Download 1999 HOPE-EXCHANGE PROGRAMME FOR HOSPITAL

HOPE EXCHANGE PROGRAMME
FOR HOSPITAL AND
HEALTHCARE PROFESSIONALS
EXCHANGE DOCUMENT 4 - p. 1 / 3
DOCUMENT 4
QUESTIONNAIRE FOR THE PARTICIPANT’S REPORT
Each professional is to write a five-page report (in English, French or German) at the end of
his/her attachment by completing this form legibly or by using the scheme of this Document
4. The professional is kindly requested to send one copy to his/her host, one to the coordinator in the sending country, one to the co-ordinator in the host country and one to
HOPE and this not later than 31 July 2008. If you send this report by post, please do it by
NORMAL post and NOT REGISTERED post.
1. Name of the professional
Christer Larsson. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sending country
Sweden. . .
Host country
Denmark. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .
Grade and designation
of the professional
Sr Biomedical Engineer at Dept of Medical Physics and
Biomedical Engineering
Professional's
employing organisation
. Central
Hosting organisation
. Hvidovre
Hospital in Vaexjoe at County of Kronoberg. . .
University Hospital and Aarhus University
Hospital, Denmark. .
2. Please describe what you did during the period of your attachment?
The Danish programme was divided into five parts:
a. General information from the Co-ordinators and the Danish Regions for all participants
b. A two weeks period at Hospital number one, for me, Hvidovre University Hospital
c. A one day information for all participants at Odense University Hospital and the first scheduled
group-work regarding the Paris- presentation
d. A two weeks period at Hospital number two, for me, Aarhus University Hospital
e. A final meeting in Copenhagen at Danish Regions for work with the presentation and for a summary
and evaluation of the Danish program
HOPE – European Hospital and Healthcare Federation
Bd. A. Reyers 207-209, b7 – BE-1030 BRUSSELS
Tel +32 -2-742 13 20 – Fax +32-2-742 13 25 – [email protected]
THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE
www.hope.be
HOPE EXCHANGE PROGRAMME
FOR HOSPITAL AND
HEALTHCARE PROFESSIONALS
EXCHANGE DOCUMENT 4 - p. 2 / 3
During the whole Hope Exchange Programme in Denmark, nurses all over the country were on strike
with exception of emergency and acute care nurses. This had only minor effect on the Hope
programme.
a. At the Danish Regions we first got a thorough information about HOPE , the Danish Hope
Exchange Program, the history of Hope and facts covering “Key health data 2007” for the EUarea, all given by the Danish National Co-ordinator, Mr Nils-Erik Sanden.
The Ministry of Health and Prevention through Mr John Erik Pedersen, Head of Dept, Office of Health
Politics, together with Danish Regions, through Ms Christina Carlsen, Office of Health and Welfare at
Danish Regions and member of Hope liaison board, informed about the Danish health care system
and its main issues. Denmark has recently (1 jan-2007) reduced the number of municipalities from
275 into 98 and from 15 Counties has 5 Regions been formed. The Regions and the Municipalities
have different responsibilities in the health and social care system. The Regions are financed from
the government (80%) and from the Municipalities (20 %) and has no taxation right themselves.
Challenges in the Danish health care are an aging population, relatively low average life
expectancy (women 80.4 years and men 75.9), lifestyle related illnesses and lack of most
categories of health care staff. In Denmark, you have the right to treatment within one month after
diagnose. All public health care in Danmark is free. Another important factor is the General
Practitioners (GP) and 98 % of the Danish is listed for a choosen GP (group 1) and the other 2 %
(group 2) have choosen not to be connected to a specific GP and they have to pay a minor fee
for their care.
National Board of Health, by Ms Charlotte Hosbond, Head of Section Health Care Planning, National
Board of Health, informed about “Main features of the Danish health care system” and about their
duties as giving assistance, planning and advice to the Ministry of Health and Prevention. Main
tendencies in health care is: Increased centralization, increased quality, increased use of e-Health,
focus on patients rights and increased focus on coherence in the health care sector. Large efforts
and investments are done in the field of cancer care.
Denmark has a “National star rating system” with league tables on hospital performances. This
information was given by Mr Thomas Schioler, MD, Senior Medical Adviser, National Board of Health.
It covers totally 217 hospitals, both private and public, and measures 14 different general indicators
for 178 different treatments/ diseases. Examples of general indicators are: Beds per room, infections
after surgery, hygienic aspects, contact-person, errors in medication, errors in surgery procedures,
general satisfaction. There are also treatment specific indicators such as for example regarding
apoplexy: Need for physiotherapy, death-rate within 30 days, scanning (CT/MR), medication. The
patient can check their own choice of indicators on internet for a certain hospital and a certain
disease, to see if the hospital is performing below, above or average compared to an average
“normal” figure.
An interesting lecture covered “Health technology assessment (HTA)”, by Ms Camilla Palmhoj Nielsen,
Special Adviser at National Board of Health. Health technology means: Application of scientific
knowledge in health care and prevention. Examples of important fields here are: Diagnostic and
treatment methods, medical equipment and pharmaceuticals. The full term HTA is a
multidisciplinary process where medical, social, economic and ethical issues are summarised and
weighted, in order to get safe and effective health policies, that are patient focused. The Danish
HOPE – European Hospital and Healthcare Federation
Bd. A. Reyers 207-209, b7 – BE-1030 BRUSSELS
Tel +32 -2-742 13 20 – Fax +32-2-742 13 25 – [email protected]
THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE
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HOPE EXCHANGE PROGRAMME
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HEALTHCARE PROFESSIONALS
EXCHANGE DOCUMENT 4 - p. 3 / 3
model integrates: Technology, patient, organisation and economy. On Hospital level there is a
suitable tool called mini-HTA. The tool can be used for instance where a hospital is planning to
introduce new health technology, for example robot surgery or use of telemedicine for patient
home care. Mini-HTA is a checklist with a number of questions to fill in, this takes usually about 10-15
hours.
Next subject was about “The Danish strategy for IT in health care” which was related to the subject for
HOPE Exchange Programme this year, and very interesting. Information given by Mr Ivan Lund
Pedersen, Project Manager, Digital Sundhed. The Danish government and the Danish Regions both
agree upon supporting the development of an “Electronic Patient Journal (EPJ)” and to develop a
strategy to secure a common IT-architecture and platform and following one standard. The new ITstrategy will be developed between 2008-2012 and the first action plan was appoved in February
2008. Important factors in the new strategy are: More shared patient data, more on-line data
available, standardisation of infra-structure, step by step convergence of local solutions, more
patient participation and managing of their own pathway, expansion of tele-medicine,
development of a national patient index with basic information and an index to supplementary
information, access for patients in year 2011 (in four phases). Municipalities and General
Practitioners should be connected and have access to the common infra-structure and patient
index. The development of this strategy will be very interesting to follow and learn from and could
be a large step for a much better continuity of care for the patient.
Patient safety in Denmark by Mr Jonas Egebart, MD, Danish Society for Patient Safety. The purpose is to
gather, analyse and communicate knowledge of patient safety matters in order to reduce the
number of incidents in the Danish hospital system. The Act requires frontline personnel to report
incidents. The patient safety organisation are separated from the three other systems for handling
of adverse events in health care such as, the complaint system, the supervision system and the
patient insurance system. It is a learning system and health care professionals who reports to the
patient safety organisation cannot be blamed or subject to any disciplinary or legal actions. The
patient complaint system cannot access any information from the learning system and use this for
disciplinary actions. In 2007 a total of more than 20.000 patient incident reports was filed and 75% of
these reports led to actual improvements in the care.
