Sample Checklist for Surgical Team Services (Admission/Discharge)

1. 0 Patient’s admission process in the hospital’s surgical service | |MET |PARTIALLY |NOT | | | |MET |MET | |1. 1 Evaluation of patient at the point of first contact to match the patient to surgical care | | a. Identifying the scope of care and treatment delivered to | | | | |patient either in the in-patient or ambulatory care setting | | | | | b. Proper evaluation process to ensure ability of the service to | | | | |deliver care and treatment | | | | | c. If the patient’s needs are not met, there is alternative process | | | | |for stabilizing the patient or for referral system | | | | |1.

2 Categorization according to the need of the service | | a. Priority given to immediate needs (emergency care) | | | | | b. Waiting lists are established and maintained | | | | | c. Pre-registration system for ambulatory patients (non-urgent | | | | |care) | | | | |1. 3 Operational policies and procedures are followed for admitting the patient | |.

a. Patient-related information taken from: | | | | |? patient; and/or immediate family | | | | |? patient’s significant others (friends, relatives, etc. ) | | | | |?referring practitioners | | | | |? records of previous related visits | | | | |*tick the box that applies | | | | | b. Informed consent taken from: | | | | |? patient (at legal age) | | | | |? if underage or incapacitated, patient’s father or from | | | | |patient’s brother (at legal age) | | | | |? in absence of paternal side, the head of surgical team in | | | | |knowledge of patient’s mother or immediate family | | | | |*tick the box that applies | | | | | c. Routine pre-operative work-ups | | | | |1.

4 Patient and family are provided with information during admission | | a. Orientation to service | | | | | b. Orientation to the physical environment of the service | | | | | c. Visitation protocols for in-patients | | | | | d. Introduction to caregivers | | | | | e. Routines and rules of the service | | | | | f. Patient and family’s right and responsibilities (right to | | | | |participate in decision-making regarding care and treatment; | | | | |its concerns; and compliance for safety-related requirements. ) | | | | Comments:

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_________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________ SURGICAL TEAM SERVICES ________________________________________ ( ) Paediatric Surgery Department ( ) Plastic Surgery Department ( ) Neurosurgery Department ( ) Transplant Surgery Department ( ) Eye Surgery Department PREPARATION FOR DISCHARGE, TRANSFER OR FOLLOW-UP: 6. 0 Process to discharge, transfer, and follow-up | |MET |PARTIALLY MET |NOT MET | |6. 1 Planning method starting from admission, in-patient care up to discharge/transfer/follow-up | | a.

Discharge from operation theatre including post-anaesthetic | | | | |recovery up to: | | | | |? in-patient surgical unit | | | | |? home | | | | |*tick the box that applies | | | | |6. 2 Provisions for support services (community-based services) and continuation of medical services after| | | | |discharge/ transfer: | | | | |? follow-up care post-surgery | | | | |? histopathology results | | | | |? needs further investigations (post-operative | | | | |complications) | | | | |? re-admission to hospital | | | | |*tick the box that applies | | | | |6. 3 Determination of patient’s readiness for discharge/ transfer/ follow-up includes: | | | | |

? tolerance of oral intake | | | | |?adequate pain control with oral analgesia | | | | |? ability to mobilize and self-care | | | | |? no evidence of complications and untreated medical | | | | |problems | | | | |*tick the box that applies | | | | |6. 4 Patient and family’s right to be informed well in advance for the provisions prior | | | | |discharge/transfer/follow-up | | | | |6. 5 Education of patient for discharge/transfer/follow-up : | | | | |? individual setting | | | | |? group setting | | | | |*tick the box that applies | | | | |6.

6 Clinical records and discharge summary include: | | | | |? list of discharge diagnoses | | | | |? invasive and non-invasive procedures performed during | | | | |admission | | | | |?summary of hospital course by problem | | | | |? discharge instructions | | | | |? discharge medication list (what is stopped, started, and | | | | |indications and ending dates) | | | | |? rehabilitation orders & follow-up appointments | | | | |? tests results still outstanding & alerts on problems needing | | | | |follow-up | | | | |? baseline cognitive status & physical function status at | | | | |transfer | | | | |? current advanced directives (code status, etc. ) | | | | |? include copies to Private Consulting Physicians, hospital | | | | |consultants & next venue care | | | | |*tick the box that applies | | | | |6. 7 Mandatory reports for specified diseases and events include:

| |MET |PARTIALLY |NOT | | | |MET |MET | |1. 1 Evaluation of patient at the point of first contact to match the patient to surgical care | | a. Identifying the scope of care and treatment delivered to …

The following services will not be provided by the Province, which are not covered by Hospital services Plan. 1. Services to such persons who are eligible under other provincial or federal legislations. 2. Mileage or travel subject to approval of …

CHIEF COMPLAINT: The patient presents to the emergency room this morning complaining of lower abdominal pain. HISTORY OF PRESENT ILLNESS: The patient states that she has been having vaginal bleeding, more like spotting, over the past month. She denies the …

CHIEF COMPLAINT: The patient presents to the emergency room this morning complaining of lower abdominal pain. HISTORY OF PRESENT ILLNESS: The patient states that she has been having vaginal bleeding, more like spotting, over the past month. She denies the …

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