Patient cohorts

Local and NSW Health policies and procedures inform perioperative care. There are specific considerations for some patient cohorts.

NSW Health aims to provide quality health services that are accessible, non-discriminatory and equitable. Vulnerable patient groups requiring supports and adjustments include:

• Aboriginal patients
• Culturally and linguistically diverse patients
• Frail or older patients
• Paediatric patients
• Pregnant patients or patients with neonates or infants
• Rural and regional patients

Aboriginal patients

The Aboriginal Chronic Conditions Network works to improve the experience and delivery of healthcare for Aboriginal people with chronic conditions in NSW.

Healthcare services should be culturally relevant and safe. Empower and actively involve Aboriginal families and carers in decision making. The perioperative care team:

• uses shared decision making resources for Aboriginal people and their healthcare professionals to make decisions together, such as the ‘Finding your way’ shared decision making model
• coordinates with local health services or a patient’s usual doctor or healthcare worker to provide preoperative services close to home for rural and remote locations¹
• engages Aboriginal health workers, community workers or Aboriginal liaison officers where available, to foster understanding and trust and help coordinate care, for example, attendance at pre-admission clinics and travelling to hospital.¹

Culturally and linguistically diverse patients

NSW Health supports culturally responsive care that recognises and respects linguistic and cultural needs. This commitment includes providing access to care and supporting health literacy to enable shared decision making.

When supporting culturally appropriate care for a patient from a culturally and linguistically diverse background, the perioperative care team:¹

• accesses an interpreter if the patient does not speak English as a first language. This service can be by telephone or videoconferencing
• provides accessible translated written communication.

Frail or older patients

Frail or older patients may have difficulty attending a preoperative assessment face-to-face, particularly if they live in a residential aged care facility. Alternative options include:

• conducting virtual preadmission clinics or other consultations¹
• performing assessments at their residential aged care facility¹
• using geriatric outreach services.

The perioperative care team considers age-related perioperative factors and complications, including:²

• putting in place advance care directives and/or resuscitation plans at end of life
• making adjustments to fasting requirements
• choosing an appropriate anaesthesia approach
• managing delirium
• preventing falls
• addressing functional decline.

Locally adapted guidelines should inform perioperative care for children. The perioperative care team considers:¹

• factors including age, weight, size, developmental stage
• possible special conditions, e.g. behavioural problems
• reviewing results of assessment using a paediatric patient health questionnaire
• minimising fasting times
• providing education and support for families and carers.

Pregnant patients or patients with neonates or infants

Do not delay urgent and emergency surgery due to pregnancy. However, planned surgery should be postponed until after delivery. Pregnant patients should have an obstetrician as part of their perioperative care team.³

Support patients to continue breastfeeding following anaesthesia or sedation. Interruption to breastfeeding has short- and long-term risks and is generally not necessary. The perioperative care service provides:⁴

• breast pumps and spaces for patients to express breastmilk
• safe storage for breastmilk
• access to breastfeeding support and maternity care
• policies and procedures to limit periods of separation of the breastfeeding patient and the infant.

Rural and regional patients

The Rural Health Network works to improve information access and early identification of rural patients, their families and carers.

Surgery poses a challenge to people living in rural, regional and remote NSW, as they are often separated from home and their support networks.

Perioperative support for rural and regional patients may include:

• virtual assessments
• phone-based pre-admission clinics
• in-person assessments with local doctor or health care.

The perioperative care team liaises with the primary health network, local doctor or healthcare workers to:

• assist with optimising the patient’s condition prior to surgery
• organise any necessary tests or pre-work.

References

1. South Australia Health. Pre-operative assessment of booked adult elective surgery. SA, Australia: Government of South Australia; 6 Aug 2018 [cited 28 Mar 2024].
2. American College of Surgeons. Optimal perioperative management of the geriatric patient: Best practice guideline from ACS NSQIP/American Geriatrics Society. United States: ACS; 2016 [cited 28 Mar 2024].
3. UpToDate. Nonobstetric surgery in pregnant patients: Patient counseling, surgical considerations, and obstetric management. Massachusetts, USA: UpToDate; 7 Jul 2023 [cited 10 Jan 2024].
4. Australian and New Zealand College of Anaesthetists. PG07(A) Guideline on pre-anaesthesia consultation and patient preparation 2023. Sydney, Australia: ANZCA; 1 Nov 2023 [cited 27 Mar 2024].