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Assessment of obese patients to facilitate day case admission Sister Sue Roberts – Pre-op nurse practitioner Dr James Palmer – consultant anaesthetist.

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Presentation on theme: "Assessment of obese patients to facilitate day case admission Sister Sue Roberts – Pre-op nurse practitioner Dr James Palmer – consultant anaesthetist."— Presentation transcript:

1 Assessment of obese patients to facilitate day case admission Sister Sue Roberts – Pre-op nurse practitioner Dr James Palmer – consultant anaesthetist Salford Royal Hospitals NHS Trust

2 Introduction Why change practice? Audit What could be changed? Implementation Effects of new process

3 Why change? Improve patient experience Manage patients effectively Meet day surgery targets Meet 18 week pathway targets

4 Audit of Gynae Overnight stays One year’s data (2004-5) 27 ASA1 patients admitted with BMI >35 1 required additional analgesia, 1 had vaginal pack, 2 had no social support. 5 went home same day (1 with BMI=46), 22 NO nursing/medical intervention required overnight!

5 Population Audit of Obesity Health survey for England 2000-2002. Proportion of population with BMI >30 National 21.4% (quoted as 21.8% elsewhere from same source) Greater Manchester 21.1% Salford 22.1%

6 Audit figures at Salford Royal Hospital 5.5% of daycases done have BMI ≥37. 6% of non daycase elective surgical patients BMI>37 Anaesthetic audit showed vast majority feared: –postoperative hypoxia in the obese –OSA Some patients might benefit from referral for sleep studies and possible home CPAP.

7 What are other NW trusts doing? 2007 telephone/email audit of all NW day case units Questions: –Do you have an upper limit for BMI for day surgery? –What is it? –Why has this figure been chosen?

8 Results

9 Discussion points Choice of max BMI not evidence based –Pennine acute Follow up for high BMI cases –None declared Planned development –None declared Active preassessment –None declared

10 How to assess Consulted respiratory team in trust Developed process for pre-op nurses to follow

11 Process ASA 1 with BMI >37 Baseline sitting SpO2 <95% not fit for DSU >3% desturation >95% do 2 minute step test <3% desaturation complete OSA questionnaire Negative Refer for PSG ADMIT TO DSU Improvement with CPAP Positive PSG – referred for NCPAP training

12 Pre-op assessment clinic Generic clinic Qualified nurse practitioners Pre-op support workers Equipment In house sleep studies referral

13 Implementation Step test Epworth score Sleep studies how to refer? ?stop clock

14 Outcome Individualised patient process identified Utilising day surgery more effectively Increased patient satisfaction No cancellations/AIRs Day surgery staff report no problems

15 Thank you Questions???


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