IFHE 27TH CONGRESS, TORONTO – KEYNOTE ADDRESS
Treated at home GP home visit
Sent to hospital admissions unit
Sent for
Patient feels unwell
Visits GP surgery diagnostic tests
Referred to specialist
Critical Acuity
Visits emergency department
Emergent Lower Acuity Figure 2. Rethinking care pathways using Acuity.
severity of the patient condition, then it becomes quite easy to translate these requirements to determine the healthcare care setting required and the subsequent infrastructure requirements that need to be provided. Healthcare settings would be graded
to respond to the different acuity levels. The magic formula for efficiency in terms of access, cost, and ultimate sustainability is to encourage patients to enter the system at the lowest setting that is safe and appropriate to their condition, then be referred up the line by skilled clinical decision-making when necessary. For example, if Ambulatory or Same-day service is appropriate to the acuity level, the system will avoid unnecessary and automatic use of inpatient services. By using patient Acuity, at the system and population levels, we have the means to anticipate, grade, and categorise future needs, make rational judgements about the operational and capital resources required to meet those needs, and critically examine the most appropriate locality to deliver timely and appropriate patient care while avoiding duplications.
The healthcare planning process The future hospital needs to review the ‘departmental concept’ and focus on models of care and patient pathways. Having a theatre department that carries out day surgery, elective, and emergency surgery may seem to make logistical sense, but in the event of emergencies and bed blocking, day and elective lists may be cancelled. We must radically reorganise the constituent parts of the hospital if we are to reduce significant patient backlogs, and we must develop facilities more suited to the types of procedures being carried out and avoid dependency on ICU beds. Design for Acuity must also address
the ‘known unknowns’ – those semi- predictable or unpredictable events that can quickly overwhelm and destabilise hospitals and wider health systems. The initial effects of the unpredictable are usually apparent in the Emergency
24
Department, followed by inpatient accommodation and ICU, with a reduced effect impacting on operating theatres. This suggests that the re-examination of the patient pathways through the Emergency Department together with a level of Acuity adaptability could prevent blockages in the Emergency Department and increase hospital efficiency. Emergency Departments already implement a type of acuity assessment via Triage Categories (typically 1 to 6). However, instead of streaming the patients differently according to the Triage Category, busy and crowded Emergency Departments gradually turn into a whole hospital within a hospital, providing everything form outpatient care to inpatient care and even surgery within the bounds of one department. This creates a feedback loop which brings all the issues of hospital management inefficiency into the compact setting of an Emergency Department, leading to unacceptable waiting times and great frustration. As well as new technologies, new
procedures are being developed, and more operations are using ‘blocking’ rather than general anaesthesia. We propose a reorganisation that challenges the fundamental flows into, around, and out of the health system. A focus on Acuity will expand our
knowledge of emergence and recovery and so drive integration around the health and support cycle. Our proposition will radically challenge the settings for
Critical Severe
Moderate Low
Severity of disease Figure 3. Plan and design differently using Acuity as the currency. IFHE DIGEST 2023
diagnostics, surgery, and recovery, and show how Acuity adaptability can be enhanced through the creation of virtual or physical hubs. We will use Acuity as the basis to evaluate and adapt systems and will develop an advanced hospital system workload model.
System Economic Modelling The DHSC Health Infrastructure is explicit: health infrastructure is more than just ‘bricks and mortar’ and hospitals are more than land, equipment, and maintenance budgets. Rather, they are (or should be) the embodiment of improved care pathways and technological innovation, and enablers of staff development. They should be integral partners of the local and regional health systems, supporting the delivery of community and home care systems, and pivotal in the efforts to integrate tertiary, secondary, primary, and social care services. If hospitals are to be embedded partners in a fully functional integrated care ecosystem, it is only right that their value should be assessed through some form of System Economic Modelling. Hospitals are centres of knowledge, expertise, and the latest technologies – richly made up of high-quality staffing resources, and usually highly capital- intensive. But ultimately in an integrated health system, the overall operation and efficiency of the system should take precedence over one individual hospital. Therefore, investments in new hospitals should be rigorously assessed through
Infrastructure requirement Mechanical ventilation
Oxygen therapy Isolation
Return home
Diagnostic tests
Inpatient medical treatment
Inpatient surgical treatment
Inpatient treatment
Outpatient treatment
Step-down aftercare
Step-down aftercare
Step-down aftercare
Return home
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97
