Presentació a Volterra (18 de febrer de 2011)

1. La dimissione Joan Escarrabill, MD Master Plan For Respiratory Diseases (PDMAR) Ministry of Health Health Studies Institute Barcelona [email_address]

2. Punti chiave 1 La dimissione è importante dal punto di vista de la sicurezza dei pazienti e de l'efficacia del trattamento 2 Il processo è complesso e richiede il lavoro di squadra. 3 Ogni volta che si verifichino dei cambiamenti di trattamento è necessario prendere in considerazione l'adattamento del paziente.

3. Agenda

4. Discharge planning

5. Discharge planning Long-term care facilities General ward ICU Emergency department Outpatient clinic Weaning center

6. Monaldi Arch Chest Dis 2007; 67: 3, 142-147. n = 792 patients 20% 45% 16% 36%

7. Monaldi Arch Chest Dis 2007; 67: 3, 142-147. n = 792 patients 18%

8. Escarrabill J. Eur Respir Mon, 2008, 41, 367–376

10. Neale G. J R Soc Med 2001;94:322-330.

11. CMAJ 2004;170:1235-40

12. Teamwork Communication Most problems (and accidents) relate with …

15. Il team ottiene risultati migliori rispetto alla somma dei risultati ottenuti da ogni singolo membro.

16. Wagner. BMJ 2000;320:569-72. Casas and Romeu in tandem (1897)

17. Aiken L. NEJM 2003;348:164-6 Increasing role of non-physcian health professionals .

19. BMJ 2009; 339:b3595

20. The network of discharge Financial issues Public/Private Discharge team Case manager Risk management Education Experience Health Service Health professionals Supplier Caregiver Home carers

21. Escarrabill J. Eur Respir Mon, 2008, 41, 367–376

22. Piper A. Breathe 2010;6:323-33

23. J Nurs Care Qual 2004;19:67-73 Case manager coordinates the discharge plan Confidence & competence Understanding of what is needed Confidence that the patient’s needs are being met Patient and caregiver Nurses & RRT Physician

24. Agenda

26. Discharge planning... ...is defined as the development of an individualised discharge plan... ...prior to them leaving hospital.

27. NIV: Feasibility

28. Aumento del rischio, i risultati clinici più incerto e più costosi. 103 pazienti 457 transitions

30. Needs assessment Home carers Equipment & supplies Communication Daily living Risk management Funding

31. Home carers Home carers Equipment & supplies Communication Daily living Risk management Funding O Noeregaard & J Escarrabill Tailored educational programmes for patients and caregivers Well-structured programme with theoretical knowledge and practical skills

32. Patient & Caregiver Training Source: Eurovent Survey Home carers Equipment & supplies Communication Daily living Risk management Funding Patients Caregivers Is training crucial before discharge? 97% 84% Is there a continued training after discharge? 36% 34%

33. Equipment needs for NIV Schönhofer B, Sortor-Leger S. Eur Respir J 2002;20:1029-38 Home carers Equipment & supplies Communication Daily living Risk management Funding

34. Augmentative and alternative communication (AAC) Home carers Equipment & supplies Communication Daily living Risk management Funding Speak slowly If able, use gestures Identify the topic first before Writing Boards Software: word prediction.... www.muscle.ca/ Specialized Telephone Equipment

36. Daily living activities Home carers Equipment & supplies Communication Daily living Risk management Funding

38. Room setting www.medame.com Home carers Equipment & supplies Communication Daily living Risk management Funding

40. Home carers Equipment & supplies Communication Daily living Risk management Funding

41. Home carers Equipment & supplies Communication Daily living Risk management Funding

42. Home carers Equipment & supplies Communication Daily living Risk management Funding

43. http://freespace.virgin.net/michael.bowell/equip.html

44. August 14 2000 Power cut kills man on home ventilator BY SAM TOWLSON AN INVESTIGATION has been launched into the death of a disabled man whose life-saving equipment failed during a power cut. Safety Home carers Equipment & supplies Communication Daily living Risk management Funding Feb 15, 2001 A Fatal Complication of Noninvasive Ventilation Lechtzin N., Weiner C. M., Clawson L. N Engl J Med 2001;344:533

45. Risk minimisation (i) Adapted from AK Simonds, 2001 Technical aspects Home carers Equipment & supplies Communication Daily living Risk management Funding

46. Risk minimisation (ii) Adapted from AK Simonds, 2001 Medical and social aspects Home carers Equipment & supplies Communication Daily living Risk management Funding

47. Check-list Piper A. Breathe 2010;6:323-33

48. HMV: Funding Home carers Equipment & supplies Communication Daily living Risk management Funding Tax-funded Social-insurance-funded

49. Agenda

50. Dimissione ospedaliera, in pratica Timing il processo di dimissione ospedaliera inizia il più presto possibile Fattibilità Identificare il caregiver competenti Istruzione Analizzare i problemi pratici Prenditi il tuo tempo Caratteristiche della casa Dimissione Evitare il week-end Case manager

51. Characteristics of care Source: Eurovent Survey 49% without home care

52. Systematic follow-up Escarrabill J. Breathe 2009;6:37-42. Population: 291.500.000

54. Eur Respir J 2009; 33: 411–418 Nurse-centred tele-assistance Tele-assistance Control Aveva meno ricoveri, meno ammissioni nel pronto soccorso, meno chiamate urgenti al GP di riduzione dei costi 33%

56. Am J Phys Med Rehabil. 2010 May;89:401-6. Thirty hospitalizations were avoided. On-demand consult and MI-E access program 29 ALS patients Oximetry feedback program

57. Respite care http://southlakemac.com Provision of short-term, temporary relief to those who are caring for family members

58. Respir Med 2007;101:62-68 Post-operative intubation time 3,8 + 3,2 h. Only 1 patient > 12 h. Stay un postsurgical reanimation unit 19 + 9 h. 19 + 6 h. in the general population n=16

59. End-of-life 57% of patients died at home The percentage of patients who die in hospital ranges from 18.7 to 62.5% (p=0.045). ERS 2010 (Barcelona) n = 77

60. Eur Respir J 2010; 35: 1064–1071 Family burden private assistance high financial burden 26 % 17 %

61. Conclusione

62. Grazie per la vostra attenzione Download la presentazione… www.slideshare.net/jescarra