Page 114 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP2.4 Staff Empowerment 13:15 Room 221

Monday, 18 May Peri-operative Mangement Team Enhances Surgical Outcomes
Chong LC 1, Wu CP 1, Lai PL1,2, Yuen K 1,2, Lee D 1,2, Wong YW 1,2, Leung YY 1,2, Kong SW 1,2, Li TW 1,2, Chan SW 1,2
1Department of Surgery, 2Peri-operative Management Team, Department of Surgery, Tseung Kwan O Hospital, Hong Kong

Introduction

Traditional peri-operative management mainly relies on the decision of surgeon-in-charge. Communications amongst
disciplines mainly depends on ineffective written documentations. We have developed a holistic care management team to
deliver a more coordinated and collaborative fashion. Working closely with various disciplines towards a more coordinated
and collaborative care delivery model, post-operative morbidities are minimised. More importantly, our programme has
initiated a cultural change in how our staff perceives peri-operative care since last year.

Objectives

(1) To minimise the incidence of major post-operative symptomatic complication of atelectasis, pneumonia and acute
myocardial infraction (AMI) through optmisation of the patient; (2) to have an early detection of potential life-threatening post-
operative condition for a more precise decision; (3) to improve, empower and coordinate multidisciplinary peri-operative care
beyond ward boundaries through regular discussion among team members of a Peri-operative Management Team; and (4) to
align efforts of different disciplines to the core of post-operative care including haemodynamics, respiratory care, nutrition,
mobilisation.

Methodology

(1) Work group of Peri-operative Management Team with representatives of ward senior surgeons, senior nursing staff, allied
health staff and one Advanced Practice Nurse (APN) of Quality Improvement (QI) was set up in the department. (2) Conduct
cross ward boundary round to patients undergoing major surgeries in the department by APN(QI) and report patients’
progress to consultant surgeons directly. (3) Provide nursing assessment and evaluate care plans. (4) Daily reporting the
progress of critical major operative cases, which allows early decision on comprehensive intervention. (5) Collaborate
with other departments to negotiate the plan of patient management. (6) Coordinate service with other disciplines, e.g.
physiotherapist and dietitian etc. on patient progress and treatment planning alignment. (7) Provide education to junior staff
on handling patients undergoing surgery, complication detection and prevention through clinical supervision. (8) Conduct
sharing and case reviews on surgical outcomes.

Results

Since November 2012, more than 150 patients per year were involved. The incidence of post-operative complications were
decreased by more than 25% in 2013. Communications amongst disciplines were also enhanced. With aligned treatment
targets and better training, care was more focused and effectively delivered. We have showed a great improvement in annual
surgical outcome audit (SOMIP) amongst all the surgical departments in Hong Kong. We climbed up from the worst motality
outlier to the fourth rank amongst all the surgical departments in emergency major and ultra-major surgeries. We created a
more harmonic environment for communication, cooperation and coordination between nursing and medical staff; different
medical disciplines and different departments.

HOSPITAL AUTHORITY CONVENTION 2015

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