Perioperative Journey Research Articles

If the peri-operative patient pathway was right, what would it look like?

Patients undergoing surgery deserve the best possible peri-operative outcomes. Each stage of the peri-operative patient journey offers opportunities to improve care delivery, with shorter lengths of stay, less complications, reduced costs and better value. These opportunities were identified through narrative review of the literature, with consultation and consensus at the hidden pandemic (of postoperative complications) summit 2, July 2023 in Adelaide, Australia RESULTS: Before surgery: Some patients who receive timely alternative treatments may not need surgery at all. The period of waiting after listing should be a time of preparation. Risk assessment at the time of surgical listing facilitates recognition of need for comorbidity optimisation and identifies those who will most benefit from prehabilitation, particularly frail and deconditioned patients. During the surgical admission, ERAS programs result in less postoperative complications, shorter length of stay and better patient experience but require agreement between clinicians, and coordinated monitoring of delivery of the elements in the ERAS bundle of care. At-risk patients need to have the appropriate levels of monitoring for cardiovascular instability, renal impairment or respiratory dysfunction, to facilitate timely, proactive management if they develop. Access to allied health in the early postoperative period is also critical for promoting mobility, and earlier discharge, particularly after joint surgery. Where appropriate, provision of rehabilitation services at home improves patient experience and adds value. The peri-operative patient journey begins and ends with primary care so there is a need for clear communication, documentation, around sharing of responsibility between practitioners at each stage. Identifying and mitigating risk to reduce complications and length of stay in hospital will improve outcomes for patients and deliver the best value for the health system.

Design overview and usability of the codesigned My Surgical Pathway E-health tool for supporting patient self-managed surgical preparation and recovery

IntroductionSurgery plays a critical role in global health, often facing significant quality challenges such as high rates of postoperative complications, variability in patient outcomes, and inconsistencies in care pathways, due to the complex nature of the perioperative journey. The My Surgical Pathway (MSP) app is an e-health intervention designed to address these challenges by supporting self-management and integrated care throughout the entire perioperative journey. This study aims to describe the features and functions of MSP and report on the results of usability testing from both patients and healthcare workers. MethodsThis mixed-methods study evaluated the usability of the My Surgical Pathway (MSP) app using quantitative surveys, qualitative feedback, and observation data from patients and healthcare workers. Structured 2-hour user testing sessions included interaction with the MSP app, completion of the User Version of the Mobile Application Rating Scale (uMARS), and think-aloud activities. Data analysis combined quantitative and qualitative insights to identify usability issues and inform potential improvements. ResultsThe mixed-method user-testing evaluation of the co-designed e-health intervention revealed high overall app quality scores, with an average of 4.50 out of 5. All user-type interfaces received mean scores above the minimum acceptability threshold of 3.0, demonstrating the intervention's efficacy in supporting patient surgery journeys, enhancing healthcare worker coordination, and meeting diverse user needs. Notably, the highest individual item scores were for credibility of source (4.92) and interactivity (4.85), highlighting the application's reliability and engaging nature. ConclusionsThe study evaluated the 'My Surgical Pathway' (MSP) e-health intervention, co-designed with consumers and healthcare workers to support self-management of surgical care. Results indicate high user satisfaction, with an overall app quality score of 4.50 out of 5 on the uMARS tool. Users praised MSP's engagement, education, and responsiveness, highlighting its potential to improve patient experiences and clinician workflows. Recommendations for future research include expanding participant diversity and hospital settings, and employing longitudinal designs for a comprehensive evaluation.

CSP2023: 191 - Mapping the perioperative information journey of people undergoing surgery for degenerative cervical myelopathy. First steps towards improving patient care

CSP2023: 191 - Mapping the perioperative information journey of people undergoing surgery for degenerative cervical myelopathy. First steps towards improving patient care

Codesigning an E-Health Intervention for Surgery Preparation and Recovery.

