Enhanced Perioperative Care
Guidance on Establishing and Delivering Enhanced Perioperative Care Services
Enhanced Perioperative Care (EPC) is a model of care for surgical patients who cannot be optimally cared for in a general ward environment. This guidance is a joint publication with the Faculty of Intensive Care Medicine.
Enhanced Perioperative Care provides the best pathway for patients with monitoring, treatment or care needs which are greater than those provided on normal postoperative wards, but who are not expected to require Level 2 or 3 (critical care) interventions or staffing to meet their care needs. The aim of establishing an EPC service is to improve quality of care and safety for this group of surgical patients.
EPC facilities will also release critical care capacity previously used to support initial postoperative care for such patients; this will lead to a reduction in ‘last minute’ cancellation of inpatient surgery, for which one of the biggest risk factors is requirement for postoperative critical care.
An EPC service can protect surgical capacity during times of increased critical care activity, such as during emergency surges or winter pressures.
EPC is not for patients at immediate risk of deterioration and is not a substitute for or step down from critical care. Instead, it bridges the gap between existing ward and critical care facilities, allowing patients to be managed safely in an appropriate environment dependent on their needs.
Structure of the Guidance
- Patient expectations
- Purpose and structure of an EPC Facility
- Governance structures to inform local guidelines
- Workforce Considerations
- Training and Education
- Monitoring performance and quality improvement
- Estates considerations
- Funding considerations
Enhanced Perioperative Care supports the delivery of holistic, high quality care to surgical patients at increased risk of adverse outcomes. Enhanced care services should provide benefit to patients (reduced likelihood of cancellation and postoperative complications) and to systems (more efficient care, reduced length of hospital stay and reduced pressure on critical care services). Today, in the midst of the COVID-19 pandemic, there are obvious benefits of creating Enhanced Perioperative Care services, to deliver the best quality care, even as Critical Care units are at or above their baseline capacity. However, these services will remain a positive legacy once we have passed through this global crisis – a clinical innovation which will provide enduring benefit to patients and the NHS for years to come.
Enhanced Care Skills Passport
As part of the joint FICM/CPOC Guidance on Establishing and Delivering Enhanced Perioperative Care Services, a means of passporting staff with generic transferrable skills was identified by the working party. A short life-working group led by Dr Michael Bannon, Lead Dean for ICM, developed the initial version.
This suite of multi-professional competencies has been designed to support safe, compassionate and effective care and treatment to Enhanced Care patients. The passport is intended to:
- allow individuals to identify their existing skills and additional learning needs within an evidence based framework.
- allow employers to identify and map the relevant competencies across the different staff groups working within Enhanced Care to ensure patients are able to receive the right care and treatment they require in a timely manner.
It is anticipated that existing educational programmes and training packages within a Trust, Deanery or other Higher Education Institution will be used to support additional skills acquisition required to set up an Enhanced Care service. It is not expected that all individuals working on the EC facility will possess all the competencies, but rather that core elements will be supplemented by additional skills depending on the individual’s role and the needs of the service.
Patients with different clinical conditions will require different treatment plans according to the clinical and operational needs of the Enhanced Care service. Monitoring and therapeutic interventions will therefore vary depending on individual providers.
During the next phase of the COVID-19 pandemic, patients require reassurance that operations will take place in a safe, timely and protected environment. This additional guidance, detailing an Enhanced Perioperative Care pathway, provides a framework that delivers these needs but also lays down principles that support patient surgical care that will have lasting benefits for patients well beyond COVID-19.
We would like to thank the following bodies for their rapid response to and engagement with this initiative under tight deadlines during a time of extreme demand on healthcare services.
- Academy of Medical Royal Colleges Trainee Doctors Group
- Association of Surgeons of Great Britain & Ireland
- British Dietetic Association
- Chartered Society of Physiotherapy
- Faculty of Public Health (CPOC Board member)
- Intensive Care Society
- National Outreach Forum
- NHS England Adult Critical Care Clinical Reference Group
- Royal College of Anaesthetists (CPOC Board member)
- Royal College of Nursing (CPOC Board member)
- Royal College of Occupational Therapists
- Royal College of Physicians (CPOC Board member)
- Royal College of Speech & Language Therapists
- Royal College of Surgeons of England (CPOC Board member)
- UK Clinical Pharmacy Association
Want to find out more and read the full guidance?