Primary care

Before surgery

Primary care provider to the perioperative service

At referral, the primary care provider:

• supports the patient, family or carer in making decisions regarding the surgery or procedure
• provides advice to the perioperative service on the patient’s condition, e.g. medical, cognitive, emotional, social, functional
• provides advice to the perioperative service on the expectations of the patient, family, carer and other clinical specialists
• collaborates with the perioperative service for diagnosis and optimisation of high-risk patients
• provides investigations and test results.

Perioperative service to primary care

Supply the primary healthcare provider (including GP, Aboriginal medical service and/or community nurse) with information about the patient’s perioperative and optimisation goals. This enables the primary healthcare provider to support the patient with these goals.

Discharge

Perioperative service to primary care

Send the primary healthcare provider a written transfer of care referral within 48 hours of the transfer. Information includes:

• a summary of the patient’s clinical episode of care
• a list of medications on discharge with information about:
  • changes to medications
  • management of medications including a pain management plan
• advice regarding follow-up arrangements, including need for additional services, e.g. rehabilitation, home care, residential care, mental health services, or drug and alcohol services¹
• pending tests or studies
• results from pre-admission clinic (even if not directly impacting the surgery)
• unexpected changes to baseline presentation
• a contact number for questions or concerns after discharge.

Where appropriate and of benefit, consider a videoconference to support transfer of care. This may be particularly relevant for residential aged care facilities and out of area transfers.

Communicate critical or other important information, particularly regarding high-risk patients, directly via telephone.

Provide the primary healthcare provider (including GP, Aboriginal medical service and/or community nurse) with information about the patient’s perioperative and optimisation goals. This enables the primary healthcare provider to support the patient with these goals.

Primary care provider to the perioperative service

The primary care provider:

• supports transfer of care following surgery or procedure
• advises and refers patients to postoperative services
• advises the perioperative service of adverse health outcomes related to the perioperative episode of care and other health outcomes, as appropriate.

Adverse event notification

The primary care provider and/or patient may contact the surgeon or surgical team to report any adverse events after discharge. Ideally, any adverse event notification should also go to the medical lead of the perioperative medicine team. Provide a phone number and/or email address with the transfer of care documentation.

Alternatively, the clinical governance unit or quality and safety directorates generally manage incident reviews. Provide a phone number and/or email address with the transfer of care documentation.

The patient may also attend a postoperative clinic or appointment with the surgeon or present directly to the emergency department.

The surgeon, medical lead of the perioperative medicine team or clinical governance unit should advise the primary care provider of the outcome of any incident review.

The NSW Clinical Excellence Commission provides guidance on incident management in NSW.

Encourage the patient and their family or carer to report any adverse events associated with the use of a medicine, vaccine or medical device directly to the Therapeutic Goods Association.

Perioperative pathways

A perioperative care pathway is a framework for treating patients with specific conditions or needs.

Perioperative care pathways are evidence-based and help standardise clinical practice. This supports better patient outcomes.²

References

1. NSW Ministry of Health. Care coordination: From admission to transfer of care in NSW public hospitals. NSW, Australia: NSW Ministry of Health; Jul 2011 [cited 28 Mar 2024].
2. Patel J, Tolppa T, Biccard BM, et al. Perioperative Care Pathways in Low- and Lower-Middle-Income Countries: Systematic Review and Narrative Synthesis. World J Surg. Sep 2022;46(9):2102-13. DOI: 10.1007/s00268-022-06621-x