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The perioperative period extends from the moment of contemplation of surgery through to recovery at home. Patients on a surgical pathway will experience multiple transition points in their care. As we move to more collaborative working and caring for increasingly medically complex patients, we must establish robust processes to mitigate against the potential for patient harm posed by these multiple transition points. This article reviews best practice and guidance on handover of care throughout the perioperative period. We will look at models of transition of care beyond the hospital environment and how better use of community resources can smooth the transition of care out of hospital for ongoing rehabilitation.

Background This paper describes a rapid response project from the Chartered Institute of Ergonomics & Human Factors (CIEHF) to support the design, development, usability testing and operation of new ventilators as part of the UK response during the COVID-19 pandemic. Method A five-step approach was taken to (1) assess the COVID-19 situation and decide to formulate a response; (2) mobilise and coordinate Human Factors/Ergonomics (HFE) specialists; (3) ideate, with HFE specialists collaborating to identify, analyse the issues and opportunities, and develop strategies, plans and processes; (4) generate outputs and solutions; and (5) respond to the COVID-19 situation via targeted support and guidance. Results The response for the rapidly manufactured ventilator systems (RMVS) has been used to influence both strategy and practice to address concerns about changing safety standards and the detailed design procedure with RMVS manufacturers. Conclusion The documents are part of a wider collection of HFE advice which is available on the CIEHF COVID-19 website (https://covid19.ergonomics.org.uk/).

Having an operation is a major event in a patient’s life. Many will have had limited previous exposure to hospitals. There is much patients can do to improve their physical and mental health prior to surgery that can have a significant impact on their recovery and long-term health. Understanding the steps they can take can empower patients to make lasting changes. Fitter, Better, Sooner is a toolkit aimed at helping patients to prepare physically and psychologically for surgery (Figure 1). It was produced by the Royal College of Anaesthetists (RCoA), with representatives from the Royal College of General Practitioners (RCGP) and the Royal College of Surgeons (RCS), and with patient representatives playing key roles on the working group, reflecting the importance of multidisciplinary input for optimal perioperative care. The resources have been endorsed by both the RCGP and RCS, and have been awarded ‘highly commended’ in the BMA Patient Information Awards 2019. Figure 1. Fitter, Better, Sooner patient information resources. https://www.rcoa.ac.uk/patient-information/ preparing-surgery-fitter-better-sooner. © Royal College of Anaesthetists. The toolkit is intended for patients who are awaiting, or considering, surgery. It introduces the many ways in which they can optimise their health, lifestyle, and activity levels to maximise their chances of a good recovery, free of complications. It …

In 2016, NHS England set up 10 integrated care systems (ICSs) which aim to devolve some responsibility for delivery of health and social care services to local healthcare providers in partnership with local government, social care, primary care networks, and voluntary and charitable organisations. These are new ways of working and provide an opportunity to better integrate perioperative care across the entire pathway from the moment of contemplation of surgery through to recovery at home. This review describes the ways in which the aims of many ICS plans can be met with good perioperative care, and how clinicians can use this opportunity to make significant progress in improving outcomes for patients. We describe examples of initiatives in cancer pathways which are already proving successful and have caught the imagination of the local community at all levels, as well as examples of integrated perioperative care across the country which can be applied to other systems. We hope to demonstrate ways in which perioperative care can add value to a local health population given the right support and chance to deliver it.