Perioperative care - what you need to do now to reduce the backlog, reduce complications and improve patient satisfaction
The desperately long waiting lists following the pandemic give an opportunity to do things better. Perioperative care is everything from the moment an operation is contemplated through to full recovery.
The Centre for Perioperative Care has demonstrated massive benefits for each patient and for the service. A perioperative approach can reduce complications by 30%-80% and length of stay by 1-2 days. There are many factors: (search for these topics on www.cpoc.org.uk ):
• Shared Decision Making – listening to patients’ expectations and discussing Benefits, Risks, Alternatives and what happens if Nothing is done (BRAN). This involves training clinicians in motivational interviewing. It can reduce unwarranted surgery.
• New Day Surgery guidance could maximise day surgery, avoiding cancellations or competition for beds, and creating geographically-distinct pathways. There is two-fold variation between top decile and bottom decile Trusts in proportion of patients admitted overnight. Most Trusts work to archaic protocols. A new guideline from Getting It Right First Time (GIRFT), CPOC, and British Association of Day Surgery (BADS) explains how to do this. Many trauma, emergency and high volume pathways could be converted to day case.
• Patient interventions before surgery, principally smoking cessation and regular exercise, can reduce complication rates by up to 50% even in the short time-frames of cancer surgery. Nutrition, alcohol moderation, psychological preparedness, medication review and practical preparedness help and empower patients. Pre-operative assessment should focus on optimisation at ‘the teachable moment’. Staff should be trained in motivational interviewing and local signposting, for example about the practicalities of cycling or swimming for Orthopaedic patients with difficulty weight-bearing.
• Workforce gaps worsen care. A ‘Trans-Disciplinary team’ needs team-working and education - so skills are shared and key steps still occur even if specialist staff are not present.
Pathways should be co-designed locally with nurses, geriatricians, anaesthetists, GPs, AHPs, patients and administrative staff. These effectively give every patient the benefit of a specialist approach even where workforce deficiencies persist.
Education, empowerment, pathways, team-working - Perioperative care is key