Reflexion about the Oncology-Haematology Day-Care … · Aquagym (Raviva) 253 Emotions et mental...

JL Canon, MD

Cancer and Blood Disease Pole

Grand Hopital de Charleroi

Reflexion about the Oncology-Haematology

Day-Care Hospital in 2022

Disclaimer

• The views expressed in these slides are those of the

individual speaker and do not necessarily reflect the views of

Roche.

Etude GHdC – Le 19 janvier 2012, Jambes Centre d’Etudes en Aménagement du Territoire – UCL

GHdC 2022: Health Campus « Les Viviers »

Grand Hôpital de Charleroi

2013 2020 Delta

Classical Hospitalisation 1109 786 -29%

Day Hospital – Beds* 125 74 -39%

Day Hospital - Seats 133 112 -16%

Total Hospital 1363 972 -29%

* Excluding Psychiatric Day Hospital

Health Campus « Les Viviers »: Master Plan


Performant

GHDC 2013

GHDC 2013

2013 Performant

GHDC

2020/2040

2040 2020

GHDC

Progress

2020/2040

2040 2020

Step 1: Performance Optimization

Step 2: Extrapolate in

the future.

Step 3: Prospective

effect of Strategic choice

Base



Basic Data (sources =

GHDC Minimal Clinical

Summary)

By pole & By spec. /

Classical & Day Hospital

Admission number

(Hospital Stay)

Mean Stay Duration

(MSD)

Beds Number 2020 et 2040

By pole & spec. Classical & Day

Hospital

• Demography • Epidemiology • Ambulatorisation • Medical

development • Market Share


Corrective Index


# 2013 Stay x Corrective Index x 2020 MSD 7.9 days x 365

(days /year) x 0.8 (80% occupation)

2018: 48 Classical beds 2022: 41 Classical beds

Cancer Center Master Plan: Classical Hospitalisation

2013 2014 2015 2016 2017

# Stay 1237 1174 1133 1285 1215

# Different patients 699 719 686 787 711

Total duration (days)

12695 12763 11270 13808 13456

MSD 10.46 11.00 10.09 10.92 11,08


# Stay Occupation rate (%) # Beds/Seats

2013 14688 100 56

2020 15484 150 42

2040 17957 180 40

Cancer Center Master Plan: Day Hospitalisation

2018: 48 Day beds/Seats 2022: 42 Day beds/Seats

2013 2014 2015 2016 2017

# Treatment realized

14688 15598 15326 14595 15067

2018 occupation rate: 125%


How to resolve our 2022 Challenge:

Doing better with Less

• Improve day hospitalisation performance

• Find innovative way of treatment: Home hospitalisation

• Improve care quality


1 . Selection of patients treated in the context of the day hospital:

• Use the day hospital facilities in its primary purpose: To complete treatment and

therapeutic or diagnostic actions requiring by their complexity a short hospitalisation

• Clear distinction between day hospitalization and consultation

• Oncological-Haematological emergencies are seen in the emergency department by our

team

Improve Day Hospital Performance


2. Improve the flow in the use of the day hospital structure:

• Decrease duration of stay trought a better efficiency of the one day clinical pathway

• Specific clinical pathway for patients receiving a treatment previously prescribed

(Chemotherapy Day 2, treatment with low risk of side effect and variability not requiring a

contact with a doctor each time…)

• With a same efficacy, encourage short treatment or the most convenient way for drug

administration (SC Monoclonal antibodies, SC Chemotherapy)

GHdC: Early use of SC route: financial loss equivalent to 1200 « maxi forfait »

Favorable effect of the new one day chemotherapy reimbursement



• Organization of the arrival at the day hospital according to the treatment duration:

1/ Long duration poly-chemotherapy

2/ Middle duration poly-chemotherapy

3/ Mono-chemotherapy

4/ Oral or SC therapy (also prescribed in the consultation setting)

• Strict planning of patients arrival at the day hospital

• Consider larger working range of the one day structure (Evening, 6 days/week)



No Go

Report

Adapted care structure

orientation

Go Nurses (Anamnesis,

parameters, IV line)

MD (Anamnesis, Physical examination, Chemo prescription, Medical

directives)

Discharge (With medical

directives, appointements, Drugs)

General practitionner, Emergency,

consultation

Day before

3. Clinical pathway in our day hospital:

Planning of the appointment



Home Hospitalisation: GHdC Experience

• Launched on January 2016 following consultation with home care nurses and

general practitionners

• Objectives:

- Shift care usually performed in the hospital to the home

- To limit multiple round trip of the patient to the hospital

- To improve confort and quality of life

- To decrease the hospitalisation rate and re-hospitalisation

- To decrease hospitalisation duration

- To improve communication between 1st and 2d care line


• 3 types of patient care:

