8. Good practice model
The Modernisation Agency Theatres Programme good practice model has a number of key components that should be examined:
Using pre-operative assessment to identify patients who:
- have potential anaesthetic difficulties;
- have pre-existing medical conditions;
- report a change in their medical condition following their outpatient appointment;
- no longer wish to have the operation, or are unsure.
Implementing pre-operative assessment to:
- plan pre-operative care, e.g. any special requirements;
- provide the opportunity for explanation and discussion;
- allay fear and anxiety;
- provide an opportunity to discuss with patients any self-help matters to improve the outcome of their urgency of their surgery (e.g. stopping smoking or losing weight);
- start planning for discharge.
Validating waiting lists to:
- identify patients who no longer require their operations;
- telephone patients near to the date of admission to confirm attendance;
- provide surgical teams with reports on the number of patients removed from the list without having treatment;
- contact patients who did not attend pre-operative assessment to ensure that they still require their operations;
- produce and analyse cancellation reports to ascertain where improvements should be made;
- produce and analyse theatre utilisation reports to identify where there is spare/potential additional capacity and why cancellations are made.
Develop partnerships with local primary and community care organisations to:
- identify where delays and unnecessary overnight admissions occur - e.g. ordering of transport;
- develop benchmarking information, and incentivising the move towards increased day case and day surgery rates through commissioning;
- publish a local benchmark of best and worst performers to kick start action planning to improve and provide regular reports to ensure momentum continues;
- develop pilots to provide for recovery at home and other primary care follow up processes in the patient pathway, transport facilities, patient hotel facilities;
- co-ordinate an examination of the skills mix implications for moving to increased day-case work for each professional group;
- clarify which procedures could move to outpatients and primary care.