Managing Perioperative Care
Managing Perioperative Care
This chapter focuses on the preparation and care of adult patients undergoing elective surgery, the associated challenges, and supporting evidence in providing safe and effective care. A key principle is the identification of relevant health issues and optimizing comorbidities prior to admission for surgery, which will minimize cancellations on the day ofsurgery. Informed consent, patient education, and teamworking all contribute to effective care and efficient service delivery. To provide the optimum healthcare, it is essential that the health professional has a full understanding of the patient’s physical and psychological health and social history, allowing tailored care to be shaped and implemented. It is important that the patient understands the associated risks and benefits of planned treatment. Patients often present for elective surgery with comorbidities. In optimizing the treatment, it is possible to prevent negative consequences related to planned care, and to increase the patient’s understanding of these so that he or she they can make an informed choice. Gathering information prior to admission is important because patients are often anxious on the day of surgery, and medication/anaesthetic agents can render them unable to provide clear decisions relating to treatment. This is commonly referred to as the preoperative assessment (POA), but is probably better referred to as patient preparation. Patient preparation is the process by which a patient’s health status is identified and comorbidities made known to the relevant healthcare professionals. The healthcare professional will interpret the information, decide on additional investigations and examinations, and then determine the risk factors associated with the patient’s health and the anticipated anaesthetic and surgical intervention. The patient must be informed of the risk and benefits and be provided with sufficient information to ensure an informed choice. Integral to patient preparation is the anticipation of potential outcomes, including length of hospitalization, ability to complete activities of daily living, and discharge planning. The process will involve the patient and his or her carer(s) and all healthcare professionals appropriate to the individual patient in primary and secondary care. It may be that, at the end of the patient preparation stage, the patient decides not to proceed with surgery.
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