Remote Preoperative Assessment at Golden Jubilee National Hospital Essay

REMOTE PREOPERATIVE ASSESSMENT AT GOLDEN JUBILEE NATIONAL HOSPITALA TECHNOLOGICAL PILOT & A ; PRELIMINARY FEASIBILITY STUDYTable OFContentss1.0Introduction – Research Context1.1 Pre-Operative Appraisal1.2 The Golden Jubilee National Hospital2.

0 Problem Description2.1 Related Work2.2 Research Questions2.3 Aims2.

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4 Deliverables2.5 Learning Outcome3.0Research Method3.1 System Architecture3.2 System Development4.0Plan4.

1Time Scale – Gantt chart4.2 Hazard Analysis and Contingency PlanMentionsAppendix

1.0Introduction – Research Context

1.1 Pre-Operative Appraisal

Preoperative Assessment ( POA ) is a field of Perioperative Medicine ( i.e. what happens earlier, during and after surgery ) which focuses on the period that precedes surgery and aims to optimise a patient’s fittingness for surgery. It is composed of the set of clinical probes ( medical history pickings, testing and proving ) which precedes surgery and is the duty of the anesthesiologist ( Garcia-Miguel et al. , 2003 )The field is complex and is characterized by a deficiency of grounds ( Solca, 2006 ) and a deficiency of standard appraisal procedures ( Bouamrane and Mair, 2014a, Bouamrane and Mair, 2014b )POA involves a figure of distinct clinical stairss, including: patient medical history pickings, surgical and anesthesia appraisal and hazard marking, preoperative testing, readying of the patients for surgery and obtaining informed consent.

Several surveies have suggested that preoperative procedures have been developed in an ad-hoc mode harmonizing to local precedences and patterns which makes construing the consequences of the appraisal more challenging ( ( Zuidema et al. , 2011 ) , Bouamrane & A ; Mair, 2014a, Bouamrane & A ; Mair, 2014b )Besides, deficient information sharing and unequal communicating systems can impede good attention coordination and can besides present unneeded hazards for the patients ( Bouamrane and Mair )Several surveies have argued that electronic information systems can here play a cardinal function in easing information sharing across the multi-disciplinary attention squads and better attention coordination ( ( Bouamrane & A ; Mair, 2014a ) , ( Bouamrane & A ; Mair, 2014b ) )In a study for the medical Institute of Medicine, Menachemi et Als have suggested that electronic information systems could supply of import support in the quality of attention by cut downing mistakes through computerized algorithms, automatic qui vives and reminders, clinical determination supports and fiscal inducements ( Menachemi et al. , 2008 ) .( Edsall et al. , 1993 ) suggested that that Anaesthesia Information Management Systems ( AIMS ) played a cardinal function in easing record maintaining while ( Gibby, 2002 ) suggested that effectual pre-operative appraisal plans could play an of import function in reduction health care costs. The ( Institute of Medicine.

Committee on Quality of Health Care in, 2001 ) besides suggested that information engineering applications in health care had an of import function to play in attention quality and patients outcomes betterment.( Binhas et al. , 2008 ) , ( Coulter and Ellins, 2007 ) and ( Gibby et al. , 1997 ) suggested that overall, perioperative medical specialty ( anesthesia, surgery, nursing, rehabilitation and general pattern ) can be supported and enhanced by computerized appraisals systems. Such system can assist for illustration testing healthy patients from those who need extra attention support and resources.


2 The Golden Jubilee National Hospital

Golden Jubilee National Hospital ( GJNH ) is a province of the art national referral centre in NHS Scotland and carries out major surgical operations ( general, cardiac, orthopaedic and thoracic ) with a committedness to cut down the waiting national clip of patients across the NHS in Scotland and at the same clip presenting high quality attention.The infirmary has 15 operating theaters and treated over 23,000 patients in 2013. Patients who undergo surgery are frequently aged patients with chronic composite and chronic morbidity. They require careful pre-operative appraisal, attention planning and post-discharge monitoring after surgery.As patients are been referred to GJNH from all across Scotland for intervention, a figure challenges for patients and clinicians arises.These include:- Patients needed to go down to GJNH for appraisal from all across Scotland ( including every bit far as from the Hebrides or the Shetland Islands ) . This may necessitate them to remain in hotel overnight. The traveling disbursals are presently been incurred by the mentioning NHS wellness board which consequence in 1000000s of lbs in cost yearly.

