INTRODUCTION
Having an operation is a major event in a patient’s life. Many will have had limited previous exposure to hospitals. There is much patients can do to improve their physical and mental health prior to surgery that can have a significant impact on their recovery and long-term health. Understanding the steps they can take can empower patients to make lasting changes.
Fitter, Better, Sooner is a toolkit aimed at helping patients to prepare physically and psychologically for surgery (Figure 1). It was produced by the Royal College of Anaesthetists (RCoA), with representatives from the Royal College of General Practitioners (RCGP) and the Royal College of Surgeons (RCS), and with patient representatives playing key roles on the working group, reflecting the importance of multidisciplinary input for optimal perioperative care. The resources have been endorsed by both the RCGP and RCS, and have been awarded ‘highly commended’ in the BMA Patient Information Awards 2019.
Fitter, Better, Sooner patient information resources.
https://www.rcoa.ac.uk/patient-information/ preparing-surgery-fitter-better-sooner.
© Royal College of Anaesthetists.
The toolkit is intended for patients who are awaiting, or considering, surgery. It introduces the many ways in which they can optimise their health, lifestyle, and activity levels to maximise their chances of a good recovery, free of complications. It informs patients about the perioperative pathway, so they better know what to expect and to feel more in control, which in turn reduces anxiety. It also deals with the practicalities and benefits of actively planning, both for an admission to hospital and for their recovery at home.
The toolkit comprises:
an electronic leaflet;
an animation for showing on screens in waiting rooms or on portable electronic devices; and
six procedure-specific leaflets covering some of the most common operations in the UK (cataract surgery, hysteroscopy, cystoscopy, hernia, knee arthroscopy, and total knee replacement.)
The above resources, as well as helpful resources for healthcare professionals including posters and stickers to advertise the resources to patients, can be viewed at https://www.rcoa.ac.uk/patient-information/preparing-surgery-fitter-better-sooner.
An important consideration in developing the toolkit is that patients today are beginning to move forward from a passive role, seeing medical treatment as something ‘done to them’, to a more active role managing their own health. This can be particularly effective in the run-up to surgery where shared decision making can reduce anxiety, improve adherence to treatment plans, and increase patient satisfaction.
There are many resources available to patients online, but patients may struggle to find well-written and accurate resources in one place specific to NHS care. These resources have been produced using data from the first Sprint National Anaesthesia Project,1 which evaluated patient-centred outcomes on over 15 000 NHS patients undergoing surgery.
SUPPORTING PATIENTS TO IMPROVE THEIR CHANCES OF A GOOD SURGICAL OUTCOME
The most common complications after surgery include wound complications and infections (surgical site and lung). There is a clear relationship between poor cardiorespiratory fitness and developing postoperative complications. This is why research is currently focusing on the impact of an increase in physical activity preoperatively on recovery from surgery. Not all patients will be able to do this, but it is known that the gains are greatest with modest increases in physical activity. Maintaining alcohol consumption within recommended limits improves wound healing. Smoking cessation can reduce several perioperative complications2 including, cardiac, respiratory, wound, and infectious adverse events. Preoperative anaemia is associated with both short-term morbidity and mortality after major surgery,3 and also an increased risk of blood transfusion, which is associated with poorer long-term outcomes in cancer surgery.4 Poorly controlled diabetes mellitus (HbA1C >65 mmol/mol or 8.5%) is associated with postoperative harm including wound complications and infections.5 Hypertension should be controlled to reduce the risk of perioperative cardiovascular instability and postoperative cardiovascular and neurological events.6
WORKING TOGETHER TO IMPROVE PATIENT OUTCOMES
The Centre for Perioperative Care (CPOC) was launched in May 2019 and is a cross-organisational, multidisciplinary initiative led by the RCoA to facilitate more cohesive work and research on perioperative care for patient benefit. The RCGP is a key partner of this group. Perioperative medicine refers to the practice of patient-centred, multidisciplinary, and integrated medical care from contemplation of surgery until full recovery. Good perioperative care should improve the health of the individual (including returning to home/work and a quality of life similar to or even better than before surgery), provide a good patient experience of care, improve the health of populations, and provide value for the system as a whole. It is in the interests of all members of the perioperative team to have informed, motivated, and empowered patients. By providing information and signposting resources as early as the point of referral for surgery, or during initial discussions with GPs combined with local social prescribing initiatives, the use of time available for optimisation can be maximised, particularly for patients who have long waits for surgery.
HOW CAN GPS USE THESE RESOURCES IN THEIR SURGERIES?
Although anaesthetists and pre-assessment nurses are already successfully using these resources in pre-assessment clinics, currently there is little information for patients to read in GP surgeries on preoperative optimisation. Surgeries can display the leaflets or play the Fitter, Better, Sooner animation as a rolling loop on their screens in waiting areas. The RCoA website also offers a range of Fitter, Better, Sooner materials, including posters, flyers, and stickers to signpost the resources to patients. Many patients will merely need these resources signposting by a respected nurse or GP. Simply ‘Googling’ Fitter, Better, Sooner will also allow patients to find these resources.
Sharing these resources with relatives and carers will help them understand the patient journey and equip them to provide much needed practical and psychological support to their loved ones.
WHAT IS THE IMPACT FOR GPS?
It is known that surgery is a powerful positive stimulus to help drive conscious change in health-related behaviours and activities. The reality is that well-motivated patients may attend the surgery for advice about their health, activity, and lifestyle. Surgeries can anticipate this and help signpost the many practical resources and organisations available within their community. It is hoped that in turn GPs will be ‘rewarded’ by patients having fewer complications and fewer visits to their GP postoperatively, as well as long-term improvements to the health of their patients and their communities.
Notes
Funding
None.
Provenance
Freely submitted; externally peer reviewed.
Competing interests
The authors have declared no competing interests.
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- Received September 12, 2019.
- Revision requested November 1, 2019.
- Accepted November 25, 2019.
- © British Journal of General Practice 2020
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