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A model of community based, preadmission management for elective surgical patients

Abstract

Purpose

This paper outlines the process of preadmission elective surgical preparation utilised at our institution.

Methods

The process commences with a health status questionnaire sent to all patients. Based on the results of the questionnaire all elective surgical patients are then triaged: (i) to be assessed by an appropriately accredited general practitioner (45% of elective surgical patients) and subsequently attend preadmission clinic; (ii) to be seen by an anaesthetist (25%) and also be preadmitted at this visit or (iii) to go directly to preadmission clinic (30%).

Results

This has resulted in a 96% same day admission rate for all elective surgery. Cancellations due to suboptimally prepared patients are < 1%. The involvement of general practitioners in this process has reduced patient inconvenience. There has been marked improvement in the ability to admit patients on the same day of surgery for all types of surgery while minimising late cancellations. This has been achieved at a minimum real cost.

Conclusion

Preanaesthetic assessment is important for patient well-being and hospital throughput. We describe a system for utilising non-anaesthetist general practitioners in this process. Their familiarity with their own patients and appropriate training in preoperative assessment significantly contributes to the efficiency of our elective surgical throughput.

Résumé

Objectif

Exposer le rôle de la préadmission en chirurgie élective d’un jour en vigueur dans notre institution.

Méthodes

Au départ, tous les patients répondent à un questionnaire sur leur état de santé. Sur la base des résultats de ce questionnaire, tous les candidats à une chirurgie non urgente sont dirigés: (i) vers un omnipraticien accrédité de la clinique de préadmission pour évaluation (55% de tous les patients chirurgicaux électifs); (ii) vers un anesthésiste (25%) pour préadmission ou (iii) directement vers la clinique de préadmission (35%).

Résultats

Grâce à ce système, le taux d’admission le même jour pour toute la chirurgie non urgente a atteint 96%. Les annulations dues à une préparation insuffisante sont inférieures à 1%. L’introduction des omnipraticiens dans ce système a réduit les inconvénients pour les patients. Ceci s’est manifesté par une amélioration de notre capacité d’admettre les patients le jour même de l’intervention pour tous les types de chirurgie tout en ramenant au minimum les annulations de dernière heure. Ceci a été réalisé à bon prix.

Conclusion

L’évaluation préanesthésique est importante pour le patient et l’efficacité de l’hôpital. Notre système utilise des omnipraticiens sans formation anesthésique. La connaissance intime de leurs patients et une formation appropriée en évaluation préopératoire contribuent de façon significative au rendement du programme de chirurgie élective.

References

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Author information

Correspondence to William Shearer.

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Shearer, W., Monagle, J. & Michaels, M. A model of community based, preadmission management for elective surgical patients. Can J Anaesth 44, 1311 (1997). https://doi.org/10.1007/BF03012782

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Keywords

  • Preoperative Assessment
  • Health Status Questionnaire
  • Consultant Anaesthetist
  • Preadmission Clinic
  • Prepared Patient