one-stop preanaesthetic assessment clinic · cardiology respiratory medicine dental pathology blood...

OneOne--stop stop PreanaestheticPreanaestheticAssessment ClinicAssessment Clinic

A Kwan, WG Fok, KL Tong, HK MaDepartment of Anaesthesiology and Pain Medicine,

Operating Room Department and Day Surgery Centre

United Christian Hospital

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Preoperative preparationPreoperative preparation

Thorough, comprehensiveEfficient‘Hassle-free’

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Objectives of PACObjectives of PACEase of referral by surgeonMinimal visits to hospital or different areas of hospital by patientMinimal cancellations on day of operation due to unstable medical condition

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PAC

OneOne--stop stop PreanaestheticPreanaesthetic Assessment ClinicAssessment Clinic

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Multidisciplinary teamMultidisciplinary teamDSC Nurse/ArtisanDSC ClerkAnaesthesiologistSurgeonOther ConsultantsGP/GOPD Doctor

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SOPDSurgical specialties

PAC

SOPDMedical:

GeneralGeriatricsCardiologyRespiratory

MedicineDental

PathologyBlood investigationsT&S

X-ray Department

DS/SDA/Post-holiday list

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DSC Clerk

Patient Carer/Family

DSC Nurse Artisan Anaesthesiologist

Surgeon

Other Consultants• Physicians• Haematologist• Dental Surgeon• Radiologists

GP GOPD Doctor

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PAC

OneOne--stop stop PreanaestheticPreanaesthetic Assessment ClinicAssessment Clinic

SOPD>70% of all

elective operation

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SurgeonSurgeon

Provides information on surgeryObtains written informed consent for surgery and blood transfusion if necessaryRescheduling of lists as necessary

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PAC

OneOne--stop stop PreanaestheticPreanaesthetic Assessment ClinicAssessment Clinic

•Screening•Vital signs•Investigations•Education

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DSC NurseDSC Nurse

Nurse assessment for all patientsPreoperative education and instructions Co-ordinates preoperative planningCollates investigations resultsCollects data for KPIs

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ArtisanArtisan

Assists with preanaesthetic questionnaireTakes pulse, BP, SpO2, weight, height, urinePerforms ECG and blood tests

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PAC

OneOne--stop stop PreanaestheticPreanaesthetic Assessment ClinicAssessment Clinic

•Assessments•Optimization•Consent•DS/SDA/IP

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AnaesthesiologistAnaesthesiologistAssesses patients requiring anaesthesiology careProvides information on anaesthetic choiceObtains written informed anaesthetic consentOrders/performs (T&S) relevant investigationsOrganises consultation referrals and follow-upsFollow-up abnormal resultsLiases with subspecialty or procedural anaesthesiologistLiases with surgeonsRefers to postoperative HDU/ICU as appropriate

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PAC

OneOne--stop stop PreanaestheticPreanaesthetic Assessment ClinicAssessment Clinic

•Bed booking - DS/SDA/IP•Consultation Clinic booking•Reminder•Confirmation

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DSC ClerkDSC Clerk

Checks patient detailsRequests patient medical recordsArranges and coordinates patient appointmentsTelephones patient to confirm surgical appointmentAssists in data collection

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Other ConsultantsOther Consultants

Provide specialist consultation services Provide advice and treatment to optimise patient for surgery

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GP/GOPD DoctorGP/GOPD Doctor

Provides information to perioperative team as the patient’s primary physicianProvides treatment to optimise patient for surgery

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20072007

No. of cases seen at PAC 3,307 (+2,845)

No. of patients referred to other specialties 124 (3.8%)

Total no. of preadmission T&S 649

Cancellation rate due to medical problems DS SDA

0.3% 0.2%

Average waiting time to see Anaesthesiologist 35 mins

Patient satisfaction rate 99% very satisfied

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ConclusionsConclusions

The one-stop Pre-anaesthetic Assessment Clinic is an efficient preoperative assessment/planning service that meets the expectations of patients/carers and surgeons

It requires collaboration and good communication with the various operating specialties, and other specialties to which we may be referring patients

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PAC

OneOne--stop stop PreanaestheticPreanaesthetic Assessment ClinicAssessment Clinic

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Opening hours of PAC

Nurse assessment: 09:00 - 18:00

Anaesthesiology assessment : 13:30 - 18:00

Closed Saturdays, Sundays and public holidays

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AimsAims

1. Optimising the patient’smedical conditionnursing preparationsub-specialty and allied health preparationdischarge planning

Department of Health, New South Wales. 2007.. [WWW}

http://www.health.nsw.gov.au/policies/gl/2007/pdf/GL2007_018.pdf

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AimsAims

2. Meeting expectations of the patientthe carerthe referring surgeonthe anaesthesiologist

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3. Efficient co-ordination and integration of resources

AimsAims