Rosanne Lyles Powys Operating Theatre Manager

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Rosanne LylesPowys Operating Theatre Manager
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Powys Local Health Board

• 17 GP Practices
• 10 Community Hospitals
• 2 Operating Theatres, Mid South Powys
• Day Case Intermediate Surgery
• 16 Visiting Consultant Surgeons
• 2 GP Surgeons
• 4 GP Anaesthetist
• Visiting Consultant Anaesthetist

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Basket of Surgery

• Gynaecology
• Orthopaedic
• Ophthalmology
• General Surgery
• Plastics
• ENT
• Oral Surgery

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Nurse-led Pre-anaesthetic Screening ClinicWhy?

• No identified pathway
• Sessions underutilised
• High rate cancellation by patient
• High rate cancellations by Anaesthetist
• Patients cancelled on the day of surgery
• Inadequate patient information planning
• Patients allocated to the wrong waiting list
• First contact with nurse/on admission
• Admission rate high

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What did we hope to achieve?

• Give the choice of when and where the plan of
  care is delivered to the patient.
• Accurate information, education, planning
• Increase Theatre Sessions
• Prepare the patient for surgery
• Identify patients at RISK within a rural
  community hospital.
• Reduce cancellations.
• Reduce patient pathway stages
• Increase patient Staff satisfaction
• Decrease length of stay

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How did we go about this?

• Data Collection
• Patients cancelled
• Patients cancelled by Anaesthetist
• DNA
• Follow a Patients Pathway from admission to
  discharge QUAD Tool
• Process Mapping

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Data Collection
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Patient Pathway on Admission

• QUAD Tool NATN

Ward
Anaesthetic Room
Recovery
Operating Theatre
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Process Mapping

• Old Pathway

Consultant Refer
1
2
5
4
3
6
GP Ref
OPD
Admin MIP
Date Offered Post
Nurse Clerking Prior OP
Anise Clerk Prior OP
GP Ref
10
8
7
9
Surgery
Surgery
Date Offered Post
GP Ref
Consultant Ref
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Problems Identified

• Unnecessary stages, that did not add value to the
  patients care
• Multiple Hand-offs
• Delay in treatment
• Increase patient stress anxiety
• Patients recovery delayed
• Unnecessary Cancellations
• Sessions under utilised
• Unplanned admissions

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Introduction Nurse-led Pre-anaesthetic Screening
Clinic
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Introduced a patient Pathway Admission Pack
Day Surgery Admission Pack
Hospital Name
Patient Hosp No
Consultant
Speciality
Admission date
Time
Time into Anaesthetic
Time into Op Room
Knife to Skin
Time in Recovery
Time Return to Ward
Discharge Date
Time
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Planning
Referral letters GP Consultant
Nurse Led Discharge Letter Patient GP Notes
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Guidelines Policies
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Training Programme
Nurse-Led Pre-anaesthetic Screening
Clinic Competencies
In-house Training Programme 2004 - 2005
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Team Work

• Anaesthetist
• Staff
• Surgeons

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Trust
Belief
Medical Staff
Trust
Lack of Knowledge skills
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Motivated Dedicated Staff
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Evidence Base
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Current pathway
1
2
4
3
OPD
Nurse-led Clinic Same day
Surgery
GP Ref
Consultant Ref
GP Ref
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What are the Benefits?

• For the patient-
• Patients are allowed to decide and choose the
  date for surgery
• Patients able to plan work home environment.
• Direct booking, patient did not have to return to
  be assessed
• Education, information counselling
• Reduce anxiety stress
• Reduced Cancellation on the day of surgery
• Delay treatment Reduced

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Benefits to the Organisation

• Patient Cancellation reduced
• Anaesthetist cancellation reduced
• Theatre sessions fully utilised
• Reduction administrative documentation
• Patients unfit placed on correct waiting list
  (Inpatient or DGH)

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Results
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Methods of Evaluation

• Patient Satisfaction Audits
• Theatre Utilisation Audits
• Record Keeping Audit
• Patient information Audit
• Staff Satisfaction

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Perfection is determined by a patients experience
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What Next

• CTD Pathway Nuerophysiology test OPD
  Screen
• Nurse-Led PSA Clinic
• GP/Nurse-led Fracture Clinic