1. Telephone Pre-admission Assessment Annette Thorpe (R.B.H) and Ann-Marie Malley (NHSD)

2. NHS Direct NHS Direct is leading the world as the largest e-health service of its kind. Half a million telephone calls per month Projected to rise to 1.2 million in three years Half a million on-line visits per month Very high satisfaction rates Hosted by 22 NHS Trusts/PCTs

3. Growth in service (0845) Out-of-hours integration –technical links by end 2004 –full clinical integration to follow Low priority ambulance calls from mid 2005 Expansion of on-line and digital TV services Supporting local agendas Service priorities

4. Responsibility for commissioning NHS Direct moved to PCTs from April 2004 A new national NHS Direct provider established to manage the service from April 2004 New Organisational structure

5. The beginning Problems had been identified with pre-admission assessment service at the Trust: –Not enough capacity, in terms of staffing and space, to allow all patients to be pre-assessed –Some patients were being brought back to the hospital at the time of their OP appointment when they could be pre-assessed in a different setting

6. Advantages Experienced highly trained staff Staff available at key times Security Local knowledge of nurses Staff able to work with protocols Ability to offer additional services of NHS Direct

7. Long Term Aims To increase the proportion of patients who have access to pre-admission assessment To ensure that patients receive pre-admission assessment in an appropriate setting at a convenient time To maximise the skills and expertise of staff in both partner organisations in demonstrating a real example of working across boundaries

8. Getting going…. November 2000 - proposal put together with NHS Direct Resources were obtained from Booked Admissions A project team was set up February 2001 - Go live with Orthopaedics and Gynaecology followed by General and Oral surgery

9. Issues to be addressed  Clinical guidelines and protocols  Screening from OPD  Patient information and publicity  IT and data transfer issues  The development of an operational policy  Recruitment and training

10. Clinical Specialities Gynaecology Orthopaedics General Surgery Oral Surgery Eye surgery Urology

11. Further joint working Electronic booking of ECG’s and further discussions with other departments.

12. Patient suitability Aged over 16 BMI less than 35 Diastolic reading less than 95 No obvious need for investigations Agreed TCI date to be least 3 weeks before the admission date

13. Informed Consent to NHS Direct pre-assessment Form to be completed Time spent by nursing staff giving explanation Written information provided for reference Posters are displayed in the outpatient waiting areas

14. The process Patient attends outpatient dept for consultation Requires surgery (LA or GA) and is suitable for day care admission - agrees convenient date for surgery Given verbal information regards telephone pre assessment Agrees and completes consent form Given printed information leaflet for further information

15. Consent and booking form are taken to registration department Details from the consent form logged onto data base by the Registration staff (dedicated team) NHS Direct contact patient and complete electronic Performa NHS Direct attempt to contact the patient on at least 3 occasions Appropriate investigations identified and booked. The process

16. If the patient cannot be contacted or it is less than 2 weeks before their admission date they are referred back to the hospital for face to face pre assessment Completed Performa accessed by registration department via shared database. Performa ddelivered to the relevant ward/unit in preparation for admission Investigations initiated by the pre-assessment staff completed and results sent to ward prior to admission

17. New Initiatives Plastic surgery Radiology patients – Barium enema Endoscopy patients – Sigmoidoscopy – Colonoscopy

18. Pit falls!! Initially time consuming Turnaround time for return of information needed to be reviewed Dependant on e-mail Calls needing to be made at NHS Directs busiest times Training issues for NHS Direct staff

19. Why a patient questionnaire ? To monitor and evaluate the scheme: -highlight areas that are working well -highlight any areas that need improvement To discover patient views of the scheme and suggestions: -communicate this feedback to staff

20. Patient feedback 96% said they were contacted at a convenient time96% said they were contacted at a convenient time 96% said that they felt comfortable answering questions about their health by phone96% said that they felt comfortable answering questions about their health by phone 89% found the information leaflet useful in preparation for their telephone pre-admission assessment.89% found the information leaflet useful in preparation for their telephone pre-admission assessment.

24. Patient comments  ‘I was phoned on Saturday morning which was very reassuring, because I felt the nurse had made an extra effort to contact me out of hours’  ‘Just to say these people are a rare breed. They are so patient and reassuring towards you. They must deal with so may people, but they make you feel the important one!’  ‘I felt very reassured about having the operation, as I was a bit apprehensive before the call’  ‘It was more convenient to do the pre-assessment over the phone, I didn’t need to book time off work and avoided wasting everyone's time sitting around at the hospital’  ‘I don’t like talking about my health over the phone.’

25. Staff comments ‘ Initially a lot of paperwork to get used to it’ ‘It’s now accepted as part of the service we offer’ ‘The patient’s like it’

26. Thank You