Elective admission ward

There is not much scientific literature available about the elective admission ward. The literature that is used for this section comes from a patient leaflet about the Preoperative Care Unit (POCU) and the feasibility study that was performed at Rijnstate, produced to see if it would be feasible to develop this ward. The elective admission ward (EAW) is a new ward that is being developed at Rijnstate Hospital Arnhem. The EAW is located within the operating room ward and is based on a few concepts. The EAW is a ward where only patients older than 19 years

will be admitted, there is no distinction between the different specialties and all patients that are not already inpatient will go through the EAW before going to surgery. The EAW has the underlying idea that the ward starts empty in the morning and will be empty during the night. The day the patient is admitted and discharged at this ward is equal to the date of the operation. The emergency patients will not be seen at the EAW, with the exception Emergency 3, the other emergency patients will go straight from the holding to the operating room. The EAW can be compared to the day treatment ward in the way that day treatment patients that have been operated come back to the EAW and will go home from there, they will not go to an inpatient ward. Inpatients, on the other hand, will be admitted before the operation on the EAW and go to the inpatient wards of the hospital after their operation. The flow of the patients can be found in Figure 8. The EAW originates from the fuse of the holding and the surgery part of the day treatment ward. Certain activities that were normally performed in the holding will be performed at the EAW, which can decrease costs and patient flow times since the holding is a very cost-intensive ward11,20_.

There are certain advantages of this ward found in the feasibility study. The first advantage is that the patient barely has to travel through the hospital before the operation since the ward is directly next to the operating theatre; this can lead to a reduction in elevator movements. The patient can be completely prepared at the EAW, which can lead to a more calm preparation before the operation, since the accompanying person can stay with the patient until right before the operation11,20_{. This can reduce stress for the patient. The patient will be able to arrive in} a shorter timeframe before the operation (one hour before the operation starts) and will have shorter waiting times and more information about the progress of the operating programme. The nurse can perform the preoperative screening at the EAW and one ward is responsible for the entire preoperative process. In turn, this decreases possible accidents that can happen because of miscommunication since there is no communication necessary between the wards before the operation.

Due to the integration of the day treatment ward and the holding, this can lead to increased efficiency in the number of beds. There are separate pre-operative rooms in which most processes that would normally be executed in the holding are performed. The patient will get their infusion at the EAW instead of the holding and the patients that need any type of anaesthesia except full anaesthesia will go to these pre-operative rooms. The EAW will increase the efficiency of the operating room planning since it is easier to estimate when the patient has to arrive at the operating room and there is no unnecessary delay since there is no elevator movement necessary. It is already known which patients are and are not present and there is no waiting time at the start of the day. Another advantage is that the doctors can quickly check up on the patients since they are adjacent to the operating rooms. The disadvantage that is found in the feasibility study is that the patient may find it unpleasant to be transfered to another ward after the operation, since only the day-care patients will return to the EAW. The inpatients will go to the inpatient wards to recover11_.

There are also some advantages of the EAW for the other wards. The nurses of the inpatient wards can spend all their attention in the morning on the patients that already had surgery. There is no interruption from patients who need to be admitted for their surgeries, which means that there are no hasty preparations in order to get the patient ready in time. This can decrease the stress for both the nurses and the patients and give the nursing staff more time to care for the patients in their ward. In addition to this, the beds at the inpatient ward do not have to be empty at 7:30 hours since the patients are now admitted at the EAW there is no rush to empty the beds at the inpatient ward before 10:00 hours11,20. The schematic overview of the patient flow is described in Figure 9.