Surgery is a significant part of healthcare, but its demand is increasing, leading to challenges in managing patient care. Inefficient perioperative practices and traditional linear models contribute to adverse outcomes and patient anxiety. E-health interventions show promise in improving surgical care, but more research is needed. The purpose of this study was to involve patients and healthcare workers during the design phase of an e-health intervention that aims to support the perioperative care of elective surgery preparation and recovery. This study used an Information Systems Research Framework to guide collaborative codesign through semistructured interviews and cocreation workshops. Semistructured interviews collected insights on the perioperative journey and e-health needs from healthcare workers and consumers, resulting in the creation of a patient surgery journey map, experience map, and a stakeholder needs table. Collaborative work between consumers and healthcare workers in the cocreation workshops identified priority perioperative journey issues and proposed solutions, as well as prioritizing application software needs, guiding the development of the wireframe. The development of an e-health application aimed at supporting surgery preparation and recovery is a significant step toward improving patient engagement, satisfaction, and postsurgical health outcomes.

A Novel Digital Health Platform With Health Coaches to Optimize Surgical Patients: Feasibility Study at a Large Academic Health System.

Pip is a novel digital health platform (DHP) that combines human health coaches (HCs) and technology with patient-facing content. This combination has not been studied in perioperative surgical optimization. This study's aim was to test the feasibility of the Pip platform for deploying perioperative, digital, patient-facing optimization guidelines to elective surgical patients, assisted by an HC, at predefined intervals in the perioperative journey. We conducted an institutional review board-approved, descriptive, prospective feasibility study of patients scheduled for elective surgery and invited to enroll in Pip from 2.5 to 4 weeks preoperatively through 4 weeks postoperatively at an academic medical center between November 22, 2022, and March 27, 2023. Descriptive primary end points were patient-reported outcomes, including patient satisfaction and engagement, and Pip HC evaluations. Secondary end points included mean or median length of stay (LOS), readmission at 7 and 30 days, and emergency department use within 30 days. Secondary end points were compared between patients who received Pip versus patients who did not receive Pip using stabilized inverse probability of treatment weighting. A total of 283 patients were invited, of whom 172 (60.8%) enrolled in Pip. Of these, 80.2% (138/172) patients had ≥1 HC session and proceeded to surgery, and 70.3% (97/138) of the enrolled patients engaged with Pip postoperatively. The mean engagement began 27 days before surgery. Pip demonstrated an 82% weekly engagement rate with HCs. Patients attended an average of 6.7 HC sessions. Of those patients that completed surveys (95/138, 68.8%), high satisfaction scores were recorded (mean 4.8/5; n=95). Patients strongly agreed that HCs helped them throughout the perioperative process (mean 4.97/5; n=33). The average net promoter score was 9.7 out of 10. A total of 268 patients in the non-Pip group and 128 patients in the Pip group had appropriate overlapping distributions of stabilized inverse probability of treatment weighting for the analytic sample. The Pip cohort was associated with LOS reduction when compared to the non-Pip cohort (mean 2.4 vs 3.1 days; median 1.9, IQR 1.0-3.1 vs median 3.0, IQR 1.1-3.9 days; mean ratio 0.76; 95% CI 0.62-0.93; P=.009). The Pip cohort experienced a 49% lower risk of 7-day readmission (relative risk [RR] 0.51, 95% CI 0.11-2.31; P=.38) and a 17% lower risk of 30-day readmission (RR 0.83, 95% CI 0.30-2.31; P=.73), though these did not reach statistical significance. Both cohorts had similar 30-day emergency department returns (RR 1.06, 95% CI 0.56-2.01, P=.85). Pip is a novel mobile DHP combining human HCs and perioperative optimization content that is feasible to engage patients in their perioperative journey and is associated with reduced hospital LOS. Further studies assessing the impact on clinical and patient-reported outcomes from the use of Pip or similar DHPs HC combinations during the perioperative journey are required.

Implementing mobile health in your surgical practice: Results of a multidisciplinary convening

The perioperative journey remains complex and difficult to navigate for patients and caregivers. Poor communication and lack of care coordination lead to diminished patient satisfaction, outcomes, and system performance. Mobile health platforms have the potential to overcome some of these issues by improving care delivery through timely individualized assessments, improved patient education, and care coordination. Yet mobile health implementation in surgical practice remains limited. Based on a convening of experts using human-centered design techniques, an implementation guide for the integration of mobile health in perioperative care was created to assist with (1) identification of the use of mobile health within a specific surgical practice, (2) identification of the pathway to mobile health implementation, and (3) measurement of successful implementation including patient and surgical system impact. This article reviews those recommendations and provides references to additional literature, including the full implementation guide, to aid those seeking to implement mobile health in a surgical practice or system.

