The development of national programmes of care

Colin Doherty MD

National Clinical Lead in the Epilepsy programme

DQCC HSE

Journey

Hospital A

Hospital C

Hospital B

Private H

GPAGPB

A&E

A&E

Hospital D

Nursing Home A

Nursing Home B

GPC

What are the consequences of such fragmented care?

Example 1. Patient Safety

• Studies done since the 1970's have shown the high incidences of medical errors and deaths resulting from them.

• The Harvard Medical Practice Study (1991) estimated iatrogenic injury contributed to 180,000 deaths in US annually, more recent figures suggest 98,000.

• A recent study suggested that 17% of hospitalized patients are the victim of an error

• Yet, today only 3% of physicians believe that medical errors are a principal health concern. There is more concern with car accidents!

Comparisons

Alarming Medical Safety Stats• The total number of medical errors and deaths equals three jumbo jets

crashing every 2 days (note in 1998 no domestic airline fatalities)• The error rate of ICU's (Intensive Care Units) 1.7% would be like the

post office losing over 16,000 pieces of mail every hour of every day.• Or like our banks wrongly cashing 32,000 checks every hour of every

day, every year!• 7,000 patients die each year because of sloppy handwriting.• 7.5 million unnecessary medical and surgical procedures are

performed annually.• More than half of the U.S. population has received unnecessary medical

treatment.

Now for the Good News

• There is a way to reform the health system to create a high quality, low cost system that fair and equitable for all citizens.

• A proper system of Chronic Disease Management is central to this process.

• 2. Principles:1. Align all funding and payment incentives to encourage

integrated care of chronic disease: Centralize when necessary; decentralized when possible.

2. Promote value conscious consumption of HC. Provide quality, cost effective, transparent care backed by evidence and outcomes.

Objective of Quality and Clinical Care Directorate & the National

Programmes

Dr. Barry White

What is the mission of the Directorate of Quality & Clinical

Care?

• Better care and better use of resources

• If patients get the right treatment we can save lives and money

2. Why take a programmatic approach to change?

•The advantages of developing chronic disease management programs are:

– Structured approach

– Change is led by experienced clinicians.

– Generates clinical buy-in and ownership from the start

– Engages Colleges and professional bodies.

– Enables greater organisational responsiveness i.e. frontline staff can access the top of the organisation in one step via the national lead.

– Sustained focus

4. What are the clinical programs & initiatives?

• 2. Chronic disease management programs – Stroke– Acute coronary syndrome– Heart failure– Asthma/COPD– Diabetes– Epilepsy– Mental health

• 3. Outpatient management programs – Dermatology– Neurology– Rheumatology– Orthopaedics

• 4. Emergency function related programs – Acute Medicine– Elective surgery– Diagnostic Imaging– Care of the elderly

• 5. Key Quality Safety and Risk initiatives – Governance – Underperforming clinician process– Patient safety bundles– Incident reporting– Audit

• 6. Other Clinical program areas – Obstetrics – Paediatrics– ICU – HCAI– Palliative care – Neurorehab

• 7. Enabling programmes– Development of a resource allocation model – Pharma strategy – Implementation of Clinical Directorates– Defining a standard approach to delivering

change

1. P

rimar

y C

are

Pro

gram

4. Overall principles

• Set goals that achieve gains in cost, quality, access and compliance

• Set goals that are simple and meaningful – e.g. prevent 300 stroke deaths

• Target what is achievable • Nationalise existing local good practice - do not reinvent

the wheel • Ensure local ownership (authority, accountability and

responsibility)• Ensure patient involvement

Hospital B

Private H

GPA

Example of care pathway for chronic disease: epilepsy

Prevention Managed Primary Care (PC)

Secondary hospital Care

SC

Tertiary Hospital care regional (RC)

centre

National Specialist

centre

Antenatal careAlcohol abuseStroke prevention -HTN -Cholesterol -Afib -smokingBrain trauma -Speeding -Alcohol

General Epilepsy Care -Diagnosis -Classification -Treatment and first AID -Prognosis -Life style triggers -SUDEPAEDs -Choice -Side effects -Interactions -Long Term Illness cardWomen’s Issues -Contraception -Pregnancy -BreastfeedingSocial issues -Driving -Employment -safetyPsychology -Cognitive effects -Mood effects

General Epilepsy Care -First Seizure -Acute managementof refractory seizures -Status Epilepticus

Diagnostics -Brain imaging -EEG (if possible) -Classification -Initiate Treatment

Referral -Primary Care -Regional Epilepsy Centre Rapid AccessClinic -Mobile phone -E-mail -Video Link -Phone -Community

Epilepsy nurse clinic

General Epilepsy Care -First Seizure -Acute managementof refractory seizures -Status Epilepticus

Diagnostics -Brain imaging -EEG -Classification -Initiate Treatment -Treatment review forRefractory epilepsy -Prognosis

Access from PC and SC-Rapid Access Clinic-Subspecialty EpilepsyClinic-A&E-Video-Consultation-E-mail/phone/fax-Self management Prog

Counselling-Epilepsy Nurse

specialist-Nurse Led clinic-Brainwave CRO

Pre-Surgical Diagnostics

-Brain imaging (3T) -EEG -Video-EEG -Classification -Neuropsychology -Neuropsychiatry Access from PC, SC

and RC-Rapid Access Clinic-Subspecialty EpilepsyClinic-A&E-Video-Consultation-E-mail/phone/fax

Counselling-Epilepsy Nurse

specialist-Nurse Led clinic-Brainwave CRO

National Epilepsy Service of Ireland (NESI)

Dublin1 Paediatric1 National Centre1 Adult

Cork1 Paediatric1 Adult

Sligo1 Adult

Galway1 Adult

Limerick1 Adult

1-5 years

5-10 years

EPR Networks and Videolinks

Centres

The National Epilepsy Service of Ireland.

Welcome to the NESI web portal. Our mission is to provide our patients with epilepsy, their families, doctors and carer’s with the most comprehensive access to specialist epilepsy opinion, advice, and service in Europe.

We guarantee access to one of our centres within two weeks of first seizure and once registered we provide state of the art disease surveillance and management according best national and international practice.

www.nesi.ie/standardsofcare

Specialist centres near you

Staff

Teaching

Research

Nursing

Community support

GP access

Patient Resources

NESIsearch

home

Web Images Groups News more>>

Nov 25th 2015

Epilepsy Services in Ireland