A multidisciplinary group from two medical floors at the Royal Victoria Hospital chose the Managed Care Appropriateness Program (MCAP) to evaluate the appropriateness of the days of stay for their patients. Of 100 charts of consecutive patients examined by the nurse reviewer (comprising 1,095 patient days), 33 percent of the days were deemed inappropriate. The reasons for each of these inappropriate days were documented, and strategies were implemented to address the issues. The major outcome of the study was a change in the culture of the health professionals to a more positive approach to defining and carrying out efficient patient care.

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Aim: To establish and assess an intersectoral local network focused on the roles of registered nurses and primary healthcare nurse practitioners to ensure the continuity of care and service pathways for refugees in Quebec.Design: Developmental evaluation with a mixed methodology. Methods: The qualitative component will include: (1) a document review; (2) observations of participants during meetings of different governance structures; (3) semistructured interviews with key actors (n = 40; 20/neighbourhood interventions); and (4) focus groups with end users of the services (refugees) (n = 4; 6 to 8 participants per group). The quantitative component will be based on: (1) a data sheet on health and social interventions for refugees users filled in by registered nurses, primary healthcare nurse practitioners and physicians and (2) data analysis of the clinical-administrative database since 2012. This study received funding in June 2019 and Research Ethics Committee approval was granted in July 2020. Discussion: In Quebec, refugee vulnerability is exacerbated by the lack of integration of existing resources and the lack of access to care and continuity of services.To address these issues, an integrated local network for refugees must be developed.Additionally, we will explore the role of registered nurses and their collaboration with primary healthcare nurse practitioners.Impact: This study will provide recommendations on how to optimize the scopes of practice of registered nurses and primary healthcare nurse practitioners, adapt care and services and develop a local intersectoral network to better meet the complex needs of refugees. It will evaluate the use and the appreciation of new services for targeted populations (neighbourhoods and refugees) and aim to improve the accessibility, continuity and user experience of all health services for those populations.

Une équipe multidisciplinaire en service sur deux étages du service de médecine générale à l'Hôpital Royal Victoria a choisi la Gestion pertinente des soins de santé (GPSS) pour évaluer la pertinence de la durée du séjour de leurs patients. L'infirmière analyste qui a examiné 100 fiches de patients, admis consécutivement et dont la durée de séjour totalisait 1095 jours-patient, a conclu que 33 pour cent de ces journées n'auraient pas dû être de séjour à l'hôpital. On a obtenu des renseignements sur tes motifs invoqués pour chacune de ces journées non pertinentes et mis en place des stratégies visant à résoudre ces problèmes. Le changement de mentalité chez les spécialistes de la santé a constitué le principal résultat de cette étude: Depuis, ils abordent de manière plus positive leur choix des soins à dispenser aux malades et les façons de les administrer efficacement.

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