Perioperative care refers to the time around a patient having surgery or a procedure. There are many steps and stakeholders involved.
The perioperative care journey includes the time from referral for a surgery or procedure through to discharge, rehabilitation and follow up with primary care providers. There are many considerations, including deciding to proceed with the surgery or procedure or not.
Perioperative care journey
The diagram below outlines the key stages of the patient perioperative care journey.
The perioperative care journey includes three stages:
- perioperative
- intraoperative
- postoperative.
The components of the care journey fit across these stages, including:
- Primary care: Including referral and follow up
- Surgical and perioperative medicine team review: Including patient engagement, consent, risk assessment, pre-procedure preparation, medication management and alternative care plan
- Optimisation: Including prehabilitation, high risk clinics and effective surgery preparation time
- Operation: Including day of surgery processes
- Recovery: Including safe recovery, pain management, rehabilitation and restoration of function and transfer of care and discharge planning
- Post acute care follow up: Including primary care follow up, rehabilitation and readmission prevention programs
- Primary care: Including transfer of care back to the primary care provider
The stages and components of the care journey are mostly sequential. However, the perioperative medicine team review may result in a decision not to operate. Care for the patient may then be transferred back to primary care.
Relevant to all stages and components of the care journey are:
- clinical and corporate governance
- quality improvement, benchmarking and reporting
- shared decision making
- patient engagement.
Perioperative care team
The perioperative team includes a range of clinicians, together with the patient and their family and carers. Every circumstance is unique so the team may look slightly different for each patient.
In addition to the patient themselves, the team can include the following:
- Family and carers
- Primary care team: May include primary referrer, primary care physician or general practitioner and primary health networks
- Allied health team: May include physiotherapists, occupational therapists, dieticians, social workers, Aboriginal liaison officers, psychologists, pharmacists, speech pathology and other non-medical support workers
- Administration team: May include integrated bookings unit, waitlist manager, admissions department, administration officers, admissions clerks, patient liaison officer, patient reported measures officer
- Nursing team: May include pre-admission clinic nurse, nurse screeners, day surgery nurses, perioperative nurse manager
- Perioperative medicine team: May include consultants, e.g. anaesthesia, pain medicine, internal medicine, geriatric medicine, general practice, intensive care and other medical specialties
- Surgical team: May include anaesthetist and proceduralist
Allied health
- Physiotherapist
- Occupational therapist
- Dietitian
- Indigenous liaison officer
- Psychologist
- Pharmacist
- Speech pathologist
- Other non-medical support workers
Administration
- Integrated bookings unit
- Waitlist manager
- Admissions department
- Administration officer
- Admissions clerk
- Patient liaison officer
- Patient-reported measures officer
Perioperative medicine
- Anaesthesia
- Pain medicine
- Internal medicine
- Geriatric medicine
- General practice
- Intensive care
- Other medical specialities
Nursing
- Pre-admission clinic nurse
- Nurse screener
- Day surgery nurse
- Perioperative nurse manager
- Nurse practitioner
Primary care
- Primary referrer
- Primary care physician
- General practitioner
- Primary health networks
Surgical team
- Anaesthetist
- Proceduralist