Notes

Slide Show

Outline

1	"Transforming your" Transforming your Day Surgery Services Kit: focus on cholecystectomy
2	NHS Institute
3	NHS Institute
4	The approach
5	Cholecystectomy National Day Case Rates 08/09
6	Focus on...
7	Rapid Improvement Programme
8	Rapid Improvement Results
9	Potential cost savings
10	What’s included in the Kit Culture Pack
11	Culture – Why?
12	Culture – Why?
13	Culture – Why?
14	What’s included in the Kit Process Pack
15	Emergency Cholecystectomy Kit to follow October 2010
16	Make it real
17	Surgical sub-specialisation
18	Specialisation Solutions
19	Defaulting
20	Pre-assessment
21	Day Case Criteria No age limit Co-morbidity Social support Complexity of case BMI ?? Distance Discharge arran
22	Scheduling Barriers: Surgeons letting go / personal preference formula Complex cases first whilst surgeon is ‘fresh’ List fillers mentality
23	"Oxford Scheduling traffic light system" Oxford Scheduling traffic light system
24
25	Experience shared “Recipe” for guidance No single best way Common themes Based on: good practice favourable outcomes
26	Recipe Components? NSAIDS Local anaesthesia Antiemetic prophylaxis iv Fluids Minimal opioids “Rescue” options
27	Nurse Led Discharge Barriers: No agreed discharge criteria / out of date / surgeon specific Nurses believe its better for patients to stay overnight Nursing lack of confidence and ‘training’ Surgeon letting go
28	Nurse Led Discharge Solutions: Written guidelines Observations stable Pain & PONV controlled Mobilising Tolerated fluids & diet Audit how long it takes to achieve the above
29	"Robust readmission process" Robust readmission process Not GP Surgical nurse, unit open 7 days a week SpR assessment more than likely required Audit the post-op contact and outcomes Expect less than 3% return rate
30	"Come and visit us at" Come and visit us at Stand 51 www.institute.nhs.uk