- Chemotherapy: Short and safe treatment (subcutaneous)

- Follow up of side effects for specific therapies (Targeted therapy)

- Reduced hospital stay and coordination with the home care team

• To keep a total control on the treatment administration and the care quality

• Implementation of procedure and care journey specific for home hospitalisation

• Selection criteria (distance from hospital, compliance, social environment, …)



Launched with our own ressources

• 1,8 FTE nurses specialised in oncology care (including a coordinator)

• Acquisition of dedicated car

• Supporting a significant financial loss: +/- 130,000 €/year (lack of reimbursement)




2016 2017 Jan 2018

# Home visit 879 1283 140

# Home Chemo 507 764 41

•This project has been selected as pilote projet launched in the context of

hospital financing reform: –Chemotherapy at home (SC and extended to short IV)

–Follow up of side effects for specific oral therapies

• Financing principle: Budgetary garantee


• Feedback from patients:

- Confort of staying at home

- Avoid the medical environment and the restatement of the disease while

going to the oncology unit

- Fulfill a social need specially for elderly (No need of dependency)

• Question:

- Cost efficiency?

- To be balanced with the cost of building larger facility and operational costs



Improve Care Quality

• Improve humanization of care

• Improve quality of our practice


• Care journey allowing a dedicated time for the patient with his doctor and

nurse

• For each patient a referent oncologist/hematologist

• Major step in the treatment are discussed during a consultation allowing

more time for the dialogue

• Longer time allowed to the nurse to take in charge new patient being

treated at the day hospital for an optimal orientation

Improve Care Quality: Humanization of care


• Systematic initial contact for each new patient with our psychologial team

(6 psychologists)

• Systematic analysis of the social status of each patients and adapted

assistance (5 social assistants)

• Systematic consultation in the context of the onco-geriatric

multidisciplinary clinic for patient > 70 year and G8 score < 14 to help in

the treatment orientation and prevent side effects related to age

• Cosmetic treatment given by a social esthetician

Improve Care Quality: Humanization of care


Les Viviers: Oncology/Hematology Day Hospital

• Specific architecture of our future day hospital to accommodate the

patient in optimal condition: « Business class seat confort »


MAISON MIEUX-ETRE - GHdC - CHARLEROI 4 PILIERS MEDECINE

INTEGRATIVE ACTIVITES 2017 Participations individuelles

Energie et Vitalité

Marche nordique 70

731 Yoga (Raviva) 161

Gymnastique Santé 247 Aquagym (Raviva) 253

Emotions et mental

Sophrologie 174

661

Méditation Pleine conscience

151

Arts : peinture, dessin, floral, créatif …

216

Reflexologie plantaire 120

Nutrition et prévention Atelier culinaire 76

98 Info nutrition, alimentation …

22

Corps et esthétique

Massages 234

471 Soins esthétiques 111

Soins visage et conseils beauté (FcC - STK)

81

Coiffure 45

Infos Echanges thématiques (BRA Day et Pleine conscience et

cancer) 41 41

TOTAL 2002

Nombre de nouveaux patients inscrits en 2017 112

« Maison Mieux-Etre »

To offer the ressources to overcome cancer

hardship and live better their treatment


Improve Care Quality

• Improve humanization of care

• Improve quality of our practice - Clinician pharmacist

- Chemotherapy traceability

- E-medecine


• Systematic consultation at the beginning of each new treatment

• To complete informations given by doctors and nurses (Mode of action, side

effects, instruction for usage, contra-indicated associations…)

• To adapt the patient usual treatment according to chemotherapy treatment

• To provide a written support for the patient and his general practionner with

major chemotherapy informations

• To stay a constant ressource for everyone in order to use the prescribed

treatment in the best conditions

Improve Quality of our practice: Clinician Pharmacist


• To follow the chemotherapy itinerary from

the drug vial to its administration

• To facilitate the nursing work

• To decrease the risk of error in the

chemotherapy administration

Improve Quality of our practice: Chemotherapy Tracability


Patient Reported Outcomes (PROs): A proactive approach to better detect side effect and earlier treatment modification

AMTRA Trial: RIZIV/INAMI pilot project

Improve Quality of our practice: E.Medecine


Acknowledgments

• GHdC Direction

• Onco-Haematology medical and

nursing team

• S Demoulin, A Humblet, T Depasse

L Dumont, D Van Drooghenbroeck

Les Viviers: 2022 Thank you for your attention

R.E. Chr. Lenaerts – BE/ONCO/0318/0014c – 07/03/2018

Reflexion about the Oncology-Haematology Day-Care … · Aquagym (Raviva) 253 Emotions et mental...

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