One Stop Clinic Pathway 2024 PDF

ONE STOP CLINIC PATHWAY  ONE STOP CLINIC PATHWAY A one-stop clinic is a healthcare model that aims to provide patients with multiple services or consultations in a single visit, streamlining the care process and reducing the need for multiple appointments. ...

ONE STOP CLINIC PATHWAY  ONE STOP CLINIC PATHWAY A one-stop clinic is a healthcare model that aims to provide patients with multiple services or consultations in a single visit, streamlining the care process and reducing the need for multiple appointments.  Key features:  Multiple Services: One-stop clinics offer a range of services, which can include consultations with specialists, diagnostic tests, minor procedures, and even treatment initiation.  Single Visit: The goal is to complete all necessary assessments and interventions in one visit, saving patients time and reducing the need for multiple trips to the healthcare facility.  Efficient Care: One-stop clinics often have dedicated staff and resources to ensure smooth coordination and efficient delivery of care.  Benefits  Reduced Wait Times: Patients experience shorter wait times for consultations and procedures.  Improved Patient Experience: The convenience of accessing multiple services in one visit enhances patient satisfaction.  Increased Efficiency: Streamlined processes optimize resource utilization and improve overall healthcare efficiency.  Pathway Phases Timeline  Phase 1: Initial Consultation & Assessment (1-8 Days) (Primary Health care)  Phase 2: Hospital visit – pre surgery preparation (9-15 Days).  Phase 3: Surgery & Admission (Day of Surgery) (9 -36 Days)  Phase 4: Post discharge care (1-15 days post discharge)  Phase 5: Ongoing Follow-Up & Care (As Needed)  Training Structure:  Awareness & Regulations:  Awareness program regulations  Guidance and advice policy  Operational Processes:  Ambulatory same-day surgery policies and procedures  Education program regulations  One stop clinic coordinator job description  Lab work list regulations  Admission regulations  Ultrasound regulations  Forms  Clinical Decision-Making:  Patient journey tracking  Urgent red flags criteria  Post-Discharge  Decision tools (code)  Post-discharge service  One stop clinic criteria  post-discharge virtual home visit  Type of admission  Wound care  Partnership development and management  Patient Education & Communication:  Education tools (preoperative)  Education tools about admission process  Prescheduling phone call regulations  3-night pre-surgery call regulations  Discharge criteria Examples of Risk Factors and Optimization Strategies One Stop Clinic Eligibility Criteria  Responsible generally fit adult patient. (Age less than 2 or over 60 years old NOT included).  ASA Class I, II  BMI should be under 30  patient should be able to climb one flight of stairs if applicable  Medically free patient or with controlled comorbidities.  No recent history of MI or coronary artery disease.  Not on anticoagulation.  Has no history of bleeding disorder or hematological disorders (sickle cell anemia , spherocytosis thrombocytopenia)  Has no active respiratory problem. ( upper respiratory track infection, pneumonia , bronchitis , poorly controlled bronchial asthma , COPD )  Has no Deformity or anatomical problems in jaw or neck  Psychologically stable ( no psychosis or sever depression on psychologically not fit for consent) Gall Bladder Stones Pathway Dr. Faisal Al-Suqati  Risk factors  5F “Female, Fat, Forty, Fertile ,Fair ”  Hemolytic states(Sickle Cell, Hereditary Spherocytosis)  Rapid weight loss e.g. (gastric bypass pts)  Bile duct stasis (biliary stricture, congenital cysts,  Prolonged fasting (TPN )  pancreatitis, sclerosing cholangitis, Pregnancy, Oral contraceptives, Vagotomy  Obesity &Fatty diet  Parasitic infections (ascaris lumbricoides)  DM  Hyperlipidemia Clinical evaluation  Symptomatic cholelithiasis: The pain occurs due to a stone obstructing the cystic duct, causing wall tension; pain resolves when stone passes more than 6 hours fever (70~95%) nausea and vomiting (35~65%) Anorexia Bloating or “gassiness” If pain less than 6 hours and not associated with other symptoms like fever or jaundice this is a biliary cholic.  Physical examination: Pain vary with the severity right hypochondrial tenderness muscle guarding, rigidity, rebound tenderness tachycardia Murphy’s sign: ( pain or inspiratory arrest with deep, subcostal palpation on inspiration).  Investigation: Laboratory finding: ALT/AST: mildly raised alkaline phosphate: mildly elevated. bilirubin: variable, may rise to 85 mol/l. CBC( WBC) : elevated due to acute inflammation Cross matching, blood grouping  Radiological investigations:  ULTRASOUND (US): The most useful diagnostic tool in which will show the sign of acute cholecystitis vs simple GB stones and the biliary tree condition: Sign of acute cholecystitis : GB wall thickening more than 4mm. Sonographic murphy’s sign Presence of GB stones Pericholecystic fluid Other finding: Intra or extra- hepatic biliary radicle dilatation Color doppler scan can role out ischemic GB condition.  