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Pre-operative Assessments

2010/11

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Key sources of guidance

• PbR Guidance 2010/11

• Para 151 on Pre-operative assessments

• Para 175 on streamlined Cataract Pathway




What is a pre-operative assessment

• Institute for Innovation and Improvement

“ensures that the patient is fully informed about the procedure and the post operative recovery, is in optimum health and has made arrangements for admission, discharge and post operative care at home”




Why have a pre-operative assessment

• Patient less stressed and recover more quickly

• Ensures good medical health before anaesthesia and surgery

• Better patient knowledge means they can better maintain their support network at home

• Reduced cancellations / planned procedures not carried out




How deliver a pre-op assessment (1)

• Calderdale & Huddersfield NHS FT

– Nurse assesses general health, blood pressure, weight, height and maybe blood tests and/or ECG

– Discusses admission details and nil orally information etc.





• The Hillingdon Hospital NHS Trust

– Clinic to assess patients scheduled to have vascular and orthopaedic surgery as medically fit for anaesthesia.

– Nurse reviews medical history and carries out full anaesthetic assessment including airway assessment. May also require blood tests, ECG and / or X Ray of the chest.

– Could last up to 3 hours.





• East Cheshire NHS Trust

– Nurse assesses general health and previous health history.

– Might need to take blood sample, ECG, listen to heart and lung sounds

– Discusses admission details and what to expect





• NHS Direct runs telephone-based pre (and post) operative assessment service

• Confirms still going to attend, any changes in medication, procedure etc.

• By exception patients identified whether a face to face assessment is needed





• Department of Health have said that the preoperative assessment for a patient needing a cataract should be carried out in the attendance where the hospital confirms the diagnosis and lists the patient for surgery.

• Improves the experience for the patient

• Improves value for money for the NHS




How pay for a pre-op assessment (1)

• If the pre-operative assessment is carried out post admission then not getting the benefits of having it e.g. No time for GP to support their patient and bring their blood pressure down so they can then have the operation.

• However if it occurs post admission then not separately paid for, it is part of the spell price





• If carried out pre admission and is pre-booked consultant led outpatient attendance (and no other conditions in the contract) then it will receive the relevant price which will probably be a follow up tariff.

• If an ECG is carried out then it may be an

Outpatient Procedure tariff (EA47Z) instead.

• Note – consultant led does not mean consultant present.





• Contract might have stipulations regarding how far in advance of the admission the preoperative assessment needs to occur.

• For example the contract might say that the commissioner does not pay for pre-operative assessments on the day of admission (or up to

X days prior to admission) as doing it this close to admission does not deliver the full benefits of carrying it out.





• As with the national cataract example could have a streamlined pathway where the preoperative assessment should be carried out in the attendance where the hospital confirms the diagnosis and lists the patient for surgery.

• Might not be possible for all conditions so may need an exceptions list.





• Could look at carrying out the pre-operative assessment in a non acute setting and then by exception carrying them out in an acute setting.

– NHS Direct example is one approach

• Using primary care and a LES is another approach and potentially has more benefits

– Need to ensure that risk is carefully managed




Conclusion

• Pre-operative assessments can have significant patient benefits and help improve

NHS efficiency when carried out at the right time.

• They do not all need to be separate acute based attendances (at tariff) – there are options such as:

– streamlined pathway

– nurse led with exceptions seen by consultant

– telephone with exceptions seen in acute

– community / primary care RSR Consultants Ltd www.rsrconsultants.com


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©RSR Consultants Ltd

Pre-operative Assessments

2010/11

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