van Huizen Lidia S, Dijkstra Pieter U, van der Laan Bernard F A M, Reintsema Harry, Ahaus Kees T B, Bijl Hendrik P, Roodenburg Jan L N
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Quality and Patient Safety, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
BMC Health Serv Res. 2018 Oct 29;18(1):820. doi: 10.1186/s12913-018-3637-1.
Head and neck cancers are fast growing tumours that are complex to diagnose and treat. Multidisciplinary input into organization and logistics is critical to start treatment without delay. A multidisciplinary first-day consultation (MFDC) was introduced to reduce throughput times for patients suffering from head and neck cancer in the care pathway. In this mixed method study we evaluated the effects of introducing the MFDC on throughput times, number of patient hospital visits and compliance to the Dutch standard to start treatment within 30 calendar-days.
Data regarding 'days needed for referral', 'days needed for diagnostic procedures', 'days to start first treatment', and 'number of hospital visits' (process indicators) were retrieved from the medical records and analysed before and after implementation of the MFDC (before implementation: 2007 (n = 21), and after 2008 (n = 20), 2010 (n = 24) and 2013 (n = 24)). We used semi-structured interviews with medical specialists to explore a sample of outliers.
Comparing 2007 and 2008 data (before and after MFDC implementation), days needed for diagnostic procedures and to start first treatment reduced with 8 days, the number of hospital visits reduced with 1.5 visit on average. The percentage of new patients treated within the Dutch standard of 30 calendar-days after intake increased from 52 to 83%. The reduction in days needed for diagnostic procedures was sustainable. Days needed to start treatment increased in 2013. Semi-structured interviews revealed that this delay could be attributed to new treatment modalities, patients needed more time to carefully consider their treatment options or professionals needed extra preparation time for organisation of more complex treatment due to early communication on diagnostic procedures to be performed.
A MFDC is efficient and benefits patients. We showed that the MFDC implementation in the care pathway had a positive effect on efficiency in the care pathway. As a consequence, the extra efforts of four specialist disciplines, a nurse practitioner, and a coordinating nurse seeing the patient together during intake, were justified. Start treatment times increased as a result of new treatment modalities that needed more time for preparation.
头颈癌是快速生长的肿瘤，其诊断和治疗都很复杂。多学科参与组织和后勤工作对于及时开始治疗至关重要。引入多学科首日会诊（MFDC）以减少头颈癌患者在治疗路径中的周转时间。在这项混合方法研究中，我们评估了引入MFDC对周转时间、患者就诊次数以及符合荷兰在30个日历日内开始治疗标准的情况的影响。
从病历中检索有关“转诊所需天数”、“诊断程序所需天数”、“开始首次治疗的天数”以及“就诊次数”（过程指标）的数据，并在实施MFDC之前（2007年，n = 21）和之后（2008年，n = 20；2010年，n = 24；2013年，n = 24）进行分析。我们使用对医学专家的半结构化访谈来探究一些异常值样本。
比较2007年和2008年的数据（MFDC实施前后），诊断程序所需天数和开始首次治疗的天数减少了8天，就诊次数平均减少了1.5次。新患者在入院后30个日历日内按照荷兰标准接受治疗的比例从52%提高到了83%。诊断程序所需天数的减少是可持续的。2013年开始治疗所需天数增加。半结构化访谈显示，这种延迟可能归因于新的治疗方式、患者需要更多时间仔细考虑治疗选择，或者由于对要进行的诊断程序进行了早期沟通，专业人员需要额外的准备时间来组织更复杂的治疗。
多学科首日会诊是有效的且对患者有益。我们表明，在治疗路径中实施MFDC对治疗路径的效率产生了积极影响。因此，四个专科、一名执业护士和一名协调护士在入院时一起查看患者所付出的额外努力是合理的。由于新的治疗方式需要更多准备时间，开始治疗的时间增加了。
Zotero 插件