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Smart digital technologies are rapidly transforming perioperative care through tools such as clinical decision support systems, wearable sensors, and electronic checklists. Despite growing adoption, their specific impact on patient safety in the operating room remains insufficiently understood. This narrative review, published in the journal Patient Safety in Surgery, explores recent advancements in perioperative digital health and examines how innovations like AI-assisted systems, electronic WHO checklists, and physiological monitoring wearables contribute to safer surgical care. The evidence suggests that these tools can enhance complication detection, protocol adherence, and team communication. However, their effectiveness is tempered by challenges including alert fatigue, fragmented data systems, and added digital workload for healthcare staff.

Whole-body bathing or showering with a skin antiseptic to prevent surgical site infections (SSI) is a usual practice before surgery in settings where it is affordable. The aim is to make the skin as clean as possible by removing transient flora and some resident flora. Several organisations have issued recommendations regarding preoperative bathing. The care bundles proposed by the United Kingdom (UK) High impact intervention initiative and Health Protection Scotland recommend bathing with soap prior to surgery. The Royal College of Surgeons of Ireland recommends bathing on the day of surgery or before the procedure with soap . The USA Institute of Healthcare Improvement bundle for hip and knee arthroplasty recommends preoperative bathing with CHG soap. Finally, the UK-based National Institute for Health and Care Excellence (NICE) guidelines recommend bathing to reduce the microbial load, but not necessarily SSI. In addition, NICE states that the use of antiseptics is inconclusive in preventing SSI and that soap should be used. The purpose of this systematic review is to assess the effectiveness of preoperative bathing or showering with antiseptic compared to plain soap and to determine if these agents should be recommended for surgical patients to prevent SSI.

Data published in the New England Journal of Medicine demonstrates that use of CareFusion’s patient preoperative skin preparation ChloraPrep® (2% chlorhexidine gluconate and 70% isopropyl alcohol) reduced total surgical site infections (SSIs) by 41%, from 16.1% to 9.5%, compared to use of povidone-iodine solution, the most commonly used preoperative skin preparation. In this prospective, randomised and well-controlled outcomes trial designed to compare the efficacy of skin antiseptics in reducing the risk of SSIs, ChloraPrep proved superior in clean-contaminated abdominal, urologic, gynecologic and thoracic surgery.  “For nearly a decade, healthcare professionals have relied on the proven efficacy of ChloraPrep,” said Stephen R. Lewis, MD, chief medical officer of CareFusion. “This study is an example of our ongoing commitment to providing clinicians with evidence-based data that clinically differentiates our products in order to help improve patient care and lower costs.”

This guide from the Patient Safety Movement Foundation gives actions and resources for creating and sustaining safe practices for surgical site infections.

Getting It Right First Time (GIRFT) is designed to improve the quality of care within the NHS by reducing unwarranted variations. By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as the reduction of unnecessary procedures and cost savings. Anaesthesia is the largest hospital speciality in the UK, involved in a third of all hospital admissions, while perioperative care covers a patient's care from when they first contemplate surgery to their full recovery. The GIRFT national report for anaesthesia and perioperative medicine contains 18 recommendations based on information gathered from the 134 trusts in England with an anaesthesia and perioperative medicine service. It seeks to improve outcomes for patients having surgery in the new COVID-19 environment, including reducing the amount of time they spend in hospital. You will need a FutureNHS account to view this report, or you can watch a short video summary summarising key recommendations.

