Pembrokeshire

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Pembrokeshire Derwen NHS Trust
PRE-SCREENING SERVICE P.D.S.A.
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Pembrokeshire Derwen NHS Trust

• 1) What are we trying to accomplish?
• All patients added to a waiting list are fit
  and available for surgery
• All patients are streamed appropriately into
  inpatient, day case or outpatient
• treatment waiting lists following outpatient
  consultation
• That mechanisms are in place to arrange
  treatment options, if patients are
• found to be unfit following assessment
• Better patient/partnership in-care planning by
  providing patients with
• information packs about their surgery and the
  impacts of the procedure
• Improved patient responsibility whilst on a
  waiting list
• Full booking at the point of streaming wherever
  waiting lists are short enough

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Pembrokeshire Derwen NHS Trust

• 2) How will we know that a change is an
• improvement?
• Work towards 100 of all patients listed for
  planned surgery being pre-
• screened
• A reduction in the number of day case patients
  cancelled on day of surgery
• because they fail the day case
  criteria
• A reduction in the number of patients
  suspending for medical or social
• reasons
• Patient become better informed of their
  procedure and its implications
• An increase in the percentage of patients fully
  booked

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Pembrokeshire Derwen NHS Trust

• 3) What changes can we make that will result in
  improvement?
• The service commenced on 28 February 2005.
• The service was initially provided by a full-time
  staff
• nurse but now is supported by a full
  Pre-screening and
• Assessment Team.
• The service began by screening all Trauma
• Orthopaedic and General Surgery patients listed
• following an outpatient appointment at Withybush
• General Hospital

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Pembrokeshire Derwen NHS Trust

• PLAN
• What proportion of patients are being
• screened?
• What percentage of patients are found to
• be unfit for listing?

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Pembrokeshire Derwen NHS Trust

• PATIENTS SCREENED AT WGH
• March April May June
• TO 93 51 79 115
• General 22 15 62 76
• Surgery
• No Patients 47 173 16
  7
• Not Screened

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Pembrokeshire Derwen NHS Trust

• PATIENTS NOT LISTED FOLLOWING SCREENING
• Reasons
• Anaesthetic risk 7
• Hypertension 6
• BMI too high 2
• Teeth/skin infections 3
• Awaiting consultation for other symptoms 5
• Undergoing radiotherapy 1

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Pembrokeshire Derwen NHS Trust

• STUDY
• Reasons why all patients listed were not
  screened
• Screening nurse was on annual or sick leave
• Screening nurse had to provide cover for the
  pre-assessment
• service
• Patients were listed following appointments at
  sites other than
• Withybush where no screening service currently
  exists

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Pembrokeshire Derwen NHS Trust

• Act
• 1. Amalgamation of screening and pre-admission
  services to ensure nursing cover
• 2. Currently identifying what resources will be
  required to extend the screening service to other
  sites where outpatient sessions are held

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Pembrokeshire Derwen NHS Trust

• Further improvements which have been made
• Revision of Patient Pathway for admissions to
  the Waiting List
• Revision of letter to GP advising of actions
  required prior to patient being added to the
  waiting list
• Presentation to the GP Commissioning Group
• Further actions planned
• Standard referral protocol for GPs
• Roll-out service to all specialities by 31/3/06