Improving patient throughput for oral day case surgery. The efficacy of a nurse-led pre-admission clinic

Abstract

In an attempt to reduce patient failures and cancelled operations on the day of admission for oral day case surgery, and to improve pre-operative patient assessment and education, a nurse-led pre-admission clinic (PAC) was introduced in April 1996. Day case patients were selected in cohorts from the waiting list and invited to attend the pre-admission clinic prior to finalizing their operation dates. Clinics were run by experienced staff nurses and patients screened for medical or surgical problems that might preclude day case surgery; access to experienced anaesthetic or surgical opinion was arranged as necessary. During a 2 year period 908 patients were sent clinic appointments; but only 727 (80%) attended; of these 629 (69%) progressed to surgery, but 98 (11%) were deemed unsuitable for day case treatment usually because of medical or socio-domestic complications and were managed more appropriately elsewhere. Of the 181 non-attenders, 140 were ultimately removed from the waiting list. Pre-admission screening thus filtered out 279 patients who were either unsuitable for day case surgery or no longer interested in receiving treatment. Waiting times for surgery were reduced from over 12 months to less than 3.