Primary health care integration in day surgery programs

Abstract

Introduction: KIRUBIDE system was a pilot project to promote the collaboration between Primary Health Care (PHC) and the Day Surgery Team in Cruces University Hospital. After its implementation, more PHC centres were interested and Health Organization (Osakidetza) has increased its activity area. Description of practice change implemented: Involvement of PHC doctors supposes a new role in simple surgical pathology (such as hernias or sinus) ordering preoperative tests and sending a non-presence-consult (ICTs) to the Day Surgery Team. So a presence-consult with surgeon and anesthesiologist is coordinated the same day to establish the date of surgery in that moment. After the surgery, the follow up is also made by PHC. This simplifies the usual process, also establishing a professional relationship to solve any problem easily. Aim and theory of change: Improve the health care pathway optimizing the process by cooperation with PHC in diagnoses and follow-up in the whole attention and simplifying preoperative activity and surgical scheduling. Targeted population and stakeholders: Patients suffering major ambulatory surgery pathology from the PHC centres. Promote Primary Care selection of patients and follow-up until the end of the process. Timeline: KIRUBIDE system was implemented in 2014, after two years 150 were included in the pilot project from different PHC centres. As a result, more centres were interested and reached 300 patients after recent implantation. Highlights: There was a voluntary participation from PHC doctors of 40%. 150 patients were included in the project and 114 finally were operated. Waiting list was reduced to a mean of 15 days since surgical team consult and to 43 days after PHC consult compared to 73 and 101 days from the usual pathway. A satisfaction survey was made obtaining high level (90%) in both patients and professionals in reduction of waiting list and improvement of communication. Comments on sustainability: KIRUBIDE system may increase the workload per patient of PHC doctors. There is no investment because the communication is established online by electronic health records system. Cost effectiveness was not studied but it's assumed to improve as less appointments are needed. Comments on transferability: KIRUBIDE allows a great integration of PHC in Major Ambulatory Surgery programs and it can be applied to other hospitals that have the same organizational structure as our own increasing the efficiency. Conclusions: KIRUBIDE system simplifies the care model of candidate patients, reducing the steps in the usual assistance circuit and surgery-waiting-lists with people satisfaction. It also favours the integration of medical specialties and improves the patients’ follow-up. This program improves resources’ use and care quality because it optimizes the process by reducing steps. Discussions: KIRUBIDE system is mostly focused in simple pathology but it may be applied in others such as cholecystectomy. It only analyses a limited area with a specific organization structure not available in other places. Lesson learned: Patients need more information than the one given. Primary Health Care doctors think that time needed with each patient increases but agree that a better communication implies benefits for professionals and patients.

Keywords

• systems integration
• primary health care
• outpatient surgery
• day surgery
• referral