出版社：Utrecht University, Maastricht University, Groningen University
摘要：The survival of the critically ill patient depends on timely access to a structured critical care pathway. Arising from historic legacy arrangements, fragmentation of acute healthcare service provision in Ireland has been evident with evidence of ineffectiveness and inefficiency. A key to success of ongoing Government and State acute healthcare reforms is integration of patient-centred acute healthcare commissioning. Commissioning Pathway : In line with reform policy, Critical Care Programme (CCP) facilitates integrated and standardised commissioning in the acute sector by collating and furnishing service outputs and outcomes information in an annualised recursive input to commissioners and to the political system as part of the fiscal resource allocation decision-making process. Fiscal Allocation: Easton defined politics as the “authoritative allocation of values” (1953). Following the fiscal Vote of the political system in Ireland, top-down bloc grant funding flows to hospital service providers from which blocs critical care funds currently emerge. Capacity And Capability: The critical care bedstock capacity to meet the need of the critically ill patients is monitored by the annual Census enumeration process, which is facilitated by CCP. The capability to meet the needs of the critically ill patients is strengthened by the national integrated critical care nursing education and training and workforce planning initiative, termed Career Pathway, also facilitated by CCP and Office of Nursing and Midwifery Service Director of Health Service Executive. These national critical care capacity monitoring and capability strengthening initiatives serve to integrate and standardize national and regional critical care service provision in line with a hospital system “hub-and-spoke” Critical Care Model of Care. Audit : National critical care activity and risk-adjusted outcomes for critically ill adult patients in Ireland are monitored by the National Critical Care Audit, operated and governed by National Office of Clinical Audit, affiliated to UK Intensive Care National Audit Research Commission (ICNARC). Commissioning Cycle : The national critical care activity and outcome information, including critical care surge activity information, emerging from Audit is collated and evaluated against policy, regulatory, legislative and professional standard inputs. An annual normative national input thus is facilitated and thus recursively provided to the commissioners and the political system The aim and intended impact of this integrated commissioning pathway or cycle is to improve the survival, quality-of-life and experience of the critically ill patient in Ireland, to strengthen and sustain the critical care workforce and to modernize the care pathway and ease the care journey for the most vulnerable patients in the acute healthcare sector.
