Elective Surgery Programme Implementation Support Guide

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pre-operative checklist on the day that surgery is carried out; and will also start to inform the discharge planning process. (See: APPENDIX 6 – Sample pre-operative assessment form) Role of Anaesthesia in Pre-admission Assessment Hospital anaesthetic departments are responsible for providing both a Lead Consultant as well as overseeing senior staff (Anaesthetic Consultants and/or Specialist Registrars) to deliver, with hospital management, the service of pre-admission assessment clinics. A Lead Consultant Anaesthetist with an interest in pre-operative assessment and optimisation should oversee the pre-admission assessment clinic. Their role should be to, Provide leadership in the governance of the pre-admission assessment clinics Develop and oversee the introduction of protocols and proforma Regularly review and update protocols Establish relationships with key stakeholders Monitor and audit clinic activities Supervise the education of specialist nurse practitioners Oversee clinics in rotation with colleagues The Overseeing Anaesthetist, during the day to day workings of the clinic, should, Provide back up and support for the lead nurse Be familiar with all relevant protocols See all high risk patients See patients who require optimisation of co morbidities Communicate with patients and their carers, where necessary Communicate with anaesthetic colleagues and other specialists, where necessary Make sure all relevant information is available for the „attending‟ anaesthetist Communication with other specialists including surgeons, physicians and primary care Use the clinic as an educational opportunity for undergraduate and post graduate students when appropriate The „attending‟ anaesthetist who administers the anaesthetic at surgery is ultimately responsible for the decision to proceed with anaesthesia and the type of anaesthesia that is undertaken. As such the attending anaesthetist must see the patient prior to surgery and ensure that all preoperative checks have been performed, to check compliance with protocols and discuss additional aspects of anaesthetic care with the patient if required. (10) All preoperative investigations, results and documentation must be available to the attending anaesthetist. Good communication between the pre-admission assessment clinic and the attending anaesthetist is essential. 46 Model of Care for Elective Surgery
Risk Reduction and Service Monitoring Pre-admission assessment clinics need to ensure that their patient selection and assessment criteria will adequately guide the preoperative screening and evaluation process. It is necessary that reliable processes are in place that allow for timely and adequate assessment of patients. Pre-admission assessment clinics should be continuously audited and evaluated, looking at both process and clinical outcomes from the perspective of patients, medical and nursing staff and hospital management. Outcome measures should examine such issues as unplanned admissions, day of surgery cancellations, failure of communications and patient satisfaction (18). Such outcomes should be reviewed and acted upon by the Working Group to continually improve the service provided. Performance Metrics for Pre-admission Assessment Clinics Should include: Patient numbers and non-attendance at clinics on a monthly basis Waiting times for clinic appointment Number of charts where all appropriate investigations are performed and results are in chart on the day of admission Number of surgery cancellation after Pre-admission Assessment Patient satisfaction score Indicators of Quality of Pre-admission Assessment Clinics The Clinics assess all elective Day Surgery and Day of Surgery admissions A Working Group is established as set out in the Model of Care for Elective Surgery The Working Group is led by a Supervising/Lead Anaesthetic Consultant There are additional Overseeing Consultants Anaesthetists as may be necessary There is a Lead Nurse at CNS/CNM2 grade There are adequate support nurses and staff who have the necessary competencies Allied health professionals are included in the pre-assessment process, as appropriate The Clinic is assigned a discrete area that is in close proximity and concurrent with surgical clinics, where possible Investigations, where necessary, are carried out, reported and followed up in a timely manner according to protocol Patient elective surgery cancellations
Page 1 and 2: Elective Surgery Programme Implemen
Page 3 and 4: Overview of the Elective Surgery Pr
Page 5 and 6: What is AvLOS? It is a sub programm
Page 7 and 8: How do we know that the HIPE codes
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: include an ECG and relevant blood t
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
Page 57 and 58: APPENDIX 5 - SAMPLE PRE-ADMISSION A
Page 59 and 60: Outcome: - Accepted for Day Case Ye
Page 61 and 62: targets. It goes without saying tha
Page 63 and 64: Patient Factors: Age - there is no
Page 65 and 66: The safe and comfortable recovery o
Page 67 and 68: Accommodation required for day surg
Page 69 and 70: The Clinical Director, commonly a C
Page 71 and 72: The clinical team should be develop
Page 73 and 74: which provide enhanced services/acu
Page 75 and 76: http://www.esraeurope.org/Postopera
Page 77 and 78: APPENDIX 2 - Procedures that are su
Page 79 and 80: APPENDIX 4 - Patient conditions uns
Page 81 and 82: APPENDIX 5 - Diabetic Day Case Pati
Page 83 and 84: Total Score @ __________ (3) Nurse
Page 85 and 86: APPENDIX 8 - Suggested documentatio
Page 87 and 88: The optimal situation is when a pat
Page 89 and 90: If patients only give a Group and H
Page 91 and 92: CHAPTER 5 Discharge Planning Introd
Page 93 and 94: The patients‟ general practitione
Page 95 and 96: 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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