Perspectives

3.7. Perspectives

Une étude ultérieure pourrait évaluer les processus impliqués dans la démarche de planification de la sortie avec l’aide de la feuille jaune. En effet, rappelons que la démarche implique deux aspects différents, avec une première phase d’identification des patients à risque, et une deuxième phase d’action ciblée. On peut donc séparer d’une part la prise de conscience des membres des équipes médico-soignantes de leur

rôle dans la planification de la sortie, le calcul du score J3, la mise en commun des informations relevantes sur la feuille jaune et d’autre part, l’intervention sur les facteurs de risque modifiables et la préparation précoce de la sortie que cela soit un transfert en structure de moyen séjour, ou la mise en place des soins nécessaires à domicile. L’objectif d’une telle étude pourrait être de mieux comprendre l’impact des processus individuels ou de comparer leur efficacité les uns par rapport aux autres.

Un futur projet pourrait également tenter de mesurer les effets de l’intervention éducative-incitative sur la prise de conscience des équipes médico-soignantes quant à leur rôle dans l’organisation de la sortie. Une réflexion pourrait aussi être menée sur la meilleure manière d’évaluer l’amélioration de la collaboration entre les différents membres de l’équipe médico-soignante.

De plus, en vue d’une application plus générale de cette procédure de planification de la sortie dans l’institution, il serait important d’évaluer si les services sociaux et de physiothérapie sont capables de gérer un nombre potentiellement augmenté de demandes de prise en charge.

Finalement, une étude de l’implémentation du programme à plus long terme permettrait de s’assurer que les changements d’habitude des équipes médico-soignantes peuvent être maintenus au-delà d’une phase d’intervention aigue.

Le Prix Qualité de la Direction Médicale des Hôpitaux Universitaires de Genève a été attribué à ce projet en 2005 (Prix attribué à C. Berna, M. Kossovsky, J.M. Gaspoz et M.

Louis-Simonet)

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