– Following patients discharge after surgery, patients may hold to return to GJNH for unneeded medical examinations while others may develop complications unknown to the treating squad.

2. 0 Problem Description

This undertaking will concentrate on developing a engineering demonstrator for distant preoperative appraisal utilizing a web based app developed that is compatible and antiphonal on any web browser, a standard smart-phone or tablet. Furthermore, I will carry on a preliminary feasibleness to measure how such distant pre-operative appraisal engineering could be integrated into everyday attention at GJNH.The undertaking will include two chief constituents:

  1. the package development constituent which describes the demands specification and development tools used to implement a distant web-based pre-operative appraisal system that allow patients to pre-assess themselves and acquiring the consequence of their appraisal before surgery without the demand of coming down to the infirmary,
  2. Performing a preliminary feasibleness survey to measure how the engineering could be deployed into everyday attention at the infirmary.

To decide these issues, this undertaking aim to develop a Web Based App paradigm to back up basic pre-operative showing. This will affect replying a simple pre-operative questionnaire remotely. The showing should be able to separate which patients need to come to hospital for a complete preoperative appraisal from those who can finish the appraisal remotely. The clinical questionnaire will be developed with the anesthesia section of the GJNH.

2.1 Related Work

An illustration of one of the common patient hazard appraisal tool is the ASA physical position elucidation mark ( Zuidema et al. , 2011 ) . Used worldwide as a comprehensive and a practical tool to sort the preoperative province of patients in clinics.

Another illustration of a tool used for pre-operative appraisal of a patient expecting surgery is the ePAQ-PO ( electronic Personal Assessment Questionnaire – Pre Op ) ( Andrzejowski, 2013 ) . A distant synergistic web-based tool, which provides a comprehensive appraisal of patient medical records and anaesthesia history. Developed in Sheffield University, United Kingdom. It allows patients to transport out their pre-operative appraisal by make fulling out an online questionnaire. With the pilot trial tally of ePAQ-PO at Sheffield Teaching Hospital NHS Trust, it has shown possible in quality and betterment in efficiency, which includes the decrease in some unneeded pre-operative appraisal like vesture showing, full blood counts, urea and electrolytes trial which shows 72 % , 25 % and 35 % decrease severally, which may be avoided and with nest eggs estimation of 120,000 lbs, which is based on an one-year caseload of 30, 000 patients.


2 Research Questions

  1. What practical attacks can be used for distant pre-operative appraisals and its application
  2. What functional demand are needed to show distant pre-operative appraisals in an app based system.
  3. How can this demands be developed to supply a proficient solution that will let patients to be able to reply pre-operative appraisals questionnaire remotely.

2.3 Aims

  1. Understanding the practical attacks that can be used for pre-operative appraisals and how this approaches can be applied integrated with the context of distant pre-operative appraisals.
  2. Implementing these practical attacks into a smartphone app-based distant pre-operative appraisal system, their strengths, and failings and measuring their public presentation in order to find the most suited attack.


4 Deliverables

  1. The Dissertation study.
  2. A functional web-based application, pre-assessing the wellness position and hazard of patients expecting surgical operation.

2.5 Learning Outcome

  1. Learning a new scheduling linguistic communication.
  2. Ability to be able to efficaciously use appropriate research method and been able to implement them in undertakings.

  3. Ability to supply statement and be able to support any ain findings.
  4. Ability to be able to measure published information and statement in order to bring forth structural appraisals of any chosen subject.
  5. Ability to be able to do determinations in an independent and professional mode and be able to support the determinations.

