Effective pre-operative assessment of patients awaiting elective surgery should entail appropriate use of scarce NHS resources, as well as underpin patient safety. The pre-operative admissions service in district general hospitals is often junior doctor led, with a new cohort of clinicians taking over its running every four months. Lack of familiarity on the part of these clinicians with the investigative work up required for certain surgical procedures often results in over investigation of patients in the pre-admission setting, wasting time and NHS resources. A retrospective audit of 53 patients who underwent laparoscopic cholecystectomy over a representative two month period demonstrated that 33% of patients received unnecessary pre-admission blood tests, including clotting screen and 'group and save'. Design and implementation of a "Pre-Admission Handbook", for use by junior doctors and nurse practitioners in the pre-operative setting, reduced the rate of over investigation to 12% in a subsequent, prospective audit cycle of 50 patients, and has improved patient care by standardising the preadmissions process for elective surgery at Gloucester Royal Hospital.
ProblemThe pre-operative admissions service at district general hospitals is often junior doctor led, with a new cohort of clinicians taking over its coordination and running every four months. New to both the surgical department and to clinical practice, these clinicians are often uncertain about the pre-operative investigative work up required for the range of surgical interventions offered by the department, and therefore request a battery of inappropriate and unnecessary tests in the pre admission setting in an attempt to ensure thoroughness. In particular, lack of awareness of the NICE pre-operative guideline for laparoscopic surgery was anecdotally felt to be resulting in a high rate of over investigation of patients awaiting laparoscopic cholecystectomy at Gloucester Royal Hospital. Inappropriate requests for clotting screens and 'group and save' blood tests increase the workload of the hospital laboratories with no clinical gain, as the risk of major bleeding and need for intraoperative transfusion is low for this procedure. This indiscriminate use of resources has clear financial implications in an increasingly resource limited NHS.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.