The Danish National e-Health Portal – www.sundhed.dk. This was a very good lecture from Dr Finn
Klamer, MD and General Practitioner (GP), Medical IT-adviser, National Common Public Health
Portal. Sundhed.dk is an e-Health portal on internet with one open “Room” with health related
information, which can be seen world-wide, there are two closed “Rooms”, one for the doctor and
one for the patient. Patients can log-on and perform different health care matters under condition
that your GP is connected and using this portal. You need your own unique PIN-code (personal
number) and a digital signature to log-on and so far, about 300.000 Danish have done this. As a
patient you can read a summary of your own health record, renew prescriptions, ask for advice
and book an appointment. If the doctor perform any actions related to the patients record, the
patient will get notified by e-mail, mail and SMS-message. Fully developed and used, this system
could be an important tool for the patient´s continuity of care. Unfortunately there are 20 different
patient portals in Denmark and 19 are commercial.
b. Hope Programme at Hvidovre University Hospital, Capital Region. 30 April to 12 May. Coordinator Bjarne Andersen, Representative of the Hospital Management. Hvidovre University
HOPE – European Hospital and Healthcare Federation
Bd. A. Reyers 207-209, b7 – BE-1030 BRUSSELS
Tel +32 -2-742 13 20 – Fax +32-2-742 13 25 – [email protected]
THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE
www.hope.be
HOPE EXCHANGE PROGRAMME
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HEALTHCARE PROFESSIONALS
EXCHANGE DOCUMENT 4 - p. 4 / 3
Hospital was opened in March 1976 and is a large hospital situated 20 min by train south of
Copenhagen city center. It has about 700 beds and 3400 full-time employees and includes
psychiatric departments.
The program started with a guided tour with shorter or longer stops for extended information at certain
centers. Hvidovre Hospital has a Central store with supplies of office material etc. and a central
Sterilisatiion department. Material and sterile goods are ordered digitally and delivered via an unique
Automatic container rail-way system. The rail-way system, which is situated 2 floors below ground, has
60 stations for input/output of trolleys and is in use from 6:00 to 23:00 every day. 30 containers can be
transported at the same time and totally there are 300 containers (1000 transactions per day are
performed). The system is powered by 380 V AC supplied via open rails in the ceiling. 6 persons work
full-time with the system. Next stop was at the Scanning center where 5-6 people work. Scanning of old
patient records from micro-film are done and inserted into a digital patient record system. Also paper
records are scanned in the same way, after the patient´s discharge from the hospital. During a
hospital stay, paper records are used in most cases.
Then we visited the Delivery Dept and was informed by Ms Randi Iversen, vice Head of Dept. This
delivery dept is the largest in Denmark with 5700 deliveries per year. It is divided into two units, one
clinical unit for normal deliveries and one special unit for more complicated cases. Many of the
delivery rooms have large bath-tubes and there are 12 family rooms, where the family can stay during
2 days after delivery. Home-delivery is a right by law and about 1% of the mothers choose this option
and have then the right to an assisting midwife. Cesarian surgery rooms are situated close to the dept.
When a pregnancy is confirmed the GP and the hospital co-operates around the pregnant woman
and after delivery, a summary of the delivery report and paediatricians report are sent to the GP.
These reports are mostly by paper but sometimes an electronic patient journal can be sent. The
families are offered education in so called “go-home” classes, which also includes information from a
physio-therapeut. 20 % of the deliveries are done by cesarian surgery and 30 % of the mothers use
epidural anathesia.
Next study visit was a Warden unit for stroke patients (apoplexia) and we was informed by Ms Lone
Lundbak, Dept. Nurse and Ms Merete Schmidt, Dept management secretary and economist. Dept
get paid according to a standard pricelist related to DRG-values (Diagnos Related Groups –values)
and have for the moment 104 % patient load. The dept are using EPM-system (Electronic Patient
Medicine system) for dispensing medicines and the information is fed by small hand-held computers.
Time of dispensing and who handed out the medicine are also registred.
Bjarne Andersen then informed about the National Indicator Project (NIP). NIP was introduced in the
Danish Health Care System in 1999 and measures the quality of care provided by the hospitals to
groups of patients with specific medical conditions. For the moment 8 diseases are measured: Acute
surgery, diabetes, lung cancer, chronic obstructive pulmonary disease, hearth failure, hip fracture,
stroke and schizophrenia. The aims of the project are: Improving the quality of prevention, diagnostics,
treatment and rehabilitation - providing documentation for making priorities - information of the
quality in health care for patients and consumers. The work with indicators are of different kinds like:
Development of standards and indicators, structure indicators, process indicators and outcome
indicators. Example of indicators for Apoplexia are: Anticoagulation treatment, CT/MR scanning,
physiotherapy, ergotherapy, dysfagi-screening, mortality. In the summary diagrams one can read the
result of the hospital month by month and compare with an average result for the country. This should
be a good tool for monitoring you results and to see where to put efforts in strengthening the
performance. At the end of the first day, we discussed general matters like fire-information and
HOPE – European Hospital and Healthcare Federation
Bd. A. Reyers 207-209, b7 – BE-1030 BRUSSELS
Tel +32 -2-742 13 20 – Fax +32-2-742 13 25 – [email protected]
THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE
www.hope.be
HOPE EXCHANGE PROGRAMME
FOR HOSPITAL AND
HEALTHCARE PROFESSIONALS
EXCHANGE DOCUMENT 4 - p. 5 / 3
training, which is performed every 5:th year for all staff categories. HLR (Hearth-Lund-Resque) training is
only performed for medical staff, while by us in Sweden, this is done for all categories of staff.
May 2nd started with a breakfast with the management group and after that a presentation of the
Medical Emergency Dept incl. ward, by Sr Consultant Gertrud Ellekilde. Patients coming to the
emergency could either be referred by their own private GP who then knows the patient, a GP onduty who don´t know the patient or a GP working in the emergency dept. GP´s usually has a
connection to a hospital and work there some hours per week to increase the co-operation. The
emergency room has 40 000 contacts per year (100-120 patients per day). 25 % are coming by
ambulance and 75 % are “walk-in” patients. 20 patients per day are transferred to admission. The
emergency dept has 25 beds for initial observation, examination and treatment. 50 % are discharged
next day and 50 % are transferred to the clinics for further treatment and care. The average bed-time
is 1.1 day. All incoming patients are received by a Central Visitation unit (experienced secretaries) who
register all data and makes a short report. Then a Triage Nurse evaluate the need for care. Red group
should have care within ½ an hour, blue group within 3-4 hours and white group can wait for a long
time. The ambulances have five different levels of action where “level 1” is the most acute transport
and the arrival must be within minutes, “level 5” should arrive in a days time periode. When leaving the
emergency dept the patient get a report containing all information, results of examinations and
diagnose with plan, to show for his GP. This report could sometimes be digital but most of the times by
paper. Dr Ellekilde states the need for an electronic case note/ journal which should be in the same
format all over the country and which can communicate easily with the primary care and with the
GP´s. Hopefully the results coming from the National IT Strategy Project will solve these problems in the
future.