Codesign of health technology interventions to support best-practice perioperative care and surgical waitlist management

ObjectivesThis project aimed to determine where health technology can support best-practice perioperative care for patients waiting for surgery.MethodsAn exploratory codesign process used personas and journey mapping in three interprofessional workshops...

Captains on call: A qualitative investigation of an intervention to support children with retinoblastoma undergoing regular eye examinations.

Retinoblastoma is a rare childhood ophthalmic cancer that requires frequent eye examinations under anaesthesia and painful or distressing procedures. This can cause significant anxiety for children and their families. We evaluated a Starlight Children's Foundation programme, 'Captains on Call', at the Queensland Children's Hospital, which aims to provide positive distraction and reduce stress, anxiety and pain during the perioperative journey for children in the retinoblastoma treatment pathway. This study examined the impact of the programme on the perioperative experience of the children and their families, using a qualitative design. This study was conducted in a paediatric operating suite at a tertiary-level children's hospital in Australia. We interviewed a parent from 20 families (from a cohort of 40 families, including 44 children), whose children received treatment or screening for retinoblastoma, focusing on the programme's impact on the child and family at various stages during the perioperative journey. We undertook a thematic analysis of transcribed interviews. We identified two themes, each with two sub-themes: (1) the programme positively contributed to the overall treatment journey, by addressing different needs at different times, and helping to reframe a traumatic medical experience, and (2), the programme supported the whole family unit by empowering children through play, and adopting a family systems approach which recognised the impact of cancer treatment on the whole family. This study highlights the value of the Captains on Call programme in supporting children with retinoblastoma and their families during perioperative visits. The Captains, particularly as non-medicalised professionals in a healthcare setting, built trust and rapport with the children through play over repeated episodes of care. The interprofessional collaborative approach with a reflective cycle of practice extended it beyond a programme providing simple distraction. Other retinoblastoma services may benefit from implementing a similar approach.

Inadvertent perioperative hypothermia prevention strategies for urology surgical patients who received a blood transfusion: A retrospective analysis.

This study aimed to establish whether hypothermia was present in patients who required a blood transfusion and underwent a urology procedure, as well as identify staff knowledge and understanding. A staff survey was conducted with respondents from a range of clinical settings, with some staff working across more than one area. A retrospective review of 46 medical records was conducted between January 2021 and July 2022. All data were exported into an Excel spreadsheet and analysed. Staff (70%) were unaware of guidelines informing thermoregulation practices; however, 90% understood the importance of normothermia in the perioperative environment. Medical record review demonstrated temperature monitoring and intervention implementation varied across the perioperative journey, with 20% of patients hypothermic on admission and 89% of the cohort having two or more risk factors. There is no formal process for the management of inadvertent perioperative hypothermia throughout the patient journey at the hospital. A variety of intrinsic factors (age, patient comorbidities, American Society of Anaesthesiologists score) and external factors (patient waiting times, anaesthetic modality, type of procedure, environmental influences), impact each patient's risk of inadvertent perioperative hypothermia.

Healthcare professionals' knowledge and attitudes towards surgical site infection and surveillance: A quasi-experimental study.

SSI is one of the most prevalent healthcare-associated infections and is associated with extended hospital stays, increased need for reoperation and higher hospital readmission rates. Implementing systematic SSI surveillance can reduce these adverse outcomes. Implementing a surveillance system into a hospital is a complex intervention requiring that staff involved in a patient's perioperative journey have the knowledge of SSI prevention, the data required for surveillance, an understanding of how data informs quality improvement initiatives and their role in surveillance. The aim of this study was to evaluate the impact of a complex intervention on the knowledge and attitudes of healthcare professionals towards surgical site infection (SSI), SSI prevention and surveillance in a university hospital setting. The study used a quasi-experimental pre-test-post-test design. The impact of a complex intervention was evaluated by measuring healthcare professionals' (n = 74) knowledge of and attitudes towards SSI and surveillance. Normalisation process theory (NPT) guided the study and the development of the intervention. There was a statistically significant increase in scores on the knowledge of SSI and prevention from pre-intervention to post-test. The knowledge of risk factors scores at post-test was significantly higher than that at pre-intervention. Overall attitudes to SSI prevention and surveillance were good both pre-intervention and post-test but there was a significant change in the attitude of participants. The findings reveal an overall positive impact of the complex intervention on the knowledge and attitude of healthcare professionals relating to SSI, SSI prevention and surveillance; however, the extent of the change varied across items measured.