3.0Research Method

To accomplish the demand of this undertaking, a method needs to be outlined in order to do the undertaking successful. This method gives structural and organisation to the undertaking. The iterative and incremental package development theoretical account is the methodological analysis that will be used for the development of the distant Pre-Operative system.

As it allows assorted parts of the system to be developed in increases at different times, and can be integrated into the system when completed to do the system stable, robust and stable ( Cockburn, 2008 ) . With iterative development, the package is been developed through several loops incrementally, which makes it possible to do any necessary betterments to the system based on its deliverables ( Cockburn, 2008 ) .Iterative and incremental package development theoretical account is been selected over the waterfall theoretical account because: –

  1. The interleaving of the system demands, specification, design, proving and programming. Which when compared to the waterfall theoretical account, which each phase has to be executed before traveling to the following phase.
  2. Its flexibleness to integrate alterations into the package demand and specification, functionality during it development rhythm. Unlike waterfall theoretical account, where the functional demands are improbable to alter wholly during the system development.

  3. Ability to decide issues that are identified in each increase in the following loop.
  4. Testing and polish is a uninterrupted procedure and easier at the terminal of each loop
  5. Support the refactoring of codifications.

3.1 System Architecture

Been a web based application, that involves users interaction through graphical user interface and a client waiter, the Model View Controller was chosen as the system architecture because of It division of package application into three interrelated parts ( Model, View and the Controller ) in order to divide the internal representation of information that are presented to the user or information coming from the user.

  1. Model: – it represents the regulations and informations like the database ( MySQL ) , which allow entree for the retrieving and storing of information, which is so passes the information to the accountant which so passes it to the position bed.
  2. Position: – it’s the representation and rendition of the theoretical account position contents.

    Stipulating how informations from the theoretical account bed is been presented. It besides allows the use of informations and entry and interaction from the user.

  3. Accountant: -It makes the interlingual rendition of the user interaction with the position bed and change over them into actions that the theoretical account bed will execute.

3.2 System Development

In the system development, the following engineerings will be used: –

  1. Hypertext Markup Language 5 ( HTML 5 ): -Used to specify how the construction of the web pages would look like. Chosen because of its new grade and it support for intelligent web signifiers.
  2. Cascading Style Sheet 3 ( CCS 3 ): – The manner sheet linguistic communication that would be used for the designing and presentation of the web pages.

    It titling effects, which enhances the handiness of web pages contents is why it was chosen.

  3. JQuery: – A JavaScript library, that allows the interaction of client-server books with the user, commanding of the browser, pass oning and the neutering of web pages contents. Easier to pull strings Document Object Model ( DOM ) elements, the creative activity of lifes and managing events because of it syntax.
  4. Hypertext Preprocessor ( PHP ): – Used as the server side scripting linguistic communication, in order to bring forth dynamic and synergistic web pages.
  5. MySQL: -Used for the storing of user information and inside informations. Chosen because of: –
    • The disposal of the database is handled by phpMyAdmin
    • It ‘s easier to configure and pull off
    • It inclusion of different types of storage engines, where the most suited engine can be chosen when making the database tabular arraies.


Undertaking Attempt
Gathering of Requirements 1 hebdomad, 6 yearss
Database Design 6 yearss
Website 6 yearss
GUI Hosting 2 yearss
Question System 3 hebdomads
User Evaluation 1 hebdomad, 2 yearss
Write Ups 4 hebdomads, 1 twenty-four hours
Dissertation Due 1 twenty-four hours

4.1Time Scale – Gantt chart

Please refer to appendix for appendix


2 Hazard Analysis and Contingency Plan

  1. Hardware Failure

There will be one personal laptop used to execute development, proving and rating in analogue. Should it neglect or crash or etc. , the stages mentioned above can still be completed, nevertheless more clip will be required for each stage.Badness: HighLikelihood: LowExtenuation: Should the laptop fail, development will go on as the beginning file for the web app will be uploaded on-line sporadically in-case of failure, the university computing machine lab will be used to go on the development and transcript of the beginning file will be downloaded on it and if by any opportunity the package used on the failed personal computing machine is non installed on the university computing machine, attempt will be made to state the IT section to put in it, and if they are unable to, surrogate package will be used.


