Pessaux P, Faucher V, Cuny R, Stephan M, Klein F, González C, Blanes S, Leost E, Delattre B, Lugiez C
Institut hospitalo-universitaire (IHU), institut de chirurgie guidée par l'image de Strasbourg, université de Strasbourg, Strasbourg, 67091, France; Institut de recherche contre les cancers de l'appareil digestif (IRCAD), Strasbourg, 67091, France; Pôle hépato-digestif (PHD), hôpitaux universitaires de Strasbourg, nouvel hôpital civil, 67091 Strasbourg, France.
Pôle d'imagerie, hôpitaux universitaires de Strasbourg, nouvel hôpital civil, 67091 Strasbourg, France.
J Visc Surg. 2018 Dec;155(6):439-443. doi: 10.1016/j.jviscsurg.2018.02.005. Epub 2018 Feb 23.
Reducing the time required for diagnosis is one of the major challenges to improving and accelerating the management of patients. The aim of this work is to describe an organizational innovation in the management of patients with hepatobiliary or pancreatic diseases, and to report the initial results.
A multidisciplinary and multi-professional working group designed and instituted a patient-centered organizational system that optimizes the investigation of liver and pancreatic diseases, in order to achieve diagnosis in one day. From January 2017 to June 2017, all patients referred for consultation for hepatobiliary or pancreatic pathology were included in this new management pathway. Data were collected prospectively in a standardized form.
Fifty-six patients with hepatobiliary or pancreatic disease were evaluated in the program during dedicated slots over a total of 20 days. Of these, four patients underwent evaluation in the program twice. The average number of patient slots in the program was three per day (range: 1-5). An additional computed tomography (CT) and/or magnetic resonance imaging (MRI) was required in 23 (41.7%) of the visits. These imaging studies were performed the same day, including nine patients who required both types of imaging (16.7% of cases). "One-day diagnosis" established an accurate diagnosis by the end of the day in 49 patient encounters (81.7%). Overall assessment of this organization was considered excellent by 46 (83%) of patients.
An organizational innovation has made it possible to effectively diagnose hepatobiliary or pancreatic pathology within one day in the majority of cases, with good patient satisfaction. It is now necessary to evaluate the medico-economic aspect of this organization, and more generally to develop a methodology for multidimensional evaluation of organizational innovations.
缩短诊断所需时间是改善和加速患者管理面临的主要挑战之一。本研究旨在描述肝胆或胰腺疾病患者管理中的组织创新，并报告初步结果。
一个多学科、多专业的工作小组设计并建立了一个以患者为中心的组织系统，该系统优化了肝脏和胰腺疾病的检查流程，以实现一日内诊断。2017年1月至2017年6月，所有因肝胆或胰腺疾病转诊咨询的患者均纳入这一新的管理路径。数据以标准化表格前瞻性收集。
在该项目专门安排的时段内，共20天对56例肝胆或胰腺疾病患者进行了评估。其中，4例患者在该项目中接受了两次评估。该项目平均每天的患者评估时段为3个（范围：1 - 5个）。23次（41.7%）就诊需要额外进行计算机断层扫描（CT）和/或磁共振成像（MRI）。这些影像学检查均在当天完成，其中9例患者需要两种影像学检查（占病例的16.7%）。“一日诊断”在49例患者就诊（81.7%）时于当天结束时确立了准确诊断。46例（83%）患者对该组织的总体评价为优秀。
一项组织创新使得在大多数情况下能够在一日内有效诊断肝胆或胰腺疾病，患者满意度良好。现在有必要评估该组织的医疗经济方面，更更更更广泛地说，要开发一种组织创新的多维评估方法。
