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Table 1 – Pathway for st elevated acute miocardial infarction Infarto Miocardico ST elevato Valutazione Osservazione - monitoraggio Indagini Trattamenti Mobilizzazione, sicurezza Nutrizione - idratazione Educazione paziente e famiglia Traguardi per il paziente Emodinamica: Coronarografia, Angioplastica Monitoraggio ECG e invasivo pressione arteriosa e SaO2 Controllo tracciato (1 INF) Tricotomia, posizionamento, accesso venoso periferico (2 linee), trasporto in sala Inibitori della glicoproteina: tirofiban secondo schema di somministrazione (consumo 1 flacone / 1,5) Eventuale morfina Coronarografia (riferimento: 20’, 1MED, 2 INF di giorno, altrimenti 1) Prima dello stent: aspirazione del trombo (catetere export) Uso del pallone. Riferimento: Stent (ind 95%) – non medicati (driver) salvo situazioni particolari Dispositivo emostatico (angioseal perclose starclose) (1 MED e 1 INF di supporto per tutta la procedura, da 10 a 40’) - Digiuno - Fisiologica (continua) Consenso informato alla procedura Spiegazione condizioni cliniche (paziente prende visione condizioni coronariche) Riapertura della coronaria Riduzione o scomparsa del dolore Riduzione o scomparsa tracciato ECG sopraslivellato (riduzione del 50% sopraslivellamento complessivo e stenosi residua
CEIS Health Report 2006 ted into real pathways, needs to intervene on organization, on professional skills, on the introduction of new technology, on logistics, on available resources, on the responsibilities of personnel. Through the definition of a target pathway, process knowledge becomes then the driver to exit from an auto-referential cycle (because in time the benchmarking of a local standard with the local performance loses its promoting strength) and to evaluate the introduction of more relevant changes, in the appropriate time and setting, by the definition of a re-engineered pathway. 3.7.3 CeBePS – The Italian centre for benchmarking processes in the healthcare sector The Italian centre for benchmarking processes in the healthcare sector (acronym CeBePS), managed by Sanità & Management Consulting Srl with the partnership of AstraZeneca Spa and Pfizer Italia Srl and in collaboration with Eurosoft Informatica Medica Srl, was founded in 2004 with the aim of benchmarking care pathways. It initially took into consideration inpatient settings, that are the output of local initiatives that each participant health organization develops independently. At the end of two years of activity, the proposal for joining CeBePS has generated a network of 65 institutional participants, more than one-fifth of all Italians public health organizations. The target number of pathways expected to be included in the CeBePS database by the end of 2006 is 100. CeBePS distributes benchmarking data, in a concise and analytical form, to participants with three main objectives: • consent, through a consultation system, to explore the processing performance of other organizations; • support participants in developing benchmarking analysis, thus targeting best practices that deserve more in-depth knowledge; • promote quality management, through the imitation of those best practices. Both the summarized and the detailed reports, organized by specific diagnosis and procedures, provide sets of organizational, economic and quality indicators 7 (the latter specific to the condition considered and still being developed by participants that have already studied the process 8 ), computed on each CeBePS process received and presented with the name of the healthcare organization (reports are not anonymous). Each process reports the last update, number of patients treated and the completion of a variance tracking. 7 There is one separate report for each one of these three dimensions. CeBePS also provides a tool that allows the single participant to weigh the different indicators and to obtain the synthesis performance indicator in a minimum number of three (one for each single dimension). 8 In CeBePS reports, at the site www.samaco.it, drafts of indicators are available for inguinal hernia repair, COPD, stroke and total hip replacement. [216]
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Chapter 1 Health expenditure and fu
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3.1 - The efficiency of Regional He
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• Campania, with strong financial
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Page 210 and 211: ● Kaplan R, Norton D (1992), “T
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Diagram 4 - % composition of years
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5.2.4 Comments The results of the a
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among whites and blacks,1979-1989
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Figure 1 - Division % of the quota
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Figure 3 - Pharmaceutics expenditur
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Table 3 - Gross fixed investments i
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Table 4 - Share of medical device w
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age dimension of enterprises (90 em
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BOX 2: National Medical Device Clas
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maceutiche in Italia (1997-2001)”
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5.4 - Mobility of italian patients
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Authority (ASL) will be charged for
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43.950.716,00. At this stage, if yo
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esting data are certainly provided
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have carried out economic and stati
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[295] CEIS Health Report 2006
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✔ DE POUVOURVILLE GÉRARD Researc
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✔ MENNINI FRANCESCO SAVERIO Degre
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✔ SCHWEIGER ARTURO Health Economi
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Chapter 2

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