Enhanced Perioperative Care

Enhanced Perioperative Care (EPC) is a model of care for surgical patients who cannot be optimally cared for in a general ward environment. This guidance, a joint publication between the FICM and the Centre for Perioperative Care (CPOC), provides a framework to support and facilitate the development and delivery of an EPC service.

Enhanced Perioperative Care provides the best pathway for patients with monitoring, treatment or care needs which are greater than those provided on normal postoperative wards, but who are not expected to require Level 2 or 3 (critical care) interventions or staffing to meet their care needs. The aim of establishing an EPC service is to improve quality of care and safety for this group of surgical patients.

EPC facilities will also release critical care capacity previously used to support initial postoperative care for such patients; this will lead to a reduction in ‘last minute’ cancellation of inpatient surgery, for which one of the biggest risk factors is requirement for postoperative critical care. 

An EPC service can protect surgical capacity during times of increased critical care activity, such as during emergency surges or winter pressures.

EPC is not for patients at immediate risk of deterioration and is not a substitute for or step down from critical care. Instead, it bridges the gap between existing ward and critical care facilities, allowing patients to be managed safely in an appropriate environment dependent on their needs.

Enhanced Care Skills Passport

As part of the joint FICM/CPOC Guidance on Establishing and Delivering Enhanced Perioperative Care Services, a means of passporting staff with generic transferrable skills was identified by the working party. A short life-working group led by Dr Michael Bannon, Lead Dean for ICM, developed the initial version.

This suite of multi-professional competencies has been designed to support safe, compassionate and effective care and treatment to Enhanced Care patients. The passport is intended to:

• allow individuals to identify their existing skills and additional learning needs within an evidence based framework.
• allow employers to identify and map the relevant competencies across the different staff groups working within Enhanced Care to ensure patients are able to receive the right care and treatment they require in a timely manner.

It is anticipated that existing educational programmes and training packages within a Trust, Deanery or other Higher Education Institution will be used to support additional skills acquisition required to set up an Enhanced Care service. It is not expected that all individuals working on the EC facility will possess all the competencies, but rather that core elements will be supplemented by additional skills depending on the individual’s role and the needs of the service.

Patients with different clinical conditions will require different treatment plans according to the clinical and operational needs of the Enhanced Care service. Monitoring and therapeutic interventions will therefore vary depending on individual providers.