Admission and Pre-assessment process for patients

Admission & Pre-assessment Process for Patients

Scheduled for Elective Surgery

Auburn Hospital

2013

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Presented by

Debra Smith

NUM

Pre -assessment Unit

Auburn Hospital Periop Assessment Process for Elective Pts

Pre – Assessment For Elective Surgery

• Follow the Ministry of Health Pre-Procedure Preparation Toolkit -http://www0.health.nsw.gov.au/policies/gl/2007/pdf/GL2007_018.pdf

• Aim to optimise patients’ health before an elective procedure

• Education for the Patient Journey

• The Infrastructure was built according to the PPT


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New Facility / New Process

• New Facility custom built to accommodate a“One Stop Shop” surgical and peri-operative unit.

• Patients for elective surgery have one point of entry into unit that covers the whole pre-assessment process.

Level 3

- Surgical Coordination & Bookings

Pre Admission Clinic- Maternity Unit

Operating Suite & Recovery- Birth Unit

Day Surgery Unit- Nursery

Surgical Ward

CSSD


3

Co-location

All staff from:-

• Admissions

• Bookings / Waiting List

• Surgical coordination

• Preadmission clinic

all co -located onto level 3 with the day procedure unit, the operating suite and surgical ward.


4

Management

• Nurse Unit Manager under the umbrella of the Nurse Manager of the Operating Suite

• Regular meetings and daily liaison with the Nurse Unit Managers of the Operating Suite, Day Procedure Unit, Surgical Ward and Bed Management.

• Nursing Staff multi skilled to other areas Auburn Hospital Periop Assessment

Process for Elective Pts 5

One Management Team • The Nursing Unit Manager of the Pre- Assessment

unit has included into the position description :-

• Admissions and Bookings,

• The Pre- admission Clinic

• Waiting list management

• Surgical Coordination

• Operating Suit and Anaesthetic Scheduling

Auburn Hospital Periop Assessment


The Role of the Nurse UnitManager

• Primarily the conjugate between all aspects of the surgical care team


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Process for Referral

• Patient referred by VMO Surgeon to facility.

• Recommendation for admission delivered to facility either by :-

• Mail

• Patient personally delivers

• VMO

• Fax – if case urgent


8

Clerical Processes are reflective of the Nursing Process

• Nursing triages and schedules a tentative date for surgery from information on the Recommendation For Admission and acuity code

• Clerical enter patient details onto the waiting list

• Clerical staff enter the date for surgery plus a preadmission date for the clinic if required – All attended concurrently



• patient flow

in the Pre- Assessment Unit

In one location

Under one management

Team.


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Triage Process to Access appropriate type of Assessment

• No PAC No comorbidities

No requirement for interpreter

No procedural requirement for investigations

Under age 55 years


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• Phone PAC » Non Ambulatory

» Aged Care Facility

» Rural Residence

» Patient Reason ( individually accessed)

» Attended by both Nursing and Anaesthetics, liaise with General Practitioner.


• Nurse PAC » No Co morbidities on health questionaire

» Requirement only for interpreter or allied health

eg Social Work or Physiotherapy

» Patient request

» Education

» Organisation of admission and transport only

» Minor Procedure


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• Anaesthetic Clinic » Known Comorbidities or previous Anaesthetic issues

» Pregnant or Paediatric patient

» Requirement for non- nursing investigations

» Issue identified during the Nurse Assessment

both Nurse and Anaesthetic clinic occurs within the one

visit. Ability is built into the capacity to accept patient

into the anaesthetic clinic if an issue is identified within

the Nurse Clinic.

» Age over 55 years

» Most patient are reviewed by an anaesthetist


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Clinical Pathways

• All Patients are commenced on a clinical pathway.

• Most are commenced at time of visit to preadmission clinic or phone pac

• The few patients that are considered a

“No PAC” are commenced on admission.

• Examples are on Ministry of Health website


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Advantage of the Pathway • Gives a roadmap that the patient journey can

follow.

• Variances to this map are easily identified and acted upon.

• Acts as a checklist

• Patient is shown the pathway and educated using the pathway

• Multidisciplinary which includes:- » Medical

» Nursing

» Allied health Auburn Ho

Procspital Periop Assessment ess for Elective Pts » Clerical

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OUTCOMES: Coordinated multidisciplinary approach

Criteria for Pre assessment followed by all stakeholders

Communication between departments is effective As of 31-12-2012, no cancellations in operating suite for past 12 months due to inadequate pre assessment. Less waiting time for Patient by direct point of entry for admission.

Patient returns to this area on day of surgery so patient now orientated for Day of Admission. Clerical staff save on average 80minutes per day ( if not more) due to tAhubeur cn oHo locspitala Pteeriodp Adsesepssarment tment


Patient Focused -Positive feedback on patient surveys

Effective Communication between the teams

More streamlined admission process – in one spot!!

As part of the High Volume Short Surgical Stay model, this system of pre-assessment allows for high capacity assessment, within a safe and clinically robust framework


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References • Clinical Protocol Library for Extended Day Only (EDO) / 23-Hour Care Units, Retrieved on 21-

12-2012 from http://internal.health.nsw.gov.au/clinicalprotocol/contacts.html

• Conway, J. B., Goldberg, J., & Chung, F. (1993). Preadmission anaesthesia consultation clinics. Ambulatory Surgery, 1(2), 106-107. doi: 10.1016/0966-6532(93)90098-A

• High Volume Short Surgical Stay Model Toolkit, Retrieved on 21-12-2012 from http://www0.health.nsw.gov.au/pubs/2011/pdf/hi_vol_short_stay_surgery.pdf

• MacLellan, D. G., Smyth, T., Cregan, P. C., Lizzio, J., & Watt, H. (2012). Surgical services: Shaping future directions. ANZ Journal of Surgery, 82(1‐2), 68-72. doi: 10.1111/j.1445-2197.2011.05955.x

• Pre-Procedure Preparation Toolkit – retrieved on 21-12-2012 from http://www0.health.nsw.gov.au/policies/gl/2007/pdf/GL2007_018.pdf

• Singh, N., Brooke‐Cowden, G. L., Whitehurst, C., Smith, D., & Senior, J. (2005). The auburn elective surgery pilot project. ANZ Journal of Surgery, 75(9), 768-775. doi: 10.1111/j.1445-2197.2005.03526.x



http://internal.health.nsw.gov.au/clinicalprotocol/contacts.html

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Admission and Pre-assessment process for patients