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Helene Fuld College of Nursing ​hi there appears i'm here to present my senior capstone project about routing preoperative evaluation in preparation of elective surgical nations what is preoperative evaluation preoperative assessment and evaluation is used to properly prepare a patient for surgery and play the critical role in maintaining patient safety the main focus of improving pre-offer evaluation of preparation of elective surgical patients is improved patient health the reason it's so important is making sure that patients are properly prepared for surgery prevents lastminute cancellations by making sure that they are at an optimal state of health for surgery preventing these cancellations improves patient outcomes and Mason satisfaction both of which by huge roles in today's healthcare day of surgery cancellations also decreased operating room efficiency and waste resources which increased health care costs preoperative assessment also helps to reduce anxiety and patients by providing education which also will help increase patient satisfaction amount in an article from the American family physician website entitled preoperative evaluation of our provincial King States the purpose of preoperative evaluation is not to clear a patient but to evaluate and if necessary implement treatment to better a patient for surgery the physician that performs the preoperative evaluation must understand the level of risk of the surgery that the patient is scheduled to have and how that relates to their health problems this assessment and evaluation must be done prior to the day of surgery but not too far ahead of time that health conditions can change the preoperative assessment and evaluation can be done by the patient's primary care physician or other consulting position of affection has non medical problems it is important as well for a patient that he's seen preoperatively in the hospital's prohibition testing department and be assessed by her ship and even maybe the anesthesiologist prior to the day of surgery the agency for Healthcare Research and quality and the National guideline Clearinghouse developed a perioperative protocol health care protocol guideline which provides evidence based practice best practice recommendations for properly evaluating a patient for surgery the perioperative protocol guidelines state that all patients scheduled nurse surgery elective surgery must undergo a basic health assessment this basic health assessment must include a complete medical history and the school examination this must include allergies and email medical problems surgical history and a complete list of medications it's very important to focus on issues that pertain to the plan surgery and undergoing anesthesia this concludes the patient's current status of known health problems cardiac and pulmonary status prior personal or family problems with anesthesia smoking alcohol or drug history and any possibility of pregnancy or abnormal bleeding or anemia the physical examination should consist of height weight and vital signs cardiac and pulmonary exams and any other perfect sounds based on the patient's health history any abnormal findings discovered during this assessment would require further assessment to optimize the patient for surgery the objectives of this project are that all patients that are scheduled for elective surgery must be preoperatively seen and evaluated thoroughly evaluated also it's important to determine what's considered proper preoperative evaluation and an education of the caregivers or providers so that they understand what I was considered to be part of preoperative evaluation and the third of preoperative evaluation also understanding the risks that are involved with having a fashion inadequately prepared for surgery it threatens patient safety satisfaction on outcomes and we also want to make sure that we increase the number of patients were evaluated thoroughly preoperatively improving preoperative evaluation of preparation of elective surgery patients and Printers patient outcomes and patient satisfaction again which both played a big role in today's health care under the Affordable Care Act the reimbursement for hospitals is based on quality care and positive patient outcomes if patients have a good outcome some hospitals will receive reimbursement for caregiving and about comes or might they will not the hospital's quality information is readily available at patients on the internet this information is not good and a patient may be discouraged from using a certain hospital therefore it is important to have the best outcomes possible and thorough preoperative evaluations you can lead to the best options and the other patient surgery department wherever we admit and process all of the patients that come into surgery we have between sixty to seventy percent of our patients seen in our president testing apartment prior to coming in well this is a good many patients this number should be one hundred percent or very close to it the problem with patients being inadequate prepared one way to see every day we may not cancer patients every day but I do know that we have to call more and search for test results or reports on at least one patient every day we want to provide the best care for our patients ensuring that we have all of the information available to make sure our patients are in the best state of health possible it's personal reviving safe patient care the main people that would benefit from the thorough evaluation of preparation with being the patients

after all they are the reason we did what we do every day many of our patients come in from out of town and we're told this is why they did not come in for pata I can see how this could be a little burdensome but it would be much better than coming in and being canceled at the last minute on the data surgery the hospital staff and surgeons would also benefit from having patients properly evaluated the hospital and staffing resources would not be wasted due to cancellation and instead of having the patient scheduled that was not adequately prepared and therefore cancelled the certainly could have scheduled a patient that was well prepared and ready for surgery and the question that proposed for this project was could improving preoperative evaluation and preparation of electro surgical patients decrease lastminute cancellations or delays of surgery and that evidence I have for this project again is the perioperative protocol healthcare protocol which is the AHRQ guideline for recommending property valuation and preparing for airing of a patient for surgery they recommend that all patients scheduled for elective surgery have a complete preoperative history of it school examination no diagnostics test should be performed without clinical indication and appropriate