Question

What could improve our taking charge of patients in the acute care pathway ?

Problem description

There’s a lack of mutual knowledge and coordination between the different psy107-functions

Impact - effect

The continuity of care is not always optimal. Indeed, the interventions implemented by the various functions in the network of the user are poorly relayed.  Information about the user is sometimes lost, poorly communicated, misunderstood, misinterpreted. We may feel powerless in certain situations that are not covered by our interventions.

We don’t appeal enough and appropriately to the existent network of Doornik.  The user might get lost in the “who does what” within his network. Furthermore, it is more difficult to work on the preventive aspect of our interventions when there’s a crisis situation

To do

An appointed network key- or reference person, who coordinates the network setup for the user, who is capable of synthesising the actions taken, who’s familiar with the different professionals working around the user and representing the various psy107-functions, can appeal to the right team at the right moment.

We must have more contact with the general practitioner of the user, as well as with the representatives of different functions. However, this thinking leads to another question, the one about transmissions to or exchange of data

Theme

Acute care pathway

Topic

Other functions psy107, than function 2, involved in the acute care pathway

Reference -  contact

Nicolas Berghe, Kévin Merchez

Mobile team

2A

Project

Hainaut Occidental

Intership abroad - place

Lille (SIIC)

Date

January 2014