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Pre-operative Assessment and Planning


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Pre-operative Assessment and Planning
 


What is it and how can it help me?

Pre-operative assessment (POA) and planning, carried out prior to treatment, ensures that the patient is fully informed about the procedure and the post operative recovery, is in optimum health and has made arrangements for admission, discharge and post operative care at home.

POA and planning is an essential part of the planned care pathway which enhances the quality of care in a number of ways.

  • If a patient is fully informed, they will be less stressed and recover more quickly
  • A health check ensures good medical health before anaesthesia and surgery
  • Planning admission and discharge individually ensures that patient and carers know what to expect facilitating earlier post operative care at home
  • Cancellations due to patient ill health or DNAs are reduced
  • Admission on the day of surgery and early discharge are more likely

By improving the planned admission process, you also enhance the patient experience and the clinical process, as well as the efficiency and productivity of the trust. POA and planning should form a natural part of the process for all planned surgery. You may wish to match the intensity of the process to the patient's level of fitness and complexity of the procedure. The key areas covered in the National Good Practice Guidance on Pre-operative Assessment for Inpatient and Day Case Surgery include:

  • The objectives of pre-operative assessment
  • Who should undergo pre-operative assessment
  • When and where pre-operative assessment should take place
  • Who should perform pre-operative assessment
  • The risks, benefits and informed consent
  • What should happen after pre-operative assessment
  • What information should be given to patients
  • How records should be kept
  • How the pre-operative assessment service should be audited
  • Training in pre-operative assessment
  • Examples of effective practice

Useful links are:

Producing patient information
DNAs
Cancelled operations
Discharge planning

When does it work best?

An essential ingredient to shortening patient pathways is free uninterrupted flow from start to finish. Cancellation of any part of the process is usually a postponement rather than a removal and thus results in delay.

It is recommended that POA and Planning takes place at the earliest opportunity as there will be times when assessment reveals that the medical condition that needs further investigation and treatment. It is inappropriate that the patient starts down the pathway in this situation.

When the patient is fit for surgery he / she starts along the pathway. This will reduce cancellations and the associated inefficiencies which waste resources. The Trust will benefit by having more available capacity to treat more patients.

How to use it

Who
Pre-operative assessment and planning is a skilled job and is best performed by dedicated staff trained for the task. The majority have a nursing background. Patients judged to be at greater risk are assessed by anaesthetists.

What
The process is governed by agreed protocols and guidelines set up by the local anaesthetists.  

Why
To ensure all patients are fully informed and well prepared for their surgery and post operative recovery thus increasing both clinical and process quality and reducing inefficiency and wasted capacity.

When
POA and Planning should take place as close to the decision to treat as possible.

What next?

We recommend you look at the following information as it will further your understanding.

Producing patient information
DNAs
Cancelled operations
Protecting the Bottleneck
How to measure demand and capacity
Discharge planning

Pre-operative assessment guidance for Day Case (Modernisation Agency)
 
Pre-operative assessment fuidance for Inpatients (Modernisation Agency)

NICE clinical guidelines on the use of routine preoperative tests for elective surgery.  NICE have recommended circumstances in which the tests should be done, not done, or considered. For example, whether a certain test is recommended may depend on the patient's age or how serious the planned operation is.

1 - Plan ahead. Pre-operative assessment is all about planning the patients journey
2 - Keep the flow.  Successful pre-operative assessment ensures the patient flows through the referral to treatment pathway
6 - Focus on the whole patient journey.  Pre-operative assessment joins the parts of the journey together

Additional resources

Websites: 

Background

Work done by The Modernisation Agency - Theatre and POA Programme showed that on average 24 per cent of operations are cancelled after the patient has been given a date for their surgery. Subsequent pilot projects showed the value of POA and Planning in reducing the rate of cancellation.

© Copyright NHS Institute for Innovation and Improvement 2008