The Italian network
“Slow Hospitals and
Community Healthcare”
Marco BobbioGeneral Secretary of Slow Medicine
former Director Department of Cardiology
Cuneo Hospital
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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 più non significa fare meglio”
Le tre pratiche ad alto rischio
di inappropriatezza nell’Azienda 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
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Slow Hospital Net
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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
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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
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