Le spécialiste et la continuité des soins Durbuy, J.A. Gruwez

Code de déontologie médicale belge: « Quelles que soient les circonstances, la continuité des soins aux malades doit être assurée ». « La continuité des soins n'a de valeur que pour autant qu'elle influe sur les résultats des soins, la prévention ou la réduction des infirmités physiques, mentales ou sociales, la satisfaction des patients et le coût des soins » J.S. Gonella et M. W. Herman J.A.M.A. n° 243 (4) de 1/1980 ( )

Le spécialiste et la continuité des soins Introduction La relation médecin-patient La technologie de l'information et de la communication dans la continuité des soins La main d'œuvre médicale Exode et immigration des médecins en Belgique Sondage : perspectives pour les jeunes - les gardes Les transferts de données des gardes hospitalières La limitation du temps de travail Les urgences Conclusion J. Gruwez

T E A M Together Everybody Achieves More

Great Expectations : the 21 st century health workforce "...it is clear that we are evolving into a shortage of physicians, especially specialists, and that primary care will increasingly be done by nonphysician clinicians" George F. Sheldon (The American Journal of Surgery 185 (2003) 35-41)

Health Care Technician Surgical Physician Assistant Physician Assistant J.P. Dercq, 2002 KUL Katholieke Hogeschool Leuven Dpt. Verpleegkunde en Vroedkunde

9 >110 hôpitaux généraux adhéreront à un hub en

Electronic Medical File Exchange between On- Duty Care Providers and the Attending Paediatrician : a Belgian Paediatric Pilot Project M. Deneyer 1, S. Hachimi-Idrissi 1, L. Michel 2, M. Nyssen 3, G. De Moor 4, Y. Vandenplas 1 1 Department of Paediatrics, Universitair Kinderziekenhuis Brussel ; 2 Department of Surgery, Université Catholique de Louvain – Medical School at Mont-Godinne University Hospital ; 3 Department of Biostatistics and Medical Informatics, Vrije Universiteit Brussel ; 4 Department of Health Informatics and Medical Statistics, Ghent University Acta Chir Belg, 2012, 112,

Benefits of the project of PCF-EXEM Consult is always and everywhere possible Availability of objective health information Availability of coordinates to be able to inform legal representatives Feedback to the attending physician Administrative simplification Cost saving by centralising the reporting Tracing of « dark » diagnosis by joining information such as child abuse, Munchausen by proxy

Sign-out Handoff (debriefing) Patient Information + Responsibility Transfer Vidyarthi et al. J. Hospit. Med. 1, nr. 4, July-August 2006

Bibliography Handoffs – Sign-out Managing discontinuity in Academic Medical Centers : Strategies for a Safe and Effective Resident Sign-out Arpana R., Vidyarthi et al. Journal of Hospital Medicine, vol. 1, nr. 4, July/August 2006, p Handoffs in Teaching Hospitals : Situation, Background, Assessment and Recommendation Lia S. Logio, MD, et al. The American Journal of Medicine, vol. 123, nr. 6, June 2010, p Discontinuity of care: Further Thoughts on Standardized Processes Kyle B. Enfield et al. Journal of Hospital Medicine, vol. 2, nr. 2, March/April 2007, p Author Reply Arpana R., Vidyarthi et al. Journal of Hospital Medicine, vol. 2, nr. 2, March/April 2007, p Avoiding Malpractice Risks in the Patient Handoff Mark E. Crane Medscape Business of Medicine, WebMD, LLC

Experience with Faculty Supervision of an Electronic Resident Sign-out System Christopher Nabors et al. The American Journal of Medicine, vol. 123, nr. 4, April 2010, p Impact of Resident Workload and Handoff Training on Patient Outcomes Stephanie K. Mueller et al. The American Journal of Medicine, vol. 125, nr. 1, January 2012, p A Bridge too Far: A Critique of the new ACGME Duty Hour Requirements Joseph S. Alpert et al. The American Journal of Medicine, vol. 125, nr. 1, January 2012, p. 1-2 Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety Alexander B. Blum et al. Nature and Science of Sleep 2011: 3, p

Stratégies spécifiques pour lefficacité des transferts (NASA – Centrales nucléaires – Industrie des chemins de fer) -standardisation de linformation -sassurer que linformation est à jour -la limitation des interruptions -un échange face à face verbal structuré et écrit -Intégration doutillage électronique -Action concertée (Team-work)

Conclusions for managing discontinuity Sign-outs part of current landscape of (teaching) hospitals Hospitals are mandated to develop standards and systems to improve sign-out Allocation of resources, individualization, intensive training, ongoing evaluation Patient safety at the forefront Vidyarthi et al. J. Hospit. Med. 1, nr. 4, July-August 2006

