背景:入院前诊所(PAC)在围手术期护理中至关重要,提供评估,教育,以及手术前的患者优化。在COVID-19大流行期间,由于缺乏视频咨询的基础设施,PAC通过实施电话访问进行了调整。虽然大流行大大增加了虚拟护理的使用,包括视频预约,作为面对面咨询的替代方案,我们的PAC没有使用视频会诊进行术前评估.
目的:本研究旨在开发,工具,并将术前视频咨询整合到PAC工作流程中。
方法:使用Plan-Do-Study-Act(PDSA)方法进行了前瞻性质量改进项目。项目重点发展,实施,并整合伦敦健康科学中心和圣约瑟夫医疗保健中心的虚拟视频咨询(伦敦,安大略省,加拿大)在PAC中。系统收集数据以监测接受视频会诊的患者人数,解决患者流量问题,并增加视频咨询的比例。PAC之间的通信,外科医生办公室,分析患者的持续改善情况。解决了技术挑战,简化了程序,以促进约会日的视频通话。
结果:PAC团队,其中包括医学专业人员,麻醉,护理,药房,职业治疗,和物理治疗,为手术患者提供术前评估和教育,每年在3个医院地点进行约8000次咨询。在最初的PDSA循环之后,干预措施持续将视频咨询利用率提高到17%,表明积极的进展。随着PDSA周期3的开始,在早期阶段有明显的激增至29%的利用率。这种上升趋势还在继续,在周期的后期,虚拟视频咨询的利用率达到38%。这一提高的水平在整个2023年始终保持,突显了我们干预措施的持续成功。
结论:质量改进过程显著增强了机构的术前视频咨询工作流程。通过了解PAC内部的复杂性,在不影响效率的情况下,进行了战略干预,以整合视频咨询,士气,或安全。该项目强调了通过周到地整合虚拟护理技术来改善医疗保健服务的潜力。
BACKGROUND: The preadmission clinic (PAC) is crucial in perioperative care, offering evaluations, education, and patient optimization before surgical procedures. During the COVID-19 pandemic, the PAC adapted by implementing telephone visits due to a lack of infrastructure for video consultations. While the pandemic significantly increased the use of virtual care, including video appointments as an alternative to in-person consultations, our PAC had not used video consultations for preoperative assessments.
OBJECTIVE: This study aimed to develop, implement, and integrate preoperative video consultations into the PAC workflow.
METHODS: A prospective quality improvement project was undertaken using the Plan-Do-Study-Act (PDSA) methodology. The project focused on developing, implementing, and integrating virtual video consultations at London Health Sciences Centre and St. Joseph Health Care (London, Ontario, Canada) in the PAC. Data were systematically collected to monitor the number of patients undergoing video consultations, address patient flow concerns, and increase the percentage of video consultations. Communication between the PAC, surgeon offices, and patients was analyzed for continuous improvement. Technological challenges were addressed, and procedures were streamlined to facilitate video calls on appointment days.
RESULTS: The PAC team, which includes professionals from medicine, anesthesia, nursing, pharmacy, occupational therapy, and physiotherapy, offers preoperative evaluation and education to surgical patients, conducting approximately 8000 consultations annually across 3 hospital locations. Following the initial PDSA cycles, the interventions consistently improved the video consultation utilization rate to 17%, indicating positive progress. With the onset of PDSA cycle 3, there was a notable surge to a 29% utilization rate in the early phase. This upward trend continued, culminating in a 38% utilization rate of virtual video consultations in the later stages of the cycle. This heightened level was consistently maintained throughout 2023, highlighting the sustained success of our interventions.
CONCLUSIONS: The quality improvement process significantly enhanced the institution\'s preoperative video consultation workflow. By understanding the complexities within the PAC, strategic interventions were made to integrate video consultations without compromising efficiency, morale, or safety. This project highlights the potential for transformative improvements in health care delivery through the thoughtful integration of virtual care technologies.