Quality framework for perioperative care: rapid review and participatory exercise

BACKGROUND: This study addresses the need for a comprehensive, evidence-informed conceptually based quality framework for structures and processes of perioperative care. METHODS: We combined a rapid review of international academic literature and UK grey literature with a participatory consultation. The review included primary studies, guidelines and grey literature identified through searches of PsycINFO, MEDLINE, CINAHL and institutional websites. Findings were synthesised across studies using an inductive process, with key concepts identified, mapped, refined and organised into a preliminary framework. We consulted with UK-based multidisciplinary professionals and patient/carer representatives (public contributors), who together formed a 14-person Expert Collaborative Group using a participatory exercise hosted on the Thiscovery online platform. Descriptive analysis was used for quantitative responses and content analysis was used for free text analysis. RESULTS: We were able to develop a 10-domain framework that encapsulates structural and process-related features important to high-quality perioperative care, using the rapid review to generate a preliminary framework and consultation with professionals and public contributors to refine it. The final framework, termed 'Perioperative Framework'(P-Frame), comprises domains covering environment and facilities, leadership and governance, organisational culture, shared decision-making, multidisciplinary working, patient optimisation, clinical protocols, post-operative support, staff education and workforce planning. Importantly, the framework integrates the perspectives of patients and carers and seeks to ensure relevance across clinical, operational and experiential dimensions of care. CONCLUSIONS: P-Frame, based on the available evidence and the views of UK clinicians and patients, offers a potentially valuable tool for monitoring and improving perioperative care quality as well as supporting research efforts. It will benefit from further evaluation and testing of use in practice in different contexts and countries.