Safe recovery

In the postoperative period, the perioperative care team collaborates with the surgical team and others to manage clinical deterioration, pain, complications and patient needs.

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The perioperative medicine team supports multidisciplinary discharge planning and early rehabilitation. This is to reduce complications and improve patient outcomes.1

Safe recovery processes

  • Prioritise patients for regular postoperative review, e.g. flagged from pre-admission clinic
  • Identify high-risk patients requiring advanced monitoring in a higher care unit
  • Manage clinical deterioration for inpatients2
  • Screen and manage delirium
  • Prescribe postoperative analgesia safely and effectively
  • Manage outlying patients
  • Ensure early mobilisation in all patients (where appropriate)
  • Commence oral nutrition and hydration as soon as possible
  • Refer patients with postoperative functional or cognitive decline to restorative care such as geriatric medicine or rehabilitation medicine and allied health

High-risk patient groups require collaborative ward management, e.g. hip fracture, vascular surgery and emergency surgery.3, 4

When discharging a low-risk patient postoperatively, give them clear verbal and written instructions about:5

  • pain management
  • follow up
  • potential complications.

If clinically appropriate, remote patient monitoring and other forms of virtual care give patients the opportunity to recover at home.

Short-term restorative care

Short-term restorative care includes multidisciplinary subacute rehabilitation, geriatric evaluation and management and Commonwealth-funded transition care program (in Australia). Access to and choice of appropriate restorative care will depend on a patient’s needs and preferences as well as local factors.

    Resources

    Acute inpatient recovery

    4AT rapid clinical test for delirium
    A simple and short delirium detection tool.
    Source: MacLullich et al.

    Delirium Clinical Care Standard
    A standard to improve the prevention of delirium in patients at risk.
    Source: Australian Commission on Safety and Quality in Health Care

    Position statement on the post-anaesthesia care unit
    A guide to post-anaesthesia care units that are designed, equipped and staffed to deliver safe patient care.
    Source: Australian and New Zealand College of Anaesthetists (ANZCA)

    REACH (Recognise, Engage, Act, Call, Help is on its way)
    A system to help escalate concerns about changes in a patient’s condition.
    Source: Clinical Excellence Commission

    Recognising and Responding to Acute Deterioration Standard
    A standard to ensure acute deterioration is recognised promptly and appropriate action is taken.
    Source: Australian Commission on Safety and Quality in Health Care

    Rehabilitation and transition support

    Principles to support rehabilitation care
    A guide for the establishment or development of rehabilitation services across NSW.
    Source: Agency for Clinical Innovation

    Standards for rehabilitation services
    Seven standards for the provision of inpatient adult rehabilitation medicine.
    Source: Royal Australasian College of Physicians

    Transition Care Programme
    A program to help older people recover after a hospital stay.
    Source: Australian Government Department of Health and Aged Care

    Enhanced recovery after surgery

    Enhanced Recovery After Surgery
    A range of resources to support implementation of enhanced recovery after surgery (ERAS) protocols including key principles, audit and feedback guide, and NSW local case studies showcasing various clinical specialities.
    Source: Agency for Clinical Innovation

    Enhanced Recovery After Surgery Guidelines
    Perioperative care pathways for patients undergoing major surgery.
    Source: Enhanced Recovery After Surgery Society

    References

    1. Jones CE, Hollis RH, Wahl TS, et al. Transitional care interventions and hospital readmissions in surgical populations: a systematic review. The American Journal of Surgery. Aug 2016;212(2):327-35. DOI: 10.1016/j.amjsurg.2016.04.004
    2. Australian Commission on Safety and Quality in Health Care. National consensus statement: essential elements for recognising and responding to acute physiological deterioration. Sydney, Australia: ACSQHC; 2017 [cited 27 Mar 2024].
    3. Shaw M, Pelecanos AM, Mudge AM. Evaluation of Internal Medicine Physician or Multidisciplinary Team Comanagement of Surgical Patients and Clinical Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open. 1 May 2020;3(5):e204088. DOI: 10.1001/jamanetworkopen.2020.4088
    4. Van Grootven B, Flamaing J, Dierckx de Casterlé B, et al. Effectiveness of in-hospital geriatric co-management: a systematic review and meta-analysis. Age and Ageing. 2017;46(6):903-10. DOI: 10.1093/ageing/afx051
    5. Mitchell M. Home recovery following day surgery: a patient perspective. Journal of Clinical Nursing. Feb 2015;24(3-4):415-27. DOI
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