How can surgeons improve perioperative care?
05 July 2024 (Last updated: 5 Jul 2024 10:13)
The Centre for Perioperative Care (CPOC) was set up to promote, advance and develop perioperative care for the benefit of patients across the whole of their surgical journey. Deputy Director, Professor Scarlett McNally presented the benefits of a good perioperative approach to the 2024 BAOMS Annual Meeting, and the role of surgeons in achieving this.
Perioperative care covers the whole pathway from the moment an operation is considered until full recovery. The aim is to reduce the complications that can occur along the way by understanding why and how they can occur and taking measures to reduce risk. The actions to take are different for patients, for surgeons and for organisations.
Scarlett explains: “As surgeons we need to tell patients that there are lots of things that they can do in advance that can halve the risk of complications. This ranges from stopping smoking which reduces complications by 50%. Exercise reduces risk by 30-80% and is empowering for patients as it’s something that they can do.
“I know that we are short of time, but we can give advice around lifestyle changes and make sure they know who in the team can support them and where to get information from.” she continues.
She outlined seven measures for patients that can reduce risk:
- Smoking cessation
- Exercise reduces inflammation and impacts the metabolism
- Reducing alcohol
- Good nutrition - fruit, vegetables and protein
- A medication review - particularly in older people where polypharmacy can be an issue
- Mental health optimisation - from promoting good sleep to preparing mentally for an operation
- Practical information such as what to wear before and after an operation, figure out how to walk every day and more
Organisations can benefit from this because it results in more patients being seen as day cases which saves money and resources.
For surgeons specifically, Scarlett says: “We need to do better with our teams because people are scared of us. As surgeons we’ve spent years shouting at people and we need to retrain ourselves and change this. I know I did this but I have changed. We also need to own that surgeons are good leaders. We are used to being directive, and we carry risk in a way that many others in the team may not.”
Teamwork is a crucial factor. The CPOC has written new safety standards for patient procedures, including how to do a better team briefing ahead of an operation to make sure everyone knows who is in the room and their role. She recommends surgeons run over which parts of an operation are easy and which are more complex before it begins, where more support is needed and where the team can step back.
Returning to lifestyle factors, Scarlett demonstrated her advocacy for exercise by asking the whole auditorium to stand up and participate in a round of squats with her as she timed and encouraged them.
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