Du processus aux soins intégrés: Expérience de gestion de projet bottom-up

Le service de chirurgie cardiaque du CHU de Liège a soutenu des recherches visant à développer un programme d’épargne sanguine, enjeu actuel de taille dans ce secteur des soins de santé. Ce projet a évolué vers la création d’un itinéraire clinique chirurgical cardiaque et d’un modèle institutionnel pour le développement d’autres itinéraires cliniques. Une évolution qui permet de déterminer les missions spécifiques de l’institution et ses objectifs stratégiques, et de s’associer aux projets nationaux. L’adhésion multidisciplinaire, soutenue par un leadership médical et infirmier, ainsi que la reconnaissance institutionnelle sont les déterminants de la pérennité de cette démarche bottom-up

Saignements postopératoires et autotransfusion

Bleeding in the postoperative period of cardiac surgery is not rare. Mediastinal bleedings could potentially be saved with a cell salvage device. This practice may contribute to decreased allogeneic transfusion. This study explores the effectiveness of a chest drainage system combined with a cell salvage option during the postoperative period of cardiac surgery in patients at high risk of bleedingL'épargne sanguine à travers l'itinéraire clinique du patient opéré cardiaqu

Blood conservation strategy: a current issue

peer reviewedIn view of the demographic evolution, the progress of quality requirements and the shortage of donors, a deficiency of blood components is to be feared in the coming years.. This implies the development of a blood conservation strategy, the revision of transfusion practices and the implementation of preventive measures to limit transfusion requirements. Each department caring for patients at high transfusion risk should assess and rationalize its transfusion practices in a structured multidisciplinary wayLes produits sanguins labiles deviennent de plus en plus rares, en raison du vieillissement de la population, de la sévérité accrue des règles régissant leur qualité et de la diminution du nombre de donneurs. Cette réalité nous oblige à développer des stratégies d’épargne sanguine : reconsidérer nos habitudes en matière de transfusion et développer des mesures préventives diminuant la nécessité de ce traitement. Une étude de l’ensemble des éléments ayant un impact sur l’épargne sanguine est nécessaire dans chaque service accueillant des patients à haut risque transfusionnel. Il faut rationaliser les pratiques, notamment par une prise en charge pluridisciplinaire structurée.L'épargne sanguine à travers l'itinéraire clinique du patient opéré cardiaqu

Anesthetics

peer reviewe

A comparison of the training value of two types of anesthesia simulators: Computer screen-based and mannequin-based simulators

In this study, we compared two different training simulators (the computer screen-based simulator versus the full-scale simulator) with respect to training effectiveness in anesthesia residents. Participants were evaluated in the management of a simulated preprogrammed scenario of anaphylactic shock using two variables: treatment score and diagnosis time. Our results showed that simulators can contribute significantly to the improvement of performance but that learning in treating simulated crisis situations such as anaphylactic shock did not significantly vary between full-scale and computer screen-based simulators. Consequently, the initial decision on whether to use a full-scale or computer screen-based training simulator should be made on the basis of cost and learning objectives rather than on the basis of technical or fidelity criteria. Our results support the contention that screen-based simulators are good devices to acquire technical skills of crisis management. Mannequin-based simulators would probably provide better training for behavioral aspects of crisis management, such as communication, leadership, and interpersonal conflicts, but this was not tested in the current study. IMPLICATIONS: We compared two different training simulators (computer screen-based versus full-scale) for training anesthesia residents to better document the effectiveness of such devices as training tools. This is an important issue, given the extensive use and the high cost of mannequin-based simulators in anesthesiology