Publication

Team-based discussion on preoperative evaluation and decision-making about surgery

Festen, S., De Graeff, P., Ijzerman, J. A. & Van Leeuwen, B. L., Nov-2017, Perioperative Care of the Elderly: Clinical and Organizational Aspects. Bettelli, G. (ed.). 1 ed. Cambridge University Press, p. 60-67 8 p.

Research output: Chapter in Book/Report/Conference proceedingChapterProfessional

In vain have you acquired knowledge if you have not imparted it to others. Deuteronomy Rabbah Introduction Elderly patients will encounter different professionals, each with a different focus, prior to surgery. This will usually be a surgeon, an anesthesiologist and a nurse Depending on comorbidities and availability, a geriatrician and other medical specialists will also be involved in preoperative screening. A multidisciplinary approach may prove important in defining the optimal treatment strategy for the individual patient, especially in complex elderly patients and/or patients undergoing major surgery. However, in a multidisciplinary team, a clear division of tasks and responsibilities can prove challenging, as required (diagnostic) information may overlap between different specialisms. More importantly, involving several medical specialists may lead to situations where conflicts of professional opinions and interests hamper a unified approach. Multidisciplinary team meetings aiming to share and understand these views provide the opportunity to learn what information is valuable and can prove useful to come to novel insights regarding the patient’s best treatment. Moreover, from this discussion, a clear identification of team goals and common responsibilities may arise, increasing cohesion among team members, contributing to build a shared interprofessional culture and ultimately improving patients’ outcomes. This chapter provides a conceptual model for understanding the importance of a stepwise multidisciplinary approach towards preoperative assessment and multidisciplinary decision-making, as has been detailed in Chapters 2-8. With the aim of demonstrating the value of this approach, two cases are presented where the effort of compiling potentially different or mildly conflicting views has led to a better understanding of the patient and a more tailored treatment strategy. Areas in which sharing information among team members is critical to ensure optimal perioperative management and risk reduction are examined. Cases Patient A Mrs A, a 69-year old woman with a history of hypertension, epilepsy and chronic obstructive pulmonary disease (COPD), was referred for a radical re-resection after an incidental finding of gallbladder cancer at cholecystectomy. When escorting her from the waiting room for her surgical consult, the surgeon noticed dyspnea and a slight wheezing. Mrs A complained of fatigue, shortness of breath and had recently had a generalized seizure. On examination, her blood pressure was 230/140 mmHg. The surgeon doubted whether Mrs A was fit enough to undergo extensive surgery.

Original languageEnglish
Title of host publicationPerioperative Care of the Elderly
Subtitle of host publicationClinical and Organizational Aspects
EditorsGabriella Bettelli
PublisherCambridge University Press
Chapter9
Pages60-67
Number of pages8
Edition1
ISBN (Electronic)9781316488782
ISBN (Print)9781107139343
Publication statusPublished - Nov-2017

    Keywords

  • team-based, DECISION-MAKING, surgery, older patients

ID: 78992424