ROFPAQ team’s quality improvement activity consists of departmental and multidisciplinary projects, which aim to improve patient outcomes and experience in the perioperative period.
Project name: Preoperative Occupational Therapy assessment for Vascular patients.
Aim: To improve patient outcomes and experience with introduction of Occupational Therapy assessment in the Pre-Operative Admission (POA) vascular clinic.
Rationale: This project will:
- Improve vascular patient flow, reducing delays to discharge and patient's length of stay (LOS)
- Improve patient care by enabling earlier OT intervention with ongoing follow up from pre admission, through admission and to discharge
- Earlier OT intervention will reduce the number of poorly timed admissions, reducing the ward based caseload intervention requirement. The OT will also benefit from increased MDT support from the pre-admission team
Dr Marta Campbell, Kate Primett, Catherine Wilkinson, Kate O'Donovan, Dr Jo Hardwick
Aim: To decrease unnecessary prolonged preoperative fasting for fluids and improve patients experience.
The discomfort caused by prolonged pre-operative fasting is acknowledged and has been the topic of several recent publications in both children and adults. When we investigated patient satisfaction in our institution, long waiting times and thirst were the two major complaints. For the last two years, we have been reducing fasting times for our elective patients from an average of 9.6 hours to less than 5 hours, and the % of patients fasting for longer than 12h has been reduced from 53% to 10.5%. Think Drink is an ongoing QI initiative
Anaesthesia outcome measures
- To evaluate the quality of anaesthesia provision service
- To inform the decision-making process for patients
- To facilitate perioperative healthcare resource allocation and organisation
We aim to improve the perioperative patients experience by reducing preoperative clear fluid fasting times, maintaining normothermia and reducing postoperative pain scores and nausea and vomiting and delayed discharge from the recovery room.
The methodology comprises quality monitoring, feedback and improvement process within the anaesthesia department. We proceed to regular recording and analysis of the following parameters: preoperative fasting, temperature, nausea and vomiting, pain scores, airway complications and reasons for delayed discharge from recovery.
Dr Ravi Mangwiro, Dr Emilie Hoogenboom, Dr Marta Campbell
Renal Cancer ERAS
- Reduce risk of post-operative complications
- Reduce length of stay
- Prevent hospital readmission
- Improve patient experience
Enhanced Recovery after Surgery (ERAS) is a perioperative care model where a multidisciplinary and patient centred approach has been shown to improve patients' experience and outcomes, whilst reducing healthcare cost.
ERAS pathway contains evidence-based and protocol-led elements of surgical care,
which are embedded within an individualised approach for each and every patient.
Learn more about ERAS.
Anaesthesia Lead - Dr Craig Lyness
Surgical Lead - Mr Ravi Barod
Renal Ca Lead - Dr David Cullen
Hepatobiliary post-operative pain project
- To standardise analgesia regimes for major HPB and laparoscopic cholecystectomy surgery
- To improve post-operative pain scores and patient satisfaction within six months
This project is linked to the patient outcome measures project, which included assessment of recovery pain scores for laparoscopic cholecystectomy.
Current status: Collecting baseline data on analgesic regimes, daily post operative pain scores and patient satisfaction. Pain protocol currently in development.
Dr Jim Parry, Dr Sana Osman, Dr Harvey Parsons, Dr Michelle Reichman, Pain Nurse specialists and Dr Clare Melikian & Dr Pippa Pemberton (Supervisors)
Non-invasive Cardiac Output Monitoring in Renal Transplantation
All patients undergoing renal transplant, where indicated, to receive goal-directed intraoperative haemodynamic and fluid therapy in order to achieve optimal end organ perfusion by August 2018.
At present there is a significant degree of variation in renal transplantation anaesthesia. The use of intermittent blood pressure assessment, due to concerns regarding intra-arterial blood pressure monitoring, generates the potential for low fidelity blood pressure recording at high-risk time points in anaesthesia such as induction and reperfusion. Furthermore, the lack of cardiac output-related indices and titration of interventions for optimised end-organ perfusion leads to possible supra-normal intravascular volume status with consequent end-organ dysfunction.
At present there is little evidence base or accepted guidelines for the use of non-invasive cardiac output monitoring in this patient cohort. The ready availability of a validated device to provide this data - Edwards Lifesciences ClearSight - may provide tighter haemodynamic control with the potential for improved end-organ oxygen delivery and subsequent outcomes. We aim to determine the feasibility, validity and efficacy of the ClearSight device in renal transplantation to assess haemodynamic status and responsiveness and to develop it's use as a standard of care in the peri-operative care of these patients.
Dr. Jeremy Fabes (Academic Clinical Fellow), Dr. Amanpreet Sarna (Specialist Registrar),
Dr. Marc Wittenberg (Consultant)