management of stable comorbidities preoperatively and also a decrease that cancelled elective surgeries due to incomplete preoperative assessment the first research article that I found on the discussing this topic was a new pathway for late for surgery to reduce cancellation rates this was an observational Rachel retrospective study at a hospital in Norway what they did was they redesigned their elective surgical pathway to provide for earlier patient assessment improved communication among the staff improved management improved planning and patient participation in the planning of their elective surgery they gave the patient more input on choosing their fate of surgery and things like that the study revealed a decrease in cancellation rate increase in perform surgeries per month the number of consultations at outpatient preoperative assessment clinic the study proved that redesigning the elective surgical clinical pathways decreased cancellations and increased number of performed surgery the second article the anesthetic pre-admission clinic is effective at minimizing the surgical cancellation rates this was a retrospective investigation study of the council surgical cases at a service pattullo in the Australia that was done over a four-year period the primary purpose of this study was to determine the effectiveness of surgical patients using the preadmission clinic on analyzing the risks of the cancellations on the day of surgery and this results showed patients attending the free admission clinic prior to surgery did have fewer incidents of surgery being cancelled on the day of surgery the third article the impact of preoperative assessment clinics on elective surgical case cancellations this was a study done at a hospital in our room and the purpose of it was to determine if the preoperative assessment clinics would reduce cancellations and the elective surgical cases that they have there it was a retrospective study done over a two-year period of time one year prior to the development of their preoperative assessment clinic and then one year after the study showed that there was an increase in the number of surgeries performed at the estate cornett even though it was an insignificant increase and it also showed a significant decrease in the number of cancellations after the formation formation of the preoperative assessment the next article is the evaluation of the utilization of the free on-site clinics at a university teaching hospital this study took place in Trinidad at a hospital they've done over 12-week period of time the purpose was to evaluate the use of the adult and pediatric premium premium STD clinics and the impact that had on patients cancellations of surgery the study showed an overall incidence of cancellations was higher in patients that did not go to either the pediatric ward off free admission clinic when compared to those who did not go or indeed go excuse me and the last article was just about focused Anastasia interviewed resource to improve efficiency and body and this was just a tool that was implemented at a hospital in the southeastern United States and it was computerized tool that the audience would use that would provide electronic triggers when certain questions were answered that elicited more in-depth questions and also listed health conditions that they would need to consult the anesthesiologist for so it just helped give them more thorough evaluation of the patients this study was retrospective on 250 charts done prior to the implementation of the fair tool and 250 charts after and it showed a significant reduction in the day of surgery cancellation percentage after implementation at the fair tool compared to before there was also a decrease in the first case delays after the implementation of the tool the recommendations i have here are that all patients must be seen in pre-admission testing department to be properly evaluated before surgery and in doing this we would need to develop a team to assist in this process review and change the preoperative processes that we currently have this team will need to consist of nurses surgeons staff from the surgeons offices internal medicine physicians and the anesthesiologist and of course members of hospital leadership it must become hospital policy for patients to attend a pre-admission testing prior to having their surgery the policy must miss what is considered to the proper preoperative evaluation and preparation this information must be given to the surgeons into their offices so that they will know what their patients need to have done to be properly prepared for surgery and that way everybody to be on the same page this information would need to be determined by the anesthesiologist as they are the ones that we put the patients to sleep they would need to determine for each certain health condition what required tests or

what consultations would need to be done for that patient to be considered at their optimal health and make sure that they are in for surgery the way that we would evaluate the success of this project or how it is going with bespeak performing monthly reviews of our surgery cases and cancellations and then the pre-admission testing usage cancellations will be assessed for the use of whether they attended pre-admission testing prior to surgery as well as the reason for their cancellation a decrease in pay to cancellations after being seen in the pre-admission testing Department will be considered an improvement and an increase in the number of patients that visit the phe department there's an increase that would be an improvement expected outcomes or the of course an increase in patients being thoroughly assessed evaluated and prepared for surgery an increase in pre-mission testing message and of course excellent patient satisfaction and patient outcomes I mean conclusion the research shows that thorough preoperative evaluation can decrease dancer for cancellation and increase patient satisfaction and outcomes inadequate preoperative assessment and evaluation can lead to last minute attempts on the day of surgery by hospital staff trying to locate information on a patient and an attempt to avoid cancellation if these patients were singing on a timely manner in the pnc department or previous you testing apart this could be avoided no one ever wants to cancel a patient surgery for any great reason i don't know how many times I've had to say to a patient we would rather be safe than sorry the patients are never happy about it but they understandably have their best interest at heart and in implementing the recommendations set forth in the perioperative protocol guideline making sure that all patients at npat prior to their scheduled surgery date with decreased last-minute cancellations and therefore improved outcomes and patient satisfaction you City University of New York.