BMC Med Inform Decis Mak - A study of clinical and information management processes in the surgical pre-assessment clinic.

Tópicos

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Resumo

CKGROUND: Establishing day-case surgery as the preferred hospital admission route for all eligible patients requires adequate preoperative assessment of patients in order to quickly distinguish those who will require minimum assessment and are suitable for day-case admission from those who will require more extensive management and will need to be admitted as inpatients.METHODS: As part of a study to elucidate clinical and information management processes within the patient surgical pathway in NHS Scotland, we conducted a total of 10 in-depth semi-structured interviews during 4 visits to the Dumfries & Galloway Royal Infirmary surgical pre-assessment clinic. We modelled clinical processes using process-mapping techniques and analysed interview data using qualitative methods. We used Normalisation Process Theory as a conceptual framework to interpret the factors which were identified as facilitating or hindering information elucidation tasks and communication within the multi-disciplinary team.RESULTS: The pre-assessment clinic of Dumfries & Galloway Royal Infirmary was opened in 2008 in response to clinical and workflow issues which had been identified with former patient management practices in the surgical pathway. The preoperative clinic now operates under well established processes and protocols. The use of a computerised system for managing preoperative documentation substantially transformed clinical practices and facilitates communication and information-sharing among the multi-disciplinary team.CONCLUSION: Successful deployment and normalisation of innovative clinical and information management processes was possible because both local and national strategic priorities were synergistic and the system was developed collaboratively by the POA staff and the health-board IT team, resulting in a highly contextualised operationalisation of clinical and information management processes. Further concerted efforts from a range of stakeholders are required to fully integrate preoperative assessment within the health-board surgical care pathway. A substantial - yet unfulfilled - potential benefit in embedding information technology in routine use within the preoperative clinic would be to improve the reporting of surgical outcomes.

Resumo Limpo

ckground establish daycas surgeri prefer hospit admiss rout elig patient requir adequ preoper assess patient order quick distinguish will requir minimum assess suitabl daycas admiss will requir extens manag will need admit inpatientsmethod part studi elucid clinic inform manag process within patient surgic pathway nhs scotland conduct total indepth semistructur interview visit dumfri galloway royal infirmari surgic preassess clinic model clinic process use processmap techniqu analys interview data use qualit method use normalis process theori conceptu framework interpret factor identifi facilit hinder inform elucid task communic within multidisciplinari teamresult preassess clinic dumfri galloway royal infirmari open respons clinic workflow issu identifi former patient manag practic surgic pathway preoper clinic now oper well establish process protocol use computeris system manag preoper document substanti transform clinic practic facilit communic informationshar among multidisciplinari teamconclus success deploy normalis innov clinic inform manag process possibl local nation strateg prioriti synergist system develop collabor poa staff healthboard team result high contextualis operationalis clinic inform manag process concert effort rang stakehold requir fulli integr preoper assess within healthboard surgic care pathway substanti yet unfulfil potenti benefit embed inform technolog routin use within preoper clinic improv report surgic outcom

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