2012 annual meeting & cardiothoracic forum - Society for ...

JOINT ANNUAL MEETING 2012 ABSTRACTS
123 Same Day Admission; An Improved Cardiothoracic Surgical
Patient Pathway
Authors: Palanikumar Saravanan; C.A. Humphries; A. Knowles; B. McAlea; C.
Rozario
Lancashire Cardiac Centre, Victoria Hospital, United Kingdom
Objectives: Same day admission (SDA) for surgery has few advocates in UK
cardiothoracic surgical centres. Over an 18 month period we initiated a
comprehensive review and redesign of pre-operative assessment services through
to SDA. We discuss the advantages and problems encountered in developing the
service.
Methods: Service development included a team comprising; nurse practitioner,
cardiac anaesthetists, cardiac liaison nurses and ward staff. Pathways developed
included clinic coordination of referring hospital results with secretarial support and
single day sequential investigations. Improved scheduling of surgical and
anaesthetic reviews reduced need for pre-operative visits. Patients were offered the
SDA option with a free taxi service from home. Those accepting were given pre-SDA
protocols and on the day of surgery were processed in a segregated ward area.
Results: Elective patients increasingly indicated a preference for SDA. From a slow
uptake this has risen to over 70% of elective patients representing a rise from 24%
in May to 47% in October of all surgical patients (cardiac and thoracic) with no
cancellations. Challenges faced included; altered work patterns (secretaries,
anaesthetists and ward staff), changes in practices and procedures (pre-op
screening and preparation) and securing designated facilities (out-patient clinics,
ward, staff and transport). Benefits included; reduced length of hospital stay, cost
savings and improved patient satisfaction. This has achieved an annual cost
reduction of £140,000 against closure of four beds.
Conclusions: SDA is a safe, effective, patient centred and cost containing measure
in cardiothoracic surgery. It requires considerable re-drawing of work patterns in
multiple areas. Nevertheless this has illustrated an optimum patient pathway with
tangible benefits.
187