Table 1 Summary of the barriers, interventions and reasonable adjustments of the project
Barriers & Working group | Before the interventions | Interventions & Reasonable adjustments | After the interventions |
|---|---|---|---|
1. Reduce quality of care and poor healthcare coordination Patient care path | Long waiting time in the ES Inadequate care Sent home without proper care No information on medical care No coordination of the patient care path Transfer home or in supported residential accommodation without coordination or warning, sometimes during the night. | A simplified emergency admission procedure A disability admission sheet A central phone number for ES admissions Shorter waiting time in ES 60% ID-physician position 100% ID nurse case manager Close collaboration with the “Pain Network” Creation of the ID outpatient clinic once a week | The disability admission sheet is used throughout the HUG and by families and every supported residential accommodation in Geneva. It is available on the internet. The central phone number has been given to families and supported residential accommodations and is used very adequately by all partners. The ID-physician position is made permanent The nurse case manager plays a key role in facilitating the communication, counselling and organising the hospital stay. No transfer of patient without warning or during the night An average of four specific consultations for PWID each week take place. |
2.Poor communication and information transmission Communication | ID-Patient and families or carers not listened to by HCP No information on medical care Transfer home or in supported residential accommodation without coordination or warning, sometimes during the night. | Dedicated Internet webpage Video on the project Easy to read and understand accessible information on medical procedures | A phone call to families and carers before transfer No transfer of patient without warning or during the night. Webpage is user’s friendly and continuously improved and up-to dated The ID admission sheet is used throughout the Hospital and in all the supported residential accommodations as well as to families |
3.Lack of training of healthcare professionals Human resources | HCP not aware of the specific needs of ID patient They do not know how to care for nonverbal patient with challenging behaviour. | A flash training of fifteen minutes for doctors, chief and senior nurses A two-hour session for emergency-HCP and professionals in sensitive departments A five-day training program for HCP and hospital staff Specific training program for student nurses | Training of more than 150 HCP in 2017 Participation and professionalization of PWID as co-trainer Training is greatly appreciated by participants Training of HCP remains a challenge due to lack of time and needs to be developed. |
4.Inaccessibility Accessibility | Some buildings of the hospital are not accessible to wheel chairs Lack of rails and revolving doors not accessible to large electric wheelchairs. Insufficient parking spaces for large vehicles for PWID | Assessment on the accessibility to all buildings Eight new dedicated parking spots Replacement of the revolving doors of the main entrance of the hospital Several access ramps, handrails and doors added | Some revolving doors from the new hospital building need to be changed as well. The signalisation of the outpatient clinic is still unsatisfactory and needs to be improved New parking spaces should be provided for the outpatient clinic in 2019 |