Dedicated care before and after surgery offers patients a ‘teachable moment’ to improve long term health

Exercise and nutritional support before an operation could reduce the time patients spend recovering in hospital after surgery, according to new report by the Royal College of Anaesthetists (the College).

The report, A teachable moment: delivering perioperative medicine in integrated care systems, showcases a number of innovative and award-winning programmes in hospitals across England that are improving patient care before, during and after surgery.

The time preparing for, undergoing and then recovering from an operation is known as the perioperative period and the College believes that tailored care throughout this time will improve long-term outcomes for patients after surgery.

Professor Ravi Mahajan, President of the Royal College of Anaesthetists said: “Anaesthetists help to care for two in three of all hospital inpatients before, during and after surgery. This is the time when patients are most receptive to taking steps to improve their long-term health, and where we see real opportunity for healthcare professionals across a range of specialties to work with patients to inform decisions that improve their health – this is the teachable moment.

“Every NHS hospital is facing the same challenges as a result of an aging population with increasingly complex healthcare needs. The report identifies examples of best practice already happening, and this is why I believe so strongly that common solutions can emerge from our independent endeavours. What works for a hospital in one part of the country, can provide a blueprint for another to improve the care they provide.

“The best patient care is delivered as a team working collaboratively and we must use the national shift toward integrated care to ensure that we develop pathways of care that utilise everyone’s expertise at the opportune time”.

The College’s report highlights how NHS England’s new integrated care systems (ICSs) can facilitate this wider adoption of perioperative pathways of care. The range of initiatives included in the report address a number of the priorities of the Long Term Plan for the NHS, including cancer recovery, cardiovascular care and paediatric services.

The report focuses on the first-wave of 10 ICSs across England, and is timely, given that the Long Term Plan for the NHS includes an ambition for all of England to be covered by an ICS by April 2021.

In his foreword to the report, Professor Stephen Powis, NHS England’s National Medical Director writes that ensuring a patient is in the best possible condition for their operation, receives high quality care during surgery and is supported through to a full recovery should not be seen as three separate aims.

Instead, every patient’s journey should be along a single, coordinated pathway of care, in which the right services and staff are all involved. This is the central insight that shapes the perioperative approach.

The report looks at a number of initiatives at various stages of the perioperative period, including in preparation for surgery. One of these initiatives is the WESFIT programme that is exploring the benefits of exercise for patients undergoing cancer treatment.

Professor Mike Grocott, Professor of Anaesthesia and Critical Care Medicine at the University of Southampton, whose is part of the team delivering the WESFIT programme, said: “The WESFIT programme is about ensuring that patients have the best chance of returning to a good or even improved quality of life after their cancer treatment.

“Surgery is part of the primary treatment for approximately half of all cancer cases so the impact that WESFIT and other perioperative initiatives could offer is really substantial”.

“A move towards integrated, perioperative medicine demands a more expansive definition for what we recognise as the care of patients having surgery. For example, if exercise beforehand improves a patients’ condition after surgery, then why shouldn’t we see exercise as a key component of that surgery”.

In May 2019, the College will launch a new Centre for Perioperative Care (CPOC) bringing together a range of healthcare professionals with representatives from a number of Medical Royal Colleges, including surgeons, GPs, physicians and nurses. CPOC will be a vehicle to develop and share best practice in perioperative care across the NHS and internationally that contributes to improvements in patient care and safety.