Making Waves October 07 - James Paget University Hospitals

More documents

Recommendations

Info

Inside our Preassessment Clinic Staff will know that the preassessment clinic prepares patients for admission to surgery, as . inpatients or day cases. Patients normally have an appointment with a preassessment nurse one to two weeks before their operation. But what does the clinic achieve, and how? Here, Michael Lundberg Consultant Anaesthetist, Michelle Thompson, Preassessment Sister and Donna Carrier, Anaesthetic Administrator explain all. They recently made the semi-finals in an Eastern region Health Care Innovation Contest, and wanted to share what we told them with Making Waves readers. Left: The Preassessment Clinic team: left to right: Michael Lundberg, Consultant Anaesthetist; Debbie Norton, Staff Nurse; Sharon O’Connor, Sister; Irene Spencer, Admissions Coordinator and Michelle Thompson, Senior Sister. So what does Preassessment Do? The prospect of having even minor surgery can stir up considerable anxiety in a patient. A good psychological preparation is essential and has been shown to speed up recovery. Thus a lot of information is given to clarify what lies ahead, and ample time is allowed for questions. Many patients also need bloods taken, X-rays or ECGs done and medications stopped or modified. The Kardex and other paperwork are initiated to facilitate the admission process and pre-clerking (ie examination by a junior doctor) is frequently done at this point. One of our most important tasks is to identify the patients at risk of developing complications during or after the operation. Due to other illnesses patients may lack the functional reserves to meet the stress imposed by major surgery which has been compared to running half a marathon. Function of key organs can be so compromised that anaesthesia is hazardous. It is essential that these patients are thoroughly investigated before the operation so that specific risks can be identified and precautions taken. Such a patient may need specially tailored anaesthetic technique, monitoring and organ function support both during and after the operation. They will also benefit from close monitoring in the high dependency unit (HDU) for a time after the operation. Studies have shown a clear decrease in complications if patient risk factors are properly managed. Fewer complications translate directly into shorter length of stay and a higher patient turnover. High-risk patients are traditionally picked up by surgeons. They communicate with their anaesthetist who then initiate an investigation of the patient. Some patients slip through the net, however. When the patient is seen at preassessment one to two weeks before admission it’s often too late to address serious health problems and the operation has to be deferred. Occasionally, these patients are only picked up after admission and promptly cancelled by the anaesthetist. The patient is distressed, the surgeon occasionally upset, bed and theatre list management poor, and the result is sub-optimal use of hospital resources. 4 October 2007 Making Waves All about the Well Being Questionnaire (WBQ) In 2004 Dr Frayssinet (then a JPUH Consultant Anaesthetist) developed a system to address these short term cancellations. On decision to operate the patient is asked to fill out a health questionnaire (WBQ) designed to flag up health problems and given a slot on the waiting list. A preassessment nurse uses information from the WBQ to risk grade the patient. BMI (body mass index), general health score, exercise tolerance and type of surgery (minor/ intermediate/major) make up a risk index. Patients who are fit or have well controlled systemic disease have telephone preassessment or an appointment with a preassessment nurse. Patients with a high risk score have their notes reviewed by a consultant anaesthetist, who decides if they need a clinic appointment or further investigations and plans the level of postoperative care. No patient has their waiting list number activated unless they have been “green-lighted” by dedicated preassessment staff or an anaesthetist. The gains of the system are that resources are focused on the high risk patients, who need them most. Waiting time is used to identify and if possible optimise treatment of co-existing illness that might affect surgical outcome. Unless exceptional measures are necessary (such as coronary interventions) no patient loses their original place on the waiting list. The WBQ system was launched as a pilot covering general surgical and urological patients in January 2005. It quickly proved its worth, as showed by an audit of the first six months running: short term cancellations for major medical problems had ceased to be a problem. Gynaecology joined the system from April 2007. Part of the Anaesthetic administrative team: Donna Carrier, Anaesthetic Administrator and Sharon Peek, Anaesthetic WBQ secretary. www.jpaget.nhs.uk
