Introduction
This report covers hospital visits in Europe conducted between 20 October and 5 November 2014. The main purpose of the tour was to determine the following:
- What made these hospitals special in terms of services, beds, reputable physicians, international patients and rare complications they treated (the aim is to convince management team why these healthcare institutions are good)
- Build a better cooperation because of the duty to send patients abroad for treatment (expenses are fully covered by the government)
- Understand patient transfer protocol i.e., transfer of patients from the UAE physicians to international doctors with all patients’ records
Universitair Ziekenhuis Brussel (University Hospital Brussels – Prof. Tournaye)
The hospital is one of Belgium’s premier Centres of Excellence in healthcare, biomedical research and medical education (HealthCare Belgium 1). It is globally recognised with a legacy of innovation that relies on modern clinical programmes. The following elements of patient care were discussed:
- Patient transfer protocol
- IVF protocol discussed
- Minimum length of stay needed
- Genetic testing in the UAE before the start of treatment (preliminaries)
- Legal form/ letter of privacy/legally recovery
- Number of discharge for patients to hospital St. Luc (Prof. Debieve)
The objectives of University Hospital Brussels as COE include:
- IVF and ICSI
- Treatment cycles (1 with fresh embryo and additional maximum of 3 cycles with frozen embryos covered by HAAD
- The length of stay in Belgium should not exceed 6 months
- Control of process by UZ direct (Prof. Tournaye)
- In case of pregnancy, additional maximum of 12 weeks is considered subject to evaluation by UZ department for obstetrics (Prof. Gucciardo)
University clinics Ulm – paediatric department, Prof. Debatin
The hospital is known for excellent dental medicine, centre for surgery, tumour, research and medical training in association with universities. The following areas of concerns were discussed:
- Patient transfer protocol
- Direct contact (doctor to doctor) is absolutely necessary
- Refusing of cases
- Transplantation units (BMT, SCT) were visited
As COE, it was noted for
- SCID (one of two centres in Europe)
- Complete paediatric oncology, treatment of rare cases and diseases
RKU Ulm University and rehabilitation hospitals Ulm – Dr. Kalke
The clinics are known for their utmost patient care specifically in orthopaedics and neurology (Ekso Bionics 1). They offer acute care alongside medical and vocational patient rehabilitation (Ekso Bionics 1). The university hospital has several units for orthopaedics that include paraplegic unit. In addition, it also has a neurology centre with a stroke unit, ICU and anaesthesiology centre. Close to the centre, there is also another orthopaedic pain clinic.
The university clinics of neurological and orthopaedic sciences are reputable for research and training. They also have acute and a Centre for Integrated Rehabilitation for collaborative patient care. Hence, the RKU provides clinical medicine, vocational training and rehabilitation services at Ulm.
The following issues were discussed:
- Patient transfer protocol discussed
- General scheme with treatment of all neurologic diseases or other cases, including also exoskeleton
- Rehabilitation and physiotherapeutical facilities were visited
The clinics are COE for the following:
- Neurologic, post-traumatic, orthopaedic rehabilitation and physiotherapeutic centres,
- Huntington centre
- Parkinson centre
Stuttgart clinics – Prof. Bielack
The Klinikum Stuttgart Hospital specialises in several areas, including “medical and surgical oncology, cardiology and heart surgery, orthopaedic and endoprosthetic surgery as well as restorative surgery, abdominal surgery, vascular surgery, neurology and neurosurgery and paediatrics” (Klinikum Stuttgart 1).
The hospital has earned reputation for diabetes, foot ulcers, surgery cataracts, glaucoma and osseous sarcomas (CWS and COSS) treatment. In addition, it leads in care for ear, nose and throat as well as maxillofacial surgery treatments.
The centre also offers specialised care in paediatric oncology, haematology and immunology clinic as the best and largest one in the country (Klinikum Stuttgart 1). It has over 6,400 employees equipped with modern medical equipment. Moreover, it is also a teaching and referral centre that benefits patients with modern knowledge in medicine and a full range of options. The hospital offers individualised, specialised services on a case-by-case basis.
