NMH

NMH | 2024 166 Other Clinical Departments T he Pre-Assessment clinic was set up in June 2020. It has greatly improved the efficiency of the theatre service and reduced the number of patients who fail to attend for surgery thus improving cost effectiveness and reducing waiting list times. The nurse- led clinic is run by two Clinical Nurse/ Midwife Managers with support from an Anaesthetic Consultant and an Anaesthetic Registrar. The clinic is open five days per week and also facilitates a Consultant-led Obstetric High Risk Anaesthetic clinic on Tuesday and Wednesday afternoons. The objective of the pre-assessment clinic is to enhance the clinical care of patients by conducting timely assessments, identifying health issues and arranging prompt treatment. This leads to a reduction of cancellations, efficient use of time and resources on day of surgery and an enhanced patient experience. Timing of appointments is arranged by theatre administrative staff after electronic referral is received and date for surgery is confirmed. Administration staff book a virtual appointment for all patients, ideally 4-6 weeks pre- operatively. The virtual appointment is phone call by a nurse/midwife to a patient to obtain medical, surgical, social, physical health and a medication review. This appointment facilitates a general discussion about their procedure and peri-operative journey. Advice and education is given on adequate preparation for their surgery and planning for the post-operative period. Patient information leaflets regarding surgery and general health information in preparation for surgery is sent to patient Pre-Assessment Clinic "The objective of the pre- assessment clinic is to enhance the clinical care of patients by conducting timely assessments, identifying health issues and arranging prompt treatment." Clinic Name Number of Clinics Held Attended Telemed/ Telephone Attended Total Attended DNA Rate Anaesthetic Clinic +2.3% +14.1% +57.4% +30.2% +0.7% Theatre Pre-Assessment Clinic -0.5% +11.2% -96.6% -39.8% -2.5% Pre-Theatre Telephone Clinic +105.3% 0.0% +116.0% +116.0% +0.8% % Change from 2023 to 2024 to support education. An assessment is made by the nurse at this appointment as to whether the patient needs follow up in the clinic, require other additional correspondence/tests, or to liaise with the multidisciplinary team to ensure that they are suitable and prepared for surgery. This virtual appointment may complete the pre-assessment for some patients, others will go on to have a follow up appointment in the clinic. At the in-person follow up appointments general checks of blood pressure, temperature, pulse oxygen saturation and respirations are performed. Height and weight are recorded giving a BMI score. Blood tests, infection control screening and ECG tracing of the heart is performed as indicated. The patient can be reviewed by an Anaesthetist as required at this appointment. The telephone assessment and pre-operative advice is revised and any additional patient concerns are dealt with. Appointments in the pre-assessment clinic prepare patients for day of surgery admission, allay patient concerns, provide education and promote patient satisfaction. This ultimately reduces their hospital stay, promote recovery and reduce associated healthcare resources. 2,119 patients were assessed in 2024. On average less than 30% were in-person appointments and more than 70% were virtual appointments. The clinic anticipates that the number of virtual appointments will rise for 2025 in order to hopefully reduce some of the in-person appointments. Over the next year plans are in place to expand the service to include pre-assessment of LSCS with anaesthetic support. There will be a focus on development of patient information material to promote health and wellness for the peri-operative journey. The role of the nurse in the nurse-led clinics is also expected to expand to include nurse prescribing. The clinic has conducted surveys, audits and policy changes cognisant of recommendations made in the recently published 'Model of Care for Preassessment Clinics, 2024' and will endeavour to develop and expand these practices throughout 2025 guided by evidenced based practice. Niamh Carney and Carmel Breen, Pre-assessment Clinic CMM2.

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