Integrated PreOperative Assessment and Theatre Management

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Integrated Pre-Operative Assessment and Theatre
Management
Dr. Ian Baguley, Consultant Anaesthetist
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Theatre Efficiency
Anaesthetic sorting out time on day of surgery
90
Improved Theatre
80
Typical Theatre
70
60
50
Working harder
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Theatre Efficiency
Anaesthetic sorting out time on day of surgery
90
B
80
A
Know your risky patients well in advance through
changes to Pre-Op assessment
70
60
50
Working harder
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PRE - OPERATIVE ASSESSMENT CURRENTLY
See the data and turn it into information
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Pre-Operative Assessment A patient meets with the
pre-operative assessment nurseto discuss his
fitness for surgery
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Step 1 The Pre-operative Assessment Nurse meets
with the patient through a booked or one-stop
appointment (i.e. he is immediately referred to
the nurse following his consultant outpatient
appointment)
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Step 2 The Pre-operative Assessment Programme
prompts a series of questions for discussion with
the patient
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Pre-set responses in drop-down boxes ensure
consistent and robust assessment
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Step 3 A list of tasks that must be undertaken
to complete the assessment and ensure fitness for
surgery is generated automatically
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Step 4 The programme also asks questions to
identify the risk of the procedure to assess
whether a day case procedure may be appropriate
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Step 4 An Anaesthetic Risk Assessment Summary is
generated. Since this patient is GREEN he can be
booked in for surgery and he will be able to come
in immediately before his surgery
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This patient is RED, so needs to be seen by the
anaesthetist
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Since this patient is AMBER, the pre-operative
assessment nurse needs to discuss the case with
the anaesthetist but the patient should be able
to come in immediately prior to surgery
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Theatre Management Members of the theatre team
review a forthcoming list using the plasma screen
in the theatres department
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This slide shows the information that the
clinicians were looking at on the plasma screen
in the previous slide. They can view the theatre
schedule for the week ahead, or for future or
past dates.
NOTE Dropped sessions, utilised by Consultant
Anaesthetist to see red patients
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They can drill down to an individual list to
review the patients, including their
pre-operative assessment status.
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Theatre Management Here the theatre team is
reviewing the case notes for one individual on
the list. The patients pre-operative assessment
risk is GREEN so he is likely to require less
anaesthetic work-up. The following
information can be viewed on any networked
PC - the Theatre Planner - the patients
on each list - the traffic light
summaries - the 2 Pre-op data collection
pages
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Problems encountered
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Misunderstanding
Green

• Just because patients are Green doesnt mean
  that an anaesthetist has agreed to anaesthetise
  them. There may be problems yet to be identified.
• Seeing other anaesthetists problem patients has
  been a step too far for some (surprisingly
  younger) consultant colleagues

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Benefits to date

• Has standardised the paperwork across each
  subspecialty pre-op area.
• Has brought the same emphasis on fitness for
  surgery into each subspecialty pre-op area.
• Is used as a training tool for nurses new to the
  Pre-op area.
• Much better liaison between anaesthetists and the
  Pre-op assessment nurses

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Next Step developments

• Patients could complete page one using touch
  screens.
• Anaesthetists can access a chronological list of
  all their high risk patients
• Rapid access to results reporter
• Digital ECGs to be added. Even Heart sounds could
  be recorded digitally and added.
• Wireless Palm organisers for anaesthetists can
  alert when decisions are required.

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Keep the Specialists Working
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And doing what they do best
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Thank you