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Staggered Admissions - for All Day Surgery

Staggered Admissions - for All Day Surgery. The case for -. Take Home Message. “Preserving the Obsolete or Preparing for the Future?”. BADS. Excellence in Short est Stay Surgery. “Staggered = Flexibility!!”. Early Morning Admission Pre AM/PM Session Pre Session Priming

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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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