Model of Care for Acute Surgery National Clinical Programme in Surgery Model of Care for Acute Surgery National Clinical Programme in Surgery Forward The National Clinical Programme in Surgery is delighted to publish the Acute Surgery Model of Care. The aim of the Surgery Programme is to provide a framework for the delivery of more timely, accessible, safer, cost effective and efficient care for the acute surgical patient. This follows on from the Elective Surgery Model of Care which is currently being rolled out across Ireland. While understanding the difficulties facing healthcare delivery at the present time, we believe that the principles laid out in this document represent best practice that will, in the long term, fundamentally improve surgical care. Change of this magnitude will clearly take time to implement and will impact all care providers and the organisations within which they work. We also acknowledge that the patient care that is provided by surgeons and anaesthetists cannot be delivered without the support of a wide range of other professional and ancillary groups. Finally, we welcome the collaboration with the other programmes charged with the delivery of acute patient care. This final document could not have been completed without the widespread input and suggestions that we have received from our own team, the surgical and healthcare community as well as patients themselves. We would like to express our sincere gratitude and appreciation to one and all. Professor Frank Keane, Joint Lead Mr Ken Mealy, Joint Lead National Clinical Programme in Surgery National Clinical Programme in Surgery Model of Care for Acute Surgery 2013 2 | P a g e Table of Contents Forward ................................................................................................................................................... 1 1.0 Executive Summary ..................................................................................................................... 6 2.0 Glossary of Terms .............................................................................................................................. 8 3.0 Background and Objectives ............................................................................................................ 10 3.1 Scope of the Document ............................................................................................................... 12 4.0 Surgical Activity and Bed Occupancy – Acute and Elective ............................................................ 16 4.1 Introduction ................................................................................................................................. 16 4.2 Methodology ............................................................................................................................... 17 4.3 Results ......................................................................................................................................... 17 4.4 Discussion .................................................................................................................................... 30 5.0 The Way Forward ............................................................................................................................ 34 5.1 Core Principles ............................................................................................................................. 35 5.1.1 Quality Assured Acute Surgical Care..................................................................................... 35 5.1.1.1 Standards of Care for Acute Surgery............................................................................. 35 5.1.1.2 Knowing the Risk ........................................................................................................... 36 5.1.1.3 Communicating with Patients ....................................................................................... 37 5.1.1.4 Consent and Patient Safety ........................................................................................... 37 5.1.1.5 Consultant-delivered Service ........................................................................................ 38 5.1.2 Recognition of Acute vs. Elective Pathways ......................................................................... 39 5.1.3 Networked Solutions ............................................................................................................ 42 5.1.3.1 Hospital Groups............................................................................................................. 42 5.1.3.2 Hospital Models ............................................................................................................ 43 5.2 Strategies ..................................................................................................................................... 45 5.2.1 Efficient Patient Flow - Access & Discharge .......................................................................... 45 5.2.1.1 Importance of Access and Facilities .............................................................................. 45 5.2.2 Acute Surgical Assessment Units (ASAUs) ............................................................................ 46 5.2.2.1 Diagnostic Services ........................................................................................................ 50 5.2.3 Designated Theatres ............................................................................................................. 51 5.2.4 Manpower/Resource Optimisation ...................................................................................... 52 5.2.4.1 The Surgical Team ......................................................................................................... 52 5.2.4.2 The Need for Innovative Roles ...................................................................................... 54 5.2.4.3 Efficient use of Resources ............................................................................................. 56 Model of Care for Acute Surgery 2013 3 | P a g e 5.2.5 Capacity Planning .................................................................................................................. 57 5.2.5.1 Predicting Flows into Unscheduled Surgical Care ......................................................... 57 5.2.5.2 Critical Care Capacity Planning ..................................................................................... 62 5.2.5.3 Discharge Planning ........................................................................................................ 62 5.2.5.4 Acute Surgical Inpatients who do not have a surgical procedure ................................ 63 5.2.6 Key Performance Indicators ................................................................................................. 65 5.2.6.1 Data, Outcomes and Quality Indicators ........................................................................ 65 5.2.6.2 Audit (IASM, INOR and Critical Care audit) ................................................................... 66 5.3 Key Considerations ...................................................................................................................... 69 5.3.1 Governance ........................................................................................................................... 69 5.3.2 Surgical Specialties – Their Role in Acute Care ..................................................................... 71 5.3.3 Integration with other Stakeholders & Clinical Programmes ............................................... 72 5.3.3.1 Acute Medicine Programme ......................................................................................... 72 5.3.3.2 Emergency Medicine Programme ................................................................................. 73 5.3.3.3 Transport Medicine Programme ................................................................................... 74 5.3.3.4 Critical Care Programme ............................................................................................... 76 5.3.3.5 National Cancer Control Programme ............................................................................ 78 5.3.4 Information and Communication Technology support (ICT) ................................................ 79 5.3.5 Trauma .................................................................................................................................. 79 5.3.6 Paediatric Surgery ................................................................................................................. 81 6.0 Standards for Acute Surgical Care................................................................................................... 85 6.1 Generic Standards for Acute Surgical Care ................................................................................. 86 6.2 Surgical Specialty Standards for Acute Surgical Care .................................................................. 90 6.2.1 Cardiothoracic Surgery ......................................................................................................... 90 6.2.2 General Surgery .................................................................................................................... 91 6.2.3 Neurosurgery ........................................................................................................................ 94 6.2.4 Oral and Maxillofacial Surgery (OMFS) ................................................................................