{"id":46857,"date":"2020-03-13T16:14:51","date_gmt":"2020-03-13T15:14:51","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=46857"},"modified":"2020-03-13T16:14:51","modified_gmt":"2020-03-13T15:14:51","slug":"the-perioperative-solution-to-integrated-care","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/03\/13\/the-perioperative-solution-to-integrated-care\/","title":{"rendered":"The perioperative solution to integrated care"},"content":{"rendered":"<p><span style=\"font-weight: 400\">In early 2020, the Royal College of Anaesthetists (RCoA) asked 2,500 members across the UK to predict the future of surgical care. Almost two-thirds (63%) told us that over the next two decades, by 2040, the surgical team will look and work very differently.<\/span><span style=\"font-weight: 400\">\u00a0[1]<\/span><\/p>\n<p><span style=\"font-weight: 400\">Driving this transformation are 250,000 high-risk surgical patients with increasingly complex needs\u2014patients needing extra care each year to give them the best chance of recovery. Yet, today, their care is often designed around a specific operation or disease, not their individual or unique need. In some ways, it\u2019s easy to understand why.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Yet this approach is associated with substantial, and avoidable, increases in length of hospital stay and postoperative complications; and avoidable demand for primary and outpatient care, hospital readmissions, prolonged ill health, delayed return to work, reduced quality of life and shortened life expectancy. Not the best outcome for the patient or the NHS.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Ensuring a patient is in the best or optimal condition for their operation, receives high-quality care during surgery, and is supported to full recovery shouldn\u2019t be three separate aims. Every patient\u2019s journey should be along a coordinated pathway delivering the right services in a co-ordinated and logical way with primary, secondary and community care staff are all involved\u2014providing patient focussed, high-quality care with better outcomes, better experiences, and more efficient use of resources.<\/span><\/p>\n<p><span style=\"font-weight: 400\">This is the <\/span><i><span style=\"font-weight: 400\">perioperative<\/span><\/i><span style=\"font-weight: 400\"> approach\u2014patients empowered through shared decision-making and personalised care, with clinicians and professionals across the system working together. It\u2019s an approach that starts with getting fit for the stress of surgery or &#8220;rehabilitation,&#8221; a &#8220;teachable moment&#8221; set in a framework of screening, assessment, and promoting healthy behaviours through prescribing exercise, nutrition, and psychological interventions. And, it\u2019s an approach already <\/span><a href=\"https:\/\/www.erasplus.co.uk\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400\">cutting post-operative complications and mortality by 50%<\/span><\/a><span style=\"font-weight: 400\">, reducing length of stay, enhancing postoperative recovery, and increasing capacity for current and predicted demand.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">High quality perioperative care is dependent on seamless communication and collaboration across primary and secondary care and the social care sector, to identify the needs of communities and adapt services\u2014improving population health while reducing costs. Getting it right offers a solution to the integration challenge. Steve Powis, NHS England\u2019s National Medical Director, has encouraged \u201c<\/span><a href=\"https:\/\/www.rcoa.ac.uk\/sites\/default\/files\/documents\/2019-07\/IntegratedCareSystems2019.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400\">all system leaders within an Integrated Care System\u2026to consider how a perioperative care approach could improve patient care in their area<\/span><\/a><span style=\"font-weight: 400\">\u201d.<\/span><\/p>\n<p><a href=\"https:\/\/www.kingsfund.org.uk\/publications\/making-sense-integrated-care-systems\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400\">Integrated care means breaking traditional barriers between hospitals, GP practices, community services and social care.<\/span><\/a><span style=\"font-weight: 400\"> It means working effectively with local government, private and voluntary-sector organisations on the determinants of health. It means supporting primary, secondary and community services to build multidisciplinary teams. It means developing clear local population data to help reduce inequalities in health<\/span><span style=\"font-weight: 400\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Encouragingly, 40% of our members feel we\u2019re now already <\/span><span style=\"font-weight: 400\">moving towards effective person-centred care for people with complex needs, based on multidisciplinary working.<\/span><span style=\"font-weight: 400\"> In fact, nearly a quarter are telling us that they\u2019re <\/span><span style=\"font-weight: 400\">already working as <\/span><span style=\"font-weight: 400\">part of multidisciplinary perioperative care teams across primary, secondary and community care settings.<\/span><span style=\"font-weight: 400\"> Yet, while the NHS long term plan aims to deliver coordinated care to improve outcomes and the patient experience, it doesn\u2019t once mention perioperative care.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">In turn, few models of integrated care have seized the potential of perioperative care to reshape services to transform the lives of surgical patients\u2014and to build the vital bridge between secondary, surgical, care, and primary, community and social care. <\/span><a href=\"https:\/\/gettingitrightfirsttime.co.uk\/girft-reports\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400\">Getting it Right First Time reviews<\/span><\/a><span style=\"font-weight: 400\"> are demonstrating wide variation in the establishment of services.<\/span><span style=\"font-weight: 400\"> Perioperative care isn\u2019t about re-inventing the wheel. It\u2019s about using the skills and resources that already exist and working differently to provide an optimised, integrated, pathway for surgical patients.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">If we can shift the dial even just a fraction in the right direction over the lifetime of the NHS long term plan, and those of newly forming Integrated Care Systems, towards a perioperative approach, we could have a hugely positive impact on the lives of our patients. We can transform short and long term quality of patient care and outcomes to improve safety, clinical effectiveness, patient focus and efficiency. We can reduce demand on the NHS, \u2018level up\u2019 the public\u2019s health and elevate the productivity of the UK economy.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Our 2040 vision is of an integrated care pathway fully embedding perioperative care.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\">To coincide with <\/span><a href=\"https:\/\/www.england.nhs.uk\/integratedcare\/events\/integrated-care-in-action\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400\">NHS England\u2019s Integrated Care in Action Week<\/span><\/a><span style=\"font-weight: 400\">, the <\/span><a href=\"https:\/\/cpoc.org.uk\/about-cpoc\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400\">Centre for Perioperative Care<\/span><\/a><span style=\"font-weight: 400\">, a cross-specialty initiative led by the RCoA, has launched a new programme to address the integration challenge. Find out more, and get involved, <\/span><a href=\"https:\/\/cpoc.org.uk\/about-cpoc\/cpoc-policy\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400\">here<\/span><span style=\"font-weight: 400\">.<\/span><\/a><\/em><\/p>\n<p><em><b>David Selwyn<\/b>, Director of the Centre for Perioperative Care and Medical Director for Sherwood Forest Hospitals NHS Foundation Trust<\/em><\/p>\n<p><em><b>Mark Weiss<\/b>, Head of Policy and Public Affairs, Royal College of Anaesthetists<\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: None declared<\/em><\/p>\n<p>[1]\u00a0<span style=\"font-weight: 400\">RCoA Workforce Survey, March 2020<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In early 2020, the Royal College of Anaesthetists (RCoA) asked 2,500 members across the UK to predict the future of surgical care. Almost two-thirds (63%) told us that over the [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/03\/13\/the-perioperative-solution-to-integrated-care\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":45350,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-46857","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The perioperative solution to integrated care - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/03\/13\/the-perioperative-solution-to-integrated-care\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The perioperative solution to integrated care - The BMJ\" \/>\n<meta property=\"og:description\" content=\"In early 2020, the Royal College of Anaesthetists (RCoA) asked 2,500 members across the UK to predict the future of surgical care. 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