The following issues were discussed during the hospital tour:
- Patient transfer protocol
- For successful treatment, reliable information is required as early as possible before starting the treatment
It was identified as COE:
- Paediatric Sarcoma (osteo- and soft tissue)
Prof. Dr. Gerald Illerhaus
Dr. Illerhaus is responsible for several clinical patient conditions. In addition to normal treatment of internal disorders, there are other specialised interventions. The treatment is highly coordinated among different units and with Stuttgart Cancer Centre.
The following issues were discussed during the hospital tour:
- Patient transfer protocol
Clinic identified as COE:
- Head and neck tumours (adults), leukaemia and lymphoma
Prof. Dr. Christian Sittel – Klinikum Stuttgart
Dr. Sittel is a specialist in Ear, Nose and Throat (ENT) conditions and plastic surgery. The clinic is among the prominent supraregional ENT clinics with latest procedures and treatment for patients. There is excellent collaboration among specialists to tackle some of the most complex clinical procedures adequately. Hence, the clinic is recognised for airways and ear treatments. It is known for hearing interventions and aid. Physicians use state-of-the-art technical equipment and qualified staff to provide quality care.
The following issues were discussed during the hospital tour:
- Patient transfer protocol
- Problems with germs
Clinic identified as COE for
- ENT
- Paediatric airways
- Plastic surgery in the ENT region (Flap’s)
Beta Clinic Bonn – Prof. Reul
Beta Klinik specialised in diagnostics and treatment of head and spinal problems. Today, the clinic offers various treatments to international patients. The clinic relies on state-of-the-art facilities such as ICU, operating rooms and recovery units. It also has the latest diagnostic tools such as scanners. Beta Clinic offers diagnostic, treatments, surgery or measures of rehabilitation a holistic manner to decrease the numbers of consultations to the necessary minimum (Beta Klinik 1).
The following issues were discussed during the clinic visit:
- Patient transfer protocol
- Interdisciplinary approach to neurosurgical diseases
- Facilities, including ICU were visited
- Cooperation with Prof. Messing-JĂĽnger in St. Augustin (Asklepios) related to paediatric neurosurgery
Clinic identified as COE for
- Head/brain and spine surgery (plus minimal invasive endoscopic surgery)
- Endovascular/neurovascular surgery
University Hospital Bonn – Prof. Holzgreve
The hospital specialises in providing excellent patient care, research, teaching and referrals for international patients.
The following issues were discussed during the clinic visit:
- Patient transfer protocol
- Current research for patient (life & brain)
- Basic needs for opinions on clear diagnosis, related anamnesis, x-rays
- Emergency facilities were visited
Clinic identified as COE for
- Epilepsy – Prof. Elger
- Neurosurgery of epilepsy – Prof. Vatter
- Treatment of rare diseases – Prof. Klockgether
- Orthopaedic-traumatology and orthopaedic oncology – Prof. Wirtz
Klinik Hoehenried, Lake Starnberg – Mr. Zucker
The clinic has the latest state-of-the-art Cardiology, Orthopaedics and Psychosomatic Medicine departments, which operate directly together, using an integrated treatment model to provide adequate patient care (Klinik Hoehenried 3-8). In addition, the clinic’s location on Lake Starnberg with the surrounding park and trees are meant to facilitate well-being of patients.
During the clinical visit, the following issues were discussed:
- Patient transfer protocol
- Hoehenried presented discussion on cross boarder pathways
- Additional presentation by Hoehenried about needs of IPC-HAAD duties (protocols, procedures, length of stay (one and half months) fit to fly and follow-up among others)
- Doctor to doctor communication and cost containment
- Interdisciplinary cooperation with acute-hospitals nearby
- Non-profit organization (German pension insurance fund)
The clinic was identified as COE for
- Cardiological rehabilitation (recommended by all Munich heart centres) – Dr. Bongarth
- Clinical pathways and therapy plans for future cooperation developed with transparent costs presented (also for orthopaedics)
- Existing cooperation with hospital from the UAE such as Al Ain Cromwell
Schoen clinics München Schwabing – Mr. Hauenschild (Vogtareuth), Mr. Ludowig (Bad Aibling)
The Schön Klinik München Schwabing is known for its high-performance medicine and treatment in specialised areas for different neurological diseases orthopaedics, surgery and internal medicine based on the latest international guidelines.
