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O SPED ALI e TER RITO RI SLO W The Italian network - Bobbio Italy Slow... · The Italian network...

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The Italian network

Slow Hospitals and

Community Healthcare

Marco BobbioGeneral Secretary of Slow Medicine

former Director Department of Cardiology

Cuneo Hospital

OSPEDALI e TERRITORI SLOW

Dr. Marco Bobbio

Santa Croce e Carle Hospital

Cuneo

Geographic Location

The Hospital Santa Croce e Carle di Cuneo

is a fully equipped tertiary hospital with 690

beds, 400 physicians, 2000 employs

The clinical activity is grouped in 40

departments.Among others:

o Heart surgery

o Neurosurgery

o Neonatal intensive care

o Interventional radiology

Structures

In 2013 it was decided to identify 3

procedures at risk of

inappropriateness in each

department through a shared

procedure of brain storming.

Within each department

physicians were invited to

collectively choose 3 tests,

treatments and procedures

inappropriately prescribed.

Purposes

o A steering committee including a young physician of

each department was instituted.

o In each department several meetings were organized

to identify a list of inappropriate tests, treatments

and procedures that are usually prescribed during

hospital stay of the patients.

o The top 3 most relevant tests, treatments and

procedures were chosen by consensus.

Methods

After two months, 33 departments identified 96

tests and treatments:

o 63 diagnostic tests

o 33 treatments

37 were similar to the ones identified by the US

Choosing Wisely Project.

Result

s

Azienda Ospedaliera

S. Croce e Carle Cuneo

Fare di pi non significa fare meglio

Le tre pratiche ad alto rischio

di inappropriatezza nellAzienda Ospedaliera S. Croce e Carle di Cuneo

Aprile 2014

As far as we know this was the first project developed at a hospital level, since previously only scientific societies were involved at national levels.

In this case physicians had to choose which test, treatment or procedure they should avoid

Main strengths

o a bottom-up organization set up by a group of

physicians and not by the director of the hospital

o young physicians of each department involved in the

steering committee

o most of clinical departments participation

o wide brainstorming involving the whole medical

staff.

After 1 year each department re-evaluated their tests, treatments and procedures to verify whether they:

o were clinically irrelevant

o have already been reached

o are unreachable

o should be be partially modified to make them

more effective

Departments were also asked to identify methods

to assess and measure processes and outcomes

Nurses procedures at risk of inappropriateness

o Do not perform mechanical bowl preparation for elective

surgery

o Do not use disposable overshoes in most departments

o Reduce the time of urinary catheter use

o Do not waste disposable sterile gloves but adopt an

appropriate hand hygiene

o Do not prescribe prolonged fasting after cesarean delivery

o Do not prescribe oral nutrition support without a definite

plan

OSPEDALI e TERRITORI SLOW

Slow Hospital Net

OSPEDALI e TERRITORI SLOW

4 working groups

o how to encourage appropriateness

o how to build organization and implementation

o how to empower citizens and patients

o how to organize quantitative and qualitative evaluation of the project

OSPEDALI e TERRITORI SLOW

OSPEDALI e TERRITORI SLOW

OSPEDALI e TERRITORI SLOW

OSPEDALI e TERRITORI SLOW

Perspectives

o to extend the national net

o to collect the lists of recommendations

o to implement the recommendations of Italian professional societies

o to identify methods to assess and measure processes and outcomes

o and to assess variability among hospitals

o to start a pilot experience to characterize a hospital as a Slow Hospital

from the front desk to the discharge letter

appropriate use of diagnostic and therapeutic resources

improvement of the dialogue and the relationship of physicians and other

health professionals with patients and citizens, for wise and shared decision

making

OSPEDALI e TERRITORI SLOW

of 22/22
The Italian network “Slow Hospitals and Community Healthcare” Marco Bobbio General Secretary of Slow Medicine former Director Department of Cardiology Cuneo Hospital OSPEDALI e TERRITORI SLOW
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