Establish a clear process to follow at each stage of the patient pathway when setting up a high volume short stay (HVSS) surgical unit.
Pre-admission
The waitlist or bookings officer reviews the patient Recommendation for Admission (RFA) form. Check that the procedure and expected length of stay are within the parameters for the HVSS surgical unit.
Review patient details and history. Determine the appropriate level of pre-admission assessment required, i.e. telephone consultation or attendance at a pre-admission clinic.
Provide preoperative instructions.
Admission
Stagger patient admission times to the HVSS surgical unit for efficient flow.
Perform nursing interview and pre-surgical checks in the patient consultation room. Anaesthetic consult may also be done at this time.
Patients remain in the waiting room until the surgical team is ready to start the clinical protocol.
Preoperative
Upon request for transfer to theatre, the patient changes into a gown. Staff member escorts the patient.
Conduct patient check in and clinical procedure safety checks in the presence of the theatre nurse and HVSS unit nurse.
Intra-operative
The patient undergoes their procedure.
Post-operative
The surgeon documents post-operative instructions, medications and instructions for discharge.
Transfer the patient to the post-acute care unit (PACU) for stage 1 recovery.
Once discharge criteria are met, transfer the patient to the HVSS unit for stage 2 recovery.
Once discharge criteria are met, transfer the patient to the HVSS main ward area.
Manage patient care in line with the clinical protocol. Document any variation and report to the surgical team for action.
Discharge
Prepare the patient for discharge.
Contact family or support people to advise the estimated time of discharge.
Arrange discharge medications or any special equipment.
Complete discharge summary for the patient’s primary care provider.
Where required, make arrangements with community acute or post-acute care services, e.g. Hospital in the Home or community-based rehabilitation.
Advise the patient of the expected recovery pathway, including pain management and symptoms of potential complications. Tell them when and where to seek help from healthcare providers.
Post-discharge
Make follow up phone call after discharge.
Transfer care to primary care practitioner.
Integrate community care services where appropriate.