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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