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"I found the telephone pre-op assessment frustrating"

About: Royal Cornwall Hospital (Treliske) / Oral and Maxillofacial Royal Cornwall Hospital (Treliske) / Pre-Operative Assessment

(as the patient),

I had my wisdom tooth removed today.  I gave my positive feedback via the online system they provided shortly after my surgery.  However, it would not accept my constructive feedback and I would like to give a more holistic summary.

I found the telephone pre-op assessment frustrating.  I was originally issued with an appointment time for my pre-op assessment which I could not make.  I phoned to advise of this and a new appointment time was arranged.  However I received a letter providing a different time again, but that time was convenient to me.  Nevertheless the day of the telephone appointment, I received two calls, four hours before the appointment and one hour after - none of which I could answer cause I was working.  I phoned back the following day to reschedule and a new appointment time was made.  On the day of the revised appointment I was phoned an hour earlier than scheduled, but luckily it as during my lunch break so I was available.

The telephone assessment felt unnecessarily inefficient.  The individual repeatedly asked me to repeat myself (not my usual experience of being on the phone) and she eventually stated she was experiencing hearing problems on the day, which, while I empathise, led me to wonder why she was making telephone assessments on a day that she couldn't hear. 

I found many of the questions unnecessarily intrusive when I was undergoing a simple dental procedure, such as asking after my psychiatric history.  When asked, she provided a reasonable justification as to why a particular answer might be relevant, i.e. if you suffer with anxiety, it might be helpful for us to be aware of, but surely if that is the information that's required, I believe it would be better to ask more closed relevant questions related to presentations the clinicians might want to look out for.  Indeed, the level of unnecessary intrusion was confirmed for me when I attended my appointment and no questions, other than, how are you feeling about your procedure? were mentioned about my psychiatric history.

Most frustrating however was the difficulty I experienced in trying to determine what time I should be potentially collected.  This conversation went round in many many circles.  While I can appreciate it is impossible to know for certain, it took an unreasonable amount of time just to get an idea of the best and worst case scenario.  As someone who ordinarily lives by themselves and having to organise other people to come and collect me, this made my life particularly difficult.  Especially because when I attended for my procedure, I was instantly informed the time I could expect to be collected, which was two 1/2 hours earlier than the estimate of the best case scenario provided by the pre-op assessment; this led me to wait in the discharge lounge for those two 1/2 hours while I waited for my responsible adult to collect me.  Furthermore, the question I had, regarding the times I could eat were not answered.  While I'd received paperwork to provide guidance, the time of my appointment was not covered in the literature, and when I asked the the pre-op assessor, she could not answer, and therefore I ultimately made an educated guess airing on the side of caution (which was ultimately fine).

As previously stated, my positive experience is detailed via the platform I was asked to give feedback this afternoon.  In summary, my experience of my surgery was exceptionally good and the staff were really warm, supportive, patient, responsive, knowledgeable and able to answer all of my questions.  However my sense is that the pre-op assessment is not as well managed, and conducted by people who are seemingly not educated in the specific field of medicine they may be asked to assess people for, and I feel, at least in my situation, that led to poor/no relevant advice that would have been very helpful to me.

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Responses

Response from Claire Richards, Lead Nurse, Pre Op Assessment, Royal Cornwall Hospitals NHS Trust nearly 2 years ago
Claire Richards
Lead Nurse, Pre Op Assessment,
Royal Cornwall Hospitals NHS Trust
Submitted on 01/06/2022 at 15:52
Published on Care Opinion at 15:52


Dear michell982@aol.com,

Thank you for taking the time to share your story with us.

I am not sure whether your anaesthetic pre assessment was done in my Central Pre-Assessment department or by the as they do some of their own assessments that Central Pre-Assessment are not involved in.

We do our best to accommodate patient wishes about timings of appointments. I will check with our Bookers that our clinic letter appointments are set up to match appointment times, as I can't explain why you would be told one time and be given a letter for a different time. Please accept my apologies for being called at a time other than you were expecting. I hope that the nurse checked with you that it was convenient for you, and you weren't made to feel obliged to proceed at that time.

I am not aware that any of my nurses have hearing difficulties that affect them on the telephone, but I will raise your comments with the whole team and address what we find.

The purpose of the pre assessment is to both help you and the clinical teams to prepare for an anaesthetic. By establishing whether someone has any mental health needs before they come into hospital takes away the need to check again on the day of surgery. We intentionally ask this question generically as we must respect that some people do not like the intrusion whereas others are very keen to share details in the knowledge it will make their admission easier. If people share details, we can ask further questions to provide appropriate care for them on admission. I am sorry that you felt we were intrusive.

Your comments don't say the length of time Pre-Assessment advised you would have to wait post op before being discharged. This would vary according to if you had your procedure in the Oral Surgery Day Unit or Newlyn theatre and what type of anaesthetic you had or whether you had local anaesthetic and sedation, and whether you knew your place of admission at the time of the telephone assessment as well as many other factors including where you were placed on the operating list, staffing on the day of surgery and how you recover. Essentially what I am trying to explain is that at the time of assessment it can be difficult to predict this and please accept our apologies for getting it wrong for you.

Regarding eating after dental extraction, we would encourage patients to speak to the Oral Surgery team at the time of admission. The anaesthetic assessment nurse maybe should have directed you to the Oral Surgery team for specific advice about eating and I will ask that they do so in future.

Pre-Assessment nurses are educated in preparing people for an anaesthetic rather than the fine detail of individual surgeries and individual surgeons. I always encourage pre assessment nurses to direct patients to the relevant surgical team for specific questions which I will reiterate to the team following your feedback.

Thank you for your feedback I hope I have been the correct team to answer your queries and some of the rationale for our action makes sense.

Claire Richards

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Response from Holly Kiernan, Patient Experience Manager, Patient & Family Experience Team, Royal Cornwall Hospitals NHS Trust nearly 2 years ago
Holly Kiernan
Patient Experience Manager, Patient & Family Experience Team,
Royal Cornwall Hospitals NHS Trust
Submitted on 17/06/2022 at 10:33
Published on Care Opinion at 10:33


Thank you for taking the time to give us your opinion as we truly appreciate your feedback. We would love to contact you in future to help us inform decisions about our services and the way we work. This could range from small queries to larger projects so that you can be involved as much or as little as you like.

If this is something you would be interested in please contact the Patient Engagement Team at Royal Cornwall Hospitals NHS Trust on rcht.patientengagement@nhs.net or telephone 01872 252793, so that we can record your details.

Thank you again for taking the time to tell us about your experience.

Best wishes,

Holly

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