The Head of Adminstration, Mr Erik Brouer, informed about Telemedicine conferences between
Greenland and Denmark (Rikshospitalet Copenhagen). Greenland has 49000 inhabitants and an area
of 1.000.000 sqm. 16 cities in the western area and 2 cities in the eastern area. The city of Huuk is the
capital with 4500 citizens. The largest hospital has 140 beds. Telemedicine is mainly used for
conferences regarding X-ray pictures and ECG-recording. The hospitals in the Copenhagen Region
can connect to each others intranet.
Last visit for the day was to the Kitchen, which has a unique menu system (a comprehensive menu) for
patients. Ms Pernille K Nielsen, economist, informed and showed around the facilities. Each patient can
choose their meals more or less without restrictions and there is a large menu-card to choose from. If
one want to have breakfast three times per day, it´s OK. The patient can also choose their own timing
and size (3 different sizes) of the meals. A call-center receives the patient´s order and feed this to a
computer system which is fed to all sections of the kitchen. The kitchen has 4 different sections, which
can produce 200 portions each and the duties are different in each section, one is the cold section,
others is for hot food and another again is a packing section. More than 5 portions at a time are
delivered via the automatic container system and less than 5 portions are delivered manually by a
battery powered scoter. Patients who need special food gets advice from a dietist. Food with more
than 40 % fat has a special black mark. The menus are changed every six months. This system has a
very good result, less food is spoiled and the number of staff is the same as with a conventional system,
so money is saved. The unique automatic container system plays probably an important role in this
solution.
Visit to the X-ray dept and information by head of dept, Dr Aage Vestergaard. The dept has 15 X-ray
laboratories and perform 80000 examination per year. This includes ultrasound, CT and MRexaminations. They have been digitalised since 8 year and uses an AGFA Pacs-system (older version)
HOPE – European Hospital and Healthcare Federation
Bd. A. Reyers 207-209, b7 – BE-1030 BRUSSELS
Tel +32 -2-742 13 20 – Fax +32-2-742 13 25 – [email protected]
THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE
www.hope.be
HOPE EXCHANGE PROGRAMME
FOR HOSPITAL AND
HEALTHCARE PROFESSIONALS
EXCHANGE DOCUMENT 4 - p. 6 / 3
and a Medos RIS-system, which is an old German system. The CT-scanners are from Siemens (Siemens
Sensation 10 and Somatom Plus 4) and also the MR-cameras are from Siemens (Siemend Magnetome
Espree 1.5 Tesla resp 1.0 Tesla). Denmark as a whole is now in the process of buying 21 CT scanners as
part of the Cancer-programme, this will be decided upon centrally. The five hospitals in the Capital
Region share the same data-server and Pac-system and some co-operation is done in the area. Four
of the hospitals (not Riskhospitalet) has also the same Medos RIS-system. Further, the hospitals in the
Capital Region has a “private” secure computer network. A Web-1000 system is used, which means
that the X-ray pictures can be wieved from any PC, but only in j-peg comprimed format, which is not
always sufficient. X-ray doctors can also view X-ray pictures from their homes under condition that they
have got an extra “secure” network cable with a router and a dedicated PC for this purpose. The
General Practitioners (GP:s) can I some cases get the X-ray result report via computer, probably
through the Netcom standard.
During a lunch meeting with the Hospital management, I informed about the Swedish Health Care
system and the organisation and facilities in my own County, Kronoberg.
Visit to the MR-unit (once donated by Mr Simon Spies) and information was given by Dr Per Aakesson.
The MR-unit is a separate department working with research and clinical examinations. About 35
employees work with research and 17 on the clinical side. They have 3 MR-units all from Siemens:
Siemens Magnetome Vision (1.5 Tesla from 1992), Siemens Magnetome Expert (1.0 Tesla from 1992)
and Siemens Magnetome Trio (3.0 Tesla from 2002). Research in going on regarding MR and
metabolism studies, which could lead to examinations similar to PET-camera examinations. Regular
meetings are held in the Region, regarding Childrens Neurology.
Next day a visit to Medico/EDB Dept., and information by the Head of Dept, Mr Per Loubjerg,
Biomedical Engineer. The co-ordinator Bjarne Andersen had arranged this very interesting visit upon
my request, so many thanks to Bjarne Andersen. Medico/EDB dept is responsible for biomedical
engineering matters and IT-support including some development. Servers, back-up duties and
development is handled mainly by a new organisation, KIT, which act in the Capital Region. Physically
the servers are placed at Hvidovre University Hospital. Totally 8 persons are working with biomedical
engineering and 24 persons with IT-support. 3 persons are working with implementation of new ITsystems/applications and with education. Physiology has their own biomedical engineer and so have
MR-dept. There is only one position for a physicist in the organisation and this position is vacant. I was
also informed about the international “Vassenar” agreement (suggested by USA), whereby a data
encryption harder than 128-bit is not allowed, due to terror threat matters. A 128-bit encryption can be
decrypted within a reasonable time. Medcom is the network standard used for communication
between hospitals and GP:s and Edifact is kind of module within this system and used for laboratory
matters, prescriptions, and messages. Maternity dept is using an electronic patient record (EPJ) and
can send epicrisis electronically to GP:s.
Next visit was also nicely arranged upon my request and this was to Physiology and Nuclear Medicine
Dept and information was given by Hospital Physicist Stefan Fuglsang. The dept. has four gammacameras (2 GE Infinia Hawkeye, 1 GE Millenium VG without Hawkeye and 1 older Starcam). 2
Ultrasound units both Siemens Sequoia and one Fluoroscopy laboratory for pressure measurements in
blood-wessels and in the liver. One unit, Digimatic DM 2000 from Medimatic (a Danish Company), was
used for blood pressure measurements in toes. A whole body Bone-densitometer equipment was used
mainly for body-fat measurements. Especially HIV-patients was examined as their medication effects
the body fat distribution. Radiological treatment (using I-131) of Thyreoidea patients are done.
MedosWeb information system was used within the dept for keeping an electronic record. It´s a
HOPE – European Hospital and Healthcare Federation
Bd. A. Reyers 207-209, b7 – BE-1030 BRUSSELS
Tel +32 -2-742 13 20 – Fax +32-2-742 13 25 – [email protected]
THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE
www.hope.be
HOPE EXCHANGE PROGRAMME
FOR HOSPITAL AND
HEALTHCARE PROFESSIONALS
EXCHANGE DOCUMENT 4 - p. 7 / 3
radiological system but adapted to Physiology use. It has different modules like: Booking, scheduling,
descriptions, etc. It cannot be seen by GP:s and is not used for sending records between hospital.
Paper are still used here.