These issues were presented during the hospital visit:
- New process of patient steering through IPC
- Patient transfer protocol
- Treatment plan, follow-up, medication, equipment and maintenance, repatriation and evaluation
- Medical coordinator for all clinics existing (Dr. Herzog – Schwabing)
It was identified as COE for
- Neurological rehabilitation and ICU – Bad Aibling
- Paediatric scoliosis centre – Prof. Wimmer, Mr. Vogtareuth
- Paediatric neurology – Prof. Staudt
- Epilepsy surgery – Dr. Kudernatsch
The following issues were identified for immediate consideration:
From Schoen
- Case definitions for doctor to doctor contact
- Outcomes measurement due to better medical outcome
- Development of forms and templates
From IPC:
- Proposal for a new medical-report form
- Development of forms and templates
Gustave Roussy Cancer Campus – Grand Paris Dr. Serge Bonnetier (IPO), Charles Guepratte (directeur generale)
The hospital campus is dedicated for innovation in oncology treatment.
These issues were presented during the hospital visit:
- New cooperation and process of patient transfer protocol
- Interdisciplinary or multidisciplinary approach to all major cancer diseases presented by hospital
- Clinical trials, studies and research
- New techniques (nanoparticles, radiotherapy, medication, monoclonal antibodies) and tumour transplant program of cancer treatment
- Visitation of paediatric ICU, general wards and outpatient centres
The hospital campus was recognised COE for
- Breast cancer – Prof. Egermont
- Head and neck (ENT) cancer
- Lung-cancer, sarcoma, myeloma, lymphoma (multiple and low grade) – Mr. Hodgkin,
- Testicular/ovarian tumours and autoimmune diseases, leukaemia (AML)
- Robotic surgery (Da Vinci)
- Surgery of large tumours
- ICU only for oncological patients, adults and paediatric patients
Hospital Necker – Enfants Malades /children hospital – Paris Prof. Yves Ville
The hospital focuses on children health, genetic diseases and other rare conditions.
During the tour, these issues were addressed:
- New cooperation and process of patient transfer protocol
- Doctor to doctor communication
- Presentation of hospital (3000 paediatric beds consisting of 60 ICU beds only for neonatology, 35 centres for rare diseases, 20% of patients come from abroad and therefore development of telemedicine services is planned)
- Visitation of general wards, ICU and outpatient facilities
Hospital Necker was noted as COE for
- Only centre for neonatal surgery in France (> 200 cases), cardiac surgery, visceral surgery, intrauterine twin surgery (TTT) – foetal medicine centre, ECMO centre (e.g., for lung diseases), treatment of all congenital abnormalities, integrated services from pregnancy until delivery: MIKADO – Prof. Ville
- Direct contact to Prof. Ville for HAAD possible
- Offer from hospital to facilitate Visa service
The following issues were identified for immediate consideration:
- Hospital Necker will prepare for HAAD a proper list for international contacts to the experts and a price list
American Hospital – Paris, Mr. Andre Kather
The hospital is not-for-profit and it has specialised units for emergencies, maternity, cardiology, neurology, digestive surgery, oncology, internal medicine, paediatric and breast clinic among others (American Hospital of Paris 1).
Issues discussed during the visit included the following:
- Process of patient transfer protocol
- Presentation of outpatient centres (doctors from other hospitals offering investigations and medical treatment)
- Visitation of presidential suites and general wards
- Visitation of emergency unit and ICU
American Hospital is a COE for
- Bio-absorbed cardiac stents – Dr. Tarragano
- Robotic thyroid and gynaecological surgery, Cyber knife treatment (neurosurgery) – Dr. Chiche
The hospital is accredited by the Joint Commission and offers exclusive patient rooms
Barraquer Eye Clinics – Barcelona, Mr. Elizalde, Mr. Prats
The centre is devoted to “research, prevention, diagnosis, treatment and follow-up of ocular diseases, offering assistance to patients from all over the world” (Barraquer Eye Centre 1).