The way residents transfer patient care information reflects the culture of the institution Managing discontinuity in Academic Medical Centers A.R. Vidyarthi Journal of Hospital Medicine Vol. 1 / nr. 4 / July/Aug. 2006

La main d'œuvre médicale Méd. spéc Méd. gén Tot Fem = 33,2 % = 35,245 % Cand. spé Cand. gén Tot Méd

Prof. Dr J.A. Gruwez

20

Emigration - Immigration Belges Etranger 2008: 281 (spécialistes) 2011: 254 (spécialistes) 526 (généralistes) 780 Etrangers Belgique 210

Sondage de la profession (hom.: 19, fem.: 2, Fr.: 6, Nl: 15) (chir.: 14, autres spéc.: 7) Nos jeunes spécialistes auront difficile à trouver une bonne place? Y-a-t-il pléthore dans la profession? Nos jeunes spécialistes iront à l'étranger? Avez-vous modifié votre système de garde après la loi sur le temps de travail? Est-ce-que le transfert des données est devenu plus strict?

Résultats OUINON Un bon poste : difficile? (21 rép.) 129 (6 F) Pléthore dans la spécialité? (19 rép.) 910 Les jeunes vont sexpatrier? (19 rép.) 712 Mofification de la garde après Loi Durée du Travail? (19 rép.) 136 Transferts plus stricts? (18 rép.) 99

[…] 57. EWTD compliance – Towards 2009 J Lowry, J. Cripps. Ann R Coll Surg Engl (Suppl) 2006; 88 : SHO clinical exposure following the introduction of an EWTD-compliant shift system. HK Khan, MI Trotter, H Hathurusinghe, W Raut, F Wilson. Ann R Coll Surg Engl (Suppl) 2006; 88 : EWTD developments. H. Phillips, J. Cripps. Ann R Coll Surg Engl (Suppl) 2004; 86 : Working Time Changes: A raw Deal for Emergency Operative Training. SV Gurjar, AJ Mclrvine. Ann R Coll Surg Engl (Suppl) 2005; 87 : An EWTD-compliant shift rota decreases training opportunities. CD Marron, CK Byrnes, SJ Kirk. Ann R Coll Surg Engl (Suppl) 2005; 87 : The EWTD and retirement intentions. J Lowry, J Cripps. Ann R Coll Surg Engl (Suppl) 2005; 87 : ASiT (Association of Surgeons in Training) opinion on the EWTD. May 2006 […] Liste Bibliographique concernant le temps de travail en chirurgie. 63 références.

90 % training diminished 82 % time in theatre decreased 75 % contact with trainer fallen 84 % continuity of care f. patients suffered 58 % quality of care worse 47 % quality of life worse Matt Freudman Pres. BOTA (Brit.Orth.TraineesAssoc.) Oct Survey: 1300 Junior Surgeons

P.J. Wraighte, D.P. Forward, P. Maining … implying a decrease in the quality of training opportunities. Other implications include a reduction in trainer-trainee interaction, LACK OF CONTINUITY OF PATIENT CARE and a negative effect on trainee well being and quality of life. Ann. R. Coll. Surg. Engl

Lack of rest does not affect residents' surgery outcomes Emma Hitt July 29, 2010 Journal of Surgical Res. (80 hour workweek 2003)

Prof. Dr J.A. Gruwez

Lack of rest does not affect Residents Surgery Outcomes 80-hour workweek (2003) +5 hour rest period after 16-hrs shift (recommendation ACGME) Retrospective review of laparoscopic cholecystectomies and appendectomies July 2003-March 2009 comparison lap. cholecystect. by Surg. Resid appendect. 6 AM – 10 PM 10 PM – 6 AM NO difference in morbidity and mortality! Azezou Yaghoubian, L.A. Med. Center, Torrance

Spoedgevallendiensten in de ziekenhuizen in het Vlaamse Gewest ( )

Médecine durgence 142 services durgences spécialisées Besoins en spécialistes de la médecine durgence: 750 Formation annuelle de spécialistes en médecine durgence ± 20 Lattractivité (?!)

Conclusions Continuité des soins : …… Multitude de problèmes Transborder medicine – Médecine à travers les frontières Listes dattente – Délais de traitement ………… MERCI POUR VOTRE ATTENTION

2008 Basisdiploma:217 Erkende specialisten:281 Huisartsen: Basisdiploma:211 Erkende specialisten:224 Huisartsen: Basisdiploma:178 Erkende specialisten:184 Huisartsen: Basisdiploma:196 Erkende specialisten:254 Huisartsen:34 Nieuwsbrief BVAS-VAS maart-april Belgische gediplomeerden blijven België ontvluchten Certificaataanvragen voor emigratie