P50
ALDER HEY CHILDREN’S PRE-OPERATIVE ASSESSMENT PATHWAY: A CHANGE IN SERVICE MODEL TO IMPROVE PARENT AND PATIENT ENGAGEMENT. “NO PRE-OP; NO OP”
K. Misselbrook, P. Arnold
Alder Hey Children's Hospital, UK
BACKGROUND
The pre-operative assessment (POA) of children attending for general anaesthesia is essential to improve safety and peri-operative optimisation. Every child should be assessed by a pre-operative service (1)(2) .
Alder Hey Children’s pre-assessment service was established in 2015. Currently, we have a team of 10 nursing staff, triaging between 900-1000 patients per month.
PROBLEM
Our POA pathway starts with a telephone triage. If our nursing team are unable to contact parents/ guardians on the first attempt, the team would leave a voicemail to contact pre-assessment. Prior to spring 2023 there was no formalised follow-up system for families we were unable to contact. Consequently, children attended for surgery where parents had not engaged with the service. This risked an increase in short notice cancellation and sub-optimal preparation of children and young people attending for surgery.
In spring 2023, we formally changed our POA pathway. This quality improvement project looks at children attending for surgery in August 2022 and August 2023 to assess if our intervention has improved engagement with pre-assessment.
STRATEGY FOR CHANGE
After discussion with our whole team and other stake holders we changed our pathway in June 2023. If the pre-op nurse was unable to contact parents, they were booked for a call back in 48 hours. If contact was unsuccessful, they are booked into nurse-led face-to-face clinic.
MEASURE OF IMPROVEMENT
The patient notes were reviewed where there was non-engagement on first contact. This was to determine if there was subsequent contact and if the surgery proceeded on proposed date.
We demonstrate an improvement in engagement with pre-operative assessment (POA) with the introduction of a formalised ring back system (table 1). In 2022 31% of children, whose families could not be contacted initially, subsequently engaged, whilst in 2023 this increased to 87% (OR 16: 95% CI 9.5-27). There was a reduction in children proceeding for surgery without an up-to-date triage (<90 day). The proportion of children whose surgery did not occur on the planned day reduced from 8.5% to 2.1% (OR 0.39: 95% CI 0.26-0.6).
LESSONS LEARNT
A formalised system of call back improved engagement with POA.
MESSAGE FOR OTHERS
Accessing our service.
To sustain a model of “no pre-op, no op” in a hospital performing over 10,000 triages per year requires a significant workforce. Access to our service must meet the needs of our families and might be limited by parental commitments such as work or caring for other children. Future changes planned include progression to a digitalised health questionnaire. This could improve engagement and free nursing staff to dedicate time to children and young people with more complex issues or presenting for major surgery (2).
References:
- Royal College of Anaesthetists [RCOA] (2019). Chapter 2 Guidelines for the Provision of Anaesthesia Services (GPAS) Guidelines for the Provision of Anaesthesia Services for Pre-operative Assessment and Preparation. 2020 Feb 4:1-33.
- Association of Paediatric Anaesthetists of Great Britain and Ireland. Best Practice Guidance: Preassessment Services for Children undergoing Surgery or Procedures. Spring 2022.