Issues discussed during the visit included the following:
- Problems of patient transfer, second opinion, changing of hospital and estimated length of stay
- Problems with interpreters and medical reports
- New process of patient transfer protocol
- New process of evaluation of follow-up
- Operation theatre visited
The Eye Centre was identified as COE for
- The first intraocular chip for artificial view/vision implanted
- Longest experience with ophthalmological treatment
- Intensive-course customised trainings for doctors
- 44 specialised beds
IMO Eye Clinics – Barcelona, Dr. Corcostegui, Ms. Rodriguez
The clinic aims to protect and preserve vision and offer highly specialised ophthalmology treatment for different eye conditions.
Some of the issues addressed during the visit included:
- Problems of patient transfer, second opinion, changing of hospital and estimated length of stay
- Problems with interpreters and medical reports
- New process of patient transfer protocol
- Death case
The eye clinic was noted as COE because of broad experience in ophthalmological treatments.
Quiron/Teknon Hospitals Barcelona, Ms. Sanchez – CEO, Mr. Lavilla -RMD, Mr. Ortega international relations
Teknon is one of the leading healthcare providers in the country because of high quality services based on the highest standards of safety and staff dedication (Hospital QuirĂłn Teknon 1).
Some of the issues addressed during the visit included:
- New cooperation and process of patient transfer protocol
- Doctor to doctor communication
- Presentation of hospital
- Visitation of general wards, ICU and outpatient facilities
- Visitation of 24 hours emergency facilities
- Visitation of rehabilitation centre
It is recognised as COE for
- Oncology (multidisciplinary international breast cancer centre, prostate cancer, lung cancer) – Dr. Baselga
- Surgery – Dr. Delacy
- Da Vinci robotic surgery
Hospital Sant Joan de Deu (St. John of God – children, maternity and paediatric) Barcelona, Dr. Enrich CMO
The hospital is a leading healthcare centre for children and adolescents in Barcelona. The hospital group is internationally acknowledged for its medical specialisation, research and teaching (Sant Joan de DĂ©u 1).
During the visit, the following points were discussed:
- New cooperation and process of patient transfer protocol
- Doctor to doctor communication
- Presentation of hospital (non-profit organization, among of the top 3 paediatric hospitals in Europe, a part of university, established international network (Italy-Bambino Jesu and London Great Ormond)
It is recognised as COE for
- Oncology (neuroblastoma, retinoblastoma, musculoskeletal and brain tumours, Ewing sarcoma) – Dr. Mora
- Cardiac centre (surgery of congenital malformations, foetal and neonatal catheterysm, valvuloplasties, ablation surgery) – Dr. Caffarena
- Orthopaedics (biological reconstruction of bone defects, minimal invasive surgery, cell therapy of chondral defects, VEPTR and IAS-spine, PAO-hip, ACL-arthroscopy) – Dr. Knorr
- Neurosciences (metabolopathies, refractory epilepsy treatment, neuromuscular disorders, ataxia and movement disorders) – Dr. Campistol
- Ophthalmology (retinoblastoma, rhabdomyosarcoma, congenital glaucoma and cataract, vitroretinal surgery – Dr. Prat
Municipal Klinikum Bogenhausen – Munich, Dr. Fischer CEO Munich hospitals, Ms. Nienhaus IPO
The hospital is a complex teaching hospital that provides highest quality of medical care in Munich.
The following issues were discussed during the tour:
- Improvement on problems of running cooperation
- Patient transfer, second opinion, changing of hospitals and doctors
- Estimated length of stay
- Main problems with interpreters and translations of medical reports
- Lack of information on reports, x-rays, pathological details for oncology from UAE hospitals
- Length of stay (doctor “shopping”)
- Number of patients
The hospital is recognised as COE for
- Plastic surgery – Prof. Ninkovich
- Orthopaedic/shoulder surgery – Dr. Seebauer
- Urology – Dr. Beer
- Gastroenterology and oncology – Prof. Schepp
- ENT – Prof. Wagner (successor of Prof. Wilmes)
- Visceral surgery – Prof. Agha (successor of Prof. Heitland)
The following issues were identified for immediate consideration:
- Interpreter labelling/marking – HAAD
- Munich hospitals – English medical reports
University clinics rechts der Isar – Munich, Prof. Gradinger CMO, Mr. Zendner CEO, Ms. Schaefer, head of patient affairs
The centre is a patient-focused hospital that is dedicated for highest possible levels of healthcare. The hospital claims that it can offer treatment for every illness, from the most common to the rarest (Klinikum rechts der Isar 3-14). It rides on the philosophy of the Science of Healing, which guides the institution to offer the best medical and scientific services to heal patients. Klinikum rechts der Isar is noted for its international focus on patients.