Today was the Parliamentary launch event of the Surgical Fires Expert Working Group’s report, 'A case for the prevention and management of surgical fires in the UK', which focuses on the prevention of surgical fires in the NHS This report contains important information on surgical fires and their prevention, to be submitted to the Centre for Perioperative Care (CPOC), in order to make the case for its inclusion on their agenda. In the perioperative setting, a fire may cause injury to both the patient and healthcare professionals. Injuries caused by a surgical fire most commonly occur on the head, face, neck and upper chest. The prevention of surgical fires, which can occur on or in a patient while in the operating theatre, is an urgent and serious patient safety issue in UK hospitals.  A Short Life Working Group (SLWG) for the prevention of surgical fires was established in May 2019, following an initial discussion in December 2018 on the issue of surgical fires in the UK. The group of experts from healthcare organisations and bodies across the UK convened four times in 2019 with the aim of compiling this document, in order to recommend surgical fires for a Never Event classification. The group conducted a literature review of best practice and evidence, in the UK and internationally, which informed the development of a number of considerations that could address the issue of surgical fires. This report contains information surrounding the scale of the problem of surgical fires in the UK, in addition to reported experiences of these incidences by both healthcare professionals and patients. It also includes prevention and management materials, and mandatory training that should be consistently delivered to hospital staff, and concludes with recommendations moving forward, in order to ensure the prevention of surgical fires in UK hospitals.

In January 2017, I read an article in Outpatient Surgery involving an elderly patient in the US who suffered multiple burns following the use of chlorohexidine bottled alcoholic prep. The Oregon woman filed a million-dollar lawsuit against the Oregon Outpatient Surgery Center in Tigard, Ore., saying she suffered severe burns when her face caught on fire during an electrocautery procedure. Having read this tragic story and escalated it to my theatre manager and colleagues, I decided to design and evaluate a FRAS (Fire Risk Assessment Score) and use it as part of the WHO Surgical Checklist at "time out" to raise awareness of fires in operating theatres. Here is the FRAS tool I implemented: Fire risk assessment tool.pdf Other useful resources I found: Scoring_Fire_Risk-2.pdf Surgical Site Fire Triangle.pdf Surgical_Fire_Poster (1).pdf Video: Fire hazard demo by Zaamin Hussain and Mike Reed Demonstration: "Burning Bruce" drives home the reality of surgical fires - article in Outpatient Surgery

The Parliamentary and Health Service Ombudsman (PHSO) was set up by Parliament to provide an independent complaint handling service for complaints that have not been resolved by the NHS in England and UK government departments. This report look at how a man died after excessive wait for cancer treatment.

This report, by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) looks at the peri-operative mortality rate in the UK and argues that people die because we do not give them the level of care they are entitled to expect. In this report less than half of the high-risk patients received care that the expert advisors thought they would accept from themselves or their own institutions. Th reasons for this are examined within the report.

This leaflet produced by the World Health Organization (WHO) is aimed at patients who are undergoing a surgical procedure. It aims to enable communication between you and your surgical team, including you in safety checks.

NHS doctors, nurses and other staff are being encouraged to ask themselves ‘Why not home? Why not today?’ when planning care for patients recovering from an operation or illness, as part of NHS England and NHS Improvement's campaign – called ‘Where Best Next?’ – which aims to see around 140,000 people every year spared a hospital stay of three weeks or more. NHS England and NHS Improvement have worked with a number of partners to identify five key principles which can help ensure that patients are discharged in a safe, appropriate and timely way. The five principles relate to different stages of a patient’s stay: some to the moment of admission, some to their time on a ward and some to the end of their stay. Plan for discharge from the start Involve patients and their families in discharge decisions Establish systems and processes for frail people Embed multidisciplinary team reviews Encourage a supported ‘Home First’ approach The 'Where Best Next?' website lists specific actions for each principle and provides links to useful resources.

Maintaining safe elective surgical activity during the global coronavirus disease 2019 (COVID‐19) pandemic is challenging and it is not clear how COVID‐19 may impact peri‐operative morbidity and mortality in this population. Therefore, adaptations to normal care pathways are required. Here, Kane et al. establish if implementation of a bespoke peri‐operative care bundle for urgent elective surgery during a pandemic surge period can deliver a low COVID‐19‐associated complication profile. Kane et al. present a single‐centre retrospective cohort study from a tertiary care hospital of patients planned for urgent elective surgery during the initial COVID‐19 surge in the UK between 29 March and 12 June 2020.

