GP Clinical Update: Meet the Perioperative Anaesthetists – ensuring patients are fit for surgery and helping to optimising where possible.

The Royal Hobart Hospital have recently established a high risk preassessment clinic for medically complex patients in order to optimise their perioperative care plan.

This session is an opportunity to open the conversation between Anaesthetists and GP colleagues surrounding perioperative care plans for patients. This event will utilise the perioperative care plan framework in discussing risk assessment, medical fitness for surgery, and managing patient expectations when coming to a shared decision about surgical intervention for medically complex patients in this setting.

The session will cover:

1. What to consider when determining medical fitness for surgery
2. Strategies for improving medical fitness for surgery
3. Challenges, setting expectations, having difficult conversations
4. High risk preassessment clinic introduction including the perioperative care framework (from ANZCA)

As part of this session participants can expect to achieve the following learning outcomes:

1. Understand the co-morbidities that contribute to surgical risk, recovery, and adverse outcomes
2. Understand pre-admission guidelines to stabilise or optimise preoperative health problems
3. Determine ways to best communicate and educate patients and their carers about surgical risk and fitness for surgery

Dr Tracy-Lee Jansen is an anaesthetic consultant and co-lead for PAC at the RHH with an interest in perioperative medicine. She has completed the Monash university Masters of perioperative medicine as well as a periop medicine fellowship at Fiona Stanley Hospital in Perth. She most recently came to the Royal Hobart Hospital from New Zealand and has worked on various preassessment clinic projects such as optimising older patients for surgery (working with geriatrics) and a lifestyle optimisation project which combined rehabilitation with modifying lifestyle behaviours to optimise patient outcomes.

Dr David Alcock  is an anaesthetic consultant and co-lead for PAC at the RHH.  He completed the Monash University Masters of perioperative medicine in 2018, a fellowship in perioperative medicine and Cardiopulmonary exercise testing at University Hospital Geelong in 2015 as well as a cardiothoracic fellowship in 2016.  He was the anaesthetic representative in the multi-disciplinary ANZCA working groups that developed a definition of perioperative and the perioperative medicine frame work document for Australia and New Zealand and currently a member of the curriculum re-writing group for the ANZCA Diploma of Perioperative Medicine.

The Anaesthetic Pre-Admission Clinic is used for selected surgical patients. This aims to enhance perioperative management maximizing the individual’s physiological function and minimizing perioperative morbidity and mortality.

The function of the Anaesthetic Pre-Admission Clinic is six-fold.

1. To obtain pertinent information about a patient’s medical history and physical/medical condition(s) in order to identify particular at-risk individuals and thereby determine what preoperative investigation and/or consultation/referrals are required to maximize the individual’s physiological function.
2. To optimize patients physiological and psychological function/status perioperatively.
3. Generate an anaesthetic plan for the patient on the basis of their physical state and the nature of their proposed surgery.
4. To obtain informed consent for anaesthesia.
5. To educate the patient about anaesthesia, perioperative care and analgesia in order to reduce anxiety and facilitate recovery.
6. To make perioperative care more efficient and less expensive.

Recently Dr Jansen and Dr Alcock started a High Risk preassessment clinic. This is a clinic where more complex patients are seen. They hope to be able to assess these patients with more time prior to surgery so that their conditions could be optimised if possible and to facilitate referral to other specialities for advice. It allows for time to be spent having conversations about what is important to the patient, goals of surgery as well as risk discussions. This can assist with shared decision making as well as goals of care setting.

Suggested pre-reading:

1. An interactive infographic of the POM framework ANZCA | Our Perioperative Care Framework
2. Supporting document to the frame work The-Perioperative-Care-Framework-document (anzca.edu.au)  (the exec summary is consumable in <10min), pdf attached

Limited spaces are available for this face to face session.