In this section you will find resources relevant to perioperative care, from CPOC's partners and relevant third-party organisations.
CPOC works with its partners, stakeholders and third party organisations to ensure we provide a wealth of up to date resources in perioperative care and sign post where necessary.
If you believe there is a relevant resource that can be added to this page please email CPOC@rcoa.ac.uk
CPOC has not tested these sites and does not partner with the mentioned organisations or promote the effectiveness of any of the products listed. CPOC is simply providing links to these resources.
Please contact us at CPOC@roca.ac.uk if you would like us to include another example.
This guidance is intended to be used by primary care, surgeons, anaesthetists, perioperative teams and preoperative assessment (POA) services. It applies to all patients who are being considered for surgery, or are on a waiting list for surgery in the non-emergency setting, irrespective of the magnitude of procedure or the type of anaesthesia contemplated. Its recommendations will support the care of individual patients, the recovery of elective services, and achieving key goals of the NHS Long Term Plan including reducing health inequalities and preventing serious health deterioration.
The guideline contains key recommendations for;
- NHS X
- primary care providers
- surgeons, anaesthetists and multidiscilinary teams
- preoperative assessment services
In this podcast, CPOC’s Director Dr David Selwyn interviews CPOC Deputy Directors Dr Jugdeep Dhesi and Mrs Scarlett McNally along with CPOC’s Patient Representative Lawrence Mudford about how to turn waiting lists for surgery into preparation lists. With over 5 million people now waiting for surgery in England alone, there has never been a more pressing time to consider creative ways that will help us beat the backlog while also delivering better, person-centred care for patients.
A multidisciplinary consensus statement on behalf of the Association of Anaesthetists, the Centre for Perioperative Care, the Federation of Surgical Specialty Associations, the Royal College of Anaesthetists and the Royal College of Surgeons of England has been published on the SARS-CoV-2 infection, COVID-19 and timing of elective surgery.
The scale of the COVID-19 pandemic means that a significant number of patients who have previously been infected with SARS-CoV-2 will require surgery. Given the potential for multisystem involvement, timing of surgery needs to be carefully considered to plan for safe surgery. The consensus statement uses evidence from a systematic review and expert opinion to highlight key principles in the timing of surgery.
The guideline covers routine preoperative tests for people aged over 16 who are having elective surgery. It aims to reduce unnecessary testing by advising which tests to offer people before minor, intermediate and major or complex surgery, taking into account specific comorbidities (cardiovascular, renal and respiratory conditions and diabetes and obesity). It does not cover pregnant women or people having cardiothoracic procedures or neurosurgery.
SafeFit has been designed, in response to COVID-19, to support people living with cancer to maintain and improve their physical and emotional wellbeing, whilst following Government guidelines.
It is a free remote trial for anyone in the UK with suspicion of, or confirmed diagnosis of, cancer. We put you in contact with a cancer exercise specialist who will help you during the coronavirus (COVID-19) crisis.
The ASA Guidelines differ from the existing guidelines because it provides new evidence obtained from recent scientific literature as well as findings from new surveys of expert consultants and randomly selected ASA member.
The guideline updates the “Practice Guidelines for the Perioperative Management of Obstructive Sleep Apnea: a Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Obstructive Sleep Apnea,” adopted by the ASA in 2005 and published in 2006.
Moving Medicine offers guidance to help healthcare professionals integrate physical activity conversations into routine clinical care.
Ageing populations have greater incidences of dementia. People with dementia present for emergency and, increasingly, elective surgery, but are poorly served by the lack of available guidance on their peri-operative management, particularly relating to pharmacological, medico-legal, environmental and attitudinal considerations. These guidelines seek to deliver such guidance, by providing information for peri-operative care providers about dementia pathophysiology, specific difficulties anaesthetising patients with dementia, medication interactions, organisational and medico-legal factors, pre-, intra- and postoperative care considerations, training, sources of further information and care quality improvement tools.
By January 2019, all patients who are anaemic who present for elective or urgent surgery (with an anticipated blood loss of > 500 ml or >10% blood volume) in Scotland should have this anaemia investigated and treated prior to surgery. Preoperative anaemia is associated with increased postoperative morbidity and mortality, and with increased transfusion requirements. Treating iron deficiency with iron supplements can reduce the need for blood transfusion. It may also reduce the length of hospital stay and cost.
As part of the joint FICM/CPOC Guidance on Establishing and Delivering Enhanced Perioperative Care Services, a means of passporting staff with generic transferrable skills was identified by the working party. A short life-working group led by Dr Michael Bannon, Lead Dean for ICM, developed the initial version.
This suite of multi-professional competencies has been designed to support safe, compassionate and effective care and treatment to Enhanced Care patients. The passport is intended to:
- allow individuals to identify their existing skills and additional learning needs within an evidence based framework.
- allow employers to identify and map the relevant competencies across the different staff groups working within Enhanced Care to ensure patients are able to receive the right care and treatment they require in a timely manner.
Cardiff and Vale University Health Board
The guidance aims to provide a background knowledge of Cystic Fibrosis [CF] for the anaesthetist and give guidance and best practice for the perioperative anaesthetic management of the patient with CF presenting for surgery.
CF affects multiple organ systems. However, the impact of CF on the respiratory and gastrointestinal systems account for the majority of morbidity and mortality. Therefore CF patients are generally considered a high risk group for anaesthesia, particularly given their potential for postoperative respiratory complications.
The Specialised Clinical Frailty Network supports specialised healthcare teams to improve the way specialised care and treatment is tailored to the needs and preferences of individuals living with frailty. The Network commenced in 2018, and has been working with specialised teams to explore how frailty assessment and management can best be integrated into specialised service pathways. The Network is a clinically led quality improvement collaborative.