What about the Future? Developing the WBQ has given us a unique overview of the surgical services. With so many people involved, and given the time limits set by cancer targets, it is essential that everybody works to an agreed pattern to avoid “rush jobs”. Patient pathway mapping has helped us to identify and address teething problems and bottlenecks. Meetings with surgical secretaries, matrons, outpatient department staff and medical records have improved cooperation. Communication with primary care is currently being looked at, as we would appreciate more information about patient history and treatment to be included with referrals. The system continues to develop, to meet the challenges of the cancer and 18 week waiting time targets. A successful recent bid for anaesthetist cover of all preassessment sessions has enabled us to plan for a roll-out of the service to all remaining surgical specialities, subject to more spacious clinic accommodation becoming available. The WBQ system greatly simplifies the preoperative work of the anaesthetists and helps to implement admission on day of surgery. Invaluable help from Matthew Piggott in the IT department has allowed us to develop a system to register patients and print anaesthetic charts with all preassessment details filled in, which improves safety and facilitates administrative work and audits. Finally, a word about our vision: to create a ‘one-stop’ preassessment service, where patients can go straight after their meeting with the surgeon. It would make life a lot easier for everybody, and above all, for our patients!! www.jpaget.nhs.uk Welcome to our New Governors Following the recent elections to the Governors Council, we are welcoming three new members to the Council, and celebrating the re-election of Rachel Hulse, Gillian Pope, Russell Allen and Neville Sanderson. Many thanks go to Allison Bester and Peter Gordon for all their work on the Governors Council. Below, meet your new Governors, hear what they can offer the Council and how they will be getting involved. Laurie Howarth Laurie has worked at the James Paget University Hospital since 1986. She sees the role of Governor as an opportunity for her to promote the Trust. She says: ‘We need to educate and support staff to have ownership of the Trust so that they feel appreciated. Communication is part of my everyday role and I hope to play a key part in keeping both staff and the public informed about the work of the Trust. As ward manager of the neonatal unit I hope my listening skills and organisational abilities will be helpful.’ Brian Callan Brian has 21 years experience as a manager in Yarmouth and Waveney Health Authority being as Director of Patients Amenity Services. He’s also clocked up forty years service in local community organisations and served as a County, District and Parish Councillor. Brian says: ‘Having received excellent service and treatment from JPUH and its staff over the years, I became an early supporter and member of the Foundation Trust. To me, my offer of personal practical help plus the experience I have gained seems a good way to show my thanks. I hope my experience as a researcher and writer, and my wide community contacts, will really benefit the Governors Council.’ Tim Barrett Tim has 30 years experience running a care home group in East Anglia which was highly regarded. Tim says: ‘My team and I were passionate about resident welfare and staff development and won numerous awards for training. Now that I have sold the care home group I would like to retain an interest in healthcare by helping the Trust to continue to provide the best of care to the local population. Having lived in the area for 26 years my family and I have all used the services of the hospital.’ Don’t forget the League of Friends The League of Friends actively fund raise for the Trust, and have money available to give to wards and departments. Anything from the very small to a bigger bit of kit can be supported. You can apply in writing for anything under £500, or fill in a form for items of greater value. Then all you have to do is come to a Friends meeting, present your bid, and hopefully secure a contribution or the full amount! For more information, contact Chairman Heather Cave through the Friends shop in the foyer, or Wendy Burman on x2680. October 2007 Making Waves 5
Page 1 and 2: October 2007 James Paget University
Page 3: Enhanced recovery after surgery (ER
Page 7 and 8: CSCA Bus Many staff will have met m
Page 9 and 10: O/A’s! The Outpatient Assistants
Page 11 and 12: Thank You! Another small sample of
Page 13 and 14: Excellent Service Awards On 4th Jul
Page 15 and 16: James Paget Hospital A celebration

Making Waves October 07 - James Paget University Hospitals

Create successful ePaper yourself

Delete template?

Save as template?