The York Model
Innovation and Improvement
Around 12 million operations are performed annually in the UK, of which 15% will be deemed as “high risk.” These high risk patients account for more than 80% of inpatient elective surgical deaths. Fortunately it’s a rarity that a patient will not survive an anaesthetic, the difficulty often begins in the post-operative period when their medical comorbidities take their toll. It is often post-operative infection or myocardial infarction that leads to the post-operative morbidity and mortality we see associated with major surgery.
There has been an increasing drive to involve anaesthetists more in the multidisciplinary care of patients. The Royal College of Anaesthetists have recently developed compulsory training modules in the provision of perioperative care which extends into the post-operative period.
Traditionally the anaesthetist’s involvement has not extended significantly beyond the immediate post-operative period. Following a Health Foundation: Innovating for Improvement grant, a group of anaesthetists and nurse specialists developed a service which aimed to prove a complete anaesthetic-led, physiological review and care plan in the post-operative period. This was to compliment the surgical ward round and to specifically review the physiology of each patient in an attempt to identify derangement at an early stage. For patients who were recovering well it was to promote the principles of Enhanced Recovery, encourage mobilisation and to facilitate early discharge planning. For those patients whose recovery was not going as planned, early invovlement from a specialist team meant that deterioration was identified and rectified early.
As far as we are aware, this is the first time an organisation is known to have introduced such an intensively protocolised approach to the immediate post-operative management of patients. The protocols themselves have been derived from the critical care environment and this innovative approach involves rollowing out advanced treatments and technologies to the ward environment. This is supported with extensive staff training and support to ensure care is delivered safely and effectively.
Following the Health Foundation Grant. York Teaching Hospital Foundation Trust has continued to fund the service. You can read our final health foundation report which provides a summary of the project here.