The purpose of this investigation by the Healthcare Safety Investigation Branch (HSIB) is to help improve patient safety in relation to the care of patients who have NHS-funded surgery in an independent hospital. This was initiated in the context of the COVID-19 pandemic, where because of increased pressure on the NHS, independent hospitals have been providing more care for NHS patients, including urgent elective surgical care and delivery of cancer pathways. The HSIB investigation reviewed the experience of a patient with a diagnosis of bowel cancer, who was booked to undergo laparoscopic (keyhole) surgery to remove part of his bowel in in an independent hospital. Following surgery, the patient made slow progress and on day eight following surgery he started to deteriorate rapidly. He was transferred to the local NHS hospital for investigation and further surgery. He died later the same day as a result of sepsis following a complication of his recent surgery. The investigation explored: Safety issues associated with the establishment of surgical services in independent hospitals to support the NHS and in particular the specialist services that are in place to deliver patient care. The assessment of patients prior to surgery to identify their risk and suitability for an operation and where it was to be undertaken; this included identification of patients with frail physical states. Key findings included: National and local NHS organisations had limited understanding of independent hospitals’ capabilities. This resulted in variation in how independent hospitals were used during Covid-19. Some independent hospitals saw patients with increasingly complex conditions and undertook more complex operations during Covid-19. The increasing complexity was well managed where capability of the independent hospitals had been evaluated and addressed prior to implementation of new services. Where pathways between NHS and independent hospitals were effective, it was often found that relationships between the hospitals had been longstanding and direct. There was variation in how preoperative assessments were undertaken across NHS and independent hospitals. This included what tests were ordered and risk assessments undertaken. Preoperative nutrition screening was inconsistent across NHS and independent hospitals. Examples were identified where it was not undertaken, or undertaken too late to allow any preoperative optimisation – that is, to make sure the patient was in the best possible nutritional state before their operation. Remote preoperative assessment became the norm during Covid-19, but created risks when staff were not able to see the patient. Lack of video call facilities and staff preference meant assessments were commonly done by telephone. Safety recommendations HSIB recommends that NHS England and NHS Improvement ensures that effective processes have been implemented in integrated care systems to identify local capability and capacity of their independent acute hospitals. HSIB recommends that NHSX expands its work programme addressing the challenges associated with interoperability of information systems used in healthcare to include transfer of information between the NHS and independent sector in support of safe care delivery. HSIB recommends that the Care Quality Commission reviews and appropriately develops its methodology for regulatory assurance of arrangements between NHS and independent providers for the provision of care across care pathways. This is to include any screening and risk management processes used to ensure the safe transfer of care between providers. HSIB recommends that NHS England and NHS Improvement reviews models of perioperative care for their value and impact. This should inform future work to support implementation of a standardised approach, based on evidence, across all healthcare providers that deliver surgical services. HSIB recommends that NHS England and NHS Improvement establishes a process to ensure that findings of the National Institute for Health Research’s policy research programme into frailty in younger patient groups are reviewed and acted upon.

The CPOC Newsletter is for all doctors, nurses and allied health professionals working in or with an interest in the developments of perioperative care. The monthly publication highlights the most up to date information on the workstreams, partner projects, perioperative events, recently published journals, live surveys and successful perioperative initiatives.

