Quality statement 4: Discussion with a healthcare professional
Quality statement
Adults discuss their clinical assessment, perioperative risks and treatment options with their healthcare professional before surgery.
Rationale
Adults having surgery need to be able to weigh up the risks, benefits and consequences of surgery to make an informed decision as to whether surgery is the right treatment option for them. The clinical assessment and assessment of perioperative risk provide important information about, and for, the adult having surgery (such as whether there is an increased chance of morbidity or mortality), and this may impact their decision to have surgery or not. A healthcare professional should use their surgical knowledge and expertise to communicate the findings of the assessments in an understandable way, give information on surgical and non-surgical options, and support informed shared decision making.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.
Process
Proportion of adults having surgery who have a discussion with their healthcare professional about their clinical assessment, perioperative risks and treatment options, before surgery.
Numerator – the number in the denominator who have a discussion with their healthcare professional about their clinical assessment, perioperative risks and treatment options, before surgery.
Denominator – the number of adults having surgery.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from electronic patient records.
What the quality statement means for different audiences
Service providers (secondary and tertiary care services) ensure that adults having surgery have their clinical assessment, perioperative risks and treatment options discussed with them before surgery.
Healthcare professionals (such as doctors, nurses and dentists) discuss the findings of the clinical assessment and the assessment of perioperative risk with adults having surgery, before a decision is made on whether to proceed with the surgery as planned. Communicate findings clearly and accessibly, encouraging the adult to express their needs and preferences, and provide information on the availability and suitability of surgical and non-surgical options based on the findings. Ensure the adult having surgery has understood the information, and encourage them to be actively involved in discussions, to reach a shared decision about the right treatment option for them. Recognise that adults may have differing perspectives on the balance of benefits, risks and consequences of surgery to their healthcare professional. Consider using a structured form of shared decision making including frameworks such as Benefits Risks Alternative Nothing (BRAN) to support the discussion.
Commissioners ensure that the services they commission have sufficient resources to enable discussions to take place between the healthcare professional and the adult having surgery about the adult's clinical assessment, perioperative risks and treatment options, before surgery. Ensure clear pathways exist for healthcare professionals to access senior decision makers, with defined routes and escalation points for concerns.
Adults having surgery have a discussion with their healthcare professional about any conditions that affect their overall health including how these will be managed, their risks of surgery, and the surgical and non-surgical options open to them, before deciding whether to proceed with surgery. They should feel informed and supported to express their needs and preferences and make a shared decision with their healthcare professional about whether to have the surgery or not.
Source guidance
Perioperative care in adults. NICE guideline NG180 (2020), recommendation 1.3.1
Definitions of terms used in this quality statement
Adults having surgery
Adults who are booked for an elective or emergency surgical procedure, including dental surgery. [NICE's guideline on perioperative care in adults]
Clinical assessment
A structured evaluation of health before surgery to identify and manage any conditions that could affect surgical safety, perioperative outcomes and recovery. [Expert opinion]
Perioperative risk
The likelihood of an adult experiencing adverse outcomes related to surgery. An adult's perioperative risk is identified through a structured assessment using a validated risk stratification tool. [Expert opinion]