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. 2017 Jun 20:6:9.
doi: 10.1186/s13741-017-0065-4. eCollection 2017.

Re-designing the pathway to surgery: better care and added value

Michael P W Grocott  1   2   3   4 , James O M Plumb  1   2   3   5 , Mark Edwards  1   2   3   5 , Imogen Fecher-Jones  1   2   5 , Denny Z H Levett  1   2   3   4
Affiliations

Re-designing the pathway to surgery: better care and added value

Michael P W Grocott et al. Perioper Med (Lond). .

Abstract

The case for radical pathway re-design before surgery is in part driven by healthcare system pressures which are in turn the result of continuously rising demand in the face of tightly constrained resources. Such circumstances tend to drive revolutionary, rather than incremental, change. The current approach to preoperative assessment, that typically occurs in the weeks leading up to surgery, but is all too often only a few days before surgery, results in a lost opportunity for perioperative physicians to improve patient care. Re-engineering this process based on a patient-focused, pathway-driven vision of perioperative medicine offers a means of exploiting this opportunity. This review explores drivers for change, the opportunity offered by pathway re-design, and suggests a variety of strategies to add value in the preoperative pathway, each of which is facilitated by early engagement between perioperative physician and patient: collaborative decision-making, collaborative behavioural change, targeted comorbidity management as well as expectation management and psychological preparation for surgery including surgery schools.

Keywords: Anaesthesia; Business process re-engineering; Collaborative behavioural change: “lifestyle modification”; Collaborative decision-making; Comorbidity management; Perioperative medicine; Re-design; Surgery; Surgery school; Surgical pathway.

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Figures

Fig. 1
Fig. 1
Traditional model of the journey from GP referral through to surgery
Fig. 2
Fig. 2
The pathway “re-engineered”—a model of process evolution in perioperative pathways. This re-engineered model aims to shift the timing of pre-assessment to much earlier in the pathway using simple online risk stratification tools and then early staging using objective physiological assessments (namely CPET). The aim is to have detailed information prior to any decision to operate with true collaborative decision-making taking centre stage. Surgery school and any “bolt-ons” occur in conjunction aiming to have things optimized prior to final decisions regarding surgery
See this image and copyright information in PMC

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