Andrzejowski, D.J. ( 2013 ) ‘Sheffield Clinical Research Facility Newsletter: ePAQ-POthe hereafter of pre-operative appraisal? ‘.Binhas, M. , Roudot-Thoraval, F.

, Thominet, D. , Maison, P. & A ; Marty, J. ( 2008 ) ‘Impact of written information depicting postoperative hurting direction on patient understanding with proposed intervention ‘ .European diary of anaesthesiology,25 ( 11 ) , pp.884-890.

Bouamrane, M.-M. & A ; Mair, F. ( Year ) Published. ‘A survey of information direction in the patient surgical tract in NHSScotland ‘ . 2013.

pp.557-561.Bouamrane, M.-M. & A ; Mair, F.

S. ( 2014a ) ‘A survey of clinical and information direction processes in the surgical pre-assessment clinic-The Experience of the Dumfries & A ; Galloway Royal Infirmary Preoperative Clinic ‘ .BMC medical information sciences and determination devising,14 ( 1 ) , pp.22.Bouamrane, M.-M. & A ; Mair, F.S.

( 2014b ) ‘Implementation of an integrated preoperative attention tract and regional electronic clinical portal for preoperative appraisal ‘ .BMC Medical Informatics and Decision Making,14 ( 1 ) , pp.1-19.Cockburn, D.A.

( 2008 ) ‘Using Both Incremental and Iterative Development ‘ .Coulter, A. & A ; Ellins, J. ( 2007 ) ‘Effectiveness of schemes for ratting, educating, and affecting patients ‘ .

BMJ: British Medical Journal,335 ( 7609 ) , pp.24.Edsall, D.W. , Deshane, P. , Giles, C. , Dick, D.

, Sloan, B. & A ; Farrow, J. ( 1993 ) ‘Computerized patient anaesthesia records: less clip and better quality than manually produced anaesthesia records ‘ .Journal of clinical anaesthesia,5 ( 4 ) , pp.275-283.Garcia-Miguel, F.

J. , Serrano-Aguilar, P.G. & A ; Lopez-Bastida, J.

( 2003 ) ‘Preoperative appraisal ‘ .The Lancet,362 ( 9397 ) , pp.1749-1757.Gibby, G.L.

( 2002 ) ‘How preoperative appraisal plans can be justified financially to hospital decision makers ‘ .International anesthesiology clinics,40 ( 2 ) , pp.17-30.

Gibby, G.L. , Paulus, D.A. , Sirota, D.J.

, Treloar, R.W. , Jackson, K.I. , Gravenstein, J.S. & A ; van der Aa, J.

J. ( 1997 ) ‘Computerized pre-anesthetic rating consequences in extra absent comorbidity diagnosings ‘ .Journal of clinical monitoring,13 ( 1 ) , pp.35-41.Institute of Medicine. Committee on Quality of Health Care in, A. ( 2001 )Traversing the quality chasm: A new wellness system for the twenty-first century.

National Academy Press.Menachemi, N. , Chukmaitov, A. , Saunders, C. & A ; Brooks, R.G. ( 2008 ) ‘Hospital quality of attention: does information engineering affair? The relationship between information engineering acceptance and quality of attention ‘ .

Health attention direction reappraisal,33 ( 1 ) , pp.51-59.Solca, M.

( 2006 ) ‘Evidence-based preoperative rating ‘ .Best Practice & A ; Research Clinical Anaesthesiology,20 ( 2 ) , pp.231-236.Zuidema, X. , Meesters, R.C.T.

, Siccama, I. & A ; Houweling, P.L. ( 2011 ) ‘Computerized theoretical account for preoperative hazard appraisal ‘ .British diary of anesthesia,107 ( 2 ) , pp.180-185.



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