Surgical Patient Preparation and Process

1. Surgical Patient Preparation and Process Preadmit > Preop > Postop/Discharge

2. Purpose of the presentation To provide a framework for the facilitation of: • Comprehensive preoperative workup and postoperative connection/continuity • Closed-loop communication between provider facilities • Continued dialogue on process improvement

3. Helpful terminology Transitional care refers to the critical actions of healthcare professionals designed to ensure the coordination and continuity of health care during the movement of patients,

4. Helpful terminology called care transition, to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location.

9. Where do we start? It starts with your… facility & surgeon

10. Scheduling Scheduling process: • The surgeons office faxes a surgery reservation to scheduling • An account is made in SCM • The patient is placed on the schedule • Scheduling notifies preadmit concerning surgery, time, date, and location of patient

11. Preadmit Preadmit calls facility to: • Gather patient medical/surgical history and current medication list • Give preop instructions including preop labs, NPO status, preop medications

12. Preadmit Preadmit will begin to fax • Consents to be signed • Lab orders • Preop instructions

13. Consent Draw a line & have the patient or designee initial here and circle “I” or “we” “do” or “do not”

14. Consent The patient or signatory signs here Enter date & time here. Circle A.M. or P.M. The nurse who witnesses the signing of the consent prints their name here The nurse who witnesses the signing of the consent places their signature here

15. Preop instructions

16. Preop instructions

17. Preop instructions

18. Preop Preop is the patient intake for the day of surgery. To ensure a successful transition of care please call report to our charge nurse at: 764-6340

19. Preop report • LOC • Admit dx • Allergies • O2: Flow rate ______ via ______ • IV site/fluids • DM: Last BBG ______ • Isolation precautions

20. Preop report • Level of ambulation • Last time each med was taken • Last set of VS: Temp, HR, BP, Resp, 02 Sat

21. Surgery The easiest part! 

22. Recovery Patients will stay a minimum of 1 hour in the PACU where we will ensure: • Adequate breathing • VS remain stable and/or at baseline • Achieve baseline LOC • Pain is under control • Gag reflex has returned

23. Dishcarge Patients will stay a minimum of 30 minutes in discharge and until discharge criteria is met: • VS at baseline • Gag reflex • Ambulation • PONV • Fluid I/O

24. Discharge • Adequate airway • LOC at baseline • Pain controlled • Minimal surgical bleeding • Sensation and movement • Discharge order

25. Nurse-to-Nurse Report A discharge nurse will call your facility and ask for the nurse caring for surgery patient in our care.

26. Nurse-to-Nurse Report • 1. Access United Regional portal • 2. Click on “Clinical” Summary” tab • 3. Click on drop down to “Transfer to Outside Facility” • 4. Receive report

27. Patient Transfer Summary

28. Transport Form

29. Transport The patient is transported back to your facility. When you receive the patient please call with any questions. 764-6340 If you don’t remember the name of the nurse you spoke to the charge nurse will help.

30. Have we closed the loop?

31. One more question… What is continuity of care?

32. Continuity of care Continuity of care is concerned with the quality of care over time. There are two important perspectives on this. Traditionally, continuity of care is idealized in the patient's experience of a 'continuous caring relationship' with an identified health care professional. For providers in vertically integrated systems of care, the contrasting ideal is the delivery of a 'seamless service' through integration, coordination and the

33. Continuity of care cont’d… sharing of information between different providers. As patients' health care needs can now only rarely be met by a single professional, multidimensional models of continuity have had to be developed to accommodate the possibility of achieving both ideals simultaneously. Continuity of care may, therefore, be viewed from the perspective of either patient or provider. Continuity in the experience of care relates

34. Continuity of care cont’d… conceptually to patients' satisfaction with both the interpersonal aspects of care and the coordination of that care. Experienced continuity may be valued in its own right. In contrast, continuity in the delivery of care cannot be evaluated solely through patients' experiences, and is related to important aspects of services such as 'case-management' and 'multidisciplinary team working'. From a provider perspective, the

35. Continuity of care cont’d… focus is on new models of service delivery and improved patient outcomes. A full consideration of continuity of care should therefore cover both of these distinct perspectives, exploring how these come together to enhance the patient-centredness of care. Gulliford M1, Naithani S, Morgan M. Division of Health and Social Care Research, King's College London, London, UK. martin.gulliford@kcl.ac.uk J Health Serv Res Policy. 2006 Oct;11(4):248-50.

36. Thank you! We want to help you: Jeremy Watkins – 764-6736 Manager of Preadmit & Outpatient Day Surgery Preadmit – 764-6148 Preop – 764-6340