It has over 4,500 employees spread in 33 individual units to cater for international, regional and local patients. The workforce is diverse with over 60 various nationalities. In addition, stakeholders work closely with international colleagues to develop best practices in medicine.
The following issues were discussed during the tour:
- New patient transfer protocol
- Problems of running cooperation (main problem: open bills)
- Length of stay discussed
- Visitation of unique neuro-radiological intervention and neuro-imaging unit (Prof. Zimmer)
- Visitation of ophthalmological department (Prof. Lohmann – visiting doctor of Al Maktoum family)
- SCT for cornea and retina, robotic surgery of retina, brand-new O-CT linked in the microscope
- Cooperation with university Essen due to melanoma of eye
The hospital is recognised as COE for
- vascular surgery – Prof. Eckstein
- Urology and oncology – Prof. Gschwend
- Sports orthopaedics – Prof. Imhoff
- Orthopaedics and oncology – Prof. v. Eisenhart-Rothe
- Nephrology (rheuma and diabetes) – Prof. Heemann
- Neurology (MS) – Prof. Hemmer
- Dermatology – Prof. Biedermann
The following issues were identified for immediate consideration:
- University hospital will prepare a list with experts and their special medical fields
SkĂĄne University Hospital – Lund (Sweden), Dr. Mikael Rosen (CEO), Ms. Ingrid Bengston (group management), Ms. Petra Ahman (chief program development officer)
SkĂĄne offers intensive patient care in different highly specialised areas such as heart and lung; diabetes; orthopaedics; paediatrics; reproductive health; and plastic surgery among others. It applies unique techniques for heart transplantation and dialysis management. It plastic and reconstructive surgery technique relies on innovative approach that lessens damages to large lymphoedemas. The university hospital is active in Cardiothoracic Surgery, Anaesthesia and Intensive Care administrated.
SkĂĄne is recognised for its international efforts in healthcare and collaboration with other specialised colleagues to improve the quality of patient care.
What was discussed:
- New cooperation and process of patient transfer protocol
- Interdisciplinary/multidisciplinary approach to diabetes and comorbidities presented by hospital
- Clinical trials, studies and research due to diabetes
- New techniques such as vascular surgery
- Cooperation with Iceland on paediatric cardiac surgery
- Visitation of general and paediatric ICU’s (top isolated rooms) and general ward
SkĂĄne is recognised as COE for
- Paediatric cardiac surgery, cardiothoracic surgery (lowest mortality in Europe) – Dr. Pelle Johnsson
- Vascular surgery (aneurysmatic surgery, grafts per catheter) – Dr. Pelle Johnsson
- Robotic surgery, plastic surgery (ear reconstruction), neurosurgery (deep brain stimulation) – Dr. Pelle Johnsson
- Endocrinology (diabetes) – Mr. Anders Dybier
The following issues were identified for immediate consideration:
- Skane will send a pricelist and medical expert list with contact details
BG Clinics Murnau – BGU Murnau, Prof. BĂĽhren (CEO)
The clinics offer the best care as the largest supraregional trauma centres in Germany. It works with patients from accident scenes, primary care to successful recovery and reintegration. The German insurance rule requires hospitals to devote all available resources for patients’ treatment.
BG Clinics handle different forms of severe injuries and polytrauma, spinal cord injuries, burns, brain, paediatric and mid-face injuries with highly specialised medical equipment. It is the global leader in minimal invasive spinal surgery based on endoscopic monitoring techniques. The technique reduces challenges to patients during interventions. The clinics ensure adequate medical care for seriously injured and surgical interventions on various parts of the body.
The following issues were discussed during the hospital visit:
- Improvement of minor problems of running cooperation
- Patient transfer, second opinion, changing of hospitals and doctors
- Estimated length of stay due to change of diagnosis
- Lack of information on reports and x-rays from the UAE hospitals
- Patient transfer protocol
- Visitation of private ward, ER and ICU
The BG Clinics are COE in European and German for traumatic surgery, road traffic accidents and polytraumatic patients with all accompanying injuries and diseases.
