For pre-assessment purposes, major surgery includes: Total hip replacement; Total knee replacement; Uni compartmental knee replacement (half a knee Replacement); and Tibial tuberosity Transfer.
Pre assessment is a vital and important part of the patient journey.
It is necessary for the surgeon and anaesthetist to have a full patient medical history prior to carrying out any surgical procedure. It ensures the safest possible outcome whilst having undertaken a general or spinal anaesthetic with sedation or local anaesthetic.
To commence this process a medical questionnaire is sent to the patient amongst a number of other documentation required. This will need to be completed as soon as possible and returned in the enclosed pre paid envelope.
Pre assessments enable the team to decide whether surgery is appropriately located for the safety of the patient i.e. within the private sector or alternative being an NHS hospital.
Pre assessment prepares the patient with valuable information and advice that is needed for them before surgery, whilst in hospital and to plan and organise their aftercare at home.
Pre assessment commences the one to one contact with Mr Aslam’s nurse, enabling continuing communication throughout their patient journey. This can happen by the nurse calling the patient direct or the patient can leave their telephone details with switchboard or pre assessment and the patient will have their calls returned.
The pre assessment appointment occurs at Spire Southbank Hospital in Worcester.
As you arrive at the entrance to the hospital, you are greeted by a receptionist who will direct you to the left hand side of her desk, through the glass doors into a waiting lounge. A further receptionist books you onto the clinic I.T. system.
The Pre assessment nurse collects you from there and takes you to a nearby clinical room.
Toilet facilities are located by the glass doors and refreshments are available in the coffee lounge, music, T.V water Dispenser is in the waiting lounge.
The assessment will take place normally on a Tuesday or Wednesday.
The appointment will be sent to you via the “In Patient bookings” dept after your surgery date has been confirmed. The pre assessment appointment will be approximately 2-3 weeks prior to the operation for major surgery. Less, if required for minor surgery.
The appointment will be for one to one and half hours. It is recommended to have accompanying with you, the person who is helping with your recovery at home so they can obtain as much insight into your post operative requirements as possible. Observations will be performed on Blood Pressure, Temperature, Oxygen capacity, pulse, respirations, urine test, MRSA /MSSA swabs from nose and top of thighs,
Measurements taken for anti embolic stockings full length/ half length, these will be worn for 6 weeks post operatively. For Hip replacements it will not be possible for the patient to apply these themselves. Blood tests and a tracing of your heart i.e. ECG.
Any existing physical / medical conditions will also be discussed in detail which may otherwise impact on your recovery.
Then you have the patient journey explained step by step for the approximate two to three day stay. A discharge criteria has to be completed before going home which involves having a post operative x-ray of the joint replacement, a post operative blood test, and a stairs assessment with the use of crutches or sticks if necessary. A follow up appointment for two weeks and six weeks to see Mr Aslam and his nurse will be given to you on discharge from hospital, as well as separate physiotherapy appointments, commencing with in the first two weeks of being at home.
Various criteria have to be fulfilled by the patient before leaving hospital.
The patient needs to have eaten and drank, if nauseated given anti emetic medication if warrants.
Passed urine by the normal route after an anaesthetic.
Pain well managed and adequate analgesia given and prescribed to take home.
Seen and assessed by physiotherapist prior to going home and safe with appliances if required.
Wound reviewed and assessed before discharge home.
A one week post operative telephone call will be made by Mr Aslam’s nurse to gain a progress report and allow for any questions or concerns to be discussed.
Pre assessment processes allow the patient to absorb all the information, advice and guidance thereby allowing them to ask constructive questions pertinent to their individual requirements.
The patient gains a good, confident rapport with Mr Aslam’s nurse, being reassured that they will be well looked after by experienced staff in a safe, professional, environment and that all aspects of their care have been addressed.
Post hospitalisation is also very important to address. Home circumstances also need to be safe once leaving hospital. Patients who have major surgery have to have someone else at home with them especially at night time for at least a week. Thereby giving any assistance when required. If this is not straight forward the pre assessment process can help with this in advance, and reducing the risks of delayed discharge or rescheduling until safe circumstances are in place at home. For this, there are a number of options available to explore and will be discussed at this stage. All equipment necessary for mobilisation at home will be dealt with by the physiotherapy team in hospital and can also be discussed at pre assessment. Half length Anti embolic stockings for Hip Replacement patients need to have a person available to remove and apply them each day for the 6 weeks post surgery. Knee replacement patients wear full length stockings for 6 weeks post surgery and are able to apply these themselves.