Integrated preoperative care pathway - a study of a regional electronic implementation

Bouamrane, M.-M. and Mair, F. (2014) Integrated preoperative care pathway - a study of a regional electronic implementation. BMC Medical Informatics and Decision Making, 14, p. 93. (doi: 10.1186/1472-6947-14-93)

Abstract

<b>Background</b> Effective surgical pre-assessment will depend upon the collection of relevant medical information, good data management and communication between the members of the preoperative multi-disciplinary team. NHS Greater Glasgow and Clyde has implemented an electronic preoperative integrated care pathway (eForm) allowing all hospitals to access a comprehensive patient medical history via a clinical portal on the health-board intranet.<p></p> <b>Methods</b> We conducted six face-to-face semi-structured interviews and participated in one focus group and two workshops with key stakeholders involved in the Planned Care Improvement (PCIP) and Electronic Patient Record programmes. We used qualitative methods and Normalisation Process Theory in order to identify the key factors which led to the successful deployment of the preoperative eForm in the health-board.<p></p> <b>Results</b> In January 2013, more than 90,000 patient preoperative assessments had been completed via the electronic portal. Two complementary strategic efforts were instrumental in the successful deployment of the preoperative eForm. At the local health-board level: the PCIP led to the rationalisation of surgical pre-assessment clinics and the standardisation of preoperative processes. At the national level: the eHealth programme selected portal technology as an iterative strategic technology solution towards a virtual electronic patient record. Our study has highlighted clear synergies between these two standardisation efforts.<p></p> <b>Conclusion</b> The adoption of the eForm into routine preoperative work practices can be attributed to: (i) a policy context - including performance targets - promoting the rationalisation of surgical pre-assessment pathways, (ii) financial and organisational resources to support service redesign and the use of information technology for operationalising the standardisation of preoperative processes, (iii) a sustained engagement with stakeholders throughout the iterative phases of the preoperative clinics redesign, guidelines standardisation and the eForm development, (iv) the use of a pragmatic and domain-agnostic technology solution and finally: (v) a consensual and contextualised.<p></p>

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Bouamrane, Dr Matt-Mouley and Mair, Professor Frances
• Authors: Bouamrane, M.-M., and Mair, F.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: BMC Medical Informatics and Decision Making
• Publisher: BioMed Central
• ISSN: 1472-6947
• ISSN (Online): 1472-6947
• Copyright Holders: Copyright © 2014 The Authors
• First Published: First published in BMC Medical Informatics and Decision Making 14:93
• Publisher Policy: Reproduced under a Creative Commons License