As trusts consider clearing the waiting list, there is an absence of objective approaches to prioritisation. There are 40 million variations of operative type and the NHS elective waiting list may reach more than 10 million. A coronavirus second wave may cause further delays and expansion of the waiting list. This blog from hub topic lead Richard Jones describes a proven approach to prioritising the waiting list built around individualised risk-adjustment for each patient and evolved from the core POSSUM methodology that is widely used for individual risk assessment pre-operatively. A significant backlog of elective surgical cases has built up during the COVID-19 crisis. The freeze on elective surgery has produced a waiting list that may take years to clear. In the US, the CDC has issued guidelines that "facilities should establish a prioritization policy committee consisting of surgery, anesthesia and nursing leadership to develop a prioritization strategy appropriate to the immediate patient needs". According to the CDC, this committee should work around 'objective priority scoring'. The MeNTS (Medically-Necessary, Time-Sensitive Procedures) instrument is a clever attempt to deliver this scoring, responding to availability of resources and the situation around COVID-19. However, the key challenge is that that the list needs to be prioritised in a way that reflects patient needs and ensures their safety. This is not something that MeNTS can deliver. It also is built around COVID-19 related limitations on resources and this will vary in significance depending on the hospital location and where it is in the journey out of lockdown. The risks of mortality and complications for a patient are a complex combination of the severity of the procedure and the physiological variables of the patient. As an example, a 55-year-old undergoing a radical laproscopic prostatectomy has a risk of mortality of 1.6%. However, if the patient has low blood pressure, that risk triples. If the patient also has low sodium then the risk is 10 times higher [C2-Ai insights]. The spectrum of different operations and key physiological variables creates at least 40 million potential combinations and hence risk. This is hard to manage with one patient but trying to prioritse a group of 5, 10, 100, 1,000 or even 10,000 becomes unmanageable. New patients will be joining the list while others leave following their procedures and so triage of the list will not be a one-off event. The list will need to be populated and triaged intelligently and in a consistent way repeatedly at least until there is a return to ‘normality’. There is evidence that some trusts are attempting to build their own systems for prioritisation. This may be possible around matching operative type and resource availability but the efficiency of these systems overall should be a concern. Best intentions are fine but, when reviewed later, the ability to correctly prioritise patients to minimise harm and mortality is likely to be limited if not flawed. C2-Ai’s COMPASS Surgical List Triage system is an example of a system that can support evidence-based triage and individualised risk assessment of patients, while supporting the objectives of the CDC. It supports clinical decision making across all phases from crisis back to steady state. It has been developed by the creator of the POSSUM system and is built around the world’s largest patient data set (140 million records from 46 countries) through the support of NHS Digital. The underlying algorithms are constantly refined against new and existing data sets to ensure relevance and accuracy. The Surgical List Triage tool combines the mortality and complication risks from the different patients to derive the prioritisation. The system carries out bulk assessments using individualised risk assessments for each patient. These reflect the operative type and their physiology to calculate the risk of mortality and complications, as well as providing a detailed breakdown of potential complications with percentage probability with a simple click. This system also suggests patients that should be reviewed for potential optimisation before any procedure. The physician can click on the link to see the detailed risks for the patient to support their decision making. The system can be used regularly to maintain the logic and integrity of the elective surgical list. This is superior to the potentially fragmented approach where parts of the list are manually considered in isolation as this cannot support effective optimisation of the whole list and the absence of any supporting evidence means the triage will vary enormously. COMPASS SLT is an evidence-based approach that supports optimal ordering of the list and clinical decision making that reduces avoidable harm and mortality. This in turn reduces variation, and cost while freeing bed capacity and also allowing the list to be tackled more quickly. When a patient comes in for the operation, an individual risk-assessment can be done using the COMPASS Pre-Operative Risk Assessment app. This provides a final check on whether the patient’s condition would justify optimising their condition before their procedure. However, it also details the most likely post-procedural complications individualised for the patient and their condition. That allows the treatment pathway to be tailored to that patient as well as recruiting the patient into their own recovery. For example, knowing that chest infection is the highest risk for a patient supports a conversation with them to stress the need for them to get up and about on the day of the operation. As an aside, the risk of mortality and complications can also be used as a strong element in showing informed consent has been obtained from the patient. In combination, these tools can provide a platform to support effective and ongoing triage of the list while reducing harm and unnecessary costs. The systems are currently in use in 12 trusts in the NHS. How are you prioritising waiting lists? We'd be interested to hear and share how you and your trust are dealing with the backlog. Opinions expressed in blogs and other content are those of the author. Patient Safety Learning welcomes sharing content and opinions that promotes safer patient care and for the reduction of avoidable harm. The views expressed on the hub however do not necessarily represent Patient Safety Learning's views or values. References to a specific product or service does not imply a recommendation or endorsement.

