Vall d’Hebron is reorganized into 32 areas of knowledge in which the different services are grouped

The covid-19 has changed the way hospitals work. Pushed by the pandemic, Vall d’Hebron, the largest health care center in Catalonia in which they work 9,000 professionals, restructured its organizational model, which became divided into areas of knowledge which group services and units around a health problem. Thus, patients were grouped according to the nursing care needs they have. That is, for a health problem.

For example. heart area groups the hospitalization units and cabinets of the cardiac surgery and cardiology services, hemodynamics, day hospitals and the rest of the hospital’s devices that have to do with the heart. This change has ended consolidating And now the hospital has presented it to the media. And the patients are now classified into three levels: acute patients, intensified care patients, and intermediate care patients.

The new organizational model of care groups together the different services and care units that have anything to do with a particular health problem. Another example: if previously a person transplanted with a kidney was admitted to the Nephrology Service, now he or she is admitted to the solid transplant area, together with other patients transplanted with other organs. Thus, this new model consists of the creation and implementation of 32 areas of knowledge: 28 specific and four cross-cutting, which are the. heart area, the solid organ transplant area or the post-surgical care area.

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“The covid opened the door for us to make a conceptual change of the entire organization. This new system facilitates the organization of the hospital and the work of nursing.” explains the manager of Vall d’Hebron, Albert Salazar. According to him, in addition, the new model also incorporates the concept of. “protected time”, which is a few hours per week that professionals will be able to save to devote to study or research.

Traditionally, hospitals have been organized by clinical services, and these, by specialized functional units. Each service corresponds to one of the specialties accredited by Health. Within the services, the management structure is hierarchical and each professional group is well differentiated (physicians, nurses, physiotherapists, social workers, orderlies, etc.). The new model created and implemented at Vall d’Hebron is based on the interdisciplinary work.

Four objectives

The objectives of this new model are fourfold: to direct the. attention to the needs of the person, to promote a knowledge-based management (promoting continuity of care), fostering teamwork and professional development (strengthening communication and interdisciplinarity and fostering new professional roles) and, finally, to implement an nursing model based on intensity of care.

With the covid, it was found that a distribution of patients by areas of expertise and by need of intensity of care had more advantages than traditional distribution by services. Thus, As the ‘covid plants’ emptied, were occupied by beds in the new areas. For example: a patient operated on for lung cancer by the Thoracic Surgery and Lung Transplantation Service has very different postoperative care needs than other patients. lung transplanted by the same service. Previously, both were hospitalized on the service floor. Now, they are directed to different areas according to the level of intensity of care they will need: the former is admitted to the post-surgical area floor, while the latter is admitted to the solid organ transplant area.

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Concentrate knowledge and competencies.

Thus, these areas allow concentrate knowledge and competencies of professionals on a given health problem. Through meetings The development of new joint protocols and the daily work between personnel from different professional groups and specialties that used to work physically separated from each other, allows us to reach a much greater consensus on the tasks, to favor the fluency and improve the continuity of care.

“It is not the same to think about heart pathologies from the point of view of the cardiology specialist as from the intensity of nursing care or the physician, who must have a holistic view of the patient. Thus, the hospital can be more focused on working for very specific health reasons. and very well defined, concentrating the entire core of knowledge and hands,” says the Vall d’Hebron care director, Antonio Roman.

This new organization emphasizes the need to create e boosting professional roles that meet these needs, such as advanced practice nurses (APRNs), among others. The advanced practice nursing is a specialized nurse who provides direct care to the complex chronic patient. “Vall d’Hebron has been promoting this figure for some years now, but the organization by areas of knowledge allows us to perfectly identify where there is a health need that a PPI can address,” he says for his part. Mari Àngels Barba, Director of Nursing.

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