#35885 ‘Direct access’ patient pathway for ambulatory care – a service review. A safe sustainable access route to the operating theatre including via the block bay

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Background and Aims

Galway University Hospital has an established ambulatory patient pathway governed by a ‘Direct Access’ policy. This was designed to minimise in- hospital time, maximise patient safety and facilitate Trauma and Plastic Surgery procedures. We conducted a review of this service to quantify volume of use, determine adherence to policy guidance and establish the level of Regional Anaesthesia involvement. Our aims are to promote the policy as a safe sustainable model for ambulatory care that maximises patient safety while increasing local Block Bay throughput.

Methods

Operating Theatre records were interrogated to derive the patients recorded as ‘Direct Access’. This was cross-referenced with our Block Bay log to establish patients who were administered a regional block. Electronic records and bed management systems were reviewed to establish adherence to policy in relation to sedation use, conversion to general anaesthesia and length-of-stay. Data was stored within the hospitals network, password protected with vetted select access. Windows Excel was used to process the data.

Results

Of the 261 cases recorded as ‘Direct Access’; 233 were confirmed and included for analysis. Full results are included in attached image of Tables 1-5. Direct Access Pathway Review Abstract: Results Tables

Conclusions

Our review reflects a pathway that minimises in-hospital time as 91% cases admitted and discharged on the same day. Policy adherence is high with very low sedation, GA and Overnight-Admission rates. The overall number of ‘Direct Access’ cases highlights the need for promotion of this pathway locally to increase traffic through our Block Bay which will benefit both patients and Anaesthesia trainees alike. Direct Access service review Results Tables 1-5