Red Flag that require ER referral Sever RUQ pain that not controlled with medication. RUQ pain with concomitant yellowish discoloration of skin or sclera. RUQ with fever or SIRS criteria Pt during evaluation was looking ill , dehydrated , cachectic Pt has RUQ pain with concomitant palpable mass. Pt has RUQ pain with progression to be generalized abdominal pain. Post laparoscopic cholecystectomy care and follow up:  Post op complications:  General complications : Atelectasis , PE , DVT , UTI  specific Complications: SSI , biliary injury , bleeding , retaind stone , post lap chole pain  Surgical site infection: redness , tenderness , hotness, and pus discharge. Need for referral to secondary hospital  Retained stone : pt still complaining of pain with elevated of Total and direct bilirubin and this pt need for referral to secondary hospital for ERCP  Post op care should include education of the patient to avoid fatty meal , avoid lifting heavy object and follow up. Stich's Removal There a 2 type of surgical suture to closure of wounds : Non-absorbable : this need to be removed after 14 days from operation. absorbable : this type of suture no need to remove just need for evaluation of the wound and roll out SSI. Hernia pathway Dr. Abdullah Al-Ali Objectives: Types Risk factors Diagnosis Complications Treatment Instructions after surgery Red flag  Definitions Hernia : Protrusion Of A Part Or Structure Through The Tissues Normally Containing It; From The Latin For “Rupture” Incarceration: Nonreducible Hernia Sac Contents That, In The Acute Setting, May Present With Obstructive Symptoms And Pain, Among Other Symptoms. Also, May Occur Chronically And Be Essentially Asymptomatic. Reducibility: Contents Of The Hernia Sac Can Be Returned To Their Normal Location. Strangulation: Incarcerated Hernia With Vascular Compromise Of The Sac Contents Leading To Gangrene And Perforation Of Hollow Viscus If Left Untreated. Types of abdominal wall hernia Inguinal Hernia Most common type of groin hernias, with prevalence of 5–10% > 60% are indirect hernias More in male patients and more on the right side due to Delayed closure of processus vaginalis and testicular, descent on the right Direct: weakness in TF (Hesselbach triangle). Indirect: patent processus vaginalis. Femoral Hernia: More common in females (but inguinal hernia still the most common in both sexes) Highest risk of strangulation (20-40%) → repair once discovered, 10% of female patients and 50% of male patients with femoral hernia will develop or have inguinal hernia De Garengeot hernia: appendix within femoral hernia Caused by weakness in the femoral ring More on the right side (similar to inguinal hernia), probably due to the blocking effect of sigmoid colon on the left femoral canal  Ventral hernia Defined as any hernia between the xiphoid and umbilicus More in male, multiple in one-third (check for other defects during surgery) and > two-thirds are off midline They almost always contain preperitoneal fat or omentum (causing severe pain despite its tiny size) Umbilical hernia hernia through the umbilical defect In adults → acquired (obesity, pregnancy, ascites, smoking, laparoscopic port site) and more in females In children → congenital  Incisional hernia Occurs in up to 20% of patients following emergent abdominal surgery, only 2% for elective clean surgery (It can reach 50% post AAA repair) Develops within 2 years postoperatively Risk factors familial smoking Obesity decrease in collagen type I and chronic increase in intra-abdominal pressure Complications incarceration: content can't be reduced strangulation: blood supply compromised to its contents Bowel ischemia then gangrene Bowel perforation  Diagnosis History: History of a palpable, soft mass that increases with Valsalva maneuver. This is often a painless mass (in the absence of incarceration or strangulation); a primary complaint of pain should prompt investigation into other sources  Physical examination: a palpable mass that increases in size while the patient performs the Valsalva maneuver. The classic “turn and cough” It is critical to examine all patients upright (preferably standing) and supine. In male individuals, a digital inspection should be performed via the scrotum to palpate the external inguinal ring. The finger should parallel the spermatic cord in the scrotum to follow it up to its exit point at the external ring.  Examination should focus on location of hernia relative to inguinal ligament. Hernias below inguinal ligament may be consistent with a femoral hernia. Femoral hernias may reflect above inguinal ligament as well, making it difficult to distinguish between an inguinal and a femoral hernia. Obesity may make it difficult to appreciate small hernias. Strangulated hernia Abdominal pain Vomiting Diarrhea Constipation On PE: Dehydrated ,vitally unstable ,fever ,tense tenderness over the hernia Leukocytosis Imaging : X-ray chest and abdomen erect and supin. U/S CT abdomen MRI abdomen &pelvis Treatment: Open or laparoscopic surgical hernia repair Postoperative complications Recurrent hernia 1% with mesh to 1.5% with tissue-based repairs Infection. Bleeding : may occur in the preperitoneal space and track retroperitoneally as well as into the scrotum. a significant amount of bleeding may occur before recognition, and a high index of suspicion must be maintained after surgery in any patient with tachycardia, hypotension, or orthostasis. Dysejaculation : Pain With Ejaculation Testicular Atrophy. Difficulty Voiding : A Thorough History Before Surgery Should Focus On Symptoms Of Prostatism, And If The Hernia Is Stable, Adequate Treatment Should Be Sought Before Hernia Repair. Post Operative Instructions Avoiding lifting heavy objects Treating the underlying causes: Cough Constipation Prostate diseases Stop smoking. Red flag Incarcerated hernia Strangulated hernia Femoral hernia Thank You