Model of Care
The Model of Care for Elective Surgery
The initial focus of the National Clinical Programme for Surgery has been on the elective patient journey. The Elective Programme is successfully working to define ways to improve the delivery of elective surgical care through a range of initiatives as follows;
- By providing a Model of Care guideline for pre-admission assessment clinics, day surgery, day of surgery admissions and discharge planning.
- By setting hospital and specialty targets for the average length of stay of surgical inpatients whether or not they have surgery (and now also including acute patients) as well as targets for day surgery across surgical specialties.
- By engaging, mentoring and monitoring hospitals for both process and clinical outcomes (such as readmission rates) during hospital site visits.
- By supporting the National Office of Clinical Audit (NOCA) in its role of auditing surgical outcomes, such as by the Irish Audit of Surgical Mortality (IASM), Irish Audit of Critical Care, Irish National Orthopaedics Register (INOR) and the Trauma Audit Research Network (TARN). Detailed information regarding clinical audit is available through the http://www.rcsi.ie/national-office-of-clinical-audit
Model of Care for Acute Surgery
The Model of Care for Acute Surgery defines the core principles on which an acute surgical service model should be built and the key strategies that underpin these principles.
Patients who need acute surgical care constitute over 60% of the workload of many surgical departments. These patients are frequently the sickest, are elderly and have considerable co-morbidities and poorer outcomes. This Model of Care for Acute Surgery sets out best practice principles and strategies necessary to ensure the provision of high-quality acute care for patients in Ireland. Adherence to these principles, strategies and underlying critical considerations is designed to ensure that the acute surgical patient experiences:-
- Safe, quality care in a suitable environment.
- Appropriate and timely attention from a senior surgical decision maker working within a dedicated multidisciplinary team.
- Prompt diagnosis, appropriate treatment and, where necessary, timely surgery and discharge.
- Effective communication and respect for their autonomy and privacy.
- An optimum outcome with good after care, support and follow up.
The document also sets out to provide a road map to inform the delivery of acute surgical care so that patient outcomes are optimised and maximum efficiencies, both clinical and process driven, are achieved. It addresses inter alia the following issues:
- Generic and specialty specific standards of care
- The separation, where possible, of acute from elective stream
- A consultant led service
- Hospital groups and networks recognising the need for appropriate and dedicated facilities
- How surgical teams (all disciplines) work and their governance
- Capacity planning
- Acute Surgical Assessment Units, where appropriate
- The importance of designated beds and theatres
- Working with other programmes in unscheduled care
Throughout the two model of care documents the importance of routinely collected data and key performance indicators (KPIs) are stressed. It emphasises the importance of metrics and enabling ICT tools to inform clinical decisions and policy making.