All patients require a pre admission review prior to surgery however not all patients need to attend a preadmission clinic. Patients identified as requiring a clinical review in PREAC require pre-surgical evaluations and investigations. Coordination of individually tailored discharge support can also be arranged during this stage of the patient journey.
Screening or assessment of patients health needs may be performed by telephone or by using telehealth services to prevent patients travelling unnecessarily or taking time off work.
Some PREAC clinics are multidisciplinary and include pharmacists and other allied health professionals.
PREAC is beneficial when there is:
- increasing demand for elective surgery
- hospital and patient initiated cancelations
- varying length of stay for similar case types
- Ensure patients are ready for surgery
- Exchange essential information regarding impending surgery
- Reduce morbidity and mortality associated with surgery
- Prevent unnecessary cancellations
- Reduce length of hospital stay
- Streamline the patient’s elective surgery journey
- Ensure patient fitness to undergo a scheduled general anaesthesia and surgery (e.g. respiratory function is checked, relevant blood tests are taken or reviewed
- Reduce delays in discharge
- Advise patients on preparations for the planned surgery (fasting, ceasing medications)
- Avoid unnecessary assessment of low risk patients and ensure necessary assessments for higher risk patients are completed before theatre scheduling.
- Preadmissions clinics can be nurse, anaesthetic or allied health led. Some clinics involve a multidisciplinary team
- A first stage patient assessment should occur within the Outpatient Department
- Develop protocols for standardised pre-operative assessment and training of nurses and junior medical staff
- Guidelines and protocols minimise unnecessary preoperative investigations
- Agree on care pathways for patients who are not fit for their operation
- Manage patients on the waiting list: maintain fitness via exercise, diet, smoking, etc
- Patients who are not ready for surgery should be given a treatment plan before they are placed on the waiting list
- Protocol driven pre-operative care via GP
- Hospital-initiated cancelation rates for elective surgery
- Patient-initiated cancelation rates for elective surgery
- Length of stay for high volume procedures
- Day of Surgery Admission (DOSA) rates
- Allows pre-operative optimisation of patients
- Reduces duration of hospital stay
- Reduces risk of unnecessary cancellations
- Pre admission clinics
- PAC
- Pre anaesthesia Clinic
Expected benefits
For patients: Appropriate and timely care, reduced possibility of cancellation, reduced length of stay, improved outcomes and potential reduction in travel time.
For staff: Agreed guidelines, protocols and clearly defined pathways promote accountability and role responsibility.
For the hospital: Increase in Day of Surgery Admission (DOSA) rates and day surgery cases, decrease in patient and hospital initiated cancelations and increase theatre utilisation. An effective preadmission process promotes confidence in the patient surgical journey.
Applicability
The PREAC service offered by hospitals is dependent on the type of surgery and the clinical needs of the patient. Some regional or rural hospitals offer preadmission services using telehealth. Some clinics are led by nurses.
