Elective Surgery Programme Implementation Support Guide

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This will be done through the HIPE (Hospital Inpatient Inquiry) system that is present in each hospital. It will be most important that accurate and full data is collected. This will mean that surgeons will be expected to participate in the HIPE coding process particularly for the target procedures. 6
How do we know that the HIPE codes of the procedures are being monitored? The target procedures together with their ICD-10 procedure codes are attached. HIPE codes, preferably generated by surgeons, will be returned by hospital HIPE Officers through the ESRI and then to the Casemix/ Health Intelligence Unit of the HSE and through the new National Office for Clinical Audit in Surgery (NOCAS) based at RCSI. A dedicated reporting tool is being developed which will deliver reports nationally, regionally, to hospitals and to individual surgeons. Are these procedure codes specific? Yes. Coding must be accurate. The codes that have been selected for this programme are not comprehensive even for the procedures that are itemised. For example, if one were to perform a straight forward laparoscopic cholecystectomy the code would be 30445.00. However a laparoscopic cholecystectomy proceeding to an open cholecystectomy comes under a different code 30446.00. This latter code is important in its own right but it will not be one of the procedures that will be monitored in this programme. Nevertheless the correct code must be entered. Why have a limited number of codes been targeted? Accurate coding is a time consuming exercise especially in cases of complexity. Our aim was to focus on and target a limited number of codes that are commonly used in order to make the exercise as simple and straightforward as possible. At this point we wish to look at only a limited number of codes in detail notwithstanding the fact that all coding must be done accurately. Is accurate coding only necessary for these proceedings? No. All procedures should be accurately coded and preferably involve both surgeons and HIPE coders. Having a limited number of codes like the ones targeted means that surgeons can have this list easily accessible so that, for example, a code can be written on the operation sheet immediately after surgery for the benefit of HIPE coders. Will hitting targets make a difference? We know, by extrapolating back to 2009 data, that, had all the targets been reached nationally in all specialties, we would have saved nearly 42,000 bed days. Having this kind of data is a powerful tool for bringing about an ability to plan surgery and operate protected beds. These will not only be forthcoming but, by shortening waiting lists, we will also obviate the necessity for the NTPF. How can targets for length of stay be achieved? This should best be done by avoiding bad habits such as bringing patients in for investigations, hot bedding, delayed discharges etc. Moreover, the Elective Programme has published a Model of Care which includes guidelines for pre-admission assessment clinics, day surgery, day of surgery admissions and discharge planning. Many of these modalities are already in widespread use but the Model of Care
Page 1 and 2: Elective Surgery Programme Implemen
Page 3 and 4: Overview of the Elective Surgery Pr
Page 5: What is AvLOS? It is a sub programm
Page 9 and 10: What is TPOT? It is a sub programme
Page 11 and 12: What is IASM? It is a part of the S
Page 13 and 14: MODEL OF CARE FOR ELECTIVE SURGERY
Page 15 and 16: CHAPTER 3 .........................
Page 17 and 18: Summary for Patients and Carers Int
Page 19 and 20: Chapter 5 describes Discharge Plann
Page 21 and 22: Patients expect to know approximate
Page 23 and 24: CHAPTER 1 The Elective Surgery Prog
Page 25 and 26: Executive are aiming to address the
Page 27 and 28: Improving access to theatre resulti
Page 29 and 30: tests are performed as expeditiousl
Page 31 and 32: (MDT) and should outline the antici
Page 33 and 34: References 1. A short cut to better
Page 35 and 36: APPENDIX 1 - THE SURGICAL CARE PLAN
Page 37 and 38: job plans of consultant anaesthetic
Page 39 and 40: The Waiting list/Admission Coordina
Page 41 and 42: Stage four: information collating
Page 43 and 44: Routine screening tests that should
Page 45 and 46: include an ECG and relevant blood t
Page 47 and 48: Risk Reduction and Service Monitori
Page 49 and 50: 9. Reed M, wright S, Armitage F. Nu
Page 51 and 52: APPENDIX 2 - Pre-admission Assessme
Page 53 and 54: Anaemia or Blood Disease Excessive
Page 55 and 56: emedies or recreational drugs) Is t
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APPENDIX 5 - SAMPLE PRE-ADMISSION A
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Outcome: - Accepted for Day Case Ye
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targets. It goes without saying tha
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Patient Factors: Age - there is no
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The safe and comfortable recovery o
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Accommodation required for day surg
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The Clinical Director, commonly a C
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The clinical team should be develop
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which provide enhanced services/acu
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http://www.esraeurope.org/Postopera
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APPENDIX 2 - Procedures that are su
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APPENDIX 4 - Patient conditions uns
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APPENDIX 5 - Diabetic Day Case Pati
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Total Score @ __________ (3) Nurse
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APPENDIX 8 - Suggested documentatio
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The optimal situation is when a pat
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If patients only give a Group and H
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CHAPTER 5 Discharge Planning Introd
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The patients‟ general practitione
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References 1. Selker HP, Beshansky
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APPENDIX 2 - Sample Patient Dischar
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APPENDIX 4 - Sample Discharge/Trans
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CHAPTER 6 Elective Surgery Indicato
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Pre-admission assessment is underta
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Dr Suzanne Crowe Paediatric Anaesth
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2 GENERAL/UNSPECIFIED TARGETS ICD-1
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4 GENERAL COLORECTAL TARGETS ICD-10
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111
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8 NEUROSURGERY TARGETS ICD-10-AM Pr
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10 ORAL MAXILLO FACIAL TARGETS ICD-
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12 PLASTIC TARGETS ICD-10-AM Proced
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14 UROLOGY TARGETS ICD-10-AM Proced
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Manager for elective surgery patien
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Are allied health professionals inc
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Are DOSA patients‟ beds ring fenc
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Elective Surgery Programme Implementation Support Guide

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