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Staggered Admissions - for All Day Surgery

Explore the benefits of staggered admissions in day surgery, improving efficiency, team collaboration, and patient experience. Discover the future of surgery practices. Stakeholders include patients, surgeons, workforce, and more.

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Staggered Admissions - for All Day Surgery

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  1. Staggered Admissions - for All Day Surgery The case for -

  2. Take Home Message “Preserving the Obsolete or Preparing for the Future?”

  3. BADS • Excellence in Shortest Stay Surgery

  4. “Staggered = Flexibility!!” • Early Morning Admission • Pre AM/PM Session • Pre Session Priming • Appointments thru’ session. • Batches thru’ session • Not One Size for All

  5. Best Practice Models Applicable to: • Out Patient* • Treatment Room* • Same Day Surgery* • 23 hour stay • 47/71/95 *Already Delivered in Primary Care Etc.

  6. Stakeholders = Beneficiaries • Surgery • Patients • Surgeons • Workforce • Estates • Anaesthesia • Commissioners

  7. Surgery under Scrutiny. • Patient Reported Outcome MeasureS • Patient Reported Experience MeasureS • Minimally Disruptive Medicine Interventionalism Radiology • Right First Time = Zero Take Backs = Zero Complications

  8. Streaming of Surgery Defaults: • Out Patients • Treatment Room • Op Room + Local Anaesthesia • OR + LA + Conscious Sedation • OR +LA + Advanced Sedation • OR + General Anaesthesia

  9. Surgeons • Spend less time operating. (Global Comparison) • Spend a lot of time waiting. • Inconsistent Practice – Pooling. • Divorced from decision to operate.

  10. Team work: Surgeons • Specialist • Trainees • First Assistant • Surgical Care Practitioner

  11. Estates - Reception Lounge Max Clinical Gain per Metre Squared: • Minimal Bed Occupancy • Chairs >>Beds • Over Equipped Ward Area • Waiting Patients in Fewer Areas • Proximity of Reception Lounge to Theatres • Competition for Care – In Patients • 40 – 70year Capital Build Cycle

  12. Patients I • Choice. • Empowered • Hi Light Poor Experiences! • Satisfaction Questionnaires • Confidentiality

  13. Patients II Where am I on the list? Why…wait so long? Why …starved so long? Missing from the ward? • Smoking Outside • Shops • Meeting Relatives • Something to Eat/Drink

  14. Team Work: Anaesthesia NB – Shift to LA & Sedation • Specialist • Trainees • PA Anaesthesia • Recovery Team • Sedation Technician

  15. Hurdles & Solutions • DNAs • Incomplete Preparation • Assessments • Diagnostics • Consent • Good Advanced List Planning • Time to See: Social Visit • Delivering Care in Teams

  16. Staggered Elsewhere= • Dental Surgery. • General Practice. • Endoscopy. • Cardiac Cath. Lab • Interventional Radiology. • The Vets…better treatment for our pets.

  17. ….and remember surgery was spawned in the barbers shop. (Sit & Wait) Hairdressers have now evolved to staggered admissions.

  18. Summary • Demonstrable Benefits to all stakeholders. • Efficiency Gains • Builds on Current Best Practice • Team Work • Pre Op • Consent • Minimally Disruptive

  19. Take Home Message “Preserving the Obsolete or Preparing for the Future?”

  20. Thank You bill.horton@aintree.nhs.uk

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