Role of the DGH Tim Jobson 22/4/2009
Role of the DGH
Tim Jobson 22/4/2009
Features of a modern DGH+
Not ‘Teaching Hospital – lite’ Access to technology ‘High tech care’ Specialisation / sub-specialisation Immediate care – 24/7 access Clinical networks Academic links (internal and external) Efficiency of scale
Role of the DGH - summary
What must be done in hospital
What is done better in hospital
What is less expensive in hospital
Acute care..........
High tech care………
Acute care - diagnosis Acute care - immediate management Trauma Technology based care - HDU, ITU Interventional care - surgery, radiology,
obstetrics, cardiology
High tech care………
Primary angioplasty Stroke thrombolysis Bariatric surgery Spinal surgery
Complex diagnostics
Inpatient approach to diagnostics Parallel diagnostics and acute care Higher dependency nursing Multidisciplinary approach Multiple opinions Imaging, laboratory, invasive
What can be done better in a DGH? Specialisation - e.g. low volume, high
complexity Relationship between elective and acute care,
and sustainability (e.g. can't have OOH care w/o critical mass of clinicians / expertise)
MDT working - e.g. cancer services Clinical inter-relationships (specialists need
others around to maintain standards, interest etc)
Clinical networks (esp with tertiary centres)
Sustainability / interdependency
A & E
GI BleedTransfusion
Acute endoscopy
Surgery
GI Medicine
Haematology
GI surgery
Clinical networks
Cancer therapies& diagnostics
Internal MDT
Tertiary care
Joint disease
Diagnostics
Orthopaedics
Rheumatology
Systemic disease
Medical specialties
Evolving quality agenda
Negative aspects – M&M, HAI HSMR Process measurements Outcome measurements SPI PROMs
…and the end of audit
Less expensive care
What is the most efficient model? Is a trip to hospital always the least
efficient? Tackling duplication Short inpatient stay to address need Avoiding inpatient stay – diagnostics,
clinical confidence, back up