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seParate streams
The Model of Care emphasises the importance of separating the
streams and activities of acute and elective surgery and aims to
address the important issues underpinning successful management
of the acute surgical patient. According to Mr Mealy, Joint Lead of
the NCPS, adherence to the Model of Care's principles, strategies and
underlying critical considerations will ensure that patients experience:
safe, quality care in a suitable environment;
appropriate and timely attention from senior doctors working
within a dedicated multidisciplinary team;
prompt diagnosis, appropriate treatment with, where necessary,
timely surgery, followed by appropriate aftercare and planned
discharge with monitored outcomes;
excellent communication and respect for their autonomy and
privacy; and,
an optimum outcome with good after care, support and follow up.
first Priority: the Patient
Professor Keane says the welfare, care and safe management of
patients is at the core of the Model of Care. He explains: "The
model stresses excellence in communication with patients and their
carers while respecting their autonomy and privacy. At the same
time, they should expect to receive more streamlined, efficient and
safer care leading to shorter hospital stays and speedier recoveries.
Process improvement and greater efficiency will, inevitably, require
better data and monitoring systems and the implementation of these
is strongly supported by the Surgery Programme. A purely target-
driven approach will not be enough on its own and we have all learnt
of the dangers of this approach from the UK's Mid-Staffordshire
Report, which is referred to in some detail in the Model of Care
If the Model of Care is to be successful, however, two requirements
are crucial, he warns: "Firstly, the establishment of strong surgical
and peri-operative governance structures and operational teams is
essential. Secondly, and equally importantly, there must be provision
of access to protected, designated beds."
the role of consultants
Echoing these comments, Mr Mealy states: "If the Model of Care's
primary focus is the acute patient, then the secondary focus is on
the surgical and peri-operative teams; it is they that will provide
the quality care. The role of Consultants is pivotal, as they must
work within, and commonly lead, these teams. The Model, of
necessity, anticipates performance improvement and practice
adjustments that will be required to meet the new demands. This
may be both demanding and unsettling but clearly is intended for
the greater good."
Patient access to a senior decision maker early in his/her journey
will require the availability of dedicated senior staff to manage
acute surgical patients on a full-time basis undistracted by other
duties such as an elective surgery list or off-site commitments.
Mr Mealy continues: "While this may be manageable with
current staffing levels in some of our larger hospitals, it may not
be possible in smaller hospitals with just three general surgeons,
for example. Understanding this should be the driver for
estimating staffing requirements, hospital resources and group
configurations. This will mean changes to work practices for
consultants, nurses or other allied health care professionals who
are involved in the delivery of acute surgical services."
Better Planning
The Model of Care for Acute Surgery has highlighted the need
for better capacity planning across the hospital system. Closer
cooperation will be a key factor, according to Professor Keane:
"Improved collaboration with other Clinical Programmes
and stakeholders will help improve the quality of information
available and, thereby, enhance capacity planning. This means
that each discipline within a hospital has to be responsible for its
own resources.
"When approaching capacity, each discipline should be
responsible for enacting an escalation plan to mitigate any
overrun whether that is as simple as an extra ward round
or discharging patients earlier. The cancellation of surgical
patients should only arise as a very last resort and in exceptional
Professor Frank Keane, Joint Lead of the nCPS.
Mr Ken Mealy, Joint Lead of the nCPS.
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