Rosanne Lyles Powys Operating Theatre Manager

1. Rosanne LylesPowys Operating Theatre Manager

2. Powys Local Health Board 17 GP Practices 10 Community Hospitals 2 Operating Theatres, Mid & South Powys Day Case & Intermediate Surgery 16 Visiting Consultant Surgeons 2 GP Surgeons 4 GP Anaesthetist Visiting Consultant Anaesthetist

3. Basket of Surgery Gynaecology Orthopaedic Ophthalmology General Surgery Plastics ENT Oral Surgery

4. Nurse-led Pre-anaesthetic Screening ClinicWhy? No identified pathway Sessions underutilised High rate cancellation by patient High rate cancellations by Anaesthetist Patients cancelled on the day of surgery Inadequate patient information & planning Patients allocated to the wrong waiting list First contact with nurse/on admission Admission rate high

5. What did we hope to achieve? Give the choice of when and where the plan of care is delivered to the patient. Accurate information, education, planning Increase Theatre Sessions Prepare the patient for surgery Identify patients at RISK within a rural community hospital. Reduce cancellations. Reduce patient pathway stages Increase patient & Staff satisfaction Decrease length of stay

6. How did we go about this? Data Collection :� Patients cancelled Patients cancelled by Anaesthetist DNA Follow a Patients Pathway from admission to discharge QUAD Tool Process Mapping

7. Data Collection

8. Patient Pathway on Admission QUAD Tool NATN

9. Process Mapping Old Pathway

10. Problems Identified Unnecessary stages, that did not add value to the patients care Multiple Hand-offs Delay in treatment Increase patient stress & anxiety Patient�s recovery delayed Unnecessary Cancellations Sessions under utilised Unplanned admissions

11. Introduction Nurse-led Pre-anaesthetic Screening Clinic

12. Introduced a patient Pathway Admission Pack

13. Planning

14. Guidelines & Policies

15. Training Programme

16. Team Work Anaesthetist Staff Surgeons

17. Trust

18. Motivated & Dedicated Staff

19. Evidence Base

20. Current pathway

21. What are the Benefits? For the patient-: Patients are allowed to decide and choose the date for surgery Patients able to plan work & home environment. Direct booking, patient did not have to return to be assessed Education, information & counselling Reduce anxiety stress Reduced Cancellation on the day of surgery Delay treatment Reduced

22. Benefits to the Organisation Patient Cancellation reduced Anaesthetist cancellation reduced Theatre sessions fully utilised Reduction administrative documentation Patients unfit placed on correct waiting list (Inpatient or DGH)

23. Results

24. Methods of Evaluation Patient Satisfaction Audits Theatre Utilisation Audits Record Keeping Audit Patient information Audit Staff Satisfaction

25. Perfection is determined by a patients experience

26. What Next CTD Pathway � Nuerophysiology test OPD Screen Nurse-Led PSA Clinic GP/Nurse-led Fracture Clinic