文章基本信息

标题：Implementation of Model of Care for Pre Admission Units
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作者：Aileen O Brien ; Jeremy Smith ; Una Quill 等
期刊名称：International Journal of Integrated Care
电子版ISSN：1568-4156
出版年度：2017
卷号：17
期号：5
DOI：10.5334/ijic.3447
出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : The cancellation of surgery in hospitals is costly for our health service and highly stressful for the patient, family/carer and staff. One of the main aims of the Pre Assessment process is to reduce the number of unnecessary cancellations. A well established and managed Pre Admission service will contribute to achieving the National Target of 75% same day surgery rate and 75% of patients having surgery as day cases. Pre-operative assessment is now recognised as part of the elective surgical process for the following reasons: It ensures that the patient is fully informed about their proposed surgery and post-operative care required It identifies patient risk factors, thereby ensuring optimum health prior to surgery It identifies any necessary tests or investigations It ensures the patient has made arrangements for admission, discharge and post-operative care at home It provides education to both patient and carer It is an efficient and cost effective method of reducing length of stay and cancellations Practice Change : The National Clinical Programme for Anaesthesia published the Model of Care for Pre Admission units in December 2014 which outlines best practice in the establishment and continuous improvement of units both locally and within a hospital group. Phase 1 of the implementation process involved: Gaining an understanding of the current status of Pre Admission units nationally Ascertaining the challenges being experienced by the multi-disciplinary team Identifying and measuring Key Performance Indicators for improvement Developing a national standardised education programme for nurses in Pre-Admission units. Ultimately improving care and access for all surgical patients Targeted Population & Stakeholders : It is recommended that in excess of 80% of patients should be pre assessed prior to scheduled surgery. Stakeholders : Surgical & Medical Teams, Nursing Staff, Management, General Practitioners, Health & Social Care Professionals, Administration and I.T. Methods : A project plan with timelines was devised to include Site visits to all units nationally to present Model of Care Follow up reports issued to all sites RAG status reports issued with 5 identified KPIs i.e. Governance Infrastructure Dedicated workforce DOSA % of patients pre assessed. Working group established to develop national Education Programme. Impact/outcomes : In summary we found, strong Governance Structures were not evident, dedicated consultant sessions were inadequate, I.T. and administration support was poor, data collection is still primarily paper based. Infrastructure was variable and requires investment. A consensus view emerged that an education programme for Pre Admission Nurses was essential. Further RAG status information gathered 6 months after initial visit will be reported in the poster. Sustainability : The Model of Care was developed by a group of multidisciplinary practitioners based on evidence based practice and value for money. RAG status reports enable solutions by highlighting issues. Transferability : The Model of Care encompasses the requirements for Pre Admission units across Model 2 to Model 4 hospitals and taking into consideration the advantages of networking within the Hospital Group structures.
关键词：reduced cancellations ; reduced waiting lists ; increased dosa ; education ; kpis