Referrals to the clinic
An important part of the Pre-Operative Assessment process involves identifying which patients who should be seen in person at the clinic. Ideally, patients would undergo a basic screening in order to decide if there are any indications for an in-person assessment. Given the limitations on information exchange that are inherent in the current medical ecosystem, a simplified approach has been taken to ensure that at-risk patients are seen in the clinic.
Current triage criteria involve a combination of the patient’s age and the severity of the surgical procedure, and are outlined in more detail below.
Patient Age
After a review of guidelines relating to the risk of cardiovascular, pulmonary, and functional complications1–4, an age of 60 years old has been selected as the threshold for automatic assessment of patients undergoing certain surgical procedures.
Surgical severity
A comprehensive review was undertaken to update the classification of surgical procedures that are performed electively in The Beacon Hospital. In line with work by the Surgical OUtcomes Resource CEntre5 (SOuRCe), The Clinical Coding & Schedule Development Group, and with minor amendments to account for local variation, procedures have been classified into the following groups:
- Minor
- Intermediate
- Major
- Major+/Complex
Overall triage process
When patients are added to the list of operations that are planned, the table below shows who should be referred to POAC. If the surgical consultant has other specific concerns then the patient can be referred at their discretion.
| Surgical severity | Action |
|---|---|
| Minor | POAC not indicated |
| Intermediate | POAC indicated if >60 years old |
| Major | POAC indicated |
| Major+/Complex | POAC indicated |
Timing of assessments
Patients should be assessed at least seven days prior to their elective procedures. In the case of surgery that is for urgent indications this will not always be achievable.
An assessment at the POAC will remain valid for a period of six months, as long as there has been no material change in the medical status of the patient in that period.