The Network delivers a programme of support framed around frailty assessment, that will help inform a clinically appropriate and holistic response to meet patient needs. Shared decision making is a key part of this response, ensuring that a patient-centred plan is agreed with patients and their carers, adopting a “what matters to you” philosophy.
The SCFN provides a range of tools and resources to support healthcare staff to improve NHS specialised services for older people living with frailty.
The network is also endorsed by the British Geriatrics Society (BGS.)
Find out more about the network.
This hub brings together articles, national guidelines and best practice relevant to frailty and is frequently reviewed and updated by the BGS Clinical Quality Committee and the BGS Frailty in Urgent Care Settings Special Interest Group (SIG).
Whole Perioperative Pathway
The Modernising Patient Pathways Programme is dedicated to improving patient journeys by delivering sustainable changes to support safe, effective, and person-centred care.
The programme has over twenty one areas of focus all across medical specialites and is undertaking projects in this area.
To find out up to date information on the work please view the MPPP on twitter,
FPM, RCoA, RCGP, RCSEng, RCN, CPOC, RPS & The British Pain Society
This document represents the work of a multi-professional and multidisciplinary collaboration and sets out the guiding principles in opioid management in the perioperative period. This guidance is intended for use by clinicians, nurses and allied healthcare providers, patients, pharmacists and policy makers.
CPOC, BADS, GIRFT
There is still wide variation in day surgery rates throughout the UK. In the lowest quartile of NHS Trusts, twice as many eligible patients are admitted as inpatients as in the highest quartile. Day surgery should be the default setting for more than just the 200 procedures identified by BADS. This would not only improve patient care and satisfaction, but would also be highly cost-effective, improve efficiency, improve staff retention and morale and reduce the demand for inpatient beds. This expansion can only be achieved safely by following clear guidelines and creating good pathways aimed at improving quality.
The pack aims to support trusts in considering reconfiguration or redevelopment of services to increase the level of day surgery for at least the 200 procedures identified by BADS and to provide advice to clinical communities on developing safe and effective day surgery pathways.
The COVID-19 pandemic has had a huge impact on patients, healthcare and the public. Dramatic changes to people’s lives and across NHS organisations have occurred swiftly. From this disruption and the emergence of the 'new normal' comes the opportunity to improve patient care, the design of services and the power perioperative care and multidisciplinary working has on the effectiveness and optimisation of the workforce.
CPOC has developed 'Delivering on Opportunities for Better Health and Perioperative Care in the COVID-19 Era' to highlight the need for a rethink moving forward and to make the case for perioperative care in a COVID-19 world.
The Royal College of Anaesthetists commissioned this report in May 2018 at a time when existing sustainability and transformation partnerships (STPs) were beginning to evolve into ICSs. The College was keen to assess the extent to which improvements in perioperative medicine, or opportunities for its role in transforming outcomes, were acknowledged or featured in the emerging thinking.
It identifies best practice and a series of recommendations to embed this within the NHS, as well as highlighting a series of pilot projects that can be scaled up once their impact has been fully assessed.
This essay collection from the Health Foundation looks at improving various aspects of public health – and at the potentially game-changing social and economic benefits to society of doing so. It concludes by proposing the need for a paradigm shift in policy, whereby health is seen as a fundamental component of a prosperous and sustainable society and a priority in all policy areas.
Patient-driven online preoperative assessment
Ultramed has developed MyPreOp®, a cloud-hosted programme, enabling patients to enter, own and share their preoperative assessment information. A report is electronically provided to the hospital to integrate into the Electronic Patient Record. Complex algorithms suggest which preoperative tests and actions should be considered. MyPreOp® empowers patients and saves nursing time.
Before an operation a person’s fitness needs to be assessed by a registered nurse. A lot of time is spent collecting information from the patient. Many hospitals have paper-based systems which cannot automatically process the information or give guidance to the nurses about what preoperative tests and actions might be needed.
MyPreOp® provides a patient-owned, cloud-hosted solution to these problems. Through the programme, the patient completes a comprehensive assessment of their general health and medical history, which is then digitally submitted to the healthcare provider. By facilitating one-stop preoperative assessment, MyPreOp® helps patients potentially avoid a further hospital appointment and saves time for healthcare professionals.
- 30% of patients completing MyPreOp® avoid having a face-to-face appointment
- In the NHS this could save 1m outpatient appointments per year
- 78% of patients said they would be extremely likely or likely to recommend MyPreOp®
- Avoiding an appointment saves mileage, carbon and patient transport costs
LifeBox is a digital pre-operative assessment ePOA tool which supports pre-op patient assessment, hospital decision-making and personalised patient care.
LifeBox (ePOA) offers patients a platform to complete part of their pre-operative assessment in their own time, at their own pace. The information provided is then available for clinicians to securely access, allowing for early triage and risk stratification which streamline workflows and support personalised patient care.
The Low Card Program is empowering people living with type 2 diabetes, prediabetes and obesity to improve their health and wellbeing through reassuringly impactful behaviour change.
The resource aims to help people lose weight, improve their HbA1c, reduce medications and place type 2 diabetes into remission.
The 2011 NCEPOD study on perioperative care ('Knowing the Risk', see above) looked at risk and outcome in patients undergoing inpatient surgery. One of the principal recommendations in the report from this study included a need for a way to rapidly and easily identify high risk patients, and in response NCEPOD and SOuRCe created the Surgical Outcome Risk Tool (SORT), a rapid percentage mortality risk estimate for patients who are undergoing non-cardiac, non-neurological inpatient surgery.
Find out more about SORT and access the tool online, or alternatively, you can download the app from the App Store and Google Play.