Role of the DGH

Tim Jobson 22/4/2009

Features of a modern DGH+

Not ‘Teaching Hospital – lite’ Access to technology ‘High tech care’ Specialisation / sub-specialisation Immediate care – 24/7 access Clinical networks Academic links (internal and external) Efficiency of scale

Role of the DGH - summary

What must be done in hospital

What is done better in hospital

What is less expensive in hospital

Acute care..........

High tech care………

Acute care - diagnosis Acute care - immediate management Trauma Technology based care - HDU, ITU Interventional care - surgery, radiology,

obstetrics, cardiology

High tech care………

Primary angioplasty Stroke thrombolysis Bariatric surgery Spinal surgery

Complex diagnostics

Inpatient approach to diagnostics Parallel diagnostics and acute care Higher dependency nursing Multidisciplinary approach Multiple opinions Imaging, laboratory, invasive

What can be done better in a DGH? Specialisation - e.g. low volume, high

complexity Relationship between elective and acute care,

and sustainability (e.g. can't have OOH care w/o critical mass of clinicians / expertise)

MDT working - e.g. cancer services Clinical inter-relationships (specialists need

others around to maintain standards, interest etc)

Clinical networks (esp with tertiary centres)

Sustainability / interdependency

A & E

GI BleedTransfusion

Acute endoscopy

Surgery

GI Medicine

Haematology

GI surgery

Clinical networks

Cancer therapies& diagnostics

Internal MDT

Tertiary care

Joint disease

Diagnostics

Orthopaedics

Rheumatology

Systemic disease

Medical specialties

Evolving quality agenda

Negative aspects – M&M, HAI HSMR Process measurements Outcome measurements SPI PROMs

…and the end of audit

Less expensive care

What is the most efficient model? Is a trip to hospital always the least

efficient? Tackling duplication Short inpatient stay to address need Avoiding inpatient stay – diagnostics,

clinical confidence, back up