The perioperative system: a new approach to managing elective surgery

A Perioperative Service has recently been introduced at liverpool hospital, a 460-bed university teaching hospital. This provides a co-ordinated system for managing all elective surgical patients from the time an admission booked until hospital discharge. This paper describes the patient assessment, structure and staff requirements, benefits of and problems encountered with this service. The patient's preoperative preparation occurs before hospital admission. Where possible, patients are admitted on the day of procedure, either as a day-only patient, or a day-of-surgery patient. Patients are initially admitted to a specifically designed Perioperative Unit, adjacent to the Operating Theatre Suite. Patients do not enter the surgical wards until after their operation. Planning of the hospital discharge process commences at the time of booking for operation. Introduction of the Perioperative Service was staged process commencing in mid-1992. The hospital admits approximately 6,400 elective surgery cases each year. From July 1992 to December 1994, day-only patients were approximately 45% of these cases. Day-of surgery admission patients increased from 6% to 35% of all cases over the same period. Approximately 22% of elective surgical cases were seen in the Perioperative Clinic. As the Perioperative Service became fully operational, the average length of stay for elective surgical procedures fell. There has been a reduction in the areas of cancellations due to unavailability of beds, inappropriate preparation of patients, and non-attendance of patients for booked procedures. Patient acceptance is high. The existence of a perioperative system facilitates the planning and management of elective surgery with maximum quality and efficiency.