CONOCIMIENTOS EN SALUD SEXUAL Y REPRODUCTIVA TABLA N°

The Laurentius Hospital in Roermond started with the development of the elective admission ward based on qualitative bottlenecks. During the admission of new patients and the discharge of operated patients at the inpatient wards situations occurred that were undesirable. The patients had to wait in hallways since no beds were free to be used. The hospital decided to create a ward specifically for the elective patients where they could be admitted before the surgery. This gives the inpatient wards enough time to discharge patients and new patients can be received after they have been operated. It was also unclear for the patients, which ward they had to go to before the operation. The healthcare inspection had recommended that patients that have already been operated and those waiting to be operated should not cross each other on a ward because this might increase the stress of the patients that need to be operated. Research also found that patients waiting at the holding area would experience higher stress levels, due to the differences in appearance of the area from a ward. Because of this further research and the building process that was going on it was decided to perform the holding activities at the newly developed elective admission ward.

The elective admission ward is located on the first floor of the hospital, which is the same floor as the operating theatre. There is however a distance that has to be crossed from the EAW to the operating room. There are six operating rooms present at the Laurentius Hospital for the elective patients and three rooms are available at t he elective admission ward for the intake. The decision to use eight beds at the ward was based on different scenarios that were conducted using the available data. Laurentius Hospital has chosen to position 32 chairs in a luxury waiting room, since the patient has to remain longer in this room than the one of an outpatient clinic, because the hospital wants to have an extra patient on stand-by. At the elective admission ward all patients are admitted with the exception of the sections, children, mamma care and emergency patients. The holding function is taken over by the EAW, but there are a few rooms at the recovery ward that can be used for the patients to get their block anaesthetic performed. Only the cataract patients will return to the elective admission ward and for each type of patients from the different specialisms a protocol is developed for the preparation of the patients.

Tactical

The elective admission ward at Laurentius Hospital is open from 7:00 hours to 16:30 hours and four nurses are working on this ward. There are two shifts of 9 hours, one shift of 8 hours and one shift of 6 hours. All shifts start at 7:00 hours and there need to be two shifts till the end of the day due to the medication protocol. The nurses are divided over the patients based on the operating rooms. There are 6 operating rooms and the anaesthesiologists decide which operating rooms they will use and each nurse communicates with their own anaesthesiologist. Laurentius Hospital has a unique concept for the nurses that work at the elective admission ward. They have chosen for a trilateral of nurses from the elective admission ward, the day treatment ward and the recovery ward. Since these wards all have nurses working on them, it is possible to interchange between the different nurses in case of a very high workload on one department. This also has a flexibility construction, because these nurses are able to work on three different wards and have a clear overview of the process for the patient. The recovery personnel also work in both the recovery room and block rooms, because most of the anaesthesia preparations are already performed at the EAW.

The patient planning is made a week in advance in Chipsoft Ezis at the elective admission ward. Currently, the hospital is working on a project with Hotflo to plan the patients more efficiently. This is a company that has

specialised in capacity calculations that will create a better balance between the different patient types and operations that are performed. Hotflo makes plan groups, which are heterogeneous groups of patients that have approximately the same OR times and the same nursing time. Based on this pool of patients a general surgery schedule can be made in which the surgeons have a spread of the different types of complex patients over a day or week. When the pool of patients is bigger, it is easier to distinguish the different plan groups of patients. The patient has a plastic bag in which all of the luggage will be transported. This plastic bag will be closed and labelled and will then be transported to the inpatient ward or day treatment ward. There are 8 beds at the elective department and a buffer of 6 beds is kept in a hall with a dead end. When the EAW runs out of beds, clean beds are transported from the bed centre of the hospital to the EAW.

Operational

The patient has to arrive at the Laurentius Hospital an hour and a half before the planned surgery time and required to go to the reception of the elective admission ward. The secretary of the EAW uses a checklist to inquire food and fluid intake in the last few hours. The patient is required to wait in the waiting room until the intake procedure takes place. After the intake, the patient will return to the waiting room or is moved directly to their assigned bed when desired or when the holding calls for the patient. The intake will be performed as soon as possible because the patient is called for 20 minutes before the start of the operation and this is not enough time for the intake and preparations. The patient needs to get dressed in their operating shirt, the infusion has to be put in place and antibiotics have to be given. The total workload per patient for the elective admission ward is approximately one hour. The nurse performing the intake will also be the nurse that brings the patient to the operating theatre for the takeover. The management has decided that the takeover will be performed in the sluice to decrease the number of mistakes during the transfer. The EAW nurse, patient, anaesthesiologist and operating assistant are present during the takeover. The patients that have been inpatient the day before their surgery date, will go through the elective admission wards, because they are closer to the operating theatre this way. The peak of patients lies between 7:00 hours and 9:30 hours and between 11:00 hours and 13:30 hours.

Experiences and future perspective

During the interview, different aspects to consider when developing and implementing an elective admission ward were mentioned. According to the head of the ward who was interviewed, it is important to discuss with the receiving ward which information should be present about the patient since this ward sees the patient only after the operation has been performed. Another important aspect is that the elective admission ward is administering the infusions for the patients, which means that the anaesthesiologists do not have many infusions they need to insert. Since this is part of the anaesthesiologist’s tasks, it is important that they do not forget the procedure in case of emergency patients. Therefore the anaesthesiologists are stationed at the EAW for a few hours every few weeks to set infusions.

The advice of the Laurentius Hospital to Rijnstate would be to have one more bed as a backup rather than a bed needed because some patients require a bed, as it would not be patient friendly to let them sit on a chair for a long time. One of the bottlenecks this hospital has experienced is that the communication between the operating room and the EAW is not completely spotless. There is no holding where a patient can be held till the the start of the next operation and therefore there should be a signal 20 minutes before the ongoing operation is ended meaning that

the next patient has to be prepared for surgery. The advice from the hospital would be to position the operating theatre and elective admission ward next to each other in order to create a waiting line for the operating rooms and let the EAW take over the holding function.

The future perspectives for this ward is that at the preoperative screening a better selection can be made of patients who will go through the elective admission ward and which patients will be admitted to the inpatient ward. In addition to this, they want to differentiate in the admission times of the patients who need longer preparation times or are able to go through the process much faster, so that not all patients have to be there an hour and a half in advance. There are certain advantages of the EAW. The first is that the operating room and holding are experiencing a better-prepared patient and almost no surgery had to be cancelled because a patient had eaten before surgery or because some preoperative proceedings were not performed. The delay of the entire care process has been reduced because of the elective admission ward, the patient is prepared for their operation in a better way and fewer mistakes are made. This ward has a high patient score and the employees of the interacting wards see the advantages of this ward.

5.1.2 Jeroen Bosch Hospital, Den Bosch