Manage peri-operative care

At the early registrar level it is expected that a prevocational doctor will have acquired the skills, knowledge and behaviours to competently manage peri-operative care.

This task describes a number of activities, as below, where proficiency should be achievable by the end of PGY3.  The doctor is encouraged to download the key clinical task guidelines and seek the support of his/her supervisor for feedback on performance.

Competent across the many threads of care:
  • Pain management (note local approaches)
  • Diabetes
  • Anticoagulation/DVT prophylaxis
  • Cardiac and respiratory issues
  • Fluid management
  • Sensible use of blood products
  • Antibiotic prophylaxis (cf. treatment)
  • PGY 1
  • PGY 2
  • PGY 3

  • Collaboration and teamwork

    • Work within the team to identify and remedy errors, particularly using a systems approach
    • Collaborate effectively with other specialist teams involved in the patient’s care
    • Encourage participation of all team members and allocate appropriate tasks to junior members
  • Communication
    • Communicate clearly and compassionately when breaking bad news or discussing difficult topics (deterioration, poor prognosis, resuscitation and end-of-life issues)
    • Collect and collate relevant information from other team members or specialist teams pertinent to decision making or patient management
    • Contribute to analysis of complex cases and imperfect outcomes, and identify any changes needed to care processes or systems
  • Health advocacy
    • Identify any gaps between management plan and patient wishes
    • Work with the patient/family/carers to develop a management plan that addresses the needs and preferences of the patient

  • Judgement and descision-making

    • Undertake continued timely reviews of patient progress and respond appropriately to any changes of condition
    • Recognise when a management plan is failing and, where appropriate, seek senior input to devise an alternative plan
    • Recognise instances of uncertainty and conflicting values, and able to alleviate their potential impact
  • Leadership and management
    • Demonstrate appropriate self-awareness and insight
  • Medical expertise
    • Can supervise/advise and understands medicines with high risk of adverse events. Double check and document dose calculations
    • Evaluate outcomes of medication therapy. Monitor and review the patient’s response to treatment
    • Provide appropriate aftercare and arrange follow-up for all procedures
    • Review and update unit protocols manual regarding pre-operative assessment and care, operative procedures and post-operative care
  • Professionalism
    • Recognise signs of a colleague in difficulty and respond with empathy
    • Act as a role model of professional behaviour in the workplace

  • Scholarship and teaching

    • Use multi-disciplinary team meetings as teaching and educational opportunities
    • Provide effective supervision using recognised techniques and skills (availability, orientation, learning opportunities, role modelling, delegation)

  • Technical expertise

    • Able to assess advanced Essential Surgical Skills constructs (competent with basic and intermediate) both for use in current position as well as for surgical education and training (SET) application – career pathway

  • Collaboration and teamwork

    • Maintain clear, accurate and concise patient records of assessment, clinical issues and planned management
  • Communication
    • Keep patients and significant others informed of management plan progress
    • Communicate effectively within multidisciplinary teams, reflecting an understanding of, and respect for, different health professional perspectives
  • Health advocacy
    • Note and understand the Enduring Power of Attorney and the Advanced Care Directives
    • Recognise health needs of an individual patient beyond their immediate condition
    • Take into account the impact of history and experience of Indigenous Australians/Maori people, and their spirituality and relationship with the land

  • Judgement and descision-making

    • Use mechanisms that minimise error, e.g. clinical checklists, Surgical Safety Checklist, handover protocols, unit protocols
    • Retrieve and use high-quality information from electronic sources for clinical decision making. Document decisions and reasons for same
    • Recognise when advice and guidance is required in development of management plans
  • Leadership and management
    • Accept opportunities for increased autonomy and patient responsibility under direction of supervisor
  • Medical expertise
    • Identify common risks in older and complex patients, e.g. falls risk and cognitive decline. Take appropriate actions to prevent or minimise harm
    • Follow-up and interpret investigation results appropriately to guide patient management
    • Work within unit-based protocols with regard to pre-operative assessment and care, operative procedures and post-operative care:
      • apply medical knowledge to clinical practice
      • implement and evaluate a management plan relevant to the patient following discussion with a senior clinician
      • identify when patient transfer is required, and manage risks prior to and during patient transfer
      • recognise indications for, and risks of, fluid and electrolyte therapy and blood products
      • provide appropriate aftercare and arrange follow up for common procedures 
      • safely manage anti-coagulant therapy and manage diabetes
      • recognise acute cardiac events and use relevant resuscitation/drug protocols
      • initiate resuscitation of the unwell patient. Recognise indicators for sepsis and implement clinically relevant plan
      • maintain a clinically relevant patient management plan of fluid, electrolyte and blood product use
      • recognise and manage fluid and electrolyte imbalances in a patient
      • effectively use semi-automatic and automatic defibrillators
      • provide appropriate aftercare and arrange follow up for more complex procedures
      • recognise when patients are ready for discharge and arrange referral to relevant members of the healthcare team to promote planning for safe discharge
  • Professionalism
    • Critically reflect on own performance and make an accurate assessment of this

  • Scholarship and teaching

    • Use a range of strategies aimed at improving patient education

  • Technical expertise

  • Collaboration and teamwork

    • Work within the team to identify and remedy errors, particularly using a systems approach
    • Collaborate effectively with other specialist teams involved in the patient’s care
    • Encourage participation of all team members and allocate appropriate tasks to junior members
  • Communication
    • Communicate clearly and compassionately when breaking bad news or discussing difficult topics (deterioration, poor prognosis, resuscitation and end-of-life issues)
    • Collect and collate relevant information from other team members or specialist teams pertinent to decision making or patient management
    • Contribute to analysis of complex cases and imperfect outcomes, and identify any changes needed to care processes or systems
  • Health advocacy
    • Identify any gaps between management plan and patient wishes
    • Work with the patient/family/carers to develop a management plan that addresses the needs and preferences of the patient

  • Judgement and descision-making

    • Undertake continued timely reviews of patient progress and respond appropriately to any changes of condition
    • Recognise when a management plan is failing and, where appropriate, seek senior input to devise an alternative plan
    • Recognise instances of uncertainty and conflicting values, and able to alleviate their potential impact
  • Leadership and management
    • Demonstrate appropriate self-awareness and insight
  • Medical expertise
    • Can supervise/advise and understands medicines with high risk of adverse events. Double check and document dose calculations
    • Evaluate outcomes of medication therapy. Monitor and review the patient’s response to treatment
    • Provide appropriate aftercare and arrange follow-up for all procedures
    • Review and update unit protocols manual regarding pre-operative assessment and care, operative procedures and post-operative care
  • Professionalism
    • Recognise signs of a colleague in difficulty and respond with empathy
    • Act as a role model of professional behaviour in the workplace

  • Scholarship and teaching

    • Use multi-disciplinary team meetings as teaching and educational opportunities
    • Provide effective supervision using recognised techniques and skills (availability, orientation, learning opportunities, role modelling, delegation)

  • Technical expertise

    • Able to assess advanced Essential Surgical Skills constructs (competent with basic and intermediate) both for use in current position as well as for surgical education and training (SET) application – career pathway