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Booked Admissions

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					  Telephone
Pre-admission
 Assessment
 Annette Thorpe (R.B.H)
          and
Ann-Marie Malley (NHSD)
                NHS Direct

• NHS Direct is leading the world as the largest
  e-health service of its kind.
• Half a million telephone calls per month
• Projected to rise to 1.2 million in three years
• Half a million on-line visits per month
• Very high satisfaction rates
• Hosted by 22 NHS Trusts/PCTs
          Service priorities

• Growth in service (0845)
• Out-of-hours integration
   – technical links by end 2004
   – full clinical integration to follow
• Low priority ambulance calls from mid 2005
• Expansion of on-line and digital TV services
• Supporting local agendas
        New Organisational
            structure
• Responsibility for commissioning NHS Direct
  moved to PCTs from April 2004
• A new national NHS Direct provider
  established to manage the service from April
  2004
        The beginning
Problems had been identified with pre-admission
assessment service at the Trust:

– Not enough capacity, in terms of staffing and space, to
  allow all patients to be pre-assessed

– Some patients were being brought back to the hospital
  at the time of their OP appointment when they could be
  pre-assessed in a different setting
                  Advantages

•   Experienced highly trained staff
•   Staff available at key times
•   Security
•   Local knowledge of nurses
•   Staff able to work with protocols
•   Ability to offer additional services of NHS Direct
         Long Term Aims
• To increase the proportion of patients who have access
  to pre-admission assessment

• To ensure that patients receive pre-admission
  assessment in an appropriate setting at a convenient
  time

• To maximise the skills and expertise of staff in both
  partner organisations in demonstrating a real example of
  working across boundaries
      Getting going….
• November 2000 - proposal put together with
  NHS Direct
  Resources were obtained from Booked
  Admissions
  A project team was set up

• February 2001 - Go live with Orthopaedics
  and Gynaecology followed by General and
  Oral surgery
Issues to be addressed

  Clinical guidelines and protocols
  Screening from OPD
  Patient information and publicity
  IT and data transfer issues
  The development of an operational policy
  Recruitment and training
         Clinical Specialities
•   Gynaecology
•   Orthopaedics
•   General Surgery
•   Oral Surgery
•   Eye surgery
•   Urology
      Further joint working

• Electronic booking of ECG’s and further
  discussions with other departments.
            Patient suitability
• Aged over 16
• BMI less than 35
• Diastolic reading less than 95
• No obvious need for investigations
• Agreed TCI date to be least 3 weeks before the
  admission date
  Informed Consent to NHS
    Direct pre-assessment

• Form to be completed
• Time spent by nursing staff giving explanation
• Written information provided for reference
• Posters are displayed in the outpatient waiting areas
                The process
• Patient attends outpatient dept for consultation
• Requires surgery (LA or GA) and is suitable for day
  care admission - agrees convenient date for surgery
• Given verbal information regards telephone pre
  assessment
• Agrees and completes consent form
• Given printed information leaflet for further
  information
      The process

• Consent and booking form are taken to registration
  department
• Details from the consent form logged onto data base by the
  Registration staff (dedicated team)
• NHS Direct contact patient and complete electronic Performa
• NHS Direct attempt to contact the patient on at least 3
  occasions
• Appropriate investigations identified and booked.
                   The process
• If the patient cannot be contacted or it is less than 2 weeks
  before their admission date they are referred back to the
  hospital for face to face pre assessment

• Completed Performa accessed by registration department
  via shared database.

• Performa ddelivered to the relevant ward/unit in
  preparation for admission

• Investigations initiated by the pre-assessment staff
  completed and results sent to ward prior to admission
           New Initiatives
• Plastic surgery

• Radiology patients
  – Barium enema

• Endoscopy patients
  – Sigmoidoscopy
  – Colonoscopy
                   Pit falls!!

• Initially time consuming
• Turnaround time for return of information needed to
  be reviewed
• Dependant on e-mail
• Calls needing to be made at NHS Directs busiest
  times
• Training issues for NHS Direct staff
 Why a patient questionnaire?


• To monitor and evaluate the scheme:
  - highlight areas that are working well
  - highlight any areas that need improvement
• To discover patient views of the scheme and
  suggestions:
  - communicate this feedback to staff
         Patient feedback
• 96% said they were contacted at a convenient
  time
• 96% said that they felt comfortable answering
  questions about their health by phone
• 89% found the information leaflet useful in
  preparation for their telephone pre-admission
  assessment.
               Patient comments
 ‘I was phoned on Saturday morning which was very reassuring,
  because I felt the nurse had made an extra effort to contact me out of
  hours’

 ‘Just to say these people are a rare breed. They are so patient and
  reassuring towards you. They must deal with so may people, but they
  make you feel the important one!’

 ‘I felt very reassured about having the operation, as I was a bit
  apprehensive before the call’

 ‘It was more convenient to do the pre-assessment over the phone, I
  didn’t need to book time off work and avoided wasting everyone's time
  sitting around at the hospital’

 ‘I don’t like talking about my health over the phone.’
Staff comments
       • ‘Initially a lot of
         paperwork to get
         used to it’

       • ‘It’s now accepted
         as part of the
         service we offer’

       • ‘The patient’s like it’
Thank
 You

				
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