Together with the Hope group staying at Naestved Hospital, we made two study visits this day and the
first one to “The Patient Insurance Association” and the next one to “National Board of
Patients´Complaints (PKN)”, presented by Ms Cornelia B Persson and Dia Graveson Thomson. Patients
who experience an injury caused by examination or treatment can apply for economic
compensation at the Patient Insurance Assosiation and/or file a complaint to the National Board of
Patents´Complaints. 25 % of the patients reports to both system. At the Patients Insurance Association
not only faults or negligence are conditions for compensation, also less serious matters can give
compensation. This is a tax-paid system where the insurance fee is paid by the Regions. 5000 cases are
reported every year and 60-70 % are turned down. 85 % of the patients agree with the decision and 15
% appeals. Some conditions for the right to compensation are for example “The Specialist Rule”, which
means that you have the right to demand the best possible practise, “The Equipment Rule” which
means that technical failures can give compensation and “The Alternative Rule” which means that
perhaps another treatment should have been used by the doctor. “The Endurability Rule” is also
considered, which means that some procedures normally give some suffering and is then not a reason
for compensation. With this system focus is moved from blame to compensation, patients are given a
greater security and costly court-cases are reduced (1 in 20 cases only goes to court). The economical
compensation is individually considered and here follows some examples of what is compensated:
Medical expenses, Lost wages, Pain, Permanent injury, Loss of ability to work, etc. The compensation is
maximized to about 1 milj. EUR. Common complaints is about delay in cancer care, infections and
nerv-damage. “The National Board of Complaints” is another line to follow and perhaps a tougher
way. Ministry of Health is financing this Board. The final decision cannot be appealed here and only
“Standard Treatment” is considered as correct (compare with “Best Possible Care” in the Insurance
line). During 2007 about 4000 complaints were filed and 26 % led to criticism and 74 % no criticism.
There are different grades of criticism and the levels are: No Criticism, No Criticism with
appropriateness, Criticism below standard, Criticism with enforcement notice, Criticism with
enforcement notice which is forwarded to prosecution = substantially below standard. In 2006 about
560 decisions with criticism and 13 % of these were published with the Health Care Professionals name
(doctor, dentist or other health professionals). IF a Doctor, or other health care professional, get
criticism 3 times, everything will be published with name. 45 % of warden dept who get criticism makes
changes in accordance with the decision.
Lecture by GP Dr Yves Sales (Family Practitioner and Practice Co-ordinator), “The Danish GP – Doctor
and Manager” . All Danish residents are covered by a National Health Insurance and 98.4 % are
connected to one GP-specialist (Group 1). As mentioned before, you also have a choice not to be
listed for a specific GP (Group 2), and have a free choice of GP and/or out-hospital specialists, but
then have to pay a smaller fee for doctor´s visits, 1.6 % have choosen this option. The Danish GP is a
private doctor, who owns and manage his/hers own clinic. More then 90 % of the income comes from
the National Health Insurance system and a normal income for a GP is around 130.000 EUR per year. It
takes about 13 years of studies and practice to be a GP-specialist and every GP should have around
1600 patients listed. GP:s usually co-operates with a hospital department and work there some hours
per week, in order to increase co-operation. Dr Yves Sales co-ordinates these actions in his area. GP:s
also have a 24 h emergency co-operation among each other. One problem is that the GP:s in
Denmark are an aging group and their share of the medical association group decreases and at the
same time the number of senior citizens in Denmark increases and will reach a maximum around year
2015-2020. Communication between different care system, like municipality, hospitals and GP:s, is not
HOPE – European Hospital and Healthcare Federation
Bd. A. Reyers 207-209, b7 – BE-1030 BRUSSELS
Tel +32 -2-742 13 20 – Fax +32-2-742 13 25 – [email protected]
THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE
www.hope.be
HOPE EXCHANGE PROGRAMME
FOR HOSPITAL AND
HEALTHCARE PROFESSIONALS
EXCHANGE DOCUMENT 4 - p. 8 / 3
so good today and there is a risk for a patient to “float” around in the health system, without getting a
good health care. Electronic communication is therefore important and many systems, or parts of
systems, are used today, but this could be much better. GP:s can send information to hospitals
electronically and also send prescriptions to the pharmacy and see their patient´s medications. All
computer actions are logged. GP:s can communicate via Medcom/ Edifact standards and can also
get a report after their patient´s admission from hospital. This is a possibility but not always used, as
many GP:s have their own web pages and prefer to communicate with their patients through this
channel. To summarize: The Danish GP system, with almost all citizens listed, is an unique possibility to a
good continuity of care, under condition that there are efficient and safe communication channels
between all players in the health care system.
Visit to Bisbebjerg Hospital in northern part of Copenhagen, built 1913, and information about
Communication between The Region and Municipality and Rehabilitation after Specialist Care, by Ms
Bettina Skovgaard from Capital Region (working with Municipality Co-operations). There are 29
municipalities in the Capital Region and a good communication is important not to “loose” any
patient. It is also important to agree upon rehabilitation matters, who will make what after the initial
specialist care period. There are large patient groups involved here like: Lung-diseases (COL),
diabetes, mental disorders and prevention/ health-promotion. A sort of catalogue has been
produced to indicate whether the municipality can take over a certain rehabilitation duty or not. The
following electronic communication based upon Medcom standards is in use for the moment in the
Capital Region:
-Basis-advis (patient admitted to hospital) is sent from hospital (H) to municipality (M) if the patient
already is serviced by the M. Used in 22 out of 29 municipalities
- Basis-advis, reply from the M to H, is in use at 18 out of 29 M
- Discharge report is sent from H to M in all municipalities
- Clinical e-mail/ correspondence/ messages is sent between H and M (double ways) in 11 M
On the last day of week two and the last day at Hvidovre University Hospital, we had breakfast with
the management group. After breakfast some discussions with Bjarne Andersen about economical
matters. Like for example, if a deptartment has more activities (patients/treatments/training) than
planned for, then more money is created from the Region and 50 % of this amount can be counted
for at the dept. If the Municipality cannot receive a patient who is ready for discharge, then the
municipality has to pay to the Region (not to the hospital). (More about financial matters later on at
Aarhus University Hospital).
Visit to the Quality Dept. and information was given by Mr Henrik Larsen, Quality Chef, and Mr Stefan
Thyrstrup. Hvidovre is an accredited hospital according to “International Standards for Hospitals” (USA)
and follows the “Joint Commissioning Book”. Inspections by the commissioning are performed every
third year. Inspections covers areas like for example: Emergency routines, fire protection, patient
procedures, patient tracers, etc. A patient responsible doctor and nurse must be specified and known,
inspections includes also talks with patients. There are totally 370 standards and 1032 measurable
elements. If problems are found during the inspection, they must be corrected within two months. All
hospitals in Denmark will be accredited in 2009. Two depts at the hospital are accredited according
to ISO 9000 namely Bio-chemistry Dept and Hearth Section (partly – rhythm cases). There is also a
Quality Handbook on the webpage at intranet. Audit routines checks the standards at least yearly.
HOPE – European Hospital and Healthcare Federation
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Patient records are audited (minimum 10 records). There should be only one record for each patient.
The EPM (Electronic Patient Medicine) system, which cover medications within the hospital, has
increased the patient safety and continuity for these matters. Other demands or goals are:
-
Transfer of patient epicrisis electronically to the GP should be done within 3 days. Goal: 85 %.
Present situation: 65 – 83 % are transferred within 3 days.
-
CAVE (allergy) should be indicated on front page of record. Goal: 90 %. Hvidovre: ?
The used principle at the quality dept is: PDSA (Plan – Do – Study – Act)
c) A one day programme at Odense University Hospital for all Hope participants, 13 of May 2008.
