Pre-operative Assessment

Transcription

1 Pre-operative Assessment Optimising Theatre Utilisation Ann-Elizabeth Bourke Suzanne Dunne 12thApril 2013 RCSI

2 Structure of Presentation Development of the Pre-operative Assessment Service Requirements for Effective Pre-operative Assessment The Role and Impact of the Surgical Co-ordinator

3 Surgical Services Pre Reconfiguration Full Surgical Service Post Reconfiguration Day Case Surgery No In-Patient Surgical beds No overnight facilities No resident surgical team in the hospital

4 Development of Pre-operative Assessment Nurse Led Unit (2010) Surgical Co-ordinator(2011) Regional Working Group for POA(2012)

5 Pre-operative Assessment Develop effective Pre-operative Assessment Triage Telephone Screens Applicable to any Model Hospital. Replacement of all cancelled cases

6 Pre-operative Assessment Increase the volume and range of surgery as day/short stay cases (BADS 2012 directory of procedures) Consultant communication Decrease the risk of adverse events, reduces post operative stay Plan Anaesthesia requirements

7 Pre-operative Assessment Primary Care involvement Optimise Patient Social conditions

8 Requirements for High Quality POA CNMII Appropriately Trained Nursing Staff Clerical Support Dedicated Anaesthetic Sessions Dedicated facilities and infrastructure Audit

9 How POA Optimises Theatre Reduce AvLOS Utilisation Increases efficiencies by utilising DOSA beds Identify essential resources and discharge requirements

10 Pre-operative Assessment March2010-March2013 March 2010-March 2013 In House Assessments, 352 (11%) Triage Telephone Assessment Unsuitable Replacement Cases, 60 (2%) Cases, 360 (12%) In House Assessments, 395, 8% Unsuitable Cases, 54, 1% Replacement Cases, 422, 9% 1.5 WTE nurse 0.5 WTE clerical 1 hr/day C/A Triage Telephone assessment, 3781, 82% Triage Telephone Assessment, 3140

11 The Role and Impact of the Surgical Co-ordinator

12 Optimise Theatre Utilisation OPD Triage Telephone Screens Bed Utilisation SSD Department

13 Optimise Theatre Utilisation Staff Skill Mix Consultants Clerical Meridian

14 The Impact of the Surgical Co-ordinator Role Maximised Theatre Utilisation Contributed significantly to the 72% increase in Day Case Admission Rates Waiting List Targets met for Surgical and Endoscopy Services

15 The Impact of the Surgical Co-ordinator Role Formed a Cohesive Working Group for the Surgical and Endoscopy Services Development of Integrated Care Pathways Policy,Procedure,Protocol and Guidelines

16 Number of Cases Day Case Statistics MWRH Nenagh Dayward Statistics Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month

17 Conclusion Effective Pre-operative Assessment (Telephone Triage for all cases and appropriate In-house assessment) Surgical Co-ordinator Replacement cases/lists Avoid late starts and early finishes (Meridian Project MWRHG)

18 Citation of References Afolabi R. Preoperative Assessment in the reduction of unplanned hospital admission and cancelled Day cases and the role of information Technology in the 21st century. TCD 2011 Association of Anaesthetist of Great Britain and Ireland. Safety Guidelines. Preoperative assessment and patient preparation.jan 2010 Association of Anaesthetist of Great Britain and Ireland. Day Surgery. Feb 2005 British Association of Day Surgery. Chung F et al. Elimination of Preoperative Testing in Ambulatory Surgery. Anaesthesia and Analgesia 2009; 108: Garcia-Miguel FJ, Serrano-Aguilar PG, Lopez-Bastida J. Preoperative Assessment. The Lancet 2003;362,9397, Kluger MT, Tham EJ, Cobman NA. Inadequate Preoperative Evaluation and Preparation. A review of 197 cases from the Australian Incident Monitoring Study. Anaesthesia 2000;55: Knox M, Myers E, Hurley M. The Impact of Preoperative Assessment Clinics on Elective Surgical Cancellations. Surgeon 2009; 7:76-8

19 Citation of References Klopfinstein CE, Forsten A,et al. Anaesthetic Assessment in an Outpatient Consultation Clinic Reduces Pre-op Anxiety. Canadian Journal of Anaesthesia.2000;47: National Good Practice Guidance on Preoperative Assessment for Day Surgery. NHS2001.( National Institute of Clinical Excellence (NICE) Preoperative Tests. Clinical Guideline 3.June 2003 Rai,M and Pandit, J. Day of Surgery Cancellations after Nurse Led Preassessment in an Elective Surgical Centre-the first 2 years. Anaesthesia 2003;58:685-7 Royal College of Surgeons in Ireland, College of Anaesthetist and HSE (2011).The Elective Surgery Programme Guidelines RCSI :Dublin South Tees Hospital NHS Trust Document G57 November 2006