Enhancing Surgical Care in BC - British Columbia Medical Association


Enhancing Surgical Care in BC - British Columbia Medical Association

Part 1: Working with the Perioperative Process

I. An Overview of the Perioperative Process

The perioperative system involves both the operating room and the entire system that supports it. For the purpose

of this paper, the perioperative portion of a patient’s surgical care begins once a decision has been made for a patient

to undergo surgery. During the preoperative phase, the surgeon and hospital prepare the patient and the resources

required to deliver the surgical care. This is followed by the operative phase, when surgery is performed in the

operating room. The postoperative phase is the period after surgery is completed, and includes patient recovery and

discharge from hospital. (Exhibit 1 illustrates the perioperative process.)

From the patient’s perspective, the journey through each phase of surgical care should flow seamlessly. However, many

factors along the continuum of patient care can affect surgical quality and efficiency, as well as the patient’s overall

experience. These factors, along with initiatives to improve the overall perioperative process, are discussed below.

Exhibit 1. The Perioperative Process

Decision for


Discharge from




Recovery in


Scheduling of

surgical case



II. Defining Perioperative Efficiency and Quality




Preparation of

patient, staff, and


Admission to


Archer and Marcario (2006) explain that the definition of perioperative efficiency depends on perspective. The various

perspectives of the organization, provider, and patient regarding efficiency include:

• Scheduling efficiency (optimizing resources assigned to the operating room).

• Financial efficiency (reducing cost per case).

• Operational efficiency (overall system efficiency, which requires work process redesign).

• Practitioner-centred efficiency (maximizing surgical cases that can be performed).

• Patient-centred efficiency (providing interventions only when necessary, and providing a smooth patient flow

with no unnecessary waiting).

The Institute of Medicine describes quality in health care as having six domains (safe, effective, patient-centred, timely,

efficient and equitable), whereby efficiency is one domain of quality (Committee on Quality of Health Care in America,

2001). The objectives of achieving efficiency and quality are complementary: increased efficiency results in higher

quality, and higher quality can result in greater efficiency. For example, when processes are standardized (efficiency),

the potential for variation and errors is reduced (quality) (Haynes et al., 2009). When the potential for postsurgical

Enhancing Surgical Care in BC – Part 1: Working with the Perioperative Process 6

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