Surgical wound management is critical to postoperative care, influencing patient recovery, infection control, and healthcare costs. Despite advances in surgical techniques, surgical site infections (SSIs) remain a concern, leading to increased morbidity and hospital stays. Standardised, evidence-based practices are essential for improving patient outcomes. This article in the British Journal of Nursing provides concise, evidence-based guidance on surgical wound management across the preoperative, perioperative, postoperative and discharge phases. It synthesises current guidelines and highlights emerging best practices for health professionals. Best practices require a multidisciplinary approach, strict infection prevention protocols, effective wound closure techniques, and patient education. Variability in clinical application persists, but early-stage innovative methods such as remote wound monitoring show promise in reducing hospital visits, detecting complications early and increasing patient satisfaction.

The Centre for Perioperative Care have many case studies on their website on preoperative optimisation and assessment, older people undergoing surgery and hip fracture care. Preoperative optimisation Preoperative assessment Case Studies: Older people undergoing surgery Hip fracture care Postoperative phase

A series of podcasts from Molnlycke UK, with host Steve Feast, discussing topics such as sustainability, patient safety and more. Episodes: Sustainability in the operating theatre - guest speakers Tod Brindle, Molnlycke Medical Director, and Toby Cobbledick, Molnlycke Sustainability Specialist. Preventing surgical site infections: pre-surgery - guest speaker Lindsay Keeley, Patient Safety and Quality Lead AfPP. Preventing surgical site infections: post-surgery - guest speaker Lindsay Keeley, Patient Safety and Quality Lead AfPP. Supporting patients in their recovery from surgery - guest speaker Helen Hughes - Chief Executive of Patient Safety Learning.

The Centre for Perioperative Care (CPOC) has started work on the UK’s first ever Green Paper on perioperative care.  The Green Paper project is a nine-month programme of consultation and research about how to advance the perioperative care agenda. It aims to draw CPOC’s diverse community of partners together around a shared set of priorities for change and a vision for the future. The project will draw on a wide evidence base, building on work already happening within CPOC, our partner organisations and across the entire health and care sector. We will also reach out to our community of thousands of health professionals and patients to generate new evidence that will enable us to develop future policy and make the best possible case for change. Get involved The Green Paper can't be delivered without the active participation and help of everyone working to deliver better patient-centred care. If you would like to get involved with this project, then please consider joining the informal ‘sounding board’ of healthcare professionals, patients, and policymakers. The kinds of things CPOC will be looking for your help with include: Giving your views as CPOC develop their policy thinking, e.g. by taking surveys, feeding back on draft papers or reports, testing the messaging, and helping plug evidence gaps or prioritise what CPOC explore further. Championing the work on social media and to your personal and professional networks. Blogging for CPOC to share your experiences, reflecting on new findings, and informing the public about this work. Attending workshops or events CPOC may host as part of the consultation work for this project. If interested email [email protected].

Previous research suggests that surgical safety checklists (SSCs) are associated with reductions in postoperative morbidity and mortality as well as improvement in teamwork and communication. These findings stem from evaluations of individual or small groups of hospitals. Studies with more hospitals have assessed the relationship of checklists with teamwork at a single point in time. The objective of this study from Molina et al. was to evaluate the impact of a large-scale implementation of SSCs on staff perceptions of perioperative safety in the operating room. They concluded that a large-scale initiative to implement SSCs is associated with improved staff perceptions of mutual respect, clinical leadership, assertiveness on behalf of safety, team coordination and communication, safe practice, and perceived checklist outcomes.

A group of clinicians and patient group representatives, called the ImPrOve Think Tank, recently convened to address common complication during high-risk surgery they consider to be most urgent and dangerous; haemodynamic instability characterised as significant drops in blood pressure. In this article for The Parliament Magazine, Professor Olivier Huet, Sean Kelly MEP and Ms Luciana Valente discuss why death rates are so high in the 30 days post-surgery, what clinicians can do to improve patient safety and what patients can do to ensure optimal patient safety and care in the perioperative process.