Evaluation Meeting: Minutes
Present: Charles, Jean Michel, Eulalie, Dick, Stefan, Jan, Filip, Karolien
Strengths of our mission:

1. A warm and very pleasant welcome from the entire management, medical staff, and all the collaborators of Kisantu Hospital. You have a knack for making us feel at ease from the moment we arrived, which made our mission very easy.
2. The enthusiasm, availability, and commitment of the entire surgical complex staff were exemplary, despite the high demands in terms of both the quality and quantity of work during these 15 days. This truly deserves our appreciation.
3. The preparation for our mission by the inpatient and outpatient staff, and especially by our two colleagues in orthopedics, was very effective, even though it always takes a few days before the public and patients arrive. 4. It is also a pleasure to see that our orthopedic workshop is doing remarkable and essential work, completing our care pathway for our orthopedic patients.
4. The team is very happy with the congress: the organization, the infrastructure, the support, etc., and believes it could become an annual part of our medical mission.

Key points identified during the mission:

1. The closure of our care loop is still lacking, notably the absolute necessity of having a physiotherapist in the orthopedic wards as an integral part of postoperative care. Currently, there is insufficient attention paid to mobilizing the joints around the orthopedic lesion, whether treated conservatively or surgically. The consequence is stiffness in the joints above and below the lesion. Early monitoring and mobilization are absolutely essential to avoid secondary problems. This care, an integral part of good orthopedic treatment, should be included in the hospital treatment fee. We believe that the workshop’s revenue should allow for the hiring of a physiotherapist for the department.
2. A manager responsible for all surgical equipment and various surgical supplies is needed. Currently, there is no one truly in charge of all the equipment. Operating room nurses assisting with procedures are also responsible for washing, preparing, packaging, and sterilizing surgical kits. Everyone is somewhat responsible without proper oversight. This makes equipment management very difficult, leading to inadequate maintenance, errors in kit preparation, lost equipment, poor surgical preparation, delays in washing and sterilizing equipment, and mix-ups of different kits and equipment, etc.
   We propose hiring a dedicated surgical equipment manager who will assume full responsibility for the equipment. This manager will be responsible for washing equipment after procedures, maintaining it, preparing surgical kits (in close collaboration with scrub nurses), ensuring timely sterilization, and overseeing the storage and overall management of the equipment.
   To implement this project, we also recommend reserving and preparing a dedicated room within the operating room (currently located in the main corridor in the middle of the operating suite) as a workspace, control room, preparation area, maintenance room, storage area, and office for the equipment manager. The surgical equipment is so precarious, expensive, and difficult to maintain that having a dedicated equipment manager is absolutely worth the investment.
3. Patient monitoring and time-outs in the operating room to prevent patient errors can be intensified and made more stringent.
4. Order and hygiene in general in the wards, offices, work areas such as the dressing room, plaster room, etc., as well as the surrounding area of ​​the hospital, can be greatly improved.
   Old beds, cabinets, and various materials such as packaging, empty boxes, spare parts, etc., are scattered everywhere and attract even more trash, mosquitoes, and dirt. Regular cleaning and inspections would solve many problems and make the hospital more appealing.
5. Radiology Department
   a. The quality of the images could be improved and standardized.
   b. The payment system for the radiology department is inefficient. The follow-up X-ray after surgery or treatment, plus a consolidation check, is not included in the hospital admission fee. This results in a lack of monitoring and makes consolidation impossible when the patient cannot afford the additional payment. Often, the patient remains unnecessarily and for too long in the ward, or the treatment cannot be adjusted during the course of treatment. Rethinking the payment system for follow-up and control X-rays is necessary.
6. An image intensifier is desirable to increase the efficiency and possibilities for interventions in the operating room, as well as the overall level of service in the orthopedic department.

Points for discussion with management:

1. During their stay, the medical team realized that follow-up X-rays for surgical patients are not included in the hospitalization fee. This often leads to problems with proper post-operative monitoring. However, this appears to be an error, and the medical director explains that as long as the patient is hospitalized, X-rays are included in the fee.
2. There is a discussion regarding post-operative mobilization physiotherapy. Is this care part of the physiotherapy department, which operates independently within the hospital with its own funding system? The medical team is convinced that mobilization of the joints above and below the affected area, as well as post-operative physiotherapy, are integral parts of post-operative care under the supervision of orthopedic surgeons. Once discharged from the hospital, the patient can follow a rehabilitation program in the physiotherapy department. There is indeed a difference between post-operative care and rehabilitation as such.