Medical Park Rehabilitation Clinics (St. Hubertus Bad Wiessee) Tegernsee, Mr. Gores (chairman of management) Prof. Horstmann
Medical Park has several healthcare services, including therapeutic and rehabilitation services and prevention. Physicians are highly experienced and clinics have modern equipment while care is offered in ambient environments to facilitate healing.
The clinics provide diagnostic and clinical specialties; illnesses and injuries of the musculoskeletal system; heart and circulatory problems; internal illnesses; illnesses of the brain and nervous system; and psychosomatic illnesses. In addition, the clinics offer specialised care in psychosomatic medicine, neurology, cardiology/internal medicine and sports medicine and orthopaedic.
In addition, the clinics also offer qualified medical interpreters to patients, including Arabs. They observe cultural influences on healthcare.
Medical Park Clinics have adopted naturopathy to provide a holistic treatment to patients. These are traditional techniques applied to optimise modern treatment for quick recovery. The clinics work collaboratively with other specialists to offer the best therapeutic interventions based on proven scientific research outcomes and medical experiences in osteopathic and manual therapy, fasting cure, acupuncture and neural therapy.
- Some of the issues explored during the visit included:
- Improvement on problems of running cooperation
- Patient transfer
- Estimated length of stay
- Doctor to doctor communication regarding following treatment in the UAE
- Patient transfer protocol
- Visitation of private ward and rehabilitation facilities
Medical Park is a centre of excellence
- Experienced rehabilitation centre (orthopaedics and cardiology)
The following issues were identified for immediate consideration:
- Medical Park wants to make an offer for partnership/cooperation
Rehabilitation Centres: Noce Lazne, Cisarske Lazne -Teplice (Czech), Ms. Yveta Sliskova, Mr. Michal Sincak
The rehabilitation centres have natural spas that focus on different medical conditions. They include mobility challenges, kidney infections, digestive problems, urinary tract infections, posture pains, orthopaedic disorders and chronic inflammatory conditions. In addition, rehabilitation centres also treat blood pressure and circulation challenges, fibromyalgia and respiratory challenges among other conditions.
The rehabilitation centres have experienced teams of physicians and specialists in medical recovery management. Personal physicians are also allowed to examine and prescribe preferred interventions their patients. There are modern health facilities in these rehabilitation centres.
Some of the issues discussed during the visit included the following:
- Patient transfer protocol
- Improvement on problems of running cooperation e.g., estimated length of stay
- Rehabilitation facilities and balneotherapy (treatment by bathing) visited
- Patient rooms visited
- Owned by a Belgian spa company
Rehabilitation centres are COE for
- Paediatric neurological rehabilitation (condition following oxygenic brain damage, congenital brain damage, global retardation)
- Spa therapy (chronic pain syndrome)
Conclusion
The report has covered the Europe Hospital Tour that took place between 20 October and 5 November 2014. Over 20 healthcare facilities were visited and outcomes recorded. Several centres of excellence and areas of cooperation and improvement were identified to facilitate transfer of patients from the UAE to Europe for specialised treatment and recovery.
Notable areas for actions were identified to facilitate the implementation of the report outcomes with the aim of enhancing collaboration and provision of quality healthcare to the UAE patients. Patient transfer protocol will eliminate challenges experienced during transfer such as missing patient information and ensure that receiving physicians receive all the necessary patient data.
Works Cited
American Hospital of Paris. Clinical Services. 2014. Web.
Barraquer Eye Centre. About The Barraquer Eye Centre. 2014. Web.
Beta Klinik. About the clinic. 2014. Web.
Ekso Bionics. RKU – The Ulm University and Rehabilitation Clinics. 2013. Web.
HealthCare Belgium. University Hospital Brussels- UZ Brussel. 2014. Web.
Hospital QuirĂłn Teknon. Hospital QuirĂłn Teknon. 2014. Web.
Klinik Hoehenried. Rehabilitation in Germany. Lake Starnberg: Hoehenried Hospital, n.d. Print.
Klinikum rechts der Isar. The Science of Healing. Munich: HM Scherer, 2012. Print.
Klinikum Stuttgart. Klinikum Stuttgart – overview. 2013. Web.
Sant Joan de DĂ©u. About Us. 2014. Web.