Cultura

A Critical Review Of Optimizing The Patient Journey In Saudi Primary And Point-Of-Entry Care: A Review Of Interprofessional Workflows From Triage To Discharge

VOLUME 21, 2024

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

Turki Mohammad Almutiri, Ahmed Marwan Yaqoub Kutbi, Hussain masud Alamri, Mohammed Masoud Alamri, Aidah Abdullah Alkatheri
Yazeed Abdulrahman Saad Alharthi, Bandar Ateq Alharbi, Salman Saleem Alrabie, Khalid Mohesn Alzahrani, Mariam Yassin Al-Ammari

Abstract

To optimize the patient journey within Saudi primary health care and point of entry environments, coordination-based interprofessional workflows spanning the triage, assessment, treatment, and discharge are required. This review of the systems is a synthesis of evidence published in the period between 2020-24 in the context of Vision 2030 and the Health Sector Transformation Program on the interaction of the nurses with the physicians, allied health professionals, and administrative staff in the context of the care continuum. There is a review of 28 studies that found that there were still inefficiencies in the system especially long waiting times at the triage desk, which is usually between 30 and 60 minutes and disjointed discharge planning which leads to frequent revisions and lateness in follow up. Nevertheless, there is a number of interventions that have evident advantages. Electronic triage systems, organized case management, and common documentation systems were linked with the decrease in length of stay between 20 and 62 percent and significant declines in boarding time. Nonetheless, its application is not even. Deterrents that are common are strict professional hierarchies, lack of reporting workflow errors, and urban/rural PHC facility differences. Core workflow and staff roles are described in tables in the examined papers, whereas graphical information presents time-related metrics and prevalence of barriers as well as the quantifiable effect of interventions. The discussion brings to light gaps in the rural oriented studies and how hierarchies within the culture impact on teamwork. In general, standardized procedures, interprofessional training, and digital integration seem to be the viable steps towards more equal and efficient PHC in accordance with the national reform objectives.

Keywords : Patient journey optimization, interprofessional workflows, triage to discharge, Saudi primary care, Vision 2030, electronic triage, case management, waiting times, discharge planning, hierarchy barriers, rural disparities, Health Sector Transformation Program.
Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty