Hospital doctor Trond

"I see the need for a multidisciplinary approach, where several specialists should work together to develop a comprehensive treatment plan that can help reduce the severity of crises or avert them altogether."

Cardiology ward

I am a doctor in specialisation on a cardiology ward. This ward, characterised by a fast-paced environment with continuous discharge and admission of patients, specialises in the management of heart-related issues. Here, patients receive effective assessment and treatment, typically resulting in brief hospital stays.

Additionally, I have another group of patients. This group has chronic heart disease alongside multiple other conditions, existing in a fragile equilibrium where minor health fluctuations may precipitate crises, necessitating rehospitalization. These patients often demand comprehensive care coordination from a broad network of healthcare providers.

I see the need for a multidisciplinary approach, where several specialists should work together to develop a comprehensive treatment plan that can help reduce the severity of crises or avert them altogether.

Astrid's needs and challenges

Following patient rounds, a detailed discussion with Astrid, hospitalized for advanced heart failure and various symptoms, allowed me to understand her life context, priorities, and aspirations. Astrid's history of frequent hospitalizations across different departments highlights a potential for improved monitoring and specialist access outside the hospital to prevent such occurrences.

Solution for patients like Astrid

I've heard that the hospital has established a multidisciplinary team that works closely with specialists at the hospital, neighbouring municipalities, and GPs to whom I can easily refer Astrid. This team can help Astrid develop a comprehensive plan that is customised to her specific needs and preferences.

This collaborative effort surpasses what I could achieve alone in a bustling ward setting.

I get information on how to refer the patient and what my responsibilities will be afterwards. I can find more information here (Norwegian), especially see points 2 and 3.