integrated pre-operative assessment (ipa) clinic
TRANSCRIPT
![Page 1: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/1.jpg)
Integrated Pre-operative Assessment (IPA) Clinic:
an one-stop day surgery service for hysteroscopy
Kathy TONO
Ambulatory Surgery CentreTKOH
![Page 2: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/2.jpg)
So much to do with so little…
We are living in a world with constraints
![Page 3: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/3.jpg)
The reality is…
Resources/budget constraintsToo little clinic sessionsSessions only limited to morning or early afternoon…
![Page 4: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/4.jpg)
A New Patient Service initiative
The Integrated Assessment Clinicwas established
On Opening of the ASC
![Page 5: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/5.jpg)
Background of IPA Development
In the past…Majority of gyn patients scheduled for operation under GA/MAC need to be admitted the day before operationHospital stay ~2-3 days
![Page 6: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/6.jpg)
The IPA Clinic
Multi-specialty CollaborationAim to provide an one-stop service to the patient for hysteroscopy through workflow re-engineering
![Page 7: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/7.jpg)
Hysteroscopy – one of the most commonly done procedure in gynaecology
1. Hysteroscope2. Pubic bone3. Bladder4. Uterus5. Anus
![Page 8: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/8.jpg)
Hysteroscopy - “See and Treat”
~1/4 of all women will complain of abnormal uterine bleeding at some time.Hysteroscopy is the current gold standard for evaluating intrauterine pathology.
(Bakour S.H. et al 2006)
![Page 9: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/9.jpg)
Why multi-specialty is required?
Patients for ambulatory hysteroscopies with adverse experiences such as anxiety, pain and dissatisfaction due to poor understanding of their condition had been reported.(Gupta J K et al, 2004)
![Page 10: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/10.jpg)
Integrated Pre-operative Assessment (IPA) Clinic
Comprehensive care thro’ multi-specialty collaboration to meet the patient needs:
• Gynae AssessmentPatient assessment and confirm treatment plan
• Pre-anaesthetic AssessmentMake sure patient is fit for surgery
• Pre-operative Nursing ClinicPre-op patient teaching & counselling
![Page 11: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/11.jpg)
Anaesthetic & OT Arrangement
GA/PCBDefault Pm operation session Session could extend to late evening
![Page 12: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/12.jpg)
One-Stop Clinic for Hysteroscopy
BenefitsDedicated ClinicPrompt diagnosis and treatment
number of hospital visitsPatient LOSWaiting time
![Page 13: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/13.jpg)
Gynaecological consultation in SOPD
WorkflowFirst Step…
![Page 14: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/14.jpg)
0800 - (ASC) scene
Admission –Ambulatory Surgery Centre 08:00
Attend IPA in TKOH Ambulatory Surgery Centre
![Page 15: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/15.jpg)
08:30In Patient’s Unit
Patient orientation & nursing assessment
![Page 16: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/16.jpg)
At 0900 (multi-function room)
09:00Gynaecological Assessment
The gynaecologist will assess the patient in ASC
![Page 17: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/17.jpg)
Perform gynae exam & confirm option for OT
We shall consider H&C…
Gynae/Ultrasound Exam
![Page 18: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/18.jpg)
Pre-op Patient Education
Provide information for anaesthesia & operation
09:30
![Page 19: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/19.jpg)
Pre-anaesthetic Assessment 10:00
Anaesthetist perform pre-anaesthetic assessment
![Page 20: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/20.jpg)
Pre-operative Nursing Clinic 10:30
ASC nurse provides pre-op education & counseling
![Page 21: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/21.jpg)
Patient Ready for Operation
![Page 22: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/22.jpg)
16:00In the Operating Theatre
An illustration showing the anaesthetist giving PCB
![Page 23: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/23.jpg)
16:30In the Operating Theatre
The patient is closely monitored
![Page 24: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/24.jpg)
16:15
PCB provides a satisfactory operating condition
The gynaecologist’s comment
![Page 25: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/25.jpg)
After Operation1st Stage Recovery in RR
Patient being observed in the RR after operation
![Page 26: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/26.jpg)
2nd Stage Recovery in ASC17:00
![Page 27: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/27.jpg)
18:00Post-op Care in ASC
Unhurried and individualized care is provided in ASC
![Page 28: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/28.jpg)
Patient DischargeYou can go
home!
18:30
The anaesthetist reviews patient’s condition before discharge.
![Page 29: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/29.jpg)
19:00Patient Discharge
Patient discharged home with company of an adult
![Page 30: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/30.jpg)
Review Records on Post-op Patient condition
Areas Reviewed GA PCBPatient no. 9 23Pain score (VAS) 0-2 0-3PONV 0 0Post-op ambulation 1 hr 1 hrReady for discharge 3 hrs 2 hrs
A total of 32 patient records reviewed.
![Page 31: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/31.jpg)
Conclusion One-stop hysteroscopy service• ambulatory, rapid-access, see-and-treat
Provides in the same day. • pre-op gynaecological assessment,• anaesthetic consultation, nursing education and • Hysteroscopy
Patients benefit from• More rapid diagnosis and treatment, • Speedier return to normal functioning and work.
The BDO reducedFlexibility in utilization of OR/ASC resources attained
![Page 32: Integrated Pre-operative Assessment (IPA) Clinic](https://reader031.vdocuments.us/reader031/viewer/2022013015/61cfd8b408f28036905ead55/html5/thumbnails/32.jpg)
Thank You!
I only need to spend one day in hospital !