SECTION 2
Client Care and Service
Community Focused
Continuing Care
Emergency/Trauma
Maternal, Child & Youth
Medical Care
Mental Health
Palliative Care
Specialized Intensive Care
Surgical Care

SECTION 3
Support Services
Information Management
Human Resources
Physical Environment

SECTION 4
Leadership/Partnership
Strategic Directions
Implementing Strategic Directions

Surgical Care

There is good team representation across the continuum of care and involvement of physicians from both surgery and anesthesia is a key strength. Note is made of the intent to pursue quality improvement initiatives through the surgical program coordinating team. A regional bed utilization team facilitates client flow along the continuum of care. A home intravenous therapy program has been successfully implemented. Work is under way to establish a dressing change clinic in the community setting.

Service provision is based on needs assessments, studies and population trends. Surgical wait list tracking is done with priority for surgical time given to services which have very long waiting lists. Surgical service profiles are adjusted according to surgeon’s specialty and as long as there is a demonstrated population need, adequate resources and trained staff. The current referral process is physician to physician referral and given the increasing pressures on bed availability, more formal referral networks should be pursued.

Time lines otherwise known as care maps are in place to ensure consistency and for most surgical diagnoses these are frequently reviewed for currency. The discharge planning team co-ordinates client care needs at time of admission, and home care is often booked in advance of surgical procedure. The realignment of surgical blocks to support procedures that are now done on a day surgery basis is a work in progress. There is ongoing monitoring of surgical schedules and flexibility in operating room time to accommodate urgent and emergency surgeries.

A pre-admission clinic is in place to provide comprehensive client orientation and education and the aesthetic consult. Additional teaching is provided through the day surgery program or on the surgical unit. Printed materials include pre-operative instructions, time lines, pain management and discharge instructions. Overall, the education provided is excellent and every effort is made to fully explain procedures and interventions. The comprehensive consent policy and process includes all invasive. procedures and blood transfusion. The surgeon obtains the consent which is updated as required.

There is a discharge planning resource guide for physicians. The discharge planning team assists with preparing the client for discharge. Enterostomal therapists are available to support and educate clients and their families and this is offered pre-operatively and post operatively. Social work support is also available.

There is good use of indicators and these include targets in relation to the quality improvement plan. There is ongoing follow up to ensure that recommendations from coroner inquests are addressed, for example, to increase use of pain scale assessment to monitor sedation levels.

Recognition is given for the new mentoring program that supports recently hired nursing staff. Although there is none at this time, there is evidence to suggest that all staff understand the need to identify and report risks. It is suggested that the team explore posting of operative educational materials on the web site. The team should continue to identify opportunities to shift day of admission procedures to day surgery to assist in reduction of in-patient days and occupancy rates. This will also position the organization to further increase the number of operating rooms without resorting to canceling elective surgeries.