Four new checklists for its Strong for Surgery Program

Surgical teams now have four new tools to help them improve outcomes for their patients in the form of screening checklists from the American College of Surgeons (ACS) Strong for Surgery program (S4S). The four common risk areas targeted in the new checklists address these issues:

 

Delirium

The recognition and treatment of delirium is critically important because postoperative delirium is associated with poor outcomes including functional decline, longer hospitalization, institutionalization, greater costs, and higher mortality. Studies have shown that age, alcohol abuse, poor cognitive and physical functioning, and abnormal laboratory values have been associated with delirium. High-risk patients identified for exhibiting some of the risk criteria can be candidates for interventions designed to prevent or reduce the impact of postoperative delirium.

 

Prehabilitation

Cognitive, gait, balance, and nutritional and functional impairments place patients at higher risk of perioperative and postoperative complications. Prehabilitation is an opportunity to help patients return quickly to the highest level of functioning possible after operation, thereby reducing surgeryrelated morbidity and/or mortality, decreasing the length of stay in hospital and rehabilitation, and reducing readmissions.

 

Pain Management

Unrelieved pain can result in longer hospital stays, increased rate of readmission, increased outpatient visits, and decreased ability to function fully. To ensure safe, effective pain management after the surgical procedure, it is recommended that patients receive counselling prior to their operations about pain management options. Presurgery counselling with patients that involves expectation setting, potential adverse effects, and the use of non-prescribed medication for pain relief can help patients set realistic goals for recovery.

 

Patient Directives

An important aspect of patient safety is patient education. Patient education before surgery helps minimize presurgery anxiety related to the operation itself. During this time, discussion referencing the financial burden, post-procedure pain, surgical risks and the necessity of the procedure are also important. The patient should feel supported in the preoperative period and should be encouraged to express his or her feelings about the surgical experience.

Checklists, which are the cornerstone of S4S, are integrated into the preoperative phase of clinical practice for elective operations by surgeons and surgical staff. By screening patients for potential risk factors that can lead to surgical complications, these checklists open the door for appropriate interventions to ensure better outcomes for patients. Global research has shown that use of a checklist improves patient optimization for an operation and helps ensure that important aspects of care are followed for each case.

"Strong for Surgery brings a well-researched presurgery checklist to surgeons' offices to help with patient education, communication, and standardization of best practices to improve clinical outcomes.  A patient's risk of negative outcomes from an operation can be improved by using best practices to prepare them for an operation, and we're starting to see study results where these checklists have helped to do just that," said Dr. Varghese.

 

American College of Surgeon
www.facs.org/media/press-releases/2018/s4schecklists112918