Department of Theatres, Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Division of Surgery and Interventional Science, University College London, London, UK.
Anaesthesia. 2020 Jan;75 Suppl 1:e46-e53. doi: 10.1111/anae.14910.
The increasing age and subsequent medical complexity of patients presenting for surgery grants the opportunity to examine the processes and delivery of peri-operative care. There is a need to redesign peri-operative pathways allowing room for shared decision making and personalised, evidence-based care. In times of financial constraint, this is no easy task. However, neglecting to transform services now may lead to challenges in the sustainability of the provision of peri-operative care in the long-term. Challenges in redesigning peri-operative care pathways include identification and optimisation of those at highest peri-operative risk to inform the difficult conversations surrounding the appropriateness of surgery. The moral burden of these conversations on patient and professionals alike is increasingly recognised and managing this issue requires innovative models of collaborative, multidisciplinary and interprofessional working. To operate or not can be a challenging question to answer with a number of different perspectives to consider; not least that of the patient.
随着接受手术治疗的患者年龄不断增长和医疗复杂性不断增加，为我们提供了一个审视围手术期护理流程和服务提供的机会。我们需要重新设计围手术期路径，为共同决策和个性化、基于证据的护理留出空间。在财政紧缩时期，这并非易事。然而，如果现在不进行服务转型，可能会导致长期围手术期护理服务的可持续性面临挑战。重新设计围手术期护理路径的挑战包括识别和优化那些处于最高围手术期风险的患者，以进行围绕手术适宜性的艰难对话。围绕手术的适宜性进行艰难对话，无论是对患者还是对专业人员来说，其道德负担都越来越大，而管理这一问题需要具有创新性的协作式、多学科和跨专业工作模式。进行手术与否可能是一个具有挑战性的问题，需要考虑许多不同的观点；而患者的观点是最不容忽视的。
