Maintaining patient safety with reduced appointment visits

One stop pre-op appointment minimises patient and staff risk

Patient and staff safety during COVID-19 is of high importance, especially as urgent elective care and cancer treatments continue to be delivered. The Advanced Colorectal Service Team at St Helens and Knowsley Teaching Hospitals identified a need to limit the number of patient appointments prior to surgery. In order to reduce visits, and minimise risk for patients, the team established pre-operative protocols and increased efforts to educate patients regarding self-isolation behaviours. Central to this was a one-stop pre-operative appointment. Two weeks prior to surgery, patients attend hospital just once (to allow for 14 days self-isolation).

“We’re bringing patients in once and doing everything we need for them in that one visit, rather than multiple outpatient appointments, and to be able to get them to the stage [where] we can bring them in for surgery.” Director of Operations and Performance

In this visit they:

  • meet the surgeon and anaesthetist to discuss the surgery
  • complete consent forms, and
  • receive clear instructions about what self-isolation means in practice.

To further reduce delays and the need to attend a testing site, patients are tested for COVID-19 on the day of their surgery (or as close to it as possible) using rapid testing facilities. Post-discharge from hospital, patients are encouraged to self-isolate for 14 days to ensure safe recovery. The team also contacts patients two weeks after their surgery to ensure they are free of COVID-19 symptoms.

“From the end of April to the beginning of June, so just around the first month of running this, we performed 273 general anaesthetic cases, and that actually went beyond cancer cases, as we started to do a lot of urgent elective work and there were 73 colorectal cancer retentions performed around that time.” Assistant Medical Director and Lead for Cancer and Urology (consultant surgeon)

The team also collected patient satisfaction data from the first 100 patients about their experience of the new system:

1. What were they most anxious about; the delays to their planned cancer treatment (or urgent clinical care), or the risk of coming into hospital and catching COVID-19?

“Overwhelmingly, the delays to their treatment rather than the perceived risk of catching COVID during that hospital stay. That’s a really important message that the public are willing and wanting to engage in this in the main.” Assistant Medical Director and Lead for Cancer and Urology (consultant surgeon)

2. Following treatment on a scale of one to ten, how happy were they, once they had come through this process and had followed the instructions given?

“The mean score was 9.5 out of 10, so I think we are really pleased that we have developed a system that is working, both for the patients, the organisation, and the wider public out there.” Assistant Medical Director and Lead for Cancer and Urology (consultant surgeon)

You can hear the whole presentation at fabNHSstuff.


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