Transcript Video The Spanish Experience < Back to Summit23 Brain Injury Management The Spanish Experience Presented by Professor Richard Ferrer & Dr. Pablo Jorge Perez And this is gonna complete our session with the implementation part. We're all eager to hear you uh from a Latin country to a Latin country. So um please, the stage is all yours. Thank you, Thomas and thank you to uh to BD Christian. Thank you for inviting us is uh for both of us. A pleasure to be here in this fantastic conference. Um We're gonna talk about the Spanish, the Spanish experience. You can think that there is, there are a lot of different and provocative Spanish experience. But here we're gonna talk about post care and cardiac arrest centers. I would like to start uh focus your attention, attention in patients. Why we decide to start this process? Why we are working together? I'm a cardiologist, Ricard Ferrer. He is an intensivist. He's leading, he's the chief of the intensive care department of Val de BR in Barcelona. So why, why we are here together is because of patients? Probably you are thinking right now all of you in, in that patient that recover or, or those who couldn't recover and we could do more if we were better organized. Probably all of you are thinking in that patient. In this picture, you can see this young guy at the right of the picture. Isa Ferrer. The other young guy in the middle is Ivan. Ivan is actually a fireman and he has been a fireman for all his life. He suffer arrest eight years ago with me in Tenerife. Not I wa I wa I was not there but he was at home with his wife and his brother in law. 40 minutes of CPR at home. Uh early transfer to to car center, early recognition witnesses bystander CPR uh A ad and shock deliver at home. Uh primary PC I of uh L AD and fully recover. He has been father for 2nd, 2nd time after he has recovered for cardiac arrest. He is still working as a fireman, not in the first line, but he's working as a fireman. He has do, he has, he has had a second opportunity in his life. And this is the way we are here. This is the way we are doing research. We are trying to improve patient care and uh of hospital care prognosis. This is the why and the how is a true collaborative work between the Spanish Society of Cardio and the intensive care, intensive care of society? Because we understand that the, the, our goal of our main objective is patience and patience is the, the, the, the, the, the the thing that we, we, we, we, we push to work together So this is the why this is the how and now we have been identified some challenge during this process that we are going to share with you for different challenge that we have to handle to develop this process. So Ricard is gonna start with the first challenge. Thank you, Pablo. So I I can tell you that Ivan has a much better quality of life than me because he's uh you know, he's training every day and he's very strong and he's doing very long trips. Uh and it was really, really fantastic to hear his history. So, so we started several years ago, this process of quality improvement uh National Quality Improvement Program. So this is very ambitious. So we started with the three, the three strategies. First one was in the in the right. You can see we collect the evidence, of course, international evidence coming from the guidelines. But also we prepare a document, collecting the evidence that we have in Spain and how we translate this international guidelines into into the Spanish scenario. This is an expert opinion, multi discipline, expert opinion paper. But for us, it's very important to have this in place before starting and then we assess which is the room for improvement we have in Spain. So for that, uh we use a survey of course and now that it is much better. But uh I have to remind you that this was done in 2020. So in 2020. It's not possible to add anything in the Spanish IC US because we were in the middle of the, of the COVID COVID pandemia. So we decide for going for a, for a survey and to assess which is the room for improvement you have in Spanish IC US, uh cardiology IC US and general IC US. And also taking data from the survey. We also assess the cost effectiveness looking if it's worth to invest in that or not. And everything is collected in this position paper that is accessible in Spanish and English from the uh uh Spanish Society of Cardiology and Spanish Society of intensive care. So the optimal could be protocol I care in one of these cardiac arrest center, this could be the optimal but this is what this is what we don't see that in our survey, we we see that many patients are transferred to the closest hospital with an IC U without looking if the center is able to do a PC I or if the the center is able to do neuroablation or a multimodal neurop pronostica. So this is the common practice. So in fact, there is a room for improvement. When uh we see how the patients with cardiac arrest are treated in Spain, you will find all the results in this position paper that I show you. This is not the topic for today. Maybe for today, we can discuss deeply about the cost effectiveness because the paper was published last month and this is more new results. So I have to say that this is data coming from a survey. So this is subjective data. So we ask, what do you have in your center? But also which are the results in your center? And we compare the results uh that are um mm explained by those centers that have tt M whether they have uh server control or TT M without server control. It's 5050 at the end. So 50% of the centers are using Servo control, say 50% of the centers are not using Servo control. And in this uh sub group of hospitals and at the end, sub group of patients, it is more than 2000 patients that they explained they treated in spain during this period. Um We see that the only independent factor for uh having a good prognosis or a better prognosis is using servo control and uh the improvement is around 13% of uh better prognosis using servo control. So we assess the effectiveness for assessing the effectiveness will look to the quality quality adjusted life year gain. And uh according to the data provided by the centers, there is an increase in 0.5 years of life gain with good quality of life if you use uh server control, according to the data coming from the survey. And when we assess the cost, we assess the cost using Euros 2020 in Spain could be completely different from Germany or from other countries because this is that coming from Spain and also it is 2020. So it could be because the inflation you know could be different from Euros 20 23rd. So there is an increase in cost using server control. In direct cost, there is an increase small increase but there is a reduction in the global cost taking into account indirect cost if you use server control. The reason is because we uh as we have uh less patients with bad prognosis, of course, the indirect cost generated by the loss of productivity, for example, and the cost of rehabilitation is lower. So at the end, when you do the equation, you find, you find that for saving one year of life with good quality of life, you have to invest €1800. Yeah. If you