1. Future Hospital: from “central role”
to “key role”
Joan Escarrabill MD
Chronic Care Program– Barcelona Esquerra.
Hospital Clínic (Barcelona)
Vic, December 12th 2013
1
Master Plan for Respiratory Diseases (PDMAR) & Home
Respiratory Therapies Observatory (ObsTRD). FORES.
Ministry of Health (Catalonia)
2. 1133 – to XVI cent.
Accommodation for
sick priests
XI – XV century
Hospital de St Jaume
Leprousy
1217
Hospital de pelegrins
o St Bartomeu
Hospital of pilgrims
2 buildings
24 beds
1348
Ramon de Terrades
Black Death
2
Hospital de lala Santa Creu
Hospital de Santa Creu
3. The City Council
participates in the
hospital management
2 buildings
24 beds
1408
Guild of
shoemakers
1348
Ramon de Terrades
Black Death
1525
Curch
involvement
1647
Canon Pere Ramis
Improvement works
3 canons
3 civilian representatives
1 councilor
1 nobleman
1 merchant or artist
3
Hospital de lala Santa Creu
Hospital de Santa Creu
4. 1713-1724
Partial use as a
military hospital
1792
1845
Sisters of Charity of
St. Vincent de Paul
1 Physician
1 Surgeon
1 apothecary
1 nurse
(“cabo de vara”)
4 servants
1920
Surgival
Service
1931
Local general
hospital
1845 & 1885: Cholera
1863: Floods
4
Hospital de la Santa Creu
6. J A Muir Gray. Lancet 2013;382:200-1
Better value through population
and personalised medicine.
Effectivity
Presonalised
Population
medicine
Quality
Safety
Value
6
Customize evidence
Biomarkers
Personal values
Clinical situation
Context
Responsibilities to the
population to be served
Avoid inequalities
Distribution of resources
7. Hospitals on the edge
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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8.
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/futurehospital-commission-background-and-workstreams
8
10. To identify the optimum
care pathway for adults
with medical illnesses
Lancet 2013;382:923-4
Increase
(emergency)
admission
Pts > 85 yrs
Multimorbidity
Cognitive
impairement
Balance
Reduction
LOS
10
11. Future hospital
No “one size fits all” : Coordinated mangement
of patients with multiple comorbidities
Specialist medical care will not be confined to
inside the hospital walls.
11
Hospitals must be designed around the needs
of patients
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
22. 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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24. Complexity
What we’re trying
to build is a
learning health
care system
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To gather data
about hospital
users
To run that data
through
predictive models
and
recommendation
systems
Personalized
diagnoses and
treatments