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Assessment of obese patients to facilitate day case admission

Assessment of obese patients to facilitate day case admission. Sister Sue Roberts – Pre-op nurse practitioner Dr James Palmer – consultant anaesthetist Salford Royal Hospitals NHS Trust. Introduction. Why change practice? Audit What could be changed? Implementation Effects of new process.

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Assessment of obese patients to facilitate day case admission

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  1. Assessment of obese patients to facilitate day case admission Sister Sue Roberts – Pre-op nurse practitioner Dr James Palmer – consultant anaesthetist Salford Royal Hospitals NHS Trust

  2. Introduction • Why change practice? • Audit • What could be changed? • Implementation • Effects of new process

  3. Why change? • Improve patient experience • Manage patients effectively • Meet day surgery targets • Meet 18 week pathway targets

  4. Audit of Gynae Overnight stays • One year’s data (2004-5) • 27 ASA1 patients admitted with BMI >35 • 1 required additional analgesia, 1 had vaginal pack, 2 had no social support. • 5 went home same day (1 with BMI=46), • 22 NO nursing/medical intervention required overnight!

  5. Population Audit of Obesity • Health survey for England 2000-2002. • Proportion of population with BMI >30 • National 21.4% (quoted as 21.8% elsewhere from same source) • Greater Manchester 21.1% • Salford 22.1%

  6. Audit figures at Salford Royal Hospital • 5.5% of daycases done have BMI ≥37. • 6% of non daycase elective surgical patients BMI>37 • Anaesthetic audit showed vast majority feared: • postoperative hypoxia in the obese • OSA • Some patients might benefit from referral for sleep studies and possible home CPAP.

  7. What are other NW trusts doing? • 2007 telephone/email audit of all NW day case units • Questions: • Do you have an upper limit for BMI for day surgery? • What is it? • Why has this figure been chosen?

  8. Results

  9. Discussion points • Choice of max BMI not evidence based • Pennine acute • Follow up for high BMI cases • None declared • Planned development • None declared • Active preassessment • None declared

  10. How to assess • Consulted respiratory team in trust • Developed process for pre-op nurses to follow

  11. Process ASA 1 with BMI >37 Baseline sitting SpO2 <95% not fit for DSU >3% desturation >95% do 2 minute step test <3% desaturation complete OSA questionnaire   Negative Refer for PSG ADMIT TO DSU Improvement with CPAP Positive PSG – referred for NCPAP training

  12. Pre-op assessment clinic • Generic clinic • Qualified nurse practitioners • Pre-op support workers • Equipment • In house sleep studies referral

  13. Implementation • Step test • Epworth score • Sleep studies how to refer? ?stop clock

  14. Outcome • Individualised patient process identified • Utilising day surgery more effectively • Increased patient satisfaction • No cancellations/AIRs • Day surgery staff report no problems

  15. Thank you Questions???

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