A series of short articles on key topics in perioperative medicine, published in the British Journal of Hospital Medicine

POM in a Nutshell


Cardiopulmonary Exercise Testing

Dr Catrin Williams ST7 Anaesthetics, Department of Anaesthetics, Morriston Hospital, Swansea SA6 6NL

08 April 2018

Cardiopulmonary exercise testing is a non-invasive test providing objective information about the cardiovascular, pulmonary and muscle function under physiological stress and the ability to deliver oxygen to peripheral tissues (Wasserman et al, 2004). Increasingly cardiopulmonary exercise testing is being used for preoperative risk assessment and to enable shared decision-making conversations with patients (Huddart et al, 2013).


The Perioperative Quality Improvement Programme: improving outcomes

Dr D Gilhooly & Dr SR Moonesinghe, Royal College of Anaesthetists, London

12 Feb 2018

The Perioperative Quality Improvement Programme has been set up as a multidisciplinary initiative to look at the quality of care and outcomes of patients undergoing major surgery in the NHS. Its aim is to reduce variation while effecting an overall improvement in morbidity.



Dr Catherine A Britton-Jones, Morriston Hospital, Swansea

14 Dec 2017

Prehabilitation is the process of enhancing a patient's ability to cope with particular stressors. Morbidity and mortality after elective surgery remain significant despite advances in anaesthetic and surgical techniques (Levett et al, 2016). By initiating prehabilitation programmes patients may be more receptive to implementing behavioural and lifestyle changes to improve their perioperative journey.


Enhanced recovery: pathways to better care

Dr Aoife Hegarty & Dr Nirav Shah, St George’s Hospital London

11 Oct 2017

Enhanced recovery after surgery comprises clinical pathways which aim to improve the quality of perioperative care and accelerate recovery. Benefits of enhanced recovery after surgery include reduced postoperative morbidity (Greco et al, 2014) and shorter length of stay, leading to reduced costs, greater throughput of patients and greater patient satisfaction. The underlying principles are reducing the surgical stress response and maintaining normal postoperative physiological functions. Strict adherence to the entire pathway produces better aggregate outcomes than implementing individual components (Gustafsson et al, 2011).


A new cross-speciality educational collaboration in perioperative medicine

Dr Katie Samuel, Dr Andrew Rogerson & Miss Ana-Catarina Pinho-Gomes

11 Oct 2017

Many clinicians will by now be increasingly familiar with the term ‘perioperative medicine’, which encompasses a refreshed way of managing the integrated, multidisciplinary medical care of the surgical patient. The principles are not necessarily new, but the success of projects such as Enhanced Recovery After Surgery in Europe and the Perioperative Surgical Home (Kehlet et al, 2015) in the USA have triggered a wave of interest and enthusiasm in trainees and consultants alike, by envisioning how revamping patients' care from contemplation of surgery through to hospital discharge could result in efficiency, quality and safety improvements.

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