PE R IOPE RAT IVE PRACT ICE


opportunities for programme development, networking and clarification together with patient involvement and education as well as staff education are all evidence-based factors. Leadership was also described as an important facilitating factor particularly the presence of a ‘clinical champion’ is central to success. The multi-modal approach requires diverse professional groups to collaborate across differing disciplines and suggests that several different champions may be required to drive progress forward. Challenges included Individual- level resistance, overcoming traditional perceptions of perioperative care, a lack of resources in terms of staffing, space and time, gaining buy-in from others, sustaining this engagement and maintaining implementation post-project. The CPOC project leads might well spend some time understanding the challenges identified in this study. It might save them a great deal of time and energy. The study recognises that ERAS is a complex set of interventions which require leadership and support from a number of different stakeholders. It will be of great interest to watch the progress that the Centre for Perioperative Care makes as it negotiates this complex set of activities.


Conclusion


What seems to be clear is that pathways which involve many different healthcare professionals working with the patient, are the way forward. The pre-assessment clinic must be the first obvious way to take the patient’s views into account and delivering education for the pathway; although some pathways take a step further back and identify inclusion by the patient’s GPs on effective preparation for surgery by


AUGUST 2020


encouraging patients to tackle their poor lifestyle choices, before they attend hospital. It should be noted that clear


communication to the patient about how they may self help and education regarding their surgery and post-operative recovery is essential at the pre-assessment stage, if not before. Pre-surgery school is a not uncommon event prior to surgery – particularly in musculoskeletal surgery, and certainly provides patients an awareness of all the expectations the teams have for them, as well as providing opportunities for useful input by the patients themselves. There is no doubt that in the post-COVID era, we will have a need to be effective and efficient with the surgical pathway. There is huge pent-up demand for resuming surgery as soon as possible. One study suggests that the pandemic has led to the cancellation of an estimated 516,000 surgeries, including 36,000 cancer procedures8


while additional


research suggests the NHS treatment backlog could reach 10 million later this year.9


There is no doubt that good communication and teamwork, as well as patient-centred pathways, which are evidenced based would provide the best mechanism for effective surgical care. Engagement of patients, who have been waiting, is even more important to their recovery and satisfactory outcomes; it is to be hoped that we can deliver this effectively using whichever chosen pathway.


2 Greenshields N., Mythen M. 2020 Current Anesthesiology Reports. Enhanced Recovery after Surgery (2020) 10: 49-55 Accessed at https://link. springer.com/content/pdf/10.1007/s40140-020- 00372-y.pdf


3 NHS Confederation. 2004 Variation in healthcare. Does it matter and can anything be done? Accessed at https://www.nhsconfed.org/-/media/ confederation/files/publications/documents/ variation-in-healthcare.pdf


4 Perioperative quality improvement programme. Annual report 2018/19 Accessed at https:// pqip.org.uk/FilesUploaded/PQIP%20Annual%20 Report%202018-19.pdf


5 Intestinal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. World J Surg 44, 2482–2492 (2020). Accessed at https:// doi.org/10.1007/s00268-020-05530-1


6 Centre for Perioperative Care. A teachable moment: delivering perioperative medicine in integrated care systems 2019 https://cpoc.org.uk/sites/cpoc/ files/documents/2019-11/Integrated%20Care%20 Systems%202019.pdf


7 Herbert, G., Sutton E. ,Burden S et al BMC Health Services Research (2017) Healthcare professionals’ views of the enhanced recovery after surgery programme: a qualitative investigation. Accessed at https://bmchealthservres. biomedcentral.com/track/pdf/10.1186/s12913- 017-2547-y


CSJ


References 1 NHS Improvement. ACT Academy. Quality, Service Improvement and Redesign Tools enhanced recovery. Accessed at https://improvement.nhs.uk/ documents/2111/enhanced-recovery.pdf


8 BJSS Journals Elective surgery cancellations due to the COVID ‐19 pandemic: global predictive modelling to inform surgical recovery plans. May 2020 Accessed at https://bjssjournals.onlinelibrary. wiley.com/doi/full/10.1002/bjs.11746


9 Independent. NHS on life support: Up to one in six will be on waiting lists as health service turns to private hospitals. 6 June 2020 Accessed at https://www.independent.co.uk/news/health/ coronavirus-nhs-waiting-times-surgery- privatisation-a9550831.html


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