PEC workflow for cardiothoracic surgery lowers cancellation rate of elective cases
A new system called Preoperative Evaluation Clinic (PEC) workflow for cardiothoracic surgery significantly reduced the cancellation rate of elective cases at the National Heart Centre Singapore (NHCS), according to a study presented at the ASEAN Federation of Cardiology Congress (AFCC) 2016 in Yangon, Myanmar.
In addition, PEC workflow serves as a platform for further expansion to a Same-Day Admission system for straightforward “low-risk” cases.
“Cardiothoracic surgeries carry significant risks and require thorough preoperative assessment and optimisation,” researchers said. “Patients are commonly admitted one day before elective operation, but cancellation rate remains high due to incomplete investigations or inadequate preparation.”
To improve the preoperative safety and efficacy, as well as to optimise the utility of resources and facilities, researchers employed a streamlined preoperative evaluation workflow in the hospital. The PEC was launched in November 2015 in the Cardiothoracic Surgery Department of the NHCS to provide both surgical and anaesthetic assessment for all elective cases.
The new evaluation system aimed to reduce last-minute cancellation of elective cases, adequately prepare patients for major cardiac or thoracic operations before admission, and identify potential risk factors so that early investigation and interventions could be made prior to surgery.
Researchers compared and analysed cancellations made before and after the PEC was launched. Since its opening, PEC has received 326 elective cases in the first 6 months. Comparisons were made between PEC and non-PEC cases when patients would go only through the “Clinic-Admission” pathway.
There was a significant reduction in cancellations of PEC cases upon admission from 5 percent in December 2015 to 0 percent in April 2016. The overall cancellation rate of elective cases decreased from a previous 18.8 percent to 12.3 percent after PEC.
The most common reasons for cancellation included onset of fever/upper respiratory tract infections after PEC visit, incidental finding of abnormal results requiring treatment such as acute deep vein thrombosis, or change of decision by patient.
Avoidable causes such as inadequate cessation of antiplatelet agents, lack of dental clearance for valve cases, or request for further investigations by anaesthetist in view of high risk for general anaesthesia were also minimised.
In addition, researchers noted how patients felt more comfortable and less anxious after appropriate orientation and counselling after PEC visit.