Transcript Case study
Case Study Emergency/Urgent Care Network Northern Minas Gerais Macroregion Area: 122,176 Km² (São Paulo: 1,523 Km²) Population: 1,558,610 (São Paulo: 10,990,249 inhabitants) Population density: 12.6 inhab./km² (São Paulo: 7,216 inhabitants/km²) 86 cities Up to 500 km away from a microregion headquarters 8 microregions Indicator: Years of Life Lost (YLL) > 1 year The leading causes of YLL among the population over 1 year of age are external causes and cardiovascular disease, which together account for more than 46% of this indicator. YLL Rate > 1 year External causes Cardiovascular disease Neoplasms Other diseases of the circulatory system Diseases of the respiratory tract Infectious/parasitic disease Diseases of the digestive tract Diabetes mellitus Others Source: SIM/DATASUS 10 Leading causes of years of life lost (YLL) in Minas Gerais, 2004-2006 DISEASE YLL (thousands) % % (cumulative) Rate Ischemic heart disease 158 9.2 9.2 8.2 Cerebrovascular disease 144 8.4 17.6 7.5 Acts of violence 111 6.5 24.1 5.8 Traffic accidents 86 5.0 29.1 4.5 Lower respiratory tract infections 68 4.0 33.0 3.5 Hypertension 63 3.7 36.7 3.3 Diabetes mellitus 59 3.5 40.2 3.1 Asphyxiation/birth injuries 57 3.3 43.5 3.0 Cirrhosis of the liver 56 3.3 46.8 2.9 Inflammatory heart disease 43 2.5 49.3 2.2 Hospital-Based Emergency Care: At the Breaking Point http:/www.nap.edu/catalog/11621.html Source: Hospital-Based Emergency Care at braking point Institute of Medicine of the national academies - 2007 1. 2. 3. 4. Correctly direct the patient… … to the appropriate level of care …that can provide the most effective treatment …as fast as possible. Economies of scale Availability of resources Quality Access PRIMARY CARE Call centers Health posts (unidade basica de saúde – UBS) Charity or small-scale hospitals (hospitais filantrópicos e de pequeno porte [HF/HPP]). Local small-scale hospitals perform a vital role within the network when access to highercomplexity services are located more than one hour away. MEDIUM COMPLEXITY Urgent Care Units (Unidades de Pronto Atendimento – UPA) Microregional hospitals – these must be accessible to at least 100,000 inhabitants, some of which should provide care for more complex traumas or stabilize such patients Emergency Mobile Care Unit (Serviço de Atendimento Móvel de Urgência – SAMU) TERTIARY LEVEL Macroregional hospitals with specialized services in line with preestablished parameters Trauma Referral Hospitals – must be located within access to at least 1 million inhabitants Hospital Referral/ CV; 400mil pop. Rehabilitation Hospitals SAMU Health posts or UBS are the local care centers Microregional/macroregional hospitals (former: more complex trauma) NUMBER NAME COLOR TIME TARGET 1 Emergency Red 0 2 Very urgent Orange 10 3 Urgent Yellow 60 4 Somewhat urgent Green 120 5 Non-urgent Blue 240 White: patients whose condition does not merit emergency/urgent care DETERMINANT RISK CLASSIFICATION APPROPRIATE NETWORK SERVICE POINT IDEAL TREATMENT TIMEFRAME Treat immediately Adult abdominal pain Microregional or macroregional hospital * In remote areas, transfer within at least 30 minutes Treat within no more than 10 minutes Adult abdominal pain Microregional hospital ** Adult abdominal pain Microregional hospital or HPP * ** Adult abdominal pain HPP or UBS Treat within 120 minutes Adult abdominal pain HPP, UBS, or residence Treat within 240 minutes (no more than 24 hours) Transfer within no more than 30 minutes Treat within 60 minutes. Same-day transfer (24 hours) MAJOR TRAUMA CARE NETWORK RESOURCES Neurosurgery Vascular surgery Angiography Upon notification: thoracic, cardiac, pediatric, plastic, maxillofacial, and implant surgery Heliport with exclusive access Emergency room (Mobile Medical and Basic Support Units) High-complexity operating room Computerized tomography Trauma surgeon Orthopedist Emergency room physician General surgeon Anesthesiologist Transfusion unit Intensive care unit HOSPITAL LEVEL 1 LEVEL 2 LEVEL 3 THE ROAD AHEAD STEPS FOR STRUCTURING THE EMERGENCY/URGENT CARE SERVICES NETWORK Step 1. Perform a situation analysis of the emergency/urgent care (EUC) network Step 2. Select the model of care for the EUC network Step 3. Develop the health districts and levels of the EUC network Step 4. Design the EUC network Step 5. Build the primary care component of the EUC network Step 6. Build the secondary and tertiary care levels of EUC network Step 7. Design network support systems Step 8. Design network logistical systems Step 9. Establish oversight systems for the EUC networks Mobile Medical Unit (MMU) Basic Support Unit (BSU) Advanced Support Unit (ASU) Command Center Air Transport Unit (ATU) Manga Monte Azul Januária Microhospital Verdelândia São João do Paraís Rio Pardo de Minas Brasília de Minas Microlevel III Trauma Hospital Urucuia Taiobeiras Microlevel III Trauma Hospital Janaúba Microlevel III Trauma Hospital São Romão Salinas Microhospital MOC Macrolevel I Trauma and Cardiac Hospital, Santa Casa MOC Macrolevel I Trauma Hospital, Clemente Faria Francisco Sá MOC Macrolevel II Cardiology Hospital, Aroldo Tourinho Coração de Jesus Fundação Dilson Godinho Pirapora Microlevel III Trauma Hospital Bocaiuva Microhospital Macrohospital Microhospital Level III Microhospital Small-scale hospital Hospitals/Level Basic R$ 20,000.00 Microregion R$ 100,000.00 Level III Trauma Hospital Level II Trauma Hospital Level I Trauma Hospital R$ 130,000.00 R$ 180,000.00 R$ 250,000.00 Level III Trauma and Cardiology Hospital Level II Trauma and Cardiology Hospital Level I Trauma and Cardiology Hospital R$ 130,000.00 R$ 210,000.00 R$ 320,000.00 - Level II Cardiology Hospital R$ 50,000.00 Level I Cardiology Hospital R$ 75,000.00 COMMAND CENTER Results Short-Term Evaluation Process: - Progressive increase in system use: Calls to Call Center (Jan. 1,742; Aug. 7,882) Pre-hospital ambulance trips (Jan. 883; Aug: 2,904) Clinical Management: - Shorter decision-making time: critical for the outcome in the U/E - 50% drop in microregional hospital patients in green and blue risk categories: integration of primary care, and Manchester Protocol implemented throughout the network - Clinical reports Recapping... Emergency care systems should be based on a regional model Emergency care systems should be under a single authority and their different points of service delivery should be coordinated Patient flows between points of service delivery and logistics should be based on risk classification Results of the system must be monitored System planning and preparations are required to address sudden increases in its use Oversight is needed to enforce rules (outsourcing) and monitor results A new financing model is necessary, based on the adjustment of goals (replacing the fee-for-service model) Recapping... Thank you! Antônio Jorge de Souza Marques