Download - Role of the DGH 22.4.09
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Role of the DGH
Tim Jobson 22/4/2009
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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
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Role of the DGH - summary
What must be done in hospital
What is done better in hospital
What is less expensive in hospital
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Acute care..........
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High tech care………
Acute care - diagnosis Acute care - immediate management Trauma Technology based care - HDU, ITU Interventional care - surgery, radiology,
obstetrics, cardiology
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High tech care………
Primary angioplasty Stroke thrombolysis Bariatric surgery Spinal surgery
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Complex diagnostics
Inpatient approach to diagnostics Parallel diagnostics and acute care Higher dependency nursing Multidisciplinary approach Multiple opinions Imaging, laboratory, invasive
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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)
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Sustainability / interdependency
A & E
GI BleedTransfusion
Acute endoscopy
Surgery
GI Medicine
Haematology
GI surgery
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Clinical networks
Cancer therapies& diagnostics
Internal MDT
Tertiary care
Joint disease
Diagnostics
Orthopaedics
Rheumatology
Systemic disease
Medical specialties
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Evolving quality agenda
Negative aspects – M&M, HAI HSMR Process measurements Outcome measurements SPI PROMs
…and the end of audit
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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