A study of clinical and information management processes in the surgical pre-assessment clinic

Matt-Mouley Bouamrane,Frances S Mair

doi:10.1186/1472-6947-14-22

Matt-Mouley Bouamrane, Frances S Mair

Open Access

https://doi.org/10.1186/1472-6947-14-22

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Abstract

BackgroundEstablishing day-case surgery as the preferred hospital admission route for all eligible patients requires adequate preoperative assessment of patients in order to quickly distinguish those who will require minimum assessment and are suitable for day-case admission from those who will require more extensive management and will need to be admitted as inpatients.MethodsAs part of a study to elucidate clinical and information management processes within the patient surgical pathway in NHS Scotland, we conducted a total of 10 in-depth semi-structured interviews during 4 visits to the Dumfries & Galloway Royal Infirmary surgical pre-assessment clinic. We modelled clinical processes using process-mapping techniques and analysed interview data using qualitative methods. We used Normalisation Process Theory as a conceptual framework to interpret the factors which were identified as facilitating or hindering information elucidation tasks and communication within the multi-disciplinary team.ResultsThe pre-assessment clinic of Dumfries & Galloway Royal Infirmary was opened in 2008 in response to clinical and workflow issues which had been identified with former patient management practices in the surgical pathway. The preoperative clinic now operates under well established processes and protocols. The use of a computerised system for managing preoperative documentation substantially transformed clinical practices and facilitates communication and information-sharing among the multi-disciplinary team.ConclusionSuccessful deployment and normalisation of innovative clinical and information management processes was possible because both local and national strategic priorities were synergistic and the system was developed collaboratively by the POA staff and the health-board IT team, resulting in a highly contextualised operationalisation of clinical and information management processes. Further concerted efforts from a range of stakeholders are required to fully integrate preoperative assessment within the health-board surgical care pathway. A substantial – yet unfulfilled – potential benefit in embedding information technology in routine use within the preoperative clinic would be to improve the reporting of surgical outcomes.

Highlights

Establishing day-case surgery as the preferred hospital admission route for all eligible patients requires adequate preoperative assessment of patients in order to quickly distinguish those who will require minimum assessment and are suitable for day-case admission from those who will require more extensive management and will need to be admitted as inpatients
Confidential Enquiry into Patient Outcome and Death (NCEPOD) in the U.K. found that 16% of the hospitals reviewed had no pre-admission anaesthetic assessment clinic, 17% had no surgical assessment clinic and that nearly 20% of elective high-risk patients were not seen in a preoperative clinic prior to surgery [2]
Rationale for the development of a pre-operative assessment clinic The pre-assessment clinics (PAC) at Dumfries and Galloway Royal Infirmary (DGRI) started operating in July 2008, in order to cover pre-assessment for general surgery and other surgical specialties

Summary

Introduction

Establishing day-case surgery as the preferred hospital admission route for all eligible patients requires adequate preoperative assessment of patients in order to quickly distinguish those who will require minimum assessment and are suitable for day-case admission from those who will require more extensive management and will need to be admitted as inpatients. The NCEPOD report emphasised the importance of high-quality preoperative assessment (POA) to ensure the early identification and effective clinical management of ‘higher-risk’ patients, in order to reduce surgical mortality rates. To establish day-case surgery as the preferred hospital admission route for all eligible patients requires the prior assessment of all patients in order to quickly distinguish those who are suitable for day-case admission from those who will require more extensive management and will need to be admitted as inpatients. Effective patient evaluation will depend upon the efficient collection of all appropriate medical information, good data management and communication between the members of the multi-disciplinary team (MDT) and the adequate use of actionable knowledge to decide on an appropriate course of action for optimum patient management [5,6]

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