A quality framework for perioperative care: rapid review and participatory exercise

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Abstract

Background This study addresses the need for a comprehensive, evidence-informed conceptual framework to describe relevant dimensions of quality in perioperative care, moving beyond traditional phase-based models.

Methods We used iterative synthesis of literature as well as consultation and participatory exercises with multidisciplinary professionals and patient representatives, who together formed an Expert Collaborative Group (ECG). The review included primary studies, guidelines, and grey literature identified through searches of PsycINFO, MEDLINE, CINAHL, and institutional websites. The findings were synthesised across studies using an inductive process to build a preliminary framework. Key concepts were identified, mapped, refined, and organised into an initial structure for further development. Fourteen ECG members evaluated a draft version of the framework via the Thiscovery online platform, focusing on relevance and coherence. Their feedback was used to refine the framework, in consultation with clinical experts.

Results Through combination of rapid review of the literature and stakeholder engagement, we were able to develop a framework comprising ten domains that encapsulate structural and process-related features critical to high-quality perioperative care. Feedback from stakeholder exercises was important in improving early versions of the framework, including reordering domains to reflect their centrality and integrating patient and carer perspectives. The resulting perioperative-framework, termed P-Frame, includes domains such as 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, ensuring relevance across clinical, operational, and experiential dimensions of care.

Conclusions P-Frame, based on the available evidence and the perspectives of clinicians and patients, offers a valuable tool for monitoring and improving perioperative care quality as well as supporting research efforts.

What is already known on this topic Perioperative care quality is typically defined within the pre-, intra-, and post-operative phases, restricting the development of broader based quality measurement. This has led to an excess of measures focused on clinical protocols, based on limited evidence and excluding the perspectives of patients and caregivers.

What this study adds This study provides a balanced framework for understanding the domains of quality and safety across all perioperative care settings.

How this study might affect research, practice, or policy It offers a foundation for the development of measures which can be used in audit, research, and targeted improvement initiatives.

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Contributors

Author: Stephen Lim

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