A first experience in ASL 1 Imperia : DAY SURGERY Sanremo

1. XXIV Congresso Nazionale ACOI Innovare conservandoMontecatini Terme 25-28 maggio 2005 • A first experience in ASL 1 Imperia : DAY SURGERY Sanremo Why? • Because the first objective in a DAY SURGERY is zero errors • Because clinical process could be “standard” • Because the Incident reporting was already in use

2. Sanremo’s Day Surgery state of the art • Electronically active since october 2003 • n° of operations\ in patients cases in DS registered on Patidok: 3.814 (till May 2005 ) • beds 7 (accettazione, degenza, follow up) • workstations n° 5 in DS • Clinical documentation is all electronically compiled and then printed and archivied as “official” • case history • first access • formal consent • clinical examination • doctor and nurse diary • same therapy sheet • operating “book” • order entry (RIS, anesthesia, LIS, Pathologic anathomy) • discharge letter

3. Outpatients’ department Anestesia • Patidok General practitioner DAY SURGERY LIS RIS Sanremo’s Day Surgery state of the art • informatic connection • already activated • 6 outpatients’ departments (on 3 different floors -12 workstations) • operating rooms (on 3 different floors -10 workstations) • ambulatory of anesthesia (same floor -1 workstation) • to be activated (april 2005) • LIS • RIS • Anathomy Pathological

4. First Check on first Access Fourth Check staying Third Check on second access Second Check on Call for OP Fifth Check on Discharge and follw up Sanremo’s Day Surgery clinical pathway ICT oriented to risk management Clinical pathway in Day Surgery Discharge Follow up Staying Second Access Selection First Access ?? Order request Therapy Formal consent Operation Allergies Discharge Letter General practitioner • LIS • RIS • Anestesia Family status

5. Selection First access Second Acces Discharge Follow up Staying Selection Allerts if an allergy exists on the patient First access in outpatients dept. • anagraphics data are taken • access and selection beginning • orders are scheduled • LIS • RIS • Anestesia

6. Selectio First access Second Acces Discharge Follow up Staying Check on first access and selection Allerts that an allergy exists on the patient All datas relevant for the first access to be checked appear in front of the doctor and all the missing,or not checked, datas turns red Formal consent is missing!!! E.C.G. Anestesia are missing !!!

7. Selectio First access Second Acces Discharge Follow up Staying Check on second access and operation Allerts that an allergy exists on the patient All datas relevant for the second access and operation to be checked appear in front of the doctor and all the missing,or not checked, datas turns red Family status is missing!!!

8. Selectio First access Second Acces Discharge Follow up Staying Second access and operation Allerts that an allergy exists on the patient • Operating book is filled with relevant datas:operating team, operation’s description...

9. Selectio First access Second Acces Discharge Follow up Staying Staying • During the staying • parameters are checked • Doctors and nurses work on the • SAME ELECTRONIC THERAPY SHEET

10. Selectio First access Second Acces Discharge Follow up Staying Check on Staying All datas relevant for the staying to be checked appear in front of the doctor and all the missing,or not checked, datas turns red All parameters have been checked

11. Selectio First access Second Acces Discharge Follow up Staying Check on discharge and follow up Patient is painful!!! All datas relevant for the discharge and follow up to be checked appear in front of the doctor and all the missing,or not checked, datas turns red Anaesthesist did not visit the patient yet!!!

12. Selectio First access Second Acces Discharge Follow up Staying Discharge and follow up Allerts that an allergy exists on the patient • Patient is followed • also when discharged • Follow up and phone • calls are electronically “registered” Follow up and phone records

13. GRAZIE PER L’ATTENZIONE Struttura Semplice di Day Surgery ASL 1 SANREMO