Introduce preoperative assessment

  • pre-operative assessment can be carried out by telephone for otherwise fit patients having minor procedures
  • timing is critical - two weeks before surgery is probably too late.  Hospitals that assess six weeks before admission have reduced their postponement rate from 40% to just 5%
  • it is not necessary for a consultant to be involved in the entire process, which can easily take an hour or more - many trusts have excellent nurse led arrangements in place with others (including the consultant) involved as necessary

How to do this in scenario generator

OUTCOME
CHANGE
Introducing preoperative assessment Route percentage of patients through the preoperative assessment step in stage 4 of the knee pathway (H04), reducing the percentage routing without this assessment to reconcile to 100%.  Add step to allow for minimum of six weeks between preoperative assessment and admission.  Test whether introducing a six week period between preoperative assessment and admission affects ability to hit 18 week maximum wait target.  Reduce operative cancellation and DNA for admission rates.  The model will reduce capacity for other outpatient activity unless capacity is also increased
Undertaking preoperative assessment by telephone As above but decrease costs and staffing required to deliver capacity or increase capacity for same cost and staffing
Undertaking preoperative assessment in primary care Decrease percentage going through preoperative assessment but still alter cancellation and DNA rates
Undertaking preoperative assessment using other staff groups, eg nurse practitioners Route percentage of patients through the preoperative assessment step in stage 4 of the knee pathway (H04), reducing the percentage routing without this assessment to reconcile to 100%.  Add step to allow for minimum of six weeks between preoperative assessment and admission.  Test whether introducing a six week period between preoperative assessment and admission affects ability to hit 18 week maximum wait target.  Reduce operative cancellation and DNA for admission rates.  Change costs and staffing required to deliver additional activity associated with preoperative assessments or increase capacity for same cost and staffing.