Das Krankenhaus ohne Direktzugang Associate Professor Katarina Göransson & Dr Erland Löfberg Emergency Medicine Function Karolinska University Hospital, Stockholm, Sweden
Health Care in Sweden
The actors in the Swedish health care system are sorted under county councils and municipalities Swedish Government Swedish Ministry of Health and Social Affairs (Socialdepartementet) County councils Municipalities Highly specialized care Elderley care Specialist care Disabled care* Primary care School health services* Dental care* Home Care services Healthcare - county councils (private/public) Elderly care - municipalities (private/public)
Stockholm County Council is the largest county council in Sweden Stockholm County Council is the largest county in terms of population, approximately 2 million people, or 21 % of the population of Sweden, lives in Stockholm 61 % of total county budget for healthcare (~ EUR 5,5bn) The county council is also facing a rapid population growth and the population is expected to increase by 35 000 on a yearly basis We re living longer there are more seniors with major medical needs. Increased demands people are assimilating more and more information and will impose greater demands for health and medical services in the future.
There are various health care providers in Stockholm County Council 7 Emergency hospitals (1 University Hospital, 1 private) 208 Family doctor clinics (60 % private) 16 Local emergency wards About 10 Psychiatry and abuse units (30 % private) 12 Geriatric clinics (60 % private) In total, 1500 private specialists and physiotherapists
Vårdval (Freedom of chice)stockholm the new patient choice model Improves freedom of choice Opens up for more healthcare providers Patients can compare care on the internet
New Karolinska Solna the largest health care investment in modern time
Nya Karolinska Solna from idea to a new hospital in 16 years 3S-Study Decision to build NKS (April) Decision on PPP(Juni) PPP process starts (Oktober) Future Health Plan established The hospital is completed 2018-2019 The idea is presented to the county council Assignment in 2012 The SNUSstudy Decision to build a new university hospital Architect competition PPP-agreement signed Construction starts Opening of the new hospital Political decision on Future Health Plan and case mix for NKS
Major investments are made in the emergency and local hospitals, besides from NKS SEK 14,5bn (EUR 1,5bn) NKS SEK 27bn (EUR 2,8bn) and Emergency and local hospitals (constructions renovations during 10 years) This is the largest healthcare investment ever carried out by the county council
Challenges How do we create a sense of urgency and anchorage for changing the health care system? How does the system manage all rebuilding and renovation of hospitals? What will happen when NKS closes the emergency ward? Future cancer care? Caretaking of the elderly? Primary care emergency wards Patients >70 years (2010) 10% of the population 42 % of days of care Future governance and reimbursement of health care? How do we improve monitoring of health care and ensure good quality throughout the system
Definitive need of improved collaboration within our healthcare system Patients and tasks are not addressed in time long waiting lists Overlaps (i.e. double lab tests) Patients are not treated at the right care level, or not treated at all Available capacity in some parts of the system Possibility for increased efficiency by improved resource management Fragmented IT-system
Plan for the Future of Health Care 2012-2018
Plan for the Future in brief Plan for the Future one of the largest investments ever made an additional SEK 28 billion will be invested in the health and medical structure during the next ten years. Expanded care increased total number of beds and services closer to the people. The big emergency hospitals need to be refined and adapted for those patients in need of its resources Extensive addition of specialist care outside the big hospitals Additional geriatric care, rehabilitation and Advanced Home Care Highly specialized care concentrated at New Karolinska
Integrated care as the basic principle in the network health care system Family doctors Geriatrics Psychiatry Specialized care outside emerg hosp Specialized care outside emerg hosp Emergency hospital Rehab University hospital
Focus on increased in-hospital beds in the Stockholm County Council 16 % increase of in hospital beds
Research in a network health care system The link between research, development, innovation, education and helath care is of great importance Close collaboration with Karolinska Institute Karolinska University Hospital has a central role Closer collaboration within all levels in the system - Academic Health Care Academic GPs Framtidsplan för hälso- och sjukvården
The emergency department at New Karolinska Solna Our biggest challgenges ahead Patient steering Staffing Education and research Framtidsplanen andra steget
Karolinska University hospital in figures 1,7 million patient visits per year 106 000 patient episodes 15 800 staff ~2 000 staff active in research ~2 500 scientific publications together with Karolinska Institute per year ~43 000 student weeks per year 1,7 billion euro yearly budget
The mandate of Karolinska To be Stockholm County Council's University Hospital, with responsibility for specialised and highly specialised health care That assignment comprises main responsibility for the County Council's research and student education in partnership with Karolinska Institutet and other universities and colleges 19
Focus on emergency care in the Stockholm County Council Emergency hospitals are limited to the patients in need of that level of care Approx 15 % of the emergency hospitals current patients can be tretead better by other HC providers
Structure for level of care the Stockholm County Council 1. 1177/Vårdguiden = telephone/internet guidance and patient steering (24/7) 2. General practitioners (weekdays and weekends 8-22*) 3. Närakuter = non hospital EDs (primary health care facilities/emergency care) (weedays and weekends 8-22) 4. Somatic specialist care 5. Geriatric care including EDs for geriatric population 6. Hospital EDs (24/7) 7. Intensive ED (24/7) * Majority of GPs Sida n 21
Emergency care visits need to be transferred to non-hosp EDs and GP GP GP GP Non-hosp ED Non-hosp ED GP GP Non-hosp ED Non-hosp ED Emergency Hosp Emergency Hosp Emergency Hosp Karolinska Univ Hosp Emergency Hosp Non-hosp ED GP GP Non-hosp ED Emergency Hosp Emergency Hosp Non-hosp ED Non-hosp ED Non-hosp ED Non-hosp ED
Patient fees in the Stockholm County Council 18-84 years GP & non-hospital EDs: 2 EUR Hospital EDs incl Intensive ED: 4 EUR +85 years All ambulatory care: free of charge +18 years A small fee for in-hospital care Maximum fee ambulatory and in-hospital care: 220 EUR/12 months Maximum fee for prescribed medication: 110 EUR/12 months 23
The New Karolinska Solna (NKS) NKS will be part of the future care system that is based on all parts of the system interacting with each other. The demanding, highly specialised care at NKS is complemented by extended emergency hospitals and specialist care outside the emergency hospitals. Information services such as the Care Guide ( Vårdguiden ) and communication between patients and care providers will lead to a more efficient care of the patient s actual needs. At the ED, patients will arrive by ambulance, helicopter or by referral from another care provider, for example primary care. In addition to this, patients who are already under treatment at NKS will be able to come directly to the hospital. 24
Patient flows Intensive ED Karolinska University Hospital Solna (eg NKS) Intensive Emergency department ED by-pass In-hospital bed Trauma STEMI Stroke 25
Our surroundings All Scandinavian capitals contain multi-site university hospitals Highly specialised care concentrated to mainly one site, with a restricted ED Open EDs, including trauma centre, at the other sites 26
Challenges ahead regarding Intensive ED When is the move to take place? Which patients is the Intensiv ED open for? Actions carried out regarding patient steering: prehospital steering? Validity of prehospital diagnosestic methods Where do the patients go? Providing high quality health care, education and research Staff retention prior to the move Communication with surrounding environment 27
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A regional triage system through the care pathway (primary health care-ed) triagehandboken.support@skane.se
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