Lecture about “Pervasive Healthcare” by Ms Jane Clemensen, PhD, Innovation Manager at the
Alexandre Institute, Aarhus. Alexandre Institute is a private consultants group sponsored by 50-60
companies. Clinics, IT-research and Industry should work together to create a pervasive healthcare.
They also work with research for creating design, develop, evaluations of new pervasive companies
and technologies for the health care sector. Ms Jane Clemendsen´s PhD work was done together with
a young engineer/IT-expert and covered “Home Treatment of Diabetic Ulcers” by using IT-methodes
and technics. So, treatment and examination was moved from the hospital to the patient´s own home
using a simple technical set-up consisting of digital-camera (actually a mobile-phone) and a special
software. High resolution pictures of the patients ulcers could be transferred to a specialist at the
hospital and in most cases suitable treatment could be done immediately by the visiting nurse. 50 % of
the former hospital visits could be cancelled and done at the patient´s home. It is an advantage to
examine the patient in his own home to see his environment (for example what shoes he´s really using
etc.). With this kind of technic, the wounds shows a faster healing then with the traditional care and all
3 parts (nurse – specialist – patient) can communicate together on-line. The computer program used is
running on internet with encryption and has the same safety level as bank-transfers. This subject and
example is covered in one of our (HOPE team of Denmark) posters presented at HOPE Angora final
meeting in Paris. Patients with COL (chronic obstructive lung-disease) can bring a special computerbriefcase home and transfer clinical measurements to the hospital for evaluation. This reduces the
need to stay at or to visit the hospital. Other areas suitable for home-care, using modern technology,
are Care of Elderly, who could perform checks of blood-pressure, temperature, weight and medicine
record from home and using telemedicine methods. Also pregnant women who suffers from diabetes
can have weekly or bi-weekly check-ups from their homes, including CTG-monitoring, instead of
visiting a hospital. Ms Jane Clemensen will now begin a new work at a company who works with a
“Global Platform for Innovations” in creating “A new health care model”. There is a need for a
“change a mindset” as the present health care system might break down soon. A new culture or a
new way of thinking must be developed and the use of modern technology and IT-systems must be
implemented much more than today. The company is in a kind of brain-storming period and a big
international conference in Copenhagen is planned. A very interesting view and we have seen
portions of the use of new technology which can both increase the medical results and reduce time
and costs for the health care. In the afternoon the Hope-group had its first session together in order to
work with the Paris-presentation. The work was constructive and a basic structure was laid down and
all groups and persons had their own duties to work with and send around by e-mail to all participants.
In the late afternoon there was a train transfer to our next hospital in the programme, for me it was
Aarhus University Hospital at the mainland of Denmark.
d) Hope Programme at Aarhus University Hospital at Region Midtjylland. 14 May – 22 May. The first day
started with introduction to the Hope Programme at Aarhus University Hospital, information about the
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City of Aarhus and information about the Central Region of Denmark, Midtjylland. Information was
given by National Co-ordinator Nils-Erik Sandén and Co-ordinator Trine Boeje. The nurses in Denmark
was still on strike, but the Hope-programme was, as far as I could see, un-affected. Region Midtjylland
has 1.2 milj. Inhabitants and is the second largest Region. The administration is situated in Viborg. Each
Region has 41 politicians but they have no taxation right. The budget is 22.6 Bill. Dkr (about 3 Bill. Euro).
About 750 mill. Dkr (100 mill. Euro) is put aside as investment for a new hospital at Skejby, just outside of
Aarhus. The economic result is minus 400 mill. Dkr (-54 mill. Euro) and the budget is considered too low
for this Region. There has also been a tax-freeze for some years. The money for the region comes from
government (66 %), municipality (23 %), other regions (8 %) and from loans (3 %). Patients has a
treatment guarantee within one month and therefore more and more patients are transferred to the
private sector in order to keep the one month promise. Aarhus University Hospital is an umbrella for
several hospitals like for example: Noerrebrogade, Tage Hansens Gade, PP Oerums Gade, Samsoe
Hospital (an Island with an 8-bed hospital) and Skejby hospital (the newest). So, Skejby Hospital will be
the main hospital in the future and replace most of the others. Phase 1 will start within 8 years and all
phases should be ready within 15 years. The Cancer-center at Noerrebrogade has about 1035 persons
employed and a budget of 547 mill. Dkr (74 mill. Euro), there are 109 beds.
Next day an “Introduction to the Organisation of Management and Administration” at Aarhus
University Hospital, Aarhus Sygehus, Noerrebrogade. Information given by Ms Ingrid Munk, Chief of
Administration. The main organisation of the hospital is as follows: Hospital Direction (Medical Director,
Economic Director and Nurse Director), Administration, 5 Centers (Medical Centre, Neurological
Centre, Surgical Centre, Oncology Centre and Service Centre). Under the Centres are totally 41 units.
In each Centre there is a Director and administration staff (5-6 persons). The is also a committee with
elected persons from different staff categories together with leaders and these committees are a very
strong factor. Service Centre includes: Technical Dept, Kitchen, Telephones, Laundry and a Staff Pool.
The administration have 150 employees and consist of the following blocks: Head of Administration,
Secretariate, Dept of Planning, Dept of Finance, Dept of Communication, Dept of Quality
Development and Patient Safety, Dept of Human Resourches and Dept of IT. Dept of Finance handles
electronic book-keeping, patient adm (especially patients from other regions), accounting, budget,
DRG (diagnose related groups), administrative support to research, “finding money” and helping with
forms for applications etc. Dept of Planning works with organisational planning (for example cancer is
now considered as an acute illness and have a 48h limit for actions), data-management and
electronic patient journals (a project from the old Aarhus County which is on-going and has spent 300
mill Dkr (40 mill Euro) so far. Some parts and modules are ready. The Secretariate handles patient
transfers especially in cases where the “One month treatment rule” cannot be kept. Patient
complaints and patient insurance are handled or reported. The Quality and Patient Safety Dept work
with ackkrediations matters and reports about patient injuries or nearly injuries. Dept of
Communication work with a staff magazine and is also helpful with graphic design and other material
if you are going to participate in a conference or similar. The IT-dept have been re-organised and 50 %
of the staff has left for work in the Region. There are large problems to keep-up with the every day
duties, like for example giving out passwords.
Service Targets. There are defined targets for certain important duties and here follows some
examples. Information about when the specialist investigation will take place within 8 days from the
GP:s referral (General Practitioner)- target 95 % and actual performance 84 %. Investigation within 14
days from GP:s referral – target 90 % and actual 49 %. Information about when the treatment will take
place within 8 days after the investigation – target 95 % and actual 77 %. Treatment within 1 month
from GP:s referral – target 90 % and actual 65 %. There is also targets about time-limits for the hospitals
sending of epicrisies to the GP after patient discharge.
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Next subject was “Introduction to Department of Quality Development and Patient Safety” by Ms Nete
Ramlau-Hansen, Chief of Quality Dept. Information about the Quality Organisation, actions done and
NIP (National Indicator Project, discussed earlier at Hvidovre). NIP is used to measure the hospital
standards for good quality compared to a national “normal” level. Example of illnesses measured
are: Apoplexi, diabetes, heath failure and lung-cancer. They also have other quality measures like for
example regarding hand-hygiene, mortality rates and overall patient satisfaction. All patients are
scanned for MSRA and also staff, who has been visiting a hospital abroad, will be tested and put in
quarantine. About 1000 incidents are reported every year.
