The clinical networks, a multidisciplinary matrix
Within the strategic framework defined by the Board of CardioMet, the Executive Council has included in the annual action plans for 2006 and 2007 the establishment of a care network.
Definition
The care network is defined as a clinical situation that is easily identifiable or a homogenous group of specialist multidisciplinary clinics. It is organised around a patient to ensure the best conditions and with the best timing, admission into hospital, diagnostic investigations, and the necessary treatments in hospital. It also organises all necessary interaction with the external care network.
The network can include protocols for the process of handling patients, multidisciplinary meetings, and multidisciplinary consultations.
The protocol for the patient handling process is defined as all the diagnostic and therapeutic measures for dealing with a precise clinical situation.
By definition, these protocols must answer one or several of the following criteria :
- A frequent clinical situation;
- A clinical situation which requires a multidisciplinary approach;
- A complex clinical situation for which the diagnostic strategies and/or the therapies were the object of a high level evidential validation
Objectives
The objectives of all the patient care protocols must :
- Guarantee the best diagnostic strategy and/or therapy for the patient based on a multidisciplinary approach;
- Identify and make the chain of clinical and para-clinical investigations function;
- Improve the flow of patients within the area of CardioMet, but also in the larger care network;
- Encourage communication between the different disciplines, reduce inter-disciplinary conflicts and take impartial decisions;
- Reinforce communication between the different care partners involved in the overall care of the patient;
- Actively participate in the process of controlling care related expenditure.
Elaboration/planning process
The Executive Committee or the Medical Council identifies and prioritises the clinical situations that could arise from a protocol for handling patients within CardioMet.
The Executive Committee designates a care coordinator for the protocol that has been identified. The coordinated is required to create a multidisciplinary group covering all the sections or units involved in the care of patients arising in the particular clinical situation identified.
The working group will assign a group leader to be the spokesperson in direct contact with the Executive Council. They will then establish a strategy for the elaboration of one or several protocols for the same clinical situation. The group then sets, in agreement with the coordinator from the Executive Committee, a detailed calendar of work.
The working group will meet regularly based on this planning. At least once a month there will be a meeting with the coordinator from the Executive Committee.
The average timing for the development of a protocol is 6 months.
Each protocol is made up of 4 stages :
- Definition of the clinical situation and general recommendations
This chapter is essentially destined to define with the maximum precision the clinical situation concerned by the protocol. Included here will be the consensus of recommendations and their sources. It is strongly recommended to specify the level of evidence.
- Flow charts for decision making and patient flow charts
This section is mainly centred on the application of recommendations within the perimeter of CardioMet clearly identifying the different relays and decisions reached by consensus.
- Associated pathology and secondary prevention
- Patient and care networks
Validation Process
At the end of its reflections, the Working Group must deliver its conclusions to the Executive Committee. This committee may, if it deems necessary, request an external opinion.
After its validation by the Executive Committee, the care protocol is submitted to the Medical Council for its opinion and consultation.
The protocol must then be put in place in the care units. The role of the Medical Council for putting this in place in the care units is vital.
The validity of a care protocol is 4 years. At the end of this time, a systematic revision of the protocol is made by a Working Group.
However, the Medical Council, the Working Group or any member of CardioMet may contact the Executive Committee to request an amendment of the protocol during its period of validity if it is considered necessary.
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