23 Hour Concept

Description

Previously the Wellington campus provided two options for elective and acute postoperative care: day case or inpatient admission.

Surgeries were sometimes cancelled due to inpatient areas at maximum occupancy, and the day surgical unit was often over or undersubscribed, or used for overflow during times of heightened acute demand.

Previous attempts to imbed an ambulant surgical unit proved difficult, with loose admission criteria, non-existent or restrictive policy relating to nurse initiated discharge, and ambiguous admission to discharge pathways for surgical patients.

In the new environment a 23 Hour post surgery aftercare service (Second Stage Recovery) and process to identify candidates was established. The Unit was designed and configured to be a highly adaptable ambulant surgical unit, co-located to theatre suite, able to flex between bed and chair configurations to suit surgical demands on a day by day basis.

Patients suitable for day case or 23 hour care are selected pre operatively during elective surgery preparation or fast tracked via the surgical admissions unit following acute assessment, and postoperative support systems are initiated before and during surgery if required.

Admission to the unit was restricted to patients who would be likely be discharged home within 23 Hours, enforced with clear operating principles.

The unit was further supported by implementing care pathway documents for common surgical presentations, standing orders maintained by clinicians, scoring based discharge systems allowing nursing staff greater autonomy, 24 hour clinical decision making and nurse initiated discharges better suited to patients.

This allowed day case surgery to occur later during theatre sessions, improved compliance with the 6 hour rule in the surgical continuum, offer a clinically and cost effective alternative to inpatient admission, and increase surgical capacity within existing resources.

While the unit has not significantly impacted patient midnights or improved day case rates (Ambulant & day case surgery is defined as same day discharge in New Zealand, and not discharge within 23 hours), it has allowed increased surgical throughput without placing additional demands on inpatient resources, and dramatically reduced hospital driven Day of surgery cancellations.

Criteria to restrict admissions to predictable surgical presentations and suitability for the ambulant care pathway allowed the unit to enjoy high patient turnover, lean resourcing, and the ability to reconfigure beds and chairs to suit surgical production planning.

The 23 Hour Concept was launched at C&C DHB by Joe McDonald in 2008.

Start Date

Dec 7, 2009

End Date

Dec 10, 2010

Location

Capital & Coast

Setting

Hospital

Target Population

All

Areas of Focus

Theatre, Day Surgery

Contact Person

Nic Maurice