Perioperative Service Improvement

The ‘Perioperative System’, ‘Perioperative Model of Care’, or the ‘Perioperative Surgical Home’ is a new approach to the organisation and management of procedural healthcare in the hospital setting.  Implementation of this changed system is difficult.   Much of the material to assist this change is scattered in diverse sources or not in mainstream peer-reviewed journals etc.

This section of the website contains papers and presentations that may be of interest to clinicians working in an organisational role in Perioperative Medicine. Some of the papers duplicate information presented in other papers on the site.  It is hoped that this material will be of use to anyone wishing to improve the performance of their Perioperative Service.

Further contributions or comments would be welcome, and may be sent to

  • The New South Wales Department of Health produced a ‘Toolkit’ to assist establishment of preprocedural services in 2007.  It is currently being updated, but the original version contains useful resources.    NSW Health Preprocedure Prep Toolkit.

On the 8th of November the NSW Agency for Clinic Innovation held a state-wide workshop in Sydney focusing on Perioperative Services. Representatives of Perioperative Services from across the state were invited to take part, and share ideas.

The day was also the launch of the draft Perioperative Toolkit, which incorporates a great deal of resources around principles underlying organisation of perioperative services. The Toolkit is a re draft of the previous Pre-Procedure Preparation Toolkit, published in 2007.  Apart from being updated, the Toolkit incorporates an increasing focus on the entire perioperative journey, including the postoperative phase. As well as the Toolkit there is a draft self-assessment checklist to allow hospitals to assess the features of their pre-admission process. Although these resources are specifically designed for the public NSW Health System, they are a useful resource for anywhere, and provide an interesting contrast to similar resources being produced by the College of Anaesthetists and the NHS in Britain, and by the Perioperative Surgical Home initiative of the American Society of Anaesthesiologists.

A recent report (2016) from Vanderbilt Hospital on the implementation of a Perioperative Service/ERAS model of care. Importantly, the results showed an improvement from a high baseline (i.e. the hospital was already in the best 20% of similar hospitals nationally).  Perioperative Service Introduction – Vanderbilt 2016

  • In 2015, the Royal College of Anaesthetists (UK) produced a report for a broad health audience outlining the advantages of the ‘Perioperative Medicine’ model of care.    Perioperative Medicine

‘The Perioperative Surgical Home’.  This report was commissioned by the American Society of Anaesthesiologists in 2014.  It contains a very extensive literature and summary of available evidence about organisational issues.  Particularly useful as it includes the ‘grey literature’ outside of conventional peer-reviewed journals.   PSH Literature Review

Material authored by Ross Kerridge (one of the Advisory Committee of this site)

  • The Challenge of implementing ‘new’ perioperative systems   A book chapter from 2009, containing general reflections and advice on organisational and system change issues concerning the Perioperative Model of Care.
  • ‘Changing the Perioperative Process’ – A review of the Evidence  A Chapter from 2009. In the current era of Evidence-Based Medicine, it can be difficult to find definitive ‘scientific evidence’ to support a system/organisational change.  This ‘flaw’ in the EBM paradigm has been discussed by Sackett and others.  Presenting the information that is available in a quality framework can be useful way of dealing with the call for evidence.