Siriraj Hospital (โรงพยาบาลศ ร ราช)

Transcription

1 Naomi Tjaden

2 The Grand Palace

3 Siriraj Hospital (โรงพยาบาลศ ร ราช) Oldest and largest hospital in Thailand Founded by King Chulalongkorn in 1888, named after his son who died of dysentery Associated medical school started in Hospital Statistics 2233 beds ~3 million outpatient visits/year ~90,000 inpatient admissions ~15,000 employees >80 buildings

4 Thailand is in mourning of the Beloved King Typical sign found all over Thailand remembering the Beloved King. He died at Siriraj Hospital on October 13, 2016, and the official period of mourning is 1 year.

5 Surgery Department Plastic Surgery Cardiovascular and Thoracic Surgery Daily grand rounds Daily Conference M&M Journal Club Case Conference Internal Audit OR or outpatient clinic

6 Siriraj Surgical Attire Women s Uniform for Surgery Communal flip-flops for inpatient wards and ORs OR with washable drapes and footwear

7 Cute ORs and supplies Labeled surgical supplies in the OR Cute combs for patient use Lead protective equipment with Tokidoki print

8 Surgery Department CVT procedure in hybrid room Plastic Surgery residents on art day

9 Topic of interest: Patient Autonomy Chosen based on profound clinical and cultural experiences at Siriraj Hospital In the context of emergent surgical management Patient communication and Translation services Pediatric Assent and measures for comfort surrounding invasive procedures Advanced directives and withdrawal of interventions Application to Pediatrics for my future practice

10 Patient communication and Translation Services No equivalent of US Civil Rights Act of 1964 prohibiting discrimination based on race, color or national origin as it applies to health care IE: Translation services required Clinical Experience: 3 year old child transferred from China did not have translator services to communicate with family attempted English and Thai only Improvements recommended: Paid translation services or use of online system

11 Pediatric Comfort re: invasive procedures Studies have shown that parental presence during induction of anesthesia in pediatric patients reduces anxiety of patient Clinical Experience: 3 year old child did not have parents present during post-op recovery at all times, and had to abide by the adult ward s visitation hour policy Improvements recommended: pediatric patients should be placed on pediatric wards, not adult wards, and should allow for open visitation hours and rooming in with parents

12 Advanced Directives Study in Chiang Mai revealed that most physicians affirmed usefulness of Advance Directives but that actual planning of death was limited Thai National Health Act recently made it clear that patients should be able to refuse care in the terminal stages of life an important first step in allowing Thai people to die according to their wishes Cultural Experience: Patients with terminal disease processes and trauma continued receiving invasive procedures and care that would not prolong life or improve quality of life Improvements recommended: required implementation of Advanced Directives, and attempt to change Paternalistic approach of medicine

13 Summary of strategies and interventions Individual Each physician make effort to go over advanced directives with the patients Don t attempt to translate without being fluent Community Information provided to patients urging them to ask their doctors about Advanced Directives System Implement advanced directives using electronic medical record Provide translation services through the hospital

14 Travel around Thailand: Chiang Mai Flower Festival Floats made out of flowers Traditional Thai Outfits

15 Travel around Thailand: Experiencing Buddhist Traditions Grand Palace Monk walking on the street Buddha

16 Travel around Thailand: Modes of Travel

17 Travel around Thailand: Food

18 References Civil Rights Act of Public Law , Title VI, Sec. 601, 78. U.S. Statutes at Large (July 2, 1964). Manivel JC, Priest JR, Watterson J, et al. (October 1988). "Pleuropulmonary blastoma. The so-called pulmonary blastoma of childhood". Cancer. 62 (8): doi: / ( )62:8<1516::aid-cncr >3.0.co;2-3 Sadeghi A, Khaleghnejad Tabari A, Mahdavi A, Salarian S, Razavi SS. Impact of parental presence during induction of anesthesia on anxiety level among pediatric patients and their parents: a randomized clinical trial. Neuropsychiatric Disease and Treatment. 2017;12: doi: /ndt.s Sittisombut S, Maxwell C, Love EJ, Sitthi-Amorn C. Physicians' attitudes and practices regarding advanced end-of-life care planning for terminally ill patients at Chiang Mai University Hospital, Thailand. Nurs Health Sci Mar;11(1):23-8. doi: /j Phenwan, Tharin. "Updating Living Will law in Thailand." EHospice. 15 Apr Web. Faculty of Medicine Siriraj Hospital, Facts and Figures. Foreign Travel Advice, Thailand.