Definition: the term pre-hospitalisation refers to a phase in which the patient enters the hospital in order to undergo all diagnostic ascertainments that must be performed before any programmed surgery
Presuppositions: the process of preparing a patient for a scheduled surgical operation is conditional upon various factors:
Health conditions (acknowledged correlated pathologies, pathologies that have emerged after booking the hospitalisation).
The need to perform further ascertainment examinations.
Pattern of inclusion in the surgery lists: the unpredictability of the Traumatological side of our work, inevitably affects the scheduling of programmed surgeries. Therefore, it is often necessary to change the organisation of surgery sessions because of the presence of traumatic injuries that require immediate treatment.
Aim: the aim of the Pre-hospitalisation Service is to improve the scheduling system of surgeries so that the first day of hospitalisation is also the day in which surgery is performed.
Therefore, such Service has an important organising role for the Operative Unit, since its aim is to combine patients' satisfaction and a decreased number of hospitalisation days.
Organisation:the staff specially assigned to the pre-hospitalisation Service include: a Ward nurse (Mr. Nerio Garotti) and another nurse (Ms Maria Antonia Venieri).
The increased demand and the important results obtained so far have led to a recent improvement of the Service through the setting up, from January 2002, of an additional nurse: Mr. Alberto Gualdrini.
The Service now runs from Monday through Friday with continuous working hours (from 8 a.m. to 7 p.m.).
The Service is now open also on Saturday mornings (from 8 a.m. to 1 p.m.).
The Service implies the existence of interdisciplinary cooperation agreements with the Anaesthesia Service (the anaesthesiology out-patients department runs on Wednesday afternoons), with the Radiology Service, with the Transfusion Centre (protocol concerning pre-deposits for self-bloodtransfusions), with the Clinical Laboratory, and Cardiology.
Pre-hospitalisation of a patient is also required when there are some particular traumatic pathologies for which immediate surgical treatment is not urgent and can be delayed of a short period of time: for example the fracture of peripheral skeletal segments (fractures of the clavicle, simple malleolar fractures), subcutaneous tendon-lesions, etc…
Also the patients that undergo surgery in Day Hospital are prepared for the operation with the coordination of the Pre-hospitalisation service.
Patient's steps: the days right after booking the surgery (which happens when the patient undergoes a specialist examination), Service professionals will call the patient on the phone or he/she can go directly to the hospital: during this interview, according to the level of urgency given to the case and based on waiting lists, the patient receives communication of the estimated date of the surgery.
Before such date patients will go through the pre-hospitalisation phase, which normally is completed with two following hospitalisations (over a period of time that depends on the kind of surgery).
If blood pre-deposits are considered to be necessary for any later self-bloodtransfusion, then a higher number of pre-hospitalisation stays are necessary (hip and knee prosthetic surgery).
During the first hospitalisation the nursing staff will fill in the pre-hospitalisation form: apart from the patient's general data and the type of hospitalisation, this form includes any anamnesis notes that might have led to a change in the clinical situation following the date of the booking.
The second section, therefore, includes all the procedures carried out during the entire pre-hospitalisation phas.
Moreover, during the first pre-hospitalisation stay, the Ward Physician writes down the first section of the medical record (anamnesis and clinical examinations) and explains the Informed consent form to the patient. The patients also receive an informative form concerning the rules that need to be followed before hospitalisation.
Because the patient enters the hospital ward on the very day of the operation, the respect of these rules is fundamental from an organisational point of view. The days after the conclusion of the pre-hospitalisation phase, the patient will receive a phone-call informing him/her of the exact date of the operation (usually performed in a period between 2 and 10 days).
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