Telephone Pre-admission Assessment

Annette Thorpe (R.B.H)

and

Ann-Marie Malley (NHSD)

NHS Direct

• NHS Direct is leading the world as the largest e-health service of its kind.

• Half a million telephone calls per month• Projected to rise to 1.2 million in three years• Half a million on-line visits per month• Very high satisfaction rates• Hosted by 22 NHS Trusts/PCTs

• Growth in service (0845)• Out-of-hours integration

– technical links by end 2004– full clinical integration to follow

• Low priority ambulance calls from mid 2005• Expansion of on-line and digital TV services• Supporting local agendas

Service priorities

• Responsibility for commissioning NHS Direct moved to PCTs from April 2004

• A new national NHS Direct provider established to manage the service from April 2004

New Organisational structure

The beginning

Problems had been identified with pre-admission assessment service at the Trust:

– Not enough capacity, in terms of staffing and space, to allow all patients to be pre-assessed

– Some patients were being brought back to the hospital at the time of their OP appointment when they could be pre-assessed in a different setting

AdvantagesAdvantages

• Experienced highly trained staff• Staff available at key times• Security• Local knowledge of nurses• Staff able to work with protocols• Ability to offer additional services of NHS Direct

Long Term Aims• To increase the proportion of patients who have access

to pre-admission assessment

• To ensure that patients receive pre-admission assessment in an appropriate setting at a convenient time

• To maximise the skills and expertise of staff in both partner organisations in demonstrating a real example of working across boundaries

Getting going….

• November 2000 - proposal put together with NHS DirectResources were obtained from Booked Admissions A project team was set up

• February 2001 - Go live with Orthopaedics and Gynaecology followed by General and Oral surgery

Issues to be addressedIssues to be addressed

Clinical guidelines and protocols

Screening from OPD

Patient information and publicity

IT and data transfer issues

The development of an operational policy

Recruitment and training

Clinical Specialities

• Gynaecology

• Orthopaedics

• General Surgery

• Oral Surgery

• Eye surgery

• Urology

Further joint working

• Electronic booking of ECG’s and further discussions with other departments.

Patient suitability

• Aged over 16

• BMI less than 35

• Diastolic reading less than 95

• No obvious need for investigations

• Agreed TCI date to be least 3 weeks before the admission date

Informed Consent to NHS Direct pre-assessment

• Form to be completed

• Time spent by nursing staff giving explanation

• Written information provided for reference

• Posters are displayed in the outpatient waiting areas

The process

• Patient attends outpatient dept for consultation• Requires surgery (LA or GA) and is suitable for day

care admission - agrees convenient date for surgery• Given verbal information regards telephone pre

assessment• Agrees and completes consent form • Given printed information leaflet for further

information

• Consent and booking form are taken to registration department

• Details from the consent form logged onto data base by the Registration staff (dedicated team)

• NHS Direct contact patient and complete electronic Performa• NHS Direct attempt to contact the patient on at least 3

occasions• Appropriate investigations identified and booked.

The process

The process

• If the patient cannot be contacted or it is less than 2 weeks before their admission date they are referred back to the hospital for face to face pre assessment

• Completed Performa accessed by registration department via shared database.

• Performa ddelivered to the relevant ward/unit in preparation for admission

• Investigations initiated by the pre-assessment staff completed and results sent to ward prior to admission

New Initiatives

• Plastic surgery

• Radiology patients – Barium enema

• Endoscopy patients – Sigmoidoscopy– Colonoscopy

Pit falls!!Pit falls!!

• Initially time consuming• Turnaround time for return of information needed to

be reviewed• Dependant on e-mail• Calls needing to be made at NHS Directs busiest

times• Training issues for NHS Direct staff

Why a patient questionnaire?

• To monitor and evaluate the scheme:- highlight areas that are working well- highlight any areas that need improvement

• To discover patient views of the scheme and suggestions:- communicate this feedback to staff

Patient feedback

• 96% said they were contacted at a convenient 96% said they were contacted at a convenient timetime

• 96% said that they felt comfortable answering 96% said that they felt comfortable answering questions about their health by phonequestions about their health by phone

• 89% found the information leaflet useful in 89% found the information leaflet useful in preparation for their telephone pre-admission preparation for their telephone pre-admission assessment.assessment.

HOW LONG DID THE PRE-ASSESSMENT LAST?

41%

48%

7%4%

< 10 minutes

10 – 20 minutes

21 – 30 minutes

31 – 40 minutes

DID THE NHS DIRECT NURSE ANSWER THE PATIENT'S QUESTIONS?

63%

37% Yes

Didn’t ask questions

THE TELEPHONE PRE-ASSESSMENT MADE THE PATIENT ...

8%

48%

44%Worry less about theoperation

Worry more about theoperation

Make no difference tohow much you worried

Patient comments ‘‘I was phoned on Saturday morning which was very reassuring, I was phoned on Saturday morning which was very reassuring,

because I felt the nurse had made an extra effort to contact me out of because I felt the nurse had made an extra effort to contact me out of hours’hours’

‘‘Just to say these people are a rare breed. They are so patient and Just to say these people are a rare breed. They are so patient and reassuring towards you. They must deal with so may people, but they reassuring towards you. They must deal with so may people, but they make you feel the important one!’make you feel the important one!’

‘‘I felt very reassured about having the operation, as I was a bit I felt very reassured about having the operation, as I was a bit apprehensive before the call’apprehensive before the call’

‘‘It was more convenient to do the pre-assessment over the phone, I It was more convenient to do the pre-assessment over the phone, I didn’t need to book time off work and avoided wasting everyone's time didn’t need to book time off work and avoided wasting everyone's time sitting around at the hospital’sitting around at the hospital’

‘‘I don’t like talking about my health over the phone.I don’t like talking about my health over the phone. ’’

Staff comments

• ‘Initially a lot of paperwork to get used to it’

• ‘It’s now accepted as part of the service we offer’

• ‘The patient’s like it’

ThankYou