BMC Med Inform Decis Mak - Implementation of an integrated preoperative care pathway and regional electronic clinical portal for preoperative assessment.

Tópicos

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Resumo

CKGROUND: Effective surgical pre-assessment will depend upon the collection of relevant medical information, good data management and communication between the members of the preoperative multi-disciplinary team. NHS Greater Glasgow and Clyde has implemented an electronic preoperative integrated care pathway (eForm) allowing all hospitals to access a comprehensive patient medical history via a clinical portal on the health-board intranet.METHODS: We conducted six face-to-face semi-structured interviews and participated in one focus group and two workshops with key stakeholders involved in the Planned Care Improvement (PCIP) and Electronic Patient Record programmes. We used qualitative methods and Normalisation Process Theory in order to identify the key factors which led to the successful deployment of the preoperative eForm in the health-board.RESULTS: In January 2013, more than 90,000 patient preoperative assessments had been completed via the electronic portal. Two complementary strategic efforts were instrumental in the successful deployment of the preoperative eForm. At the local health-board level: the PCIP led to the rationalisation of surgical pre-assessment clinics and the standardisation of preoperative processes. At the national level: the eHealth programme selected portal technology as an iterative strategic technology solution towards a virtual electronic patient record. Our study has highlighted clear synergies between these two standardisation efforts.CONCLUSION: The adoption of the eForm into routine preoperative work practices can be attributed to: (i) a policy context - including performance targets - promoting the rationalisation of surgical pre-assessment pathways, (ii) financial and organisational resources to support service redesign and the use of information technology for operationalising the standardisation of preoperative processes, (iii) a sustained engagement with stakeholders throughout the iterative phases of the preoperative clinics redesign, guidelines standardisation and the eForm development, (iv) the use of a pragmatic and domain-agnostic technology solution and finally: (v) a consensual and contextualised implementation.

Resumo Limpo

ckground effect surgic preassess will depend upon collect relev medic inform good data manag communic member preoper multidisciplinari team nhs greater glasgow clyde implement electron preoper integr care pathway eform allow hospit access comprehens patient medic histori via clinic portal healthboard intranetmethod conduct six facetofac semistructur interview particip one focus group two workshop key stakehold involv plan care improv pcip electron patient record programm use qualit method normalis process theori order identifi key factor led success deploy preoper eform healthboardresult januari patient preoper assess complet via electron portal two complementari strateg effort instrument success deploy preoper eform local healthboard level pcip led rationalis surgic preassess clinic standardis preoper process nation level ehealth programm select portal technolog iter strateg technolog solut toward virtual electron patient record studi highlight clear synergi two standardis effortsconclus adopt eform routin preoper work practic can attribut polici context includ perform target promot rationalis surgic preassess pathway ii financi organis resourc support servic redesign use inform technolog operationalis standardis preoper process iii sustain engag stakehold throughout iter phase preoper clinic redesign guidelin standardis eform develop iv use pragmat domainagnost technolog solut final v consensu contextualis implement

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