What to expect at your POAC visit

The pre-operative period is an opportunity for us to 'optimise' and improve on aspects of your health to make operations safer, reduce the risk of complications and to help you recover faster and 'better'.

Find out about you - The "HSQ"

For many, this will start with completion of what we call the "Health Screening Questionnaire", or HSQ.

This form will be given to you to complete, by your surgical team, by the POAC team, or sent to you in the post.

The HSQ helps us to find out about aspects of your health, physical fitness and any medications you may be taking.

The HSQ contains questions that will be explored in further detail in your POAC visit, we will ask about:

General health, physical activity and medical history
Previous operations, anaesthetics, and any problems you or your family may have experienced
Allergies and medications you are taking, including those from your GP and over-the-counter
Smoking, alcohol and recreational drug history and habits

Following completion of HSQ, you will either have a phone consultation, or a clinic appointment with a specialist pre-operative assessment nurse, this may be combined with meeting an Anaesthetic doctor, attending specialist clinics or undergoing investigations, more information about these different appointments may be found below.

Nurse Led Clinics

Nurse led clinic appointments generally take around an hour, though straightforward patients may take less time, and more complex patients may take more time depending on the complexity of you and/or the surgery planned.

Following seeing a specialist nurse, you may also need to see an Anaesthetist or have further investigation, tests, or sometimes treatment, we can sometimes organise these on the same day, but you may be asked to return on another day.

Anaesthetist Clinics

You may need to see an Anaesthetist as part of your preparation for surgery. Where we can this is the same day as other appointments. This appointment will be opportunity for you to discuss anaesthesia, risks, ways to reduce risks before your operation.

Shared Decision Making (SDM);

Undergoing surgery for many is a significant life event, and can be daunting.
Shared decision making describes the process that you as a patient, and we as doctors and nurses, together choose the best treatment decision for you.
It involves finding out about you, your health, what you value most about your health and future, and discussing the risks that may be involved with undergoing anaesthesia and surgery.
When meeting an Anaesthetist as part of the preparation process, discussion of risk is likely to form a large part of the discussions.
The video to the right helps to explain how this process works, and to help guide you in your own decisions.

Below are some links to websites that explain SDM in more detail. The BRAN tool can be used to help patients with decisions about care, it splits decisions into four parts; Benefits of any decision, Risks involved, Alternative Treatments that may be available, and finally "What If I do Nothing?".

Cardiopulmonary Exercise Testing Clinic (CPET)

Some patients may be asked to undergo Cardiopulmonary Exercise Testing (CPET, or sometimes CPEX). The test involves pedalling on a static bike, whilst breathing through a mouthpiece and we will monitor your heart with a continuous heart tracing (ECG). The test is used to assess the performance of your heart and lungs and will provide an accurate assessment of your physical fitness.

CPET helps to assess the risk of undergoing major operations. We know that fitter people have better outcomes from surgery; fitter patients are less likely to have complications and more likely to be discharged home earlier after their operation.

Appointments normally last an hour, and involve some breathing exercises followed by 10-15 minutes of cycling on the static bike.  After the test, we will talk to you about the test results. We will discuss the risk involved with undergoing surgery and we will also discuss ways to improve your fitness and reduce your risks. Occasionally, further tests or referrals are required following a CPET (we will tell you if this is required).

Please watch the video or click on the documents below for further information about what to expect with your CPET appointment.

CPET information poster

CPET information sheet

Tests and Investigations during POAC

We may also undertake investigations and tests as part of the pre-operative assessment process, these may include;

An electrocardiogram (ECG) - where we look at the electrical activity of your heart
Blood tests
Breathing tests (spirometry or sleep apnoea) - carried out in separate clinics
Echocardiogram (echo) - an ultrasound scan of your heart. Can sometimes be done on the same day as your clinic appointments
CPET (as above)

Some of these tests we will have the results for during your appointment, however some results will come back after, we will contact you or your GP if there are any concerns.

Anaemia Treatment within POAC

Anaemia (fewer red blood cells then expected) is common amongst some patients waiting for surgery, one of the causes of this is a lack of iron. Patients with anaemia resulting from a lack in iron, may be offered treatments to correct this, this helps to make your operation and hospital stay safer, reduce the likelihood you will need a blood transfusion, and aid your recovery.

Some patients will be advised to take iron tablets, others may be offered an appointment to have an intravenous iron infusion, this is a 1-2 hour treatment. Here is some information about our iron infusions.

The next page is about Prehabilitation; how-to help make yourself fitter for your operation.

Navigate around the POAC site using the links below.