Services

Conventionally pre-operative care is delivered by a surgical lead, with anaesthetic and nursing support. In the majority of patients after a decision to operate is made, assessment by an Anaesthetist is undertaken.

There can be a lack of emphasis on the optimisation of health and social issues in order to reduce adverse post-operative outcomes. Abnormalities found on assessment are often referred to single-organ specialists or back to primary care, which may delay surgery.

Furthermore, Surgeons may not have had training in peri-operative medicine and are therefore not familiar with evidence-based interventions to reduce peri-operative risk.

Our goal is to assist our surgical and anaesthetic colleagues to provide – coordinated, ‘patient centric’ pre-operative optimisation, post-operative medical care and discharge planning for you.

• To assess risk, optimise and manage the elective surgical patient throughout the surgical pathway.
• Risk assessment of peri-operative morbidity and mortality (including use of told and investigations as required).
• Attempt to modify risk factors which include the use of organ specific national and international guidelines.
• Medication optimisation – addressing poly pharmacy (where relevant).
• Use of inter-disciplinary and cross-specialty interventions to improve post-operative outcome.
• Clinical assessment with appropriate use of investigations and tools to preoperatively risk assess for peri-operative morbidity and mortality.
• Communication of risks with other health professionals involved and patients/relatives.
• Timely optimisation of medical co-morbid conditions (and geriatric syndromes, where relevant).
• Appropriate allocation of post-operative resources.

• Decision making regards rehabilitation, and timely and effective discharge pertinent to the surgical patient.
• Liaison with patients, Anaesthetists and Surgeons to ensure shared decision making.
• Liaison work on surgical wards in hospital – working in conjunction with the Surgeon in the post-operative journey and aid in managing post-operative medical complications (if needed, Eg. pain, constipation, nausea etc).
• Attend surgical ward multidisciplinary team meetings – liaise with physiotherapists, nurses and discharge planners to plan appropriate discharge pathways.
• Appropriate and timely communication with the GP concerned with regard to outcomes, medications changes and other issues which occur, or had occurred, during the journey.
• Peri-operative assessments (30—60mins) use the document for peri-op service that we had created to transcribe here.