Authors (including presenting author) :
Cheung YM(1), Leung AL(1), Chu SHC(2), Cheung HL(2)
Affiliation :
(1) Ambulatory Care Centre, Queen Elizabeth Hospital (2) Department of Cardiothoracic Surgery, Queen Elizabeth Hospital
Introduction :
Multidisciplinary preadmission same day service for thoracic surgery patients in out-patient clinic refers to a combination of perioperative interventions designed to minimize the impact of surgery on patients’ recovery in order to reduce postoperative complications and to allow an early discharge reducing hospital costs.
Objectives :
1) To provide comprehensive multidisciplinary pre-operative service in out-patient clinic
2) To speed up the process of pre-operative procedure
3) To engage patient in pre and post-operative management 4) To shorten hospital stay for thoracic surgery patient
Methodology :
A Multidisciplinary preadmission same day service protocol was established at Cardiothoracic Surgery outpatient clinic. We introduced a multi-disciplinary integrated perioperative pathway by engaging with every person involved, including the patients themselves. Planning and implementation of the Same Day Admission SDA program was a collaborative effort among cardiothoracic surgeons, anesthesiologists, nurses, physiotherapist, and clinical support personnel. The SDA program at our institutions started in early 2015. Initially SDA criteria were complex, but they have become more standardized and we would like to present our result recently.
Result & Outcome :
Between 1 January2018 and 31 December, 2018, total 418 patient were attended to the pre-operative clinic. We found that they were more engaged and no difference in age, sex, or total number of comorbidity factors. Diabetes, poor lung function, myasthenia gravis and patients on anticoagulant were significantly more common in preoperatively admitted patients and were independently predictive of admitting group. Significant differences between surgeons in the proportion of same-day patients admitted could not be explained by differences in common risk factors. There was no significant difference in postoperative major or minor complications or number of clinical pathway deviations. Average total hospital stay was 1 day less for same-day patients, a highly significant difference. The program resulted in a net saving of one acute bed equivalent to $ one million for the HA for the year 2018. Such preadmission evaluation might also often prevent the admission if complications are found that require postponing or cancelling the operation. We also found that although admitting decision should be those of the surgeons, however, contributions his decision can make forward the decreasing costs of medical care.The thoracic surgery pre-admission same day service in outpatient clinic has proven to be a safe perioperative management strategy to improve patient outcome and to reduce the length of hospital stay and cost after major thoracic surgery, without increasing morbidity or mortality.
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