look to our lifetime, it's a dominant intervention that means that you save money using this type of techniques. So this is the last paper we published from this, from these initiatives. So now we are going to move to the second challenge we have in this quality improvement uh strategy in Spain. Uh Yes. And after uh Ricard uh was at uh continue with Ricard was saying we the the the the project, what we started a couple of years ago, we did the survey, we did the economic analysis and then we start working and try to define uh c uh certification document that uh collect all the evidence to try to avoid the variability that we have. We have some in the, in the, in the survey and also uh in collaboration with the European societies to try to incorporate some of the quality indicators that uh Christian uh mentioned it before. So what we did is uh with the uh strong uh collaboration between societies on the, on the top, we uh we try to go to the local administration. So we have had uh so far two meetings with the Ministry of Health, but also with local health government because uh uh the health system in Spain is divided in local communities. So uh each local communities should develop uh mm areas of improvement at local uh with local resources. So even going to the Minister of Ministry of Health, we we should we have to go to different local governments to show what we are thinking to do in terms of uh certification, to avoid or to reduce variability, to give our patient best care. So we have been moving uh so far in five local communities, we receive some financial support from, from BD in Spain to try to develop all these process. And then uh at the, at the, at the uh the part in, in the in the below. Iron ore is a private company is some huge experience in Spain in certification process. Not only in health care. Also in engineer and, and different areas that they, they certificate process uh following quality of care. So this is the, the, the the whole group that is working together to try to uh develop the certification process. And where we are now is that we have been developed the uh certification uh document for out of hospital arrest between both societies and I and R is, is starting to audit to pilot centers that we are working on it. And Ricard is gonna tell something. Uh Later, this document is shared in our both societies. You can, you can check it and, and, and, and, and download it if, if you want it. And here what we have done uh similar to the quality indications uh comment by uh Christian before we have select two different levels of cardio andreo level one and level two. Level two is the uh the most uh hospital, the most centers that we have in in our different regions with emergency department. IC U uh 24 7 cla uh image and neurop pro education and level one could uh uh have more uh resources like mechanical support uh I CD implant, implement insertion and uh uh interventional radiologist. So we define some uh different areas to, to, to Audi to certify like uh as you see in the slide provision of consensus post category centers. So human resources, material resources and equipment control, if they are in good conditions to be used also the requirements for post cardiac arrest process. Uh the training, information and communication between uh nurses between families, between patients. And also the commitment with uh uh to continuous improvement with management of incidents, adverse events and sentinels. And uh we develop a process monitoring and measure to uh to try to achieve the best care for our patients. And this we can obtain from local resources from centers. But also we have been defined a specific quality indicator for, for measurement and try to do our best and give our patient our best care. So being here, we move to the last challenge that is uh where are we going right now? So which is the next the next step? The next step is that we need to pilot this certification tool. Because before scaling up, it's very important that really we fine tune with this uh with this uh certification. And then when we have the certification finished and approved by the Board of the Voice Societies, we need to lobby the administration with the objective is that those units that are certified by NR but also by the two scientific societies really are the accredit centers for cardiac arrests management. So this is where we want to go. Let's see, there are many question marks in this road map of course. So piloting certification, this is a way of testing the tool, a way of testing the tool. So we have tested the tool in two hospitals, one in Madrid and one in Barcelona, just to check how we can improve the tool, which part of the certification can be virtual and which part of the certification must be inside. And also how we manage the follow up, how the inr is checking that all the changes that are needed are really done. And and we want to do to do this also virtually instead of having another inside visit. So this is in terms of uh being pragmatic. We, we try to and and Christian discuss about that. So we have to minimize the cost and dedication for that. So we try to do part of the, of the, of the work virtually. But we have to dedicate it one single day for a complete hospital visit to all of these departments. My colleague, Juan Carlos Ruth is in the is in the room and uh he was the leader of this uh project in by lebron. So I'm sure he will happy to take questions from you. You have specific question how we handle this inside of the hospital. So after the pilot is finished, that is uh will be finished uh before the end of this year, then we have to scale up and for scaling up. Uh that means that the administration and, and Pablo said the administration in Spain is uh uh is under regional governments. So if we want to have an initiative coming from the Ministry of Health they move things if they have the agreement of all the regions, if not, they are not moving things. So maybe we are able to achieve success in some regions, maybe we are very successful. We have a national program uh in place. But the first objective is really to create a network of certified IC U IC US or better accredited IC U. Once we have this network, then we have to agree in the same protocol, of course. And then uh of course, if we need to buy or to adapt the technology, this is an opportunity to improve really an opportunity to improve for the centers. It's not an exam. It's just an opportunity that some centers that could be a level one can be a level two, but maybe they need some improvements. They have an opportunity to have an outage saying that you need that and then to improve and to achieve a level. And if this is achieved and we have a good partnership with the administration, the final idea is that the emergency systems will send patients without hospital cardiac arrest to those centers that are certified or better if are accredited. So this is our strategy. So maybe next year, if we are invited again, we can, we can explain to you how we are in this uh long uh road map that we have that we have ahead. Thank you very much for your attention and we are very happy to take questions. Created by
