Co-operation in emergency care between Helsinki University Central Hospital and City of Helsinki Liisa-Maria Voipio-Pulkki MD, PhD Chief Physician, Emergency Care Dept of Medicine, HUCH liisa-maria.voipio-pulkki@hus.fi (Senior Medical Adviser, The Association of Finnish Local and Regional Authorities, 2-12/04)
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Co-operation in emergency care between Helsinki University Central Hospital and City of Helsinki Liisa-Maria Voipio-Pulkki MD, PhD Chief Physician, Emergency.
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Co-operation in emergency care between Helsinki University Central
Hospital and City of Helsinki
Liisa-Maria Voipio-Pulkki MD, PhDChief Physician, Emergency Care
(Senior Medical Adviser, The Association of Finnish Local and Regional Authorities, 2-12/04)
Does EMS matter?
• in Finnish university hospitals in 2002, emergency / acute care consumed – 20-30% of laboratory and imaging capacity
– 44% of ward capacity (also in psychiatry)
– 27% of surgical capacity (in Meilahti 50%)
• 40% of hospital costs
Strategic questions in EMS
• Emergency/acute services have become the mainstream of health care delivery– why? is it good or bad for the outcome?– gatekeeper, outreach, crossroads or what?– thinner EBM tradition– heavy conflicts of interest common – secondary effects of political decision making
• Based on patient transfer or transfer of information, professionals & responsibility?
• Role in regional clinical pathways?
Helsinki in the 2000´s:Increasing volumes, fluctuation,
overcrowding, unclear resource allocation
• # visits and hospitalized patients in 2003– internal medicine 12 700 (51%)– surgery 8 600 (56%)– neurology 7 500 (39%)
• situation in primary care– 20-30% of GP visits– no defined strategy to centralize or
out-of-hospital EMSacute care by GP´s (public / private)
centralized primary care (4PM-)joint minor trauma and pediatric services
small ER´s by some clinics separate orthopedics & trauma center
joint ER for medicine, neurology, surgeryseparate psychiatry services
General practice and specialized care – simplified ”24/7 one door principle”
Minor trauma24 h / d
Hospital ER basic level
24 h / d
Centralized acute primary care 4-10 P.M.
Specialized care24 h / d
Predicted volume of university and city (hospital) emergency services
in 2005
Visits per year
Primary level 88 000
Intermediate level 35 000
Specialized level (excl trauma center) 35 000
Total 158 000
How to direct patient flows?
• common planning (all hospitals, EMS) with semiannual feedback consultations
• described in writing for all partners• based on needs, no organizational
borders• global acceptance for present application• inform all staff groups AND the public• provide multiple tools for implementation• surveys, audits, automated follow-up• set compliance goals (max 75-80%!)
Variable case load in specialized care– how to predict and adapt
(or perhaps even more than that…)
structured statistics, buffers, simulations…
1000
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1600
1700
1800
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tammi helmi maalis huhti
20012002
Electronic patient chart and hospital administration Electronic patient chart and hospital administration system: hourly to monthly reporting, process analysissystem: hourly to monthly reporting, process analysis
Tailored reports to all levels of staff & management,derived from the same database
How to control outcome?
(whose outcome..with which indicators..so
what?)
From reactive to proactive leadership in acute care
• explicit local agreements• appropriate clinical pathways & in-
house processes (a lot of work!)• structured treatment protocols• decision support toolkits• realistic resources (bechmarking?)• measure, inform, audit• communication, feedback mechanisms,
error surveillance and prevention
Academic Emergency Medicine?
(academic = special hospital care?)
Common strategy in EMS:is there more than the visit numbers,
walls and technology (power, money and fame…) ?
• demand evidence based practices and knowledge based political decision making
• systems thinking: move from power play to cooperation and win-win
• treasure team work and empower devoted staff, but question traditions
• HBU: EMS as a societal safety net – who´s health care is it anyway?