AHP SO05 - First year experience of running a specialist pre-op clinic for patients undergoing a Whipple procedure that focuses on patient education and improving theatre utilisation

Background

The Whipple’s pre-operative clinic was organised to ensure patients were fully aware of the impact of this operation. Additionally, it was implemented to reduce the risk of preventable theatre cancellations and unfilled operating theatre slots arising given the challenges currently faced in the current NHS climate.

The primary aim of the clinic is to improve education to ensure the patients are aware of what the procedure and aftercare entails. A secondary aim is to identify correctable issues in the pre-operative period which could prevent surgery from proceeding safely.

Method

The clinic ran over 12 months in the tertiary HPB centre at University Hospital Southampton. The clinic has two elements: a 30min video appointment with a specialist nurse for each individual patient to provide comprehensive information regarding the procedure This was followed by a checklist to ensure there was appropriate up-to-date imaging available, as well as a review of the latest blood tests and current medications.

Results

There were a total of 105 patients reviewed in the clinic. Due to this new service, 21 (20%) essential interventions were made. These included requesting or reviewing new imaging (n=14) correcting anticoagulation plans (n=2) and admitting patients for optimisation prior to surgery (n=2).

A total nine all day theatre lists were saved as a direct result of this clinic. Costing of each theatre is estimated at £12,000. Five (5%) patients had their surgeries cancelled in advance and all theatre slots were subsequently re-allocated. Four (4%) patients had interventions which directly prevented an on the day cancellation.

Conclusion

These results show that there are significant benefits from running a specialised pre-operative Whipple’s clinic. Multiple interventions have led to improving patient safety, optimising theatre utilisation and improving patient experience.