Perioperative Pain Management Simulation Course: Improving Anesthesia Trainees' Confidence in the Management of Perioperative Pain and the Associated Critical Incidents.

Introduction Pain management is a crucial aspect of patients' perioperative journey and a fundamental duty of every anesthetist. Throughout anesthesia training, there is an emphasis on the management of critical incidents, several of which surround pain management. With changes to the anesthesia curriculum over recent years, variable exposure to training opportunities, and a reduction in clinical hours during training, many trainees report feeling underprepared for their future roles as consultants. However, pain management remains a small fragment of the core anesthesia curriculum with no pain-focused simulation courses currently available across the UK.Simulation has proven to aid learning transfer in complicated and stressful scenarios with a substantial improvement in knowledge retention and prevention of skill loss while eliminating the risk of harm to patients. Aim A novel perioperative pain management simulation course was designed and implemented in the East of England to equip junioranesthesia traineeswith the knowledge, skills, and confidence to manage perioperative pain and the associated critical incidents. Methods A multidisciplinary team (MDT) was involved in the course design. The faculty consisted of anesthesia consultants, trainees, pain nurses, and simulation technicians. The course ran twice over a six-month period both locally and regionally. A blended learning approach was adopted where 17 trainees attended PowerPoint presentations providing an overview of basic pain theories, perioperativepain management, regional anesthesia, and labor analgesia. Trainees then underwent telecasted simulation training using replicated patient notes, imaging, blood gas analysis, and a high-fidelity SimMan®. A debriefing period followed each scenariousing Pendleton'smodel. An anonymized questionnaire was completed by all trainees before and after the course to assess improvement in theirknowledge and confidence levels across fourdomains covering the management of perioperative pain. Results All 17 trainees completed the questionnaire; therefore, the entire dataset was analyzed. The pre-course questionnaire showedthat usinga scale of zero to 10, the vast majority of trainees reported low levels of confidence (<6/10) in the management of chronic pain during the perioperative period (82%), intraoperative pain management (76%),regional anesthesia(88%), and labor analgesia (65%). Following thesimulation training, the results showed an overwhelmingly positive improvement in all 17 trainees' knowledge and confidence across all four tested domains. All 17 trainees (100%) also showed an improvement in their understanding of local pain protocols. The subjective feedback was positive, highlighting the overall usefulness of the course andthat thetailored complexity of each simulation scenario was appropriateto each candidate's prior level of experience. Trainees also reported feeling more confident in starting their anesthesia on-calls. Conclusion This novel simulation course is the first of its kind in pain management. It has shown great improvements in trainee confidence in managing perioperative pain and the associated critical incidents. Subjective feedback has also been positively reassuring. Its inclusion into the East of England anesthesia training programand national training curriculum would greatly enhance trainee's knowledge and experience in pain management in the perioperative setting.

Transforming perioperative patient safety clinical guidelines recommendations into measurable standards: insights from the SAFEST project

Abstract Adopting evidence-based practices can improve the safety outcomes of surgical care. However, translating evidence into practice is slow in the healthcare field; an effort should be made to overcome this challenge. One approach could be to develop measurable standards to allow the evaluation and prioritization of healthcare improvements. The SAFEST project aimed to transform a list of prioritized clinical guidelines recommendations for adults’ perioperative care into measurable standardized practices (or standards) for hospitals to implement along the perioperative patient journey. Based on a previous systematic review of guidelines and an international expert panel review, we transformed recommendations into standards through an iterative and consensus qualitative approach. First, recommendations were classified according to the perioperative period (pre, intra or post) and based on predefined clinical areas. Second, one or more recommendations were transformed into one standard. Third, for each standard, measurable elements were developed to highlight in practical terms what needs to be implemented and measured, and the source of information and responsible stakeholder were identified. The overall transformation was performed by independent reviewers and the list of measurable standards was approved and finalized through discussion. From an initial list of 101 prioritized clinical practices recommendations, we developed 103 standards with 164 measurable elements. The standards with the related measurable elements, classified based on the perioperative period, were grouped in 12 different areas based on specific topic (e.g., complications preventions). Overall, these measurable standards can enhance dissemination and implementation of patient safety standardized practices in the continuum of care for adults’ patients undergoing surgery.

