 12 12 13

Future Hospital: from “central role” to “key role”

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Joan Escarrabill MDChronic Care Program– Barcelona Esquerra. Hospital Clínic (Barcelona)

Master Plan for Respiratory Diseases (PDMAR) & Home Respiratory Therapies Observatory (ObsTRD). FORES. Ministry of Health (Catalonia)Vic, December 12th 2013

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1133 – to XVI cent. Accommodation for

sick priests

XI – XV century Hospital de St Jaume

Leprousy

1217Hospital de pelegrins

o St BartomeuHospital of pilgrims

Hospital de la Santa Creu

1348Ramon de Terrades

Black Death

2 buildings24 beds


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1408Guild of

shoemakers


1348Ramon de Terrades

Black Death

2 buildings24 beds

The City Council participates in the

hospital management

1525Curch

involvement

1647Canon Pere Ramis

Improvement works

3 canons3 civilian representatives1 councilor1 nobleman1 merchant or artist


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17921713-1724Partial use as a

military hospital


1845Sisters of Charity of St. Vincent de Paul

1920Surgival Service

1 Physician1 Surgeon1 apothecary 1 nurse(“cabo de vara”)4 servants

1845 & 1885: Cholera1863: Floods

1931Local general

hospital

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• Structural• Organizational

Dinamic

• Tailored to the needs of the population

Flexible • Local Hospital

Innovative

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Better value through population and personalised medicine.

J A Muir Gray. Lancet 2013;382:200-1

Effectivity

Quality

Safety

Value

Presonalised

Population

medicine

Customize evidence Biomarkers Personal values Clinical situation Context

Responsibilities to the population to be served Avoid inequalities Distribution of resources

Hospitals on the edge

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1. We must promote dignity and patient-centred care

2. We must redesign services.

3. We must change the way we organize hospital care.

4. We must review medical education and training.

5. We must ensure the right mix of medical skills.

6. We must renegotiate the New Deal.

7. We must improve the availability of primary care.

8. We must revolutionize the way we use information.

9. We must embed quality improvement across the system.

10.We must show national leadership.

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High quality care sustainable 24 hours a day, 7 days a week

Continuity of care as the norm

Stable medical teams for patient care and education

Optimized relationships with other teams

Appropriate balance between care by specialists and generalists

Discharge arrangements which realistically allocate responsibility for further action

http://www.rcplondon.ac.uk/projects/future-hospital-commission-background-and-workstreams



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Lancet 2013;382:923-4

Increase (emergency)

admission

Reduction LOS

Pts > 85 yrsMultimorbidity

Cognitive impairementBalance

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Lancet 2013;382:923-4

Increase (emergency)

admission

Reduction LOS

Pts > 85 yrsMultimorbidity

Cognitive impairementBalance

To identify the optimumcare pathway for adults with medical illnesses

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Future hospital

Hospitals must be designed around the needs of patients

No “one size fits all” : Coordinated mangement of patients with multiple comorbidities

Specialist medical care will not be confined to inside the hospital walls.

Continuity of care

Illnes can occur in any time: 24/7/365.

Reorganisation of ‘front door’

Vulnerable patients.

Patient experience is valued as much as clinical effectiveness

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Extended roles for physicians in the community

Three elements

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Acute care hub

Clinical coordination

center“Hub & spoke”

Fast track

Ann Intern Med. 2012;157:448-449.

Disruptive business model

Solution shop

Intutive Medicine for unstructured

problems

Hypothesis testing until diagnosis can

be made

Value-added process

Empirical medicine

Standardization

Facilitated network

Patient groups with common needs

Long-term care: adherence

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Personalized medicine

Focus on results

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Precision

medicine

Care plan:

adherence

Disruptive business model

Key words to summarize

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Concentration

Transparency

DesignContext

Complexity

Concentration

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To be or not to be

To close hospital beds or to close hospitals ?

Transparency

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General data

Specific data

Leave a foreign object inside a patient

Administer the wrong type of blood

Serious bed sore

C-diff (Clostridium difficile)

MRSA (methicillin-resistant S aureus)

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The patient room of the future is being designed as a safe, private, comfortable place conducive to healing.

Design

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BMJ 2013;347:f5479 doi: 10.1136/bmj.f5479

“Conventional models of health service design in which a hospital site is the sole focus for the delivery of emergency, acute and elective services are dated,”

“The expectation that most physicians will become highly specialised in a narrow field must be changed.”

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Context

Complexity

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What we’re trying to build is a

learning health care system

To gather data about hospital

users

To run that data through predictive

models and recommendation

systems

Personalized diagnoses and

treatments

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To conclude…

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Thank you very much for your attention [email protected]

mailto:[email protected]

Inno4 ageing 12 12 13

Health & Medicine

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