Re-designing the pathway to surgery: better care and added value

TLDR

Healthcare system pressures from rising demand and limited resources drive a need for radical pre‑operative pathway redesign, as current late assessments miss opportunities for perioperative physicians to improve care. The study proposes re‑engineering pre‑operative care into a patient‑focused, pathway‑driven model to exploit the missed opportunity for perioperative improvement. The authors review drivers for change and propose strategies such as collaborative decision‑making, behavioural change, targeted comorbidity management, expectation management, psychological preparation, and surgery schools to facilitate early perioperative physician–patient engagement.

Abstract

The case for radical pathway re-design before surgery is in part driven by healthcare system pressures which are in turn the result of continuously rising demand in the face of tightly constrained resources. Such circumstances tend to drive revolutionary, rather than incremental, change. The current approach to preoperative assessment, that typically occurs in the weeks leading up to surgery, but is all too often only a few days before surgery, results in a lost opportunity for perioperative physicians to improve patient care. Re-engineering this process based on a patient-focused, pathway-driven vision of perioperative medicine offers a means of exploiting this opportunity. This review explores drivers for change, the opportunity offered by pathway re-design, and suggests a variety of strategies to add value in the preoperative pathway, each of which is facilitated by early engagement between perioperative physician and patient: collaborative decision-making, collaborative behavioural change, targeted comorbidity management as well as expectation management and psychological preparation for surgery including surgery schools.