Perioperative management of Obstructive Sleep Apnoea: Present themes and future directions.

Obstructive sleep apnoea (OSA) is an increasingly common pathology that all those involved in perioperative care will come across. Patients with the condition present a challenge at many stages along the perioperative journey, not least because many patients living with OSA are unaware of their diagnosis.Key interventions can be made pre, intra-, and postoperatively to improve outcomes. Knowledge of screening tools, diagnostic tests, and the raft of treatment options are important for anyone caring for these patients. Recent literature has highlighted the increasing complexity of surgical patients and significant underdiagnosis of OSA in this patient population. Work has demonstrated how and why patients with OSA are at a higher perioperative risk and that effective positive airways pressure (PAP) therapy can reduce these risks, alongside evidencing how best to optimise adherence to therapy, a key issue in OSA. OSA, and particularly undiagnosed OSA, presents a huge problem in the perioperative period. Perioperative PAP reduces the risk of postoperative complications but adherence remains an issue. Bespoke perioperative pathways should be developed to identify and optimise high risk patients, although at present evidence on how best to achieve this is lacking.

How to Improve Communication Between the Perioperative Team and Patient's Family/Designee During Their Perioperative Journey While Keeping it Meaningful, Safe and Effective

How to Improve Communication Between the Perioperative Team and Patient's Family/Designee During Their Perioperative Journey While Keeping it Meaningful, Safe and Effective

Handling injectable medications in anaesthesia: Guidelines from the Association of Anaesthetists.

Peri-operative medication safety is complex. Avoidance of medication errors is both system- and practitioner-based, and many departments within the hospital contribute to safe and effective systems. For the individual anaesthetist, drawing up, labelling and then the correct administration of medications are key components in a patient's peri-operative journey. These guidelines aim to provide pragmatic safety steps for the practitioner and other individuals within the operative environment, as well as short- to long-term goals for development of a collaborative approach to reducing errors. The aim is that they will be used as a basis for instilling good practice.

Using PQIP to demonstrate the perioperative patient journey at the Royal Marsden Hospital

Using PQIP to demonstrate the perioperative patient journey at the Royal Marsden Hospital

Perioperative Medicine: What the Future Can Hold for Anesthesiology.

Perioperative Medicine: What the Future Can Hold for Anesthesiology.

AUDIT FOR ASSESSMENT OF THE FULFILLMENT OF CARDIAC ERAS GUIDELINES IN LOW EURO-SCORE II CARDIAC SURGICAL PATIENTS IN THE FREEMAN HOSPITAL.

<h3>Introduction</h3> Enhanced Recovery After Surgery (ERAS) is a multimodal, transdisciplinary care improvement initiative to promote recovery of patients undergoing surgery throughout their entire perioperative journey. These programs aim to reduce complications and promote an earlier return to normal activities. <h3>Aim</h3> Investigate the fulfilment of cardiac ERAS guidelines in low euro-score II cardiac surgical patients in the Freeman hospital in 2020. <h3>Patients & Methods</h3> A retrospective investigation of fulfillment of ERACS recommendations in patients with low euro-score II. - Data collected from the surgical data-base in 2020 and patients e-records. - The recommendations from the ERACS 2019 guidelines were used as a reference. Audit Results: The ERACS guidelines investigated included: - Preoperative data: - ALL patients had Pre-operative Albumin level done. - None of the patients had initiation of Preoperative multimodal analgesic. - None of the patients stopped smoking & hazardous alcohol 4 week before elective surgery. - None had preoperative CHO Loading. - Preoperative HbA1c in 69% of patients. - Clear liquids continued up to 2 to 4 hours before GA in 51% of patients. - Intraoperative data: - In ALL patients Hyperthermia was avoided while rewarming on CPB. - In ALL patients Tranexamic acid was given during on-pump. - Postoperative data: - All patients had Perioperative glycemic control. - ALL patients had an insulin infusion for hyperglycemia postoperatively. - In ALL patients a postoperative delirium screening tool used at least once per nursing shift . - In All patients persistent hypothermia after CPB was avoided. - The peri-operative, multimodal, opioid-sparing, pain management plan: Paracetamol: ALL Tramadol: None Dexmedetomidine: None Gabapentin: None Regional anaesthesia: None - ALL had thromboprophylaxis after surgery . - None had early detection of AKI. - All patients had early postoperative enteral feeding and mobilization. - 76% were extubated within 6 hrs. Audit Recommendations: - Initiate our own ERAS cardiac program. - Add engagement tools in pre-operative education. - Pre-habilitation and optimization for patients with multiple comorbidities. - Smoking and alcohol cessation. - Pre-operative HbA1C in all cases. - Preoperatrive correction of nutritional deficiency . - Clear liquids continued up to 2 to 4 hours before GA. - Oral CHO 2-4 h before surgery. - Pre-operative multimodal analgesic (Gabapentin 300 mg and Paracetamol 1000 mg given orally in preoperative holding area). - Minimal anxiolytics before surgery - Surgical site infection reduction care bundle. - Rigid sternal fixation. - Intraoperative multimodal analgesia. - Strategies to ensure early extubation within 6 h of surgery. - Avoid stripping or breaking the sterile field of chest tubes to remove clots. - Early detection of kidney stress - Goal-directed fluid therapy: - Early removal of Lines and drains - Management of pre-operative anaemia. - Goal directed perfusion strategies. - A protective lung ventilation strategy. ASSESSMENT OF THE FULFILLMENT OF CARDIAC ERAS GUIDELINES IN LOW EURO-SCORE II (<3) CARDIAC SURGICAL PATIENTS IN THE FREEMAN HOSPITAL, IN CALENDAR YEAR 2020.

Healthcare professionals knowledge of inherited cardiac arrhythmias ica their views towards and confidence in caring for a person with an ica in a surgical environment

Abstract Background Inherited Cardiac Arrhythmias (ICA) are potentially life-threatening conditions which may be induced by several factors during the perioperative period. Safety and quality of care of patients may be affected by insufficient knowledge, or confidence by healthcare professionals in surgical areas. Purpose To determine the knowledge of ICAs by healthcare professionals, their views towards and confidence in caring for a person with an ICA in a surgical environment. Methods In Phase One, a twenty-four item questionnaire was distributed to registered nurses and midwives, surgeons and anaesthestists within surgical areas of seventeen hospitals of the Republic of Ireland and Northern Ireland. Results Completed questionnaires were returned from 154 participants in Phase 1 involving all four professions of the participant cohort. This comprised of one hundred and seventeen nurses, seven midwives, ten surgeons and nineteen anaesthetists. Sudden Adult/Arrhythmic Death syndrome (SADs) was heard of by 91% of participants, and 54% have heard of ICA. The majority of participants were not at all confident or only slightly confident (48% and 32%) in caring for patients with an ICA. Eighty-four percent were not aware (61.7%) or not sure if they were aware (22.7%) of the drugs to avoid in ICA conditions such as Long QT and Brugada syndrome. Those aware (11%) of drugs to avoid were seven anaethetists, two midwives and eight nurses. Of the ten surgeons, none were aware of the drugs to avoid. When all participants were asked how relevant is knowledge of ICA to your current role 5.8% said it was not at all relevant, 29.2% said it was slightly relevant, 31.8% moderately relevant and 28.6% extremely relevant. Ninety-five percent (95%) of participants would like further education about these conditions delivered mainly by online sessions and face to face workshop methods. Conclusions There is limited knowledge of and confidence in caring for people with Inherited Cardiac Arrhythmias in surgical areas of the hospitals surveyed. Education is required in relation to awareness and identification of people with these conditions, signs and symptoms, unmasking and triggering a cardiac event and what medications need to be avoided. Patients may not be aware they have an Inherited Cardiac Arrhythmia, so healthcare professionals' awareness is crucial with the ability to recognise and respond appropriately to a possible cardiac event. There is a need to address these gaps as these have potential serious implications for people with an ICA during their perioperative journey. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The Cormac Trust

Renal transplant patients’ pre-operative knowledge and subsequent experience of perioperative journey – An exploratory survey informing introduction of a renal transplant ERAS pathway

Objectives: Patient education is key to ERAS - supporting their preparation for surgery and empowering them on their post-operative recovery. However, there is currently little evidence underpinning its format, timing & delivery. Pre-operative information provision can be disjointed, exacerbated by multiple teams involved in a renal transplant pathway. We explored our renal transplant patients’ understanding of their perioperative journey & their quality of recovery, to inform the development of an ERAS pathway.