Peri-operative Assessment of Patients admitted for Emergency or high Risk Surgery (PAPERS) Proforma: A tool to standardize assessment and minimise error

Abstract

Acutely unwell patients who may require emergency surgery may deteriorate suddenly and precipitously. In that eventuality, the assessment, diagnosis and treatment of this cohort can be challenging. The rapidly changing pathophysiology of the peri-operative patient may cognitively overload the attending clinicians. Furthermore, until stabilised, a comprehensive assessment of the patient is unlikely to be feasible or appropriate. So, vital data may be overlooked. In emergency situations, suboptimal management decisions may cause significant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. Indeed, the World Health Organization’s Safer Surgery Checklist has been proven to improve post-operative outcomes. So, extrapolating this concept, I have developed a checklist proforma to guide the assessment of acutely unwell patients who may require emergency surgery. This proforma also promotes the systematic recording and presentation of patient data. This can facilitate the retrieval of the specific information required for the management for these patients. Moreover, this framework for clinical reasoning can identify the need for organ support and thereby guide decisions about escalation of therapy..