Perioperative shared decision making - How do we train clinicians?

Objective: Decision making about high-risk surgery can be complex, particularly when outcomes may be uncertain. Clinicians have a legal and ethical responsibility to support decision making which fits with patients' values and preferences. In the UK, preoperative assessment and optimisation is led by Anaesthetists in clinic several weeks prior to planned surgery.

The Perioperative Quality Improvement Programme (PQIP patient study): protocol for a UK multicentre, prospective cohort study to measure quality of care and outcomes after major surgery.

Introduction: Major surgery accounts for a substantial proportion of health service activity, due not only to the primary procedure, but the longer-term health implications of poor short-term outcome. Data from small studies or from outside the UK indicate that rates of complications and failure to rescue vary between hospitals, as does compliance with best practice processes. Within the UK, there is currently no system for monitoring postoperative complications (other than short-term mortality) in major non-cardiac surgery.

Human factors/ergonomics to support the design and testing of rapidly manufactured ventilators in the UK during the COVID-19 pandemic.

Background: This paper describes a rapid response project from the Chartered Institute of Ergonomics & Human Factors (CIEHF) to support the design, development, usability testing and operation of new ventilators as part of the UK response during the COVID-19 pandemic.

Method: A five-step approach was taken to (1) assess the COVID-19 situation and decide to formulate a response; (2) mobilise and coordinate Human Factors/Ergonomics (HFE) specialists; (3) ideate, with HFE specialists collaborating to identify, analyse the issues and opportunities, and develop strategies, plans and processes; (4) generate outputs and solutions; and (5) respond to the COVID-19 situation via targeted support and guidance.

Results: The response for the rapidly manufactured ventilator systems (RMVS) has been used to influence both strategy and practice to address concerns about changing safety standards and the detailed design procedure with RMVS manufacturers.

Delivering perioperative care in integrated care systems.

In 2016, NHS England set up 10 integrated care systems (ICSs) which aim to devolve some responsibility for delivery of health and social care services to local healthcare providers in partnership with local government, social care, primary care networks, and voluntary and charitable organisations. These are new ways of working and provide an opportunity to better integrate perioperative care across the entire pathway from the moment of contemplation of surgery through to recovery at home. This review describes the ways in which the aims of many ICS plans can be met with good perioperative care, and how clinicians can use this opportunity to make significant progress in improving outcomes for patients.

Transitions of care in the perioperative period - a review.

The perioperative period extends from the moment of contemplation of surgery through to recovery at home. Patients on a surgical pathway will experience multiple transition points in their care. As we move to more collaborative working and caring for increasingly medically complex patients, we must establish robust processes to mitigate against the potential for patient harm posed by these multiple transition points.