Information from the Oncolocical Dept by Mr Thomas Oxlund Munkholm, Director of Cancer Center
(economist). There has been, and still are, a large increase of cancer patients, in year 1999 they had
6000 out-patients yearly which has increased to 17000 in 2007. In 2007 they had 33000 complete daily
radiotherapy treatments (they have 7-8 linear accelerators and Vaxjo figures today is about 8700
treatments yearly). The estimated increase in treatments is as follows: 39000 (2008), 47000 (2009), 63000
(2010) and 74000 (2011). After 2011, the patient load will level out. For economical matters, a contract
is signed between the politicians and the hospital management and it covers for example: Activities,
discharged patients, bed-days, operations, out-patients, DRG-values, level of service (waiting-tímes).
The base-activity is related to the DRG-value and you get money in advance up to a ”base-level”.
Aarhus University Hospital at Noerregade has 5 centres and 41 departments (units) and similar
contracts are made with each and every centre and department. If you perform above the base-line
you get 50 % of the value for the department. However, a centre or a department who performs well
might have to give away the profit (or part of the profit) to another department who are on the minus
side. Similar take and give is also used between centres and hospitals.
Next day a lecture about “Health Technology Assessment, HTA”, at the Centre for Public Health also
called “Health Services Research”, by Ms Ulla Vaeggemose and Mr Lars Ehlers. This subject has been
covered at Danish Regions, please see also previous notes. This Centre is financed by the Region and
work also for the University and 7-10 persons are working at this HTA-unit. There are 4 HTA-organisations
located in Aarhus, Odense (one local and one regional) and in Copenhagen (DACEHTA). HTA must
always be firmly rooted in research and research methods. A database has been is under
development covering all previous HTA-cases and this database can only be seen at the Regions. HTA
can also be used for budgetary planning and is also used by private companies. The present work is
covering the following subjects: Screening of aorta-anaerysm, lower-back problems and aorta
problems for blood-vessels going to the brain. A Mini-HTA tool is used at hospital level when introducing
new interventions, new equipment or new diagnostic modalities. The tool asks 26 questions covering
the following headings: the technology, the patient, the organisation and the economy. Example of
questions are: “On what indication will this proposal be used?”, “In what way is this proposal new?”,
“Has an assessment of literature been carried out?”, “Does the proposal imply any risks or adverse
effects?”. Rikshospitalet in Copenhagen have used Mini-HTA for many years. HTA is used also in
Sweden at County of Oestergoetland, in Australia (Melbourne Souther Health) and in Canada
(Quebec McGill University Health Centre).
Next subject was “Prehospital Diagnosis and Triage for patients with Myocardial Infarction”, Dr Jacob
Thorsted Soerensen, MD, PhD. Treatment for infarction started only 30 years ago using aspirin and
similar drugs. Now there are several treatments used, primarily balloon stents (PCI) and fibrinolysis (also
heparin is used). Criterias for a possible infarct diagnose are: Chestpain with Stemi (ECG ST-elevation,
which is typical for an infarct), ongoing chest-pain >15 minutes or paleness and shortness of breath
(even without pain). Dr Soerensen have worked with a telemedicine transfer of a full 12-lead ECG, sent
from the ambulance to nearest invasive care hospital, where a specialist can read the ECG and
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sometimes retrieve and compare with previous ECG-records. Ambulances with telemedicine possibility
are now covering the whole country and the diagnose possibilities increases. In the future blood
samples with a full marker kit can be used and transferred from the ambulance, also video-feed could
be a useful tool, together with possibilities to perform ultrasound examinations (echo-cardiography)
and transfer the pictures. 90 % of the patients with a suspect infarct has a pre-hospital diagnose today.
Every 60 min delay in a PCI treatment of an infarct, gives a 14 % higher mortality rate in 1 year.
Denmark is planning to have a complete ECG-database for the whole country, to compare old ECG:s
for a better ambulance telemedicine diagnosis. This subject was covered in our second poster (Hope
team of Denmark) presented at Hope Angora final meeting in Paris.
We continued with a study visit to the Emergency Dept at Aarhus University Hospital, Noerrebrogade.
Information was given by Ms Hanne Boyles, Head Nurse and Ms Bodil Clemensen, Head Nurse. The
300.000 inhabitants in the Aarhus area share this emergency dept. They have about 55.000 visits yearly
and 8-9 physicians and 10 nurses are working there full time. They have 17 examination rooms and
some have general x-ray equipment and full operation theatre possibilities. There is no warden dept
connected to emergency dept. You can electronically see x-ray pictures and laboratory data, but it is
not possible to send these data directly to the patients GP (secretaries can though do this). Nurses who
receive patient calls can see the patient load at other hospitals in the region and advice in case of
long waiting times.
On Monday May the 19th a visit to the Psychiatric Hospital Risskov (Aarhus University Hospital). First
lecture was about: “Psychiatry in Denmark – State and Trends – The OPUS-project” by Ms Gertrud
Krarup, Psychiatrist, Sr Consultant. The trend is as follows: Reduction in beds, no long stay patients, more
out-patient services, specialisation, minor psychiatry. There is a lack of psychiatrists and psychiatry
nurses in Denmark. Before, the specialisation was divided into: Forensic psychiatry, geriatric psychiatry
and eating disorders. Nowadays the groups are: Psychotic disorder, bipolar disorder, early intervention
team, neuropsychiatry and cross-cultural psychiatry. Patients are examined carefully including somatic
examination with blood samples, ECG, EEG, CT and MR-scan, etc. The treatment programmes
includes for example the following therapies: Case management, antipsychotic medicine, cognitive
behavioural therapy, social skills training, life style group and social interventions and rehabilitation. The
OPUS-project was performed 1998-2002 in Copenhagen and Aarhus and the definition was
“Integrated assertive treatment in multidisciplinary outreach teams”. It was a very active and intense
program during 2 years and the results were compared with “standard treatment” and the results
were very good and some of the details were: Less need for beds, less drop-out percentage, less
symptoms, less depression, lesser dosis of antipsychotics, patients and families more satisfied.
Next lesson was covering “Community Psychitry in Urban area with large Etnic Population”. Ms Ea
Boehm Jepsen, Psychiatric Consultant, was lecturing in a very good and interactive way. Denmark has
5.5 % inhabitants with non-Danish ethnicity and in Aarhus there are around 10 % and in certain areas
(Aarhus West) up to 14 %. In the Aarhus West area there are 370 psychiatric patients and approx. 44 %
of them with non-Danish ethnicity. The diagnosis (2006) are: Schizofrenia (47 %), bipolar depression etc
(34%), Nervous diseases incl PTSD (Post Traumatic Stress Disorder) (13 %) and others (6 %). The work is
performed in teams and one of the team is the “Multicultural Team”. The team consists of doctor,
nurses, psychologist and interpreter and the work includes seeing patients, lecturing, treatment and
supervision.
This lesson was followed by information about “Basic – Research – PET/Depression Project”, by Mr Poul
Videbech, Professor, Head of Dept. Depression is the most expensive brain disease for the society and
the need for more knowledge is huge. The antidepressant treatment response is about 60 % and there
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is a 80-100 % rate of recurrence. The risk of suicide is high (15-20 %) and there is a doubled risk of
dementia. One question is: “Does the depression alter the brain physically?”. In the project the
included patients were investigated in many ways including PET and MRI-scans. The project found an
increased frequency of “White Matter Lesions” in the brain and a decreased volume of the
hippocampus (situated in the deep front lobe). Hippocampus deal with: Co-ordination of lower level
limbic structure, memory tasks and stress regulation. 50 % of the depressed have too much cortisol (a
stress-hormone) and this is toxic for the brain. This high level cannot be lowered by medical treatment.
Un-treated depression can lead to atrophy of the hippocampus, if treatment is given hippocampus
can be re-normailsed, so it is very important to treat depression.
Next lesson informed about a “Clincal Trial and Treatment – Daily Work” and was continuing the
subject about depressions. Performed by Mr Poul-Erik Buchholtz, Head of Dept, Sr Consultant. This work
is about “Transcranial Magnetic Stimulation (TMS) at Depressions” and the project has been on-going
for 10 years. A dynamic magnetic field of 1 Hz is focused towards hippocampus and the treatment is
given during 2 x 1 min with a 3 min pause inbetween and 20 sessions are given. In the control group a
similar magnetic field is given but angled 90 degrees, so there will be no magnetic power absorbed by
the brain. Project will be finished within 3-4 years. The TMS treatments dampen the activity and the
bloodflow in hippocampus.
In the afternoon a very interesting visit to the “Psychiatric Art Museum, Risskov” and a very fantastic
tour performed by Ms Annette Quistgaard, Attendant at the museum. Many patients were using art as
a way to express themselves and treat themselves during illness and recovering period and Ms
Quistgaard told about many very fascinating lives. This museum can really be recommended for many
reasons.
The next day continued with the subject “Diabetic Foot Ulcers – e-Health”, by Ms Janette Brandstrup
and Mr Niels Ejskjaer, Physician. This information is related to a similar lecture in Odense by Ms Jane
Clemensen and as mentioned before this subject is covered in one of our posters (Hope team of
Denmark). A primary nurse will examine and treat patient with diabetic foot ulcers in their own home
using telemedice support. The project started 5 years ago and reduces the need for hospital visits by
50 % and increase the quality of care. Patients are examined at home and pictures of the wound by
means of a video-phone (mobile phone with mega-pixel camera), are transferred to a specialist (also
vascular surgeons can attend if needed) at the hospital for evaluation. This computer application is
assessable and run via internet, which gives a much faster communication (what takes 0.5 seconds at
internet can take 3-4 minutes at intranet). A graph was presented that shows the wound area vs time
and expected wound healing was indicated in the graph (every patient in the project has this kind of
graph in their digital record). Healing of the wound is actually slightly faster for patients examined and
treated in their homes. Access to this application is restricted and all persons who are granted access
to a patient record must have permission from the patient. Data is encrypted at “bank-safety” level.
When you open a patient record you can see a list of staff working with the patient, diagnosis, notes,
pictures, evaluation of wounds, graphs, etc. You can also send e-mail to the patient from here. If
granted access, the patient´s GP can access the record. There is also a button that hides the patient
number and name, which is useful for teaching purposes.
Next station was the “Medical Physics and Radiotherapy Dept”, shown by my collegue and friend Mr
Ole G Nielsen, Division Manager. The medical physics section has 45 persons employed and of them
about 10 of them are engineers or technicians. There is also a small IT-section with totally 2.5 persons
who handles all matters regarding the local IT-system (servers and network). The radiotherapy has 8
accelerators (5 Varian with OBI and 120 leaves MLC) and 2 Siemens accelerators (from 1998, 1999)
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and 1 accelerator is in the final stage of installation. The most advanced accelerator has a conebeam CT-possibility and a brain-lab micro MLC for stereo-taxi treatments. There are 2 CT-scanners from
Philips (one Big Bore and 1 older MX 8000). One equipment, SRT 100 – 100kV for superficial radiotherapy
and 2 brachy after-load machines for brachy-therapy (iridium sourche is used). 7 accelerators are
running clinically at day-time and one accelerator is running from 16-22 in the evening. One engineer
and one physicist are then on duty and can also work with preventive maintenance, repairs and
dosimetry at the other 7 machines. When working in the evenings, you have a fixed sum added to
your salary but have still only 37 hours weekly working hours including meals etc. The engineers are
making detailed down-time statistics and times all actions at the accelerators in minutes. Also the
number of actions are stored. They are also testing a system with a break-down of preventive
maintenance into 45 different pieces (for dosimetry 15 pieces), so that 60 small pieces of services are
performed 4 times per year and accelerator (1000 pieces per year). This means that small breaks and
evenings can be used for the necessary preventive maintenance, without having to do the whole
programme at one time. You have to add some time for bringing your service-tools and equipments
back and forth many times, which reduces the active working time (my comment). This was for me a
very interesting and useful visit and many thanks to Mr Ole G Nielsen for a good programme.
Visit to the Oncological Simulator” by Ms Annette Bojen. A very interesting 3-D adventure with 3-D
glasses of course, where you actually feel like being inside an accelerator room and you can run the
machine with the standard hand-pendant. You can put a “real” patient on the treatment couch,
which means all patient data, pictures (CT/MR) and doseplans are real and you can actually see the
patient lying on the couch ready for treatment. You can remove layers from the patient, for example
the skin, organs etc and only focus on the tumour and sensitive nearby structures. The beam is
simulated by a “free of choice” colour and can be evaluated and studied and compared with the
doseplan. This is a fantastic and useful tool for education and information, without disturbing the
clinical facilities for radiotherapy. This place is well worth a study-visit for any clinic or department
working with radiotherapy or supporting this activity.
On the last working day in Aarhus, a visit to Skejby Hospital (the future main hospital in the area) and to
the “Pharmacy Dept” by Ms Trine Persson, Pharmacist and Ms Anne-Maria Schmidt, Head Physician
and also a visit to the “Infection ward” shown by Ms Karin Buchard, Head Nurse. Skejby Hospital
produces and distributes medicine to all hospitals in the area. There are totally 180 employees. They
also compound antibiotics and cytotoxics, ready for use. There is a robot-based system, 2 robots,
Italian made, which costs about 13 milj DKr = 1.8 milj Euro, for packing the patients medicines
individually in closed bags and labelled with a unique bar-code and the patient is wearing his own
bar-code at the wrist. The input to the robots comes from the Electronic Patient Record (EPJ). When
distributing the drugs to the patients a small computer (PDA – Personal Digital Assistant) is used for
reading the barcodes and record all activities related to the dispensing (who and when). If you have
to give medicine manually, it can be fed to the system afterwards.
Visit to the “Patient Hotel” at Tage Hansens Gade, shown by Ms Charlotte Agerholm Petersen, Ward
Nurse and Head of the Facility. The hotel had family rooms and rooms for disabled people. The
patients ward department is responsible for the patient during the hotel stay. For the moment the
nurses at this hotel cannot read the patients electronic record, but notes can be put into the general
database. The cost for a bed at the hotel and calculated by number of nurses needed per bed is as
follows: Patient Hotel 0.1 nurse, Wards 1.2 nurses and Intensive Care Units 4 nurses. A Patient Hotel is a
nice and economically efficient service, which is used a lot in Denmark and also in Sweden.
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At the end of the day a verbal evaluation of the programme at Aarhus University Hospital was done
with the co-ordinators and as Hope-participants,we were very happy and impressed about the
programme. It was professional, it was nice and full of discussions and arguments. The hospitality and
the facilities were excellent.
e. A final meeting at Danish Regions in Copenhagen in order to work with the presentation, posters
and for a summary and evaluation of the Danish Programme.
The last 2 days in Denmark was spent at “The Danish Regions” in Copenhagen. We had 1.5 days
working hard with our presentation and our posters. The co-operation in the group was excellent and
we managed to cut down our huge material into a 10 minutes presentation. We also made two
posters covering: “Diabetic foot ulcers and e-Health” and “Telemedicine used in ambulance”.
3. Please describe the structure of the host organisation and compare and contrast it with
that of your employing organisation. What are the advantages and disadvantages of
each structure?
Comparing the Health Care Organisation on National Level, one can see that Denmark has
cancelled the Counties (15 Nos before) and created larger units called Regions (5 Nos), with 0.6 –
1.6 milj inhabitants. Decisions and financing are handled mainly at Government level. The reason
for this change is probably to create stronger areas with a capacity to invest in the latest
technology and care and also to make the Health Care more unified and fare. In Sweden we are
discussing the same concept, but no actions has been taken yet. We still have 20 County Councils
with a population varying from 60.000 up to 1.9 milj. There are discussions about discrepancies in the
standard of care in different Counties, which needs to be handled in a fare way, and to create
larger Regions could be one solution. The dis-advantages of larger Regions could be, that the
decisions are made far away from the citizens and that special needs locally are not taken into
consideration.
When comparing my own local organisation, Dept of Medical Physics and Biomedical Engineering,
with the corresponding dept at Hvidovre University Hospital, Medico/EDB Dept, one can see some
differences. At Hvidovre, the IT-support is incorporated in the Biomedical Dept, so that IT-support
and IT-training is included in the duties. You can also see that Medical Physicists are very rare in
Denmark and that a special University subject for them doesn´t exist for the moment.
Our Dept is divided into 3 sections namely: X-ray/ Isotope, Radiotherapy and Biomedical engineering.
The IT Dept is separated and belonging to another organisation. In all sections are engineers,
physicists and specialist nurses working side by side. We could see a need for an IT-section working
close to us with computerised biomedical equipment and in that respect the Hvidovre
organisation is good.
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4. Is there anything that could or should have been added to the Programme? If so,
what?
The Danish programme has really been excellent and professional in all aspects. To mention
something that would have been interesting, is to visit a General Practitioner´s clinic, especially
a GP, who work with sundhed.dk and uses the full scope of possibilities here (some groups
might have made such a visit).
5. Have you benefited from your attachment with the hosting organisation? If so, in what
ways? Will your experiences be of value in your own job?
I have got a lot of new knowledge generally and within my field, biomedical engineering in the
cancer treatment, I have had new information, seen new ways of working and new
advanced equipment in use. Especially interesting was the MR-section at Hvidovre, where
research is ongoing about metabolic studies in connection with MRI, which in the future might
replace PET-scanners. The oncology simulator at Aarhus (Noerrebrogade) was an unique and
very useful tool for education and information within the field of radiotherapy and
doseplanning. My collegue, Eng. Ole G Nielsen, at oncology dept, Aarhus (Noerrebrogade),
showed me new ways of working with preventive maintenance of linear accelerators.
Telemedicine in the home-care of diabetic foot ulcers is of large interest, and I will for sure
transfer this information to the corresponding dept here in Vaexjoe.
6. What problems (if any) did you meet during your attachment? How could they have been
avoided?
I had no problems at all during the Danish programme or during the stay in Denmark. Hospitality
and arrangements were excellent. I had minor problems to receive confirmation from Hope
Angora in Paris and to order an extra night at Ibis Hotel, Porte d ´Italie , but in the end it was
solved.
7. Outside of the work situation, did the attachment have any value, e.g. social and cultural
value?
We had a great social and cultural programme in Denmark. Visit to Lousiana Art-museum north of
Copenhagen, visit to Aros Art-museum in Aarhus, visit to Tivoli, Copenhagen and several
occasions with sight-seeing and traditional Danish food. Our group was very stimulating and
open-minded and we had always interesting discussions both personally and professionally.
The group have concrete plans for a re-uninon in Scotland next summer.
8. Would you recommend that the Scheme be continued or extended in any way? Why
(not)?
HOPE – European Hospital and Healthcare Federation
Bd. A. Reyers 207-209, b7 – BE-1030 BRUSSELS
Tel +32 -2-742 13 20 – Fax +32-2-742 13 25 – [email protected]
THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE
www.hope.be
HOPE EXCHANGE PROGRAMME
FOR HOSPITAL AND
HEALTHCARE PROFESSIONALS
EXCHANGE DOCUMENT 4 - p. 17 / 3
The Scheme was excellent and started with an informal “getting together” for all participants at
Hvidove University Hospital, an opportunity to meet in a relaxed way. The first 2 days at the Danish
Region in Copenhagen was also a good starting point to get an overview of the Danish Health
Care system. It was also useful to meet in the middle of the programme in Odense, to be able to
preliminary organize our work with the presentation. To divide the period into two sections with
change of Hospital and Group in the middle is a very good idea and increases the input of
information and is also an advantage socially, in that you get to know more colleagues. The
programme could include a visit to a comprehensive General Practitioner´s clinic (which was
already done for some groups).
HOPE – European Hospital and Healthcare Federation
Bd. A. Reyers 207-209, b7 – BE-1030 BRUSSELS
Tel +32 -2-742 13 20 – Fax +32-2-742 13 25 – [email protected]
THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE
www.hope.be
HOPE EXCHANGE PROGRAMME
FOR HOSPITAL AND
HEALTHCARE PROFESSIONALS
EXCHANGE DOCUMENT 4 - p. 18 / 3
9. Do you have any general comments that you would like to add?
I am very happy and grateful to have got the opportunity to participate in such a nice and
professional programme, thank you County of Kronoberg. It was very rewarding in many ways,
I got to know many nice and professional colleagues from all over Europe and I have
experienced a great hospitality and generosity for which I am very grateful. Thank you
Denmark, Danish Co-ordinators and HOPE and for good memories.
Place and date . . Vaexjoe, Sweden. . . . . . . . . . . . . . . . . . . . . . .Signature . . . . Christer Larsson.
. . .......
...........
THIS REPORT should be returned not later than 31 July 2008 preferably by e-mail or by
NORMAL POST to
HOPE
European Hospital and Healthcare Federation
European Co-ordinator of the HOPE Exchange Programme
Bd A. Reyers 207-209, b7
BE-1030 BRUSSELS
[email protected]
with a copy to the host and the co-ordinators of both sending and host country.
HOPE – European Hospital and Healthcare Federation
Bd. A. Reyers 207-209, b7 – BE-1030 BRUSSELS
Tel +32 -2-742 13 20 – Fax +32-2-742 13 25 – [email protected]
THESE DOCUMENTS ARE ALSO AVAILABLE ON HOPE'S WEBSITE
www.hope.be