The perioperative system: a new approach to managing elective surgery

Area of Science:

• Healthcare Management
• Surgical Services
• Patient Care Coordination

Background:

• Liverpool Hospital, a 460-bed university teaching hospital, introduced a Perioperative Service.
• This service aims to provide a coordinated system for managing elective surgical patients.
• The service covers the entire patient journey from booking to discharge.

Purpose of the Study:

• To describe the patient assessment, structure, and staff requirements of the Perioperative Service.
• To evaluate the benefits and challenges encountered with the new service.
• To analyze the impact of the Perioperative Service on patient flow and resource utilization.

Main Methods:

• Preoperative preparation before hospital admission.
• Admission on the day of procedure (day-only or day-of-surgery).
• Initial admission to a dedicated Perioperative Unit adjacent to the Operating Theatre Suite.
• Discharge planning initiated at the time of booking.

Main Results:

• Day-only patients constituted approximately 45% of cases; day-of-surgery admissions increased from 6% to 35% between July 1992 and December 1994.
• Approximately 22% of elective surgical cases were managed through the Perioperative Clinic.
• The average length of stay for elective surgical procedures decreased after the service became fully operational.
• Reductions observed in cancellations due to bed unavailability, inadequate patient preparation, and non-attendance.
• High patient acceptance rates.

Conclusions:

• The Perioperative Service facilitates efficient planning and management of elective surgery.
• The coordinated system enhances quality of care and operational efficiency.
• The service model demonstrates significant improvements in patient throughput and resource management.