Quick Reference Action Points For Referring Practitioners

• Patients are seen on a referral basis only and under no circumstances will be registered as patients at Queensway

Our aim is to reduce the number of general anaesthetics and where possible to provide treatment under oral, inhalation or intravenous conscious sedation. Only patients assessed as fit and healthy or with controlled systemic disease (ASA I or II) are appropriate for conscious sedation at this clinic.

1. Please use referral forms provided, ensure patients know location of clinic, and that first visit will be for assessment only

2. Please ensure patients bring all relevant Records (e.g. radiographs, copy of specialist orthodontic referral letter) and that they are aware of the proposed treatment plan (including which teeth are to be filled / extracted).

3. Please ensure that patients are aware pre-existing medical conditions may mean that they are found to be unsuitable for care in our practice, and that alternative arrangements will be made where necessary.

4. Please ensure patients bring all medications with them to the assessment appointment

5. Please do not prescribe a course of penicillin for acute infective conditions if the referred Patient requires antibiotic cover. This is to avoid firstly, the complex alternative antibiotic regimes
recommended for treatment under G.A or Secondly, delayed treatment before penicillin can be used again.

6. Please ensure sickle dex status is known prior to referral for assessment.

7. Referring dentists should ask diabetic patients to bring all medication and BM stix to the assessment visit.

March 1999

General remarks of inspector:

This is a quite exceptionally good facility for GA and sedation. It cannot be faulted in any way and the providers have gone further than they were required in providing a quality service.

I would like to emphasise a number of points.

• There is good evidence that strenuous efforts are made on all occasions to avoid general anaesthesia. In particular the rate of GA to adults is very low. If this is, as I was told, also associated with a reduction in GA provision elsewhere in Cleveland then this service has achieved its prime objective of substituting alternatives for GA.
• The facilities put many hospital operating theatres to shame.
• The staff are well trained. The dentists are largely ALS accredited and the nurses BLS accredited. This is excellent and beyond the requirements of the original brief.
• The procedures within the surgery work well. The step system from reassurance through sedation and RA to GA ensures that each patient is dealt with in the least invasive way.

This facility is a model of good practice. The approach to treatment by anxiety management has much to commend it. This is far and away the best facility I have seen. The service surpasses that in any community clinic, hospital or dental hospital that I have seen. This pilot deserves to be treated as just that. Good practice has been demonstrated. Ways to replicate similar facilities in other health authorities should be found.

March 2001

General remarks of inspector:

This service has continued to move forwards since I last visited it.

• The trend towards replacing GA services with less dangerous methods of anxiety management has continued.
• The facilities are up to the standard of units on full hospital sites.
• The staff are well trained. The dentists are ALS accredited and the nurses BLS accredited. This is excellent and beyond the requirements of the original brief.
• The procedures within the surgery work well.
• The team have conducted research on sevoflurane sedation in children and the report has been published in Anaesthesia.

The whole team at Queensway are concerned to deliver a quality service. Patient care and patient safety come first. I was unable to find any instance of substandard practice and thought has been given to all possible problems. The anaesthetic staff are of high quality and possess resuscitation skills and intensive care skills to a standard that ensures that patients would be receiving good care throughout, if it were ever necessary to transfer one to hospital.This is the best GA/sedation/anxiety management service I have seen - and I have seen many. It is superior in conception, execution and safety to any hospital-based system I have visited. It would be a great pity for the people of Cleveland if this service were lost as a result of its isolation from a hospital. It is at least as safe as many isolated day surgery and cottage hospital surgical services that continue to operate. The only deficiency is that it would be necessary to take a patient by ambulance to an intensive care unit. Given the skills of the current anaesthetists this would not be a problem.

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