Multidisciplinaire zorg voor kwetsbare ouderen

Abstract

The Reinier de Graaf Hospital in Delft has concluded that care for frail elderly with impaired mobility is not always optimal. Due to multimorbidity, traditional monodisciplinary care is not the best possible care. The Reinier de Graaf Hospital set out to improve their care process to serve the frail elderly best. It was found that the target group has a high risk for functional decline, dependence and reduced quality of life. Thus the target group can benefit from short admission and throughput times. In order to deliver the best possible care, multidisciplinary collaboration is found to be essential. Using soft and hard systems theory combined with thorough data analysis, the current process was evaluated. It was found that the average combined admission and throughput time was 196 days for the target group, in this period a patient visited the hospital 8,6 times. The hospital visits were found to be predominantly for outpatient care. The multidisciplinary care was largely delivered in a sequential manner. This leads to a lack of collaboration between medical specialist, to unnecessary long throughput times and to many hospital visits. To improve the quality of the health care logistics, improvements have been proposed in a process redesign. Instead of delivering care in a sequential manner, the redesign allows for parallel multidisciplinary treatment. In order to do so, a triage appointment is suggested at the start of the care route and appointments with multiple medical specialists should be clustered on a single day. Short admission and throughput times can be achieved by reserving capacity based on expected patient flow. By means of data analysis the expected future input volume is set at 14 patients per week and the mean capacity required was calculated accordingly. To assess the performance of the proposed design under stochastic influence, a discrete event simulation was developed and verified. The simulation results indicate that if 110% of the theoretical capacity is used, for the average patient the throughput time can be reduced by 50% to 73%, depending on the average wait time between visits. On average a simulated patient visited the hospital 4,4 times for 6,7 appointments. The cost for these improvements are an average occupancy drop for medical doctors of 15%.