Ulster Hospital showcases first paediatric pre-op service and first robotic upper GI op
Health Minister, Mike Nesbitt MLA and Regional Clinical Director for Elective Care, Professor Mark Taylor, have hailed the innovative approach to Pre-Operative Assessment at the Ulster Hospital, which has reduced cancellations by a massive 73%.
During the visit, the Health Minister and Professor Mark Taylor met Clinicians and Nursing staff who have implemented Northern Ireland’s first Nurse-led and Consultant-supported Paediatric Pre-Operative Assessment Service in the Children’s Unit.
They also toured the Adult Pre-Operative Assessment Service and Theatres where they witnessed the Trust’s first robotic assisted Upper GI surgical operation.
Chatting to members of the Surgical Team, they were able to hear about the benefits of Robotic Surgery for patients.
The Paediatric Pre-Operative Assessment Service plays an important role in ensuring children are appropriately assessed and medically fit before Surgery.
Effective Pre-Operative assessment can reduce complications, minimise cancellations on the day of Surgery and improve the use of Theatres.
As part of the initiative, Nursing staff make a check-in telephone call to families several days before Surgery to establish whether a child remains well enough to proceed. This allows children who are unwell, to have their Surgery appropriately postponed while creating an opportunity to offer the Theatre slot to another patient.
Since its introduction, the service has reduced Day-of-Surgery cancellations by 73% and created a pool of medically suitable patients who can be scheduled at short notice. The Theatre slots can now be filled by another patient, reducing waiting lists and also anxiety and inconvenience for families.
Further expansion of the service is planned to include Paediatric Dental Surgery patients.
Health Minister, Mike Nesbitt said: “I was so impressed with the Pre-Operative Assessment Service at the Ulster Hospital. The holy grail in terms of Theatre utilisation is getting to 100%.
“Without Pre-Operative Assessment, it must have been incredibly frustrating for a patient to come into hospital, perhaps occupying a very expensive acute hospital bed, only for the Anaesthetist or Surgeon to discover they were not fit for the operation and the procedure had to be postponed.
“This service makes sure patients are fit and ready for whatever procedure they are going to have. It also provides an important opportunity for clinical validation because when you talk through the procedure, the risks, the pain and the post-operative care, sometimes a patient may decide that they do not want to go through with it.
“Hospital care is not just about overcrowded Emergency Departments. That is a symptom of a wider issue around flow.
"It is about getting people into hospital, getting them their procedure, helping them recover and then having the right community capacity to support their discharge.
“Pre-Operative Assessment is a really important cog in that wheel and I was very impressed to see the work being done here.”
South Eastern Trust, Consultant Anaesthetist, Dr Ciara Mitchell, who is leading the initiative, added: “It was great to showcase our service to the wider Team and to the Health Minister.
“We looked at our current data to understand how we could build a service that suited our patients and our hospital.
"When we looked at Day-of-Surgery consultations, we found that more than 40% of children were being cancelled on the day because they were unwell or had an intercurrent illness.
“In addition to the normal pre-assessment pathway, we introduced a check-in phone call by our Nursing staff a couple of days before Surgery. This allows the Nurses to establish whether a child is well enough to proceed, avoiding a Day-of-Surgery cancellation and allowing us to appropriately delay Surgery for children who are unwell.
“Crucially, we are now able to replace these late cancellations in around three quarters of cases with other patients. This improves patient safety, reduces anxiety for families and makes better use of our resources.”
South Eastern Trust, Lead Paediatric Anaesthetist, Dr Rachel Deyermond, stated: “Paediatric Pre-Operative Assessment is still in its infancy, but we feel it is already making a huge difference.
"It is particularly significant for the Ulster Hospital, which has such a strong history as a Children’s Hospital.
"It is fantastic to be the first hospital in Northern Ireland to have accredited Nurses for Paediatric Pre-Operative Assessment and to see the work that is being taken forward by the Team.
“Dr Ciara Mitchell, our Paediatric Pre-Operative Assessment Lead Clinician, has done a huge amount of work around the encompass system and staff training and it has been fantastic to see the difference this service is making for children and their families.”
Professor Mark Taylor, commented: “I am delighted to join the Minister to see the Paediatric Pre-Operative Assessment Clinic, the first of its kind in Northern Ireland.
"I was also delighted to visit the Adult Pre-Operative Assessment Service and then to Theatres. It is absolutely fantastic to see what is happening to ensure patients are not cancelled because of issues that could have been identified through Pre-Operative Assessment and that we are maximising the number of patients coming through our Operating Theatres.
“We have seen the impact this is having on theatre utilisation and productivity and it is a real achievement for the Teams involved. We also happened to visit on the day the Trust’s first robotic Upper GI surgical procedure was taking place. The Minister was able to see the procedure in progress and hear directly from the Surgical Team about what this technology means for patient care.
“It was an outstanding visit and a massive thanks to all the staff leading the Pre-Operative Assessment work and to Dr Rachel Deyermond and the wider Team for everything they are doing to improve care for our patients.”