Surgery for morbid obesity: Framework for bariatric surgery in Victoria’s public hospitals 2009
self-assessment tool
Background
Surgery for morbid obesity: Framework for bariatric surgery in Victoria’s public hospitals outlines a best practice approach to the provision of bariatric surgery to morbidly obese patients and is intended to guide the delivery of bariatric surgery at public hospitals. The framework is based on evidence from peer reviewed literature, a review commissioned by the Victorian Policy Advisory Committee on Clinical Practice and Technology (VPACT) and the expert opinion of the Bariatric Surgery Working Group.
The Bariatric Surgery Working Group identified the key issues in the provision of safe and effective bariatric surgery services for the treatment of people with morbid obesity. These key issues are addressed in Part B: Framework for bariatric surgery programs of the framework document to guide policy and protocol development at health services.
Framework for bariatric surgery self-assessment tool
This self-assessment tool is intended to assist health services in Victoria with a bariatric surgery program to review their service and align with the Surgery for morbid obesity: Framework for bariatric surgery in Victoria’s public hospitals 2009. It provides a guide for self-assessment as part of your ongoing quality monitoring processes for bariatric surgery services. The self-assessment tool will assist you to identify priority elements for action and a process to facilitate implementation of a service that is well aligned with the guidelines.
Who should use the self-assessment tool?
The tool is designed to be used by those responsible for managing bariatric surgery services.
Guidance notes
This document is a practical tool to guide hospitals to conduct a self-assessment of bariatric surgery services. It is not intended as a specific prescription for an individual hospital, but rather as a set of principles to be adapted to each unique hospital. It is expected that the findings can be used to inform service improvement, development and planning.
Bariatric surgery framework self-assessment
Service component / Self-assessment / Gap identification / Action and solutions /N/A / A / I / Eva / Exc / L /
Patient selection (Refer p.16)
Patient selection is in accordance with the following criteria:
· have a BMI of more than 40 or a BMI of more than 35 with medically important comorbid obesity related conditions
· aged between 18 and 65 years
· have tried but failed to achieve clinically beneficial weight loss using non-surgical measures
· have the motivation and capacity to make the dietary and lifestyle changes needed for a successful long-term outcome from the surgery
· do not have psychiatric, behavioural or cognitive conditions that impair their capacity to give informed consent or commit to postoperative care plans. / □ / □ / □ / □ / □ / □
Comprehensive documentation in the patient medical record that all appropriate non-surgical measures have been tried, including details of health interventions prescribed, progress towards weight loss goal and perceived obstacles to sustained weight loss. / □ / □ / □ / □ / □ / □
Multidisciplinary medical weight loss program in place to support conservative management measures. / □ / □ / □ / □ / □ / □
Protocols and processes for consideration of surgery for patients who do not fit the defined criteria. / □ / □ / □ / □ / □ / □
Protocols and processes for screening bariatric surgery candidates for psychiatric, behavioural and cognitive conditions which may have an adverse impact on postoperative outcomes. / □ / □ / □ / □ / □ / □
Referral (Refer p.19)
Documented referral pathways for individuals requiring assessment for their suitability for surgery from:
· general practitioners / □ / □ / □ / □ / □ / □
· medical specialists / □ / □ / □ / □ / □ / □
Written information about the program for potential referrers, including details of the referral criteria. / □ / □ / □ / □ / □ / □
Written information for patients about the program. / □ / □ / □ / □ / □ / □
Pre-surgical medical assessment (Refer p.19)
Investigation of comorbidities and other factors that may affect the outcome of the surgery in an appropriate level of detail. / □ / □ / □ / □ / □ / □
Immediate and active management of comorbidities when identified, including referral to appropriate specialists for obesity-related disease stabilisation. / □ / □ / □ / □ / □ / □
Access to full range of medical specialists to manage obesity-related comorbidities and mental health conditions:
· cardiologist
· respiratory physician
· endocrinologist
· psychiatrist / □ / □ / □ / □ / □ / □
Pre-surgical evaluation and counselling (Refer p. 19)
The informed consent for surgery reflects that:
· patient fully understands the potential benefits, risks and long term consequences associated with the procedure
· the choice of surgical intervention was made jointly by the patient and the health care professionals responsible for the treatment
· the patient is motivated to make the necessary dietary and lifestyle changes
· the patient commits to long term follow up after surgery. / □ / □ / □ / □ / □ / □
Comprehensive evaluation of psychosocial or other factors that may affect compliance with postoperative care requirements. / □ / □ / □ / □ / □ / □
Patients receive individualised preparation, education and counselling to optimise their weight management before surgery from a dietician. / □ / □ / □ / □ / □ / □
Preoperative assessment by an anaesthetist with expertise in the management of the bariatric patient. / □ / □ / □ / □ / □ / □
Perioperative care (Refer p.20)
Written protocols and a standardised approach for:
· preoperative care (includes ward admission) / □ / □ / □ / □ / □ / □
· intraoperative care (includes surgery and recovery) / □ / □ / □ / □ / □ / □
· postoperative care (includes ward stay) / □ / □ / □ / □ / □ / □
Individualised patient management plans to ensure optimal management of known risks during the patient’s inpatient stay. / □ / □ / □ / □ / □ / □
Bariatric surgeon is able to manage, and has coverage to manage the postoperative patient and any complications that may occur. / □ / □ / □ / □ / □ / □
Access is available to high dependency or intensive care if required. / □ / □ / □ / □ / □ / □
Full range of medical specialists available to provide support to manage the postoperative patient and any complications that may occur:
· anaesthetist
· cardiologist
· respiratory physician
· intensivist / □ / □ / □ / □ / □ / □
Post-surgical follow up (Refer p.20)
Written protocol and care pathway for the post-surgical follow up of bariatric surgery patients. / □ / □ / □ / □ / □ / □
Written patient information outlining the post-surgical care. / □ / □ / □ / □ / □ / □
Liaison with general practitioners and other community providers that are involved with the patient’s care. / □ / □ / □ / □ / □ / □
Ongoing care and follow up is provided for the lifetime of the patient. / □ / □ / □ / □ / □ / □
Access to postoperative counselling and mental health support if required. / □ / □ / □ / □ / □ / □
Planning for reconstructive operations after weight stabilisation for certain patients. / □ / □ / □ / □ / □ / □
Multidisciplinary care (Refer p.21)
Multidisciplinary assessment and decision for surgery. / □ / □ / □ / □ / □ / □
Multidisciplinary preparation and education before surgery. / □ / □ / □ / □ / □ / □
Multidisciplinary treatment and post-surgical care. / □ / □ / □ / □ / □ / □
Clearly defined roles and responsibilities of the various members of the multidisciplinary care team. / □ / □ / □ / □ / □ / □
Coordination and communication of care between different members of the bariatric surgery team. / □ / □ / □ / □ / □ / □
Communication of patient information to other service providers involved in the patient’s care. / □ / □ / □ / □ / □ / □
Coordination of care with the patient’s general practitioner. / □ / □ / □ / □ / □ / □
Optimisation of nutrition and physical and activity (Refer p.22)
Patients receive individualised education and counselling to optimise their weight management after surgery from a dietitian. / □ / □ / □ / □ / □ / □
Where necessary, patients can access a physiotherapist or exercise physiologist to undertake a graded exercise program. / □ / □ / □ / □ / □ / □
Discussions with the patient about weight management, agreed goals and actions are documented. / □ / □ / □ / □ / □ / □
Patients are provided with a copy of their agreed goals, weight management plan and actions. / □ / □ / □ / □ / □ / □
Facility infrastructure, staffing and skill mix (Refer p.23)
Bariatric surgery is performed by surgeons who have substantial experience with the required procedures. / □ / □ / □ / □ / □ / □
The program has plans in place for the management of surgical complications including failed bariatric surgeries requiring reversal or conversion to another bariatric surgical procedure. / □ / □ / □ / □ / □ / □
Appropriate facilities and equipment to provide safe and dignified care to morbidly obese patients in:
· specialist clinic areas (outpatients) / □ / □ / □ / □ / □ / □
· ward areas / □ / □ / □ / □ / □ / □
· operating theatre complex / □ / □ / □ / □ / □ / □
· radiology / □ / □ / □ / □ / □ / □
Quality and outcome monitoring (Refer p.24)
Clinical data collection to monitor performance and patient outcomes is undertaken. / □ / □ / □ / □ / □ / □
Rating / Awareness (A) / Implementation (I) / Evaluation (Eva) / Excellence (Exc) / Leadership (L)
Assessment criteria / The organisation has an awareness and knowledge of the responsibilities and systems that need to be implemented. / Has implemented the systems, but there is little or no monitoring of outcomes or efforts for continuous improvement. / The element is achieved and efficient systems are in place. Data are collected and evaluation occurs to ensure the service works effectively and efficiently. Methods of improvement are in place. / Performance is benchmarked against other organisations or key performance indicators. Research and/ or advanced implementation strategies and/or excellent outcomes are achieved. / Can demonstrate outstanding performance and is a peer leader.