Welcome to the Perioperative Care Unit (POCU) and the 'Road to Recovery'. Let's start this journey together!

Here we will introduce the Perioperative Care Unit and its role in caring for the high-risk patient with a focus on enhanced care. We will also touch on the different types of enhanced recovery areas that exist all over the world.

In this activity we will talk about the concept of 'Risk' - how we quantify it, how we communicate this with patients and how we use this information to inform our decisions about their perioperative care requirements.

No let's consider the tools available to us which may modify patients risk and improve outcomes. For example, prehabilitation, enhanced recovery protocols and shared decision making to name a few.

Level 1.5 care or 'enhanced care' was introduced by CPOC and FICM in 2020. This chapter, we will examine the different levels of critical care and where the POCU fits in.

Congratulations on completing week one of your POCU journey. We hope you have enjoyed and are curious to continue - there is lots more to come!

Delirium and frailty as you will learn are real issues for hospital in-patients and particularly (but NOT exclusively) an ageing population of surgical patients - so let us look at this in a bit more detail.

Frailty is a predictor of adverse outcomes following surgery. Identification of frailty is key to enable targeted intervention throughout the perioperative pathway - but can you recognise a frail patient? Let's take a look...

Delirium and dementia have distinct causