Background: Preoperative assessment clinics have been employed in many institutions to manage perioperative risks1. These clinics provide an opportunity to stratify patients on the basis of risk prior to surgery, to make timely multidisciplinary referrals where appropriate, and to prescribe medical therapies according to the current best evidence resulting, in fewer last-minute cancellations for medical reasons2 and a shorter inpatient pre-operative stay3. The Anaesthetic Pre-Operative Clinic (APOC-GSH) was introduced to Groote Schuur Hospital in 2009 with the aim of assessing and optimising high risk patients undergoing intermediate or high risk surgery. The vision of the clinic is to decrease perioperative morbidity and mortality, rationally and costconsciously investigate patients, as well as to reduce theatre cancellations of inappropriately assessed and managed patients. The clinic, together with relevant role players, attempts to risk stratify patients in making an informed decision whether the intended perioperative risks are acceptable. Patients referred to the clinic fall into two categories. Either the surgical date has been scheduled and patients are referred to APOC-GSH for optimization, or the referral is for assessment of suitability to undergo an anaesthetic and thus the treatment modality hinges on the fitness for surgery. Objective The intention of the audit is to create a database of the patients seen at APOC-GSH during 2014. Primary objectives are: 1 Referral pattern: - What proportion of patients are referred for improvement of medical condition? - What proportion of patients are referred for an assessment of operability? 2 What interventions were recommended? - What was the influence of interventions on operability and timing of surgery? - Does the clinic improve theatre efficiency by reducing cancellations of patients who required further interdisciplinary discussion and investigations? Methods: Data collection will be based on the review of APOC-GSH clerking notes and hospital patient records. The following information will be collected and entered into an Excel spread sheet: the surgical discipline referring the patient, the proposed surgery, patient co-morbidities, the lead-time from the first APOC-GSH assessment to surgery, number of visits to APOC-GSH by each patient, the investigations and additional interventions instituted at APOC-GSH. We shall also calculate the proportion of patients that would have likely been cancelled had they not attended APOC-GSH but rather been assessed by an anaesthetist the day before surgery. The record of the APOC-GSH consultation will be documented on a clerking sheet established for use within the clinic (Addendum A). The original form will be included in the patients' file and a duplicate will be stored within the access controlled Department Of Anaesthesia offices at GSH. The duplicate records will be used to obtain the information for the audit. Ethical approval will be sought from the UCT Human Research Ethics Committee for the establishment of the database and retrospective review of the APOC-GSH records on the understanding that patient records would be kept confidential and that the data obtained would be stored in a password protected spreadsheet. Access to the spreadsheet will be limited to the investigators involved and no identifiable patient details will be included. Patients will be counselled as to the nature of the study and will be expected to submit signed consent forms allowing their records to be reviewed. Patients will be informed that they will not be disadvantaged by refusal to sign the consent form and that the appropriate standard of care will still be applied. No remuneration will be provided for partaking either. Consent will be documented on the consent form specifically designed for use in the APOC-GSH. (Addendum B) Statistical analysis will be performed using an Excel® spreadsheet. Means, medians, rates and percentages will be used to describe the discrete categorical data. Output and future work The audit will provide an objective assessment of the population profile referred to APOC-GSH. It may guide future implementation of APOC-GSH protocol changes and assist with resource allocation depending on the surgical discipline requirements. Patient and surgeon satisfaction ratings may be embarked at a later stage juxtaposed against an adequate assessment in a cost and time conscious manner.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/22755 |
| Date | January 2016 |
| Creators | Dass, Deshandra |
| Contributors | Nejthardt, Marcin B, Roodt, Francois |
| Publisher | University of Cape Town, Faculty of Health Sciences, Department of Anaesthesia |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MMed |
| Format | application/pdf |
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