Surgical Paediatric Ambulatory Care Pathway Division of Surgery and Perioperative Medicine in partnership with Women's and Children's Division

Transcription

1 Southern Adelaide Local Health Network Surgical Paediatric Ambulatory Care Pathway Division of Surgery and Perioperative Medicine in partnership with Women's and Children's Division Lydia Belet SALHN Perioperative Nursing Director

2 Southern Adelaide Local Health Network (SALHN)

3

4 Southern Adelaide Local Health Network (SALHN) > Provides care for 350,000 people living in the southern metropolitan area of Adelaide, as well as providing a number of state wide services, and services to those in regional areas. > More than 7500 skilled staff. > Provides a range acute, sub acute and mental health services > Three Hospitals Flinders Medical Centre, Repatriation General Hospital and Noarlunga Hospital.

5

6 Why?

7 Surgical Paediatric Ambulatory Care Pathway > Why have all the paediatric day surgery patients been cancelled due to bed availability when they do not require an inpatient bed?

8 Surgical Paediatric Ambulatory Care Pathway > Patients do not get the required surgery > Patients are distressed & fasting > Families are disadvantaged, distressed and annoyed > Theatre time is wasted > Nurses do not want to deliver the bad news of cancellation on the morning of surgery > Surgeon is frustrated

9

10 SALHN Vision We believe in providing the standard of health care that we desire for our own families and friends.

11 Purpose > To establish a consistent, safe and effective ambulatory model of care for surgical paediatric patients. > To reduce the potential for cancellation of elective surgical admissions in Paediatrics.

12 Deliverables > Reduced cancellations of booked paediatric day surgery > Improved consistent services to patients and their families > Respectful consideration of community costs > Appropriate utilization of up to $7266 of operating theatre expenditure per 4 hour list. > Improved management of paediatric surgical waiting list > Reduce loss of predicted activity revenue for paediatric surgery > Consistent, reliable training opportunities for surgical registrar trainees

13 Proposed FMC Paed DSU Process Week Prior to Surgical Booking Patient and Parent attend Pre-Admission Appointment. Day of Admission Patient s admission completed at the admissions office and directed to the PDSU Patient prepared for OT in the PDSU Patient Transferred by OT Staff direct to appropriate Theatre (handover at the bedside) Pt. Attends Procedure in OT

14 Proposed FMC Paed DSU Process Day of Admission Cont d Pt. transferred to PACU 1 for Recovery (approx. 30 mins) Pt. transferred to PDSU and handed over to the PDSU Nursing Staff Pt. Observations / recovery continues; Nurse Initiated D/C home once discharge criteria is meet. (min. 1 hour post return to PDSU)

15

16 So What s New? No Inpatient Bed required on the Paediatric Unit allows additional medical admissions. Clean, non-infectious environment Reduced length of stay; in line with current practice with other Paediatric Day Surgery Units around Australia. No cancellation of Paediatric Day Surgery Patients on a Monday or Wednesday (allocated PDSU Days) since the trial commenced in April.

17 What Next? Ongoing monitoring of the process / Review of cancellation data Investigate the potential expansion of the service to other days / other specialities i.e. Elective Orthopaedics; Paediatric MRI GA lists Facilitate the use of the PDSU as a bed management strategy during Winter. This has already occurred on an ad-hoc basis in 2015 and in one week 17 patients and families avoided cancellation through the use of this alternative model of care (and the hospital was able to utilise valuable theatre resources)

18 What Next? Continue to work at resolving potential issues identified during the trial phase Parent / patient waiting space Capacity Parent access Inconsistent theatre bookings

19 Outcomes

20 Outcomes

21 Project Team Lydia Belet SALHN Perioperative Nursing Director Rebecca Perry CSC, Paediatrics Tanya Rowett CSC, Anaesthetics and PACU Annette Boonen Nursing Director, Surgery and Speciality Services Brian Coppin Clinical Director, Paediatrics and Child Health Catherine Cord-udy Paediatric Surgeon Bronwyn Glitheroe CSC, DOSA Diana Lawrence Clinical Director, Women s and Children s Division Kerry Leaver Operations Manager, Surgery and Speciality Services Mark Markou Deputy Director, Anaesthesia and Pain Management. Tracy McPhee Acting Nursing and Midwifery Director, Women s and Children s Division Jo O Connor- Nursing and Midwifery Director, Women s and Children s Division Patsy Rosser- project notes

22 Questions

23