Preassessment Deb Smith

Auburn Hospital
Admission &
Pre-assessment Process for Patients
Scheduled for Elective Surgery
2013
Presented by
Debra Smith
NUM
Pre -assessment Unit
Auburn Hospital Periop Assessment
1
Process for Elective Pts
Pre – Assessment For
Elective Surgery
• Follow the Ministry of Health Pre-Procedure
Preparation Toolkit -
http://www0.health.nsw.gov.au/policies/gl/2007/pdf/GL2007_018.pdf
• Aim to optimise patients’ health before an

elective procedure
• Education for the Patient Journey
• The Infrastructure was built according to the

PPT Process for Elective Pts
2
New Facility / New Process
• New Facility custom built to accommodate
a“One Stop Shop” surgical and peri-operative
unit.
• Patients for elective surgery have one point of
entry into unit that covers the whole pre-
assessment process.
Level 3
- Surgical Coordination & Bookings
Pre Admission Clinic- Maternity Unit
Operating Suite & Recovery- Birth Unit
Day Surgery Unit- Nursery
Surgical Ward
CSSD

3
Co-location
All staff from:-
• Admissions
• Bookings / Waiting List
• Surgical coordination
• Preadmission clinic
all co -located onto level 3 with the day

procedure unit, the operating suite and surgical
ward. Auburn Hospital Periop Assessment
4
Management
• Nurse Unit Manager under the umbrella of
the Nurse Manager of the Operating Suite
• Regular meetings and daily liaison with the

Nurse Unit Managers of the Operating Suite,
Day Procedure Unit, Surgical Ward and Bed
Management.
• Nursing Staff multi skilled to other areas

5
One Management Team
• The Nursing Unit Manager of the Pre- Assessment
unit has included into the position description :-
• Admissions and Bookings,

• The Pre- admission Clinic
• Waiting list management
• Surgical Coordination
• Operating Suit and Anaesthetic Scheduling

6
The Role of the Nurse Unit
Manager
• Primarily the conjugate between all aspects of
the surgical care team

7
Process for Referral
• Patient referred by VMO Surgeon to facility.

• Recommendation for admission delivered to
facility either by :-
• Mail
• Patient personally delivers
• VMO
• Fax – if case urgent

8
Clerical Processes are reflective of
the Nursing Process
• Nursing triages and schedules a tentative date
for surgery from information on the
Recommendation For Admission and acuity
code
• Clerical enter patient details onto the waiting
list
• Clerical staff enter the date for surgery plus a
preadmission date for the clinic if required –
All attended concurrently
9
• patient flow
in the Pre- Assessment Unit
In one location
Under one management
Team.

10
Triage Process to Access
appropriate type of Assessment
• No PAC No comorbidities
No requirement for interpreter
No procedural requirement for

investigations
Under age 55 years

11
• Phone PAC
» Non Ambulatory
» Aged Care Facility
» Rural Residence
» Patient Reason ( individually accessed)
» Attended by both Nursing and Anaesthetics,

liaise with General Practitioner.

• Nurse PAC
» No Co morbidities on health questionaire
» Requirement only for interpreter or allied health

eg Social Work or Physiotherapy
» Patient request
» Education
» Organisation of admission and transport only

» Minor Procedure
13
• Anaesthetic Clinic
» Known Comorbidities or previous Anaesthetic issues
» Pregnant or Paediatric patient
» Requirement for non- nursing investigations
» Issue identified during the Nurse Assessment

both Nurse and Anaesthetic clinic occurs within the one
visit. Ability is built into the capacity to accept patient
into the anaesthetic clinic if an issue is identified within
the Nurse Clinic.
» Age over 55 years
» Most patient are reviewed by an anaesthetist

14
Clinical Pathways
• All Patients are commenced on a clinical
pathway.
• Most are commenced at time of visit to
preadmission clinic or phone pac
• The few patients that are considered a

“No PAC” are commenced on admission.
• Examples are on Ministry of Health website
15
Advantage of the Pathway
• Gives a roadmap that the patient journey can
follow.
• Variances to this map are easily identified and
acted upon.
• Acts as a checklist
• Patient is shown the pathway and educated
using the pathway
• Multidisciplinary which includes:-
» Medical
» Nursing
» Allied health
16
» Clerical Process for Elective Pts
17
OUTCOMES:
 Coordinated multidisciplinary approach
Criteria for Pre assessment followed by all stakeholders
Communication between departments is effective
As of 31-12-2012, no cancellations in operating suite for past 12

months due to inadequate pre assessment.
Less waiting time for Patient by direct point of entry for

admission.
 Patient returns to this area on day of surgery so patient now

orientated for Day of Admission.
Clerical staff save on average 80minutes per day ( if not

more) due to tAhubeurcn oHoloc
spitalaPtee
riodp A
dsesepssar tment
ment
18
Patient Focused -Positive feedback on patient
surveys
Effective Communication between the teams
 More streamlined admission process – in one

spot!!
 As part of the High Volume Short Surgical Stay

model, this system of pre-assessment allows for
high capacity assessment, within a safe and
clinically robust framework
19
References
• Clinical Protocol Library for Extended Day Only (EDO) / 23-Hour Care Units, Retrieved on 21-
12-2012 from http://internal.health.nsw.gov.au/clinicalprotocol/contacts.html
• Conway, J. B., Goldberg, J., & Chung, F. (1993). Preadmission anaesthesia consultation clinics.
Ambulatory Surgery, 1(2), 106-107. doi: 10.1016/0966-6532(93)90098-A
• High Volume Short Surgical Stay Model Toolkit, Retrieved on 21-12-2012 from
http://www0.health.nsw.gov.au/pubs/2011/pdf/hi_vol_short_stay_surgery.pdf
• MacLellan, D. G., Smyth, T., Cregan, P. C., Lizzio, J., & Watt, H. (2012). Surgical services:
Shaping future directions. ANZ Journal of Surgery, 82(1‐2), 68-72. doi: 10.1111/j.1445-
2197.2011.05955.x
• Pre-Procedure Preparation Toolkit – retrieved on 21-12-2012 from

http://www0.health.nsw.gov.au/policies/gl/2007/pdf/GL2007_018.pdf
• Singh, N., Brooke‐Cowden, G. L., Whitehurst, C., Smith, D., & Senior, J. (2005). The auburn
elective surgery pilot project. ANZ Journal of Surgery, 75(9), 768-775. doi: 10.1111/j.1445-
2197.2005.03526.x Auburn Hospital Periop Assessment
20

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Auburn Hospital

• Aim to optimise patients’ health before an

• Education for the Patient Journey

• The Infrastructure was built according to the

Auburn Hospital Periop Assessment

all co -located onto level 3 with the day

• Regular meetings and daily liaison with the

• Nursing Staff multi skilled to other areas

• Admissions and Bookings,

Auburn Hospital Periop Assessment

Auburn Hospital Periop Assessment

• Patient referred by VMO Surgeon to facility.

Auburn Hospital Periop Assessment

Auburn Hospital Periop Assessment

No requirement for interpreter

No procedural requirement for

Under age 55 years

» Aged Care Facility

» Patient Reason ( individually accessed)

» Attended by both Nursing and Anaesthetics,

Auburn Hospital Periop Assessment

» Requirement only for interpreter or allied health

» Organisation of admission and transport only

Auburn Hospital Periop Assessment

» Pregnant or Paediatric patient

» Requirement for non- nursing investigations

» Issue identified during the Nurse Assessment

» Most patient are reviewed by an anaesthetist

Auburn Hospital Periop Assessment

• The few patients that are considered a

Criteria for Pre assessment followed by all stakeholders

Communication between departments is effective

As of 31-12-2012, no cancellations in operating suite for past 12

Less waiting time for Patient by direct point of entry for

 Patient returns to this area on day of surgery so patient now

Clerical staff save on average 80minutes per day ( if not

Effective Communication between the teams

 More streamlined admission process – in one

 As part of the High Volume Short Surgical Stay

• Pre-Procedure Preparation Toolkit – retrieved on 21-12-2012 from

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