Elective Surgery Programme Implementation Support Guide

(MDT) and should outline the anticipated care aimed at helping a patient with a specific
condition or set of symptoms move progressively through a clinical experience to positive
outcomes and in a timely manner. It is based on guidelines and evidence, in this case, for
patients undergoing elective surgery, such that as much as possible of the journey forms part of
the clinical record, documenting the care given and allowing outcomes to be monitored and
improved upon.
It should:
Promote best practice from referral by Primary Care through the decision to operate and
continuing into hospital discharge and beyond
Be designed, implemented and monitored locally by an MDT which is integrated across
primary and secondary care
Allow evaluation of evidence based care in a more structured way
Support efficiency and cost containment while minimising repetition, duplication and
waste
Support clinical governance while improving risk management, process design, clinical
effectiveness and continuous quality improvement
Help to reduce unnecessary variations in patient care whilst allowing variations from the
pathway as may occur when clinical freedom is exercised to meet the needs of the
individual patient
Foster better communications between disciplines, teams, staff in general, and patients
and their General Practitioners. (See, for example:
http://www.stjames.ie/Patients/PatientBooklets/waiting%20for%20heart%20surgery.pdf )
A Cochrane review in 2009 showed that clinical pathways are associated with reduced inhospital
complications and improved documentation without negatively impacting on length of
stay and hospital costs. (13)
Implementation of ICPs are best guided by a process map which will help to define the
sequence of steps and activities performed during delivery of care, the specific responsibilities
for these steps and activities, the relationships that exist between the different individuals and
departments in the process, the potential problem areas and opportunities for improvements in
current practice. Integral to the process of elective surgery planning requires a Waiting List/
Admissions Coordinator/Bed Manager for Elective Surgery. It also requires a GP liaison
structure.
The guidelines and pathways outlined in the following chapters are generic and, as such, are
not directed at any specific surgical specialty or hospital but rather are aimed at being a
resource for all specialties and hospitals where elective surgery is performed.
31 Model of Care for Elective Surgery