Improving patient flow and satisfaction: an evidence-based pre-admission clinic and transfer of care pathway for elective surgery patients

Aims: To redesign, implement and evaluate a Pre-Admission Clinic incorporated with a Transfer of Care Pathway for elective surgery patients. Methods: An evidence-based approach was used to redesign the Pre-Admission Clinic and the Transfer of Care Pathway. The impact of the pre-admission clinic and the care pathway was evaluated. De-identified data containing patient outcomes was collected from the hospital electronic medical record system from May 2014 to March 2015. Outcome measures included surgical cancellations, last-minute cancellations, average length of stay, discharge delays, and adverse events that were compared pre and post-implementation. Patient satisfaction was measured pre and post-implementation by using a modified version of Best Practice hospital survey. Results: A total of 10,854 eligible cases were included (5716 in the pre-implementation period and 5138 in the post-implementation period). The overall cancellation rate remained relatively stable (p = 0.95), however, the last-minute cancellation rate was reduced post-implementation (p = 0.02). Although no difference was observed in average length of stay (p = 0.39), the percentage of discharge delays was reduced (p = 0.027). The incidence of adverse events was too low to draw statistical conclusion. A sample of 102 patients completed the patient satisfaction survey. The overall satisfaction improved post-implementation (p = 0.03). Conclusions: The evidence-based Pre-Admission Clinic and the Transfer of Care Pathway had a positive impact on last-minute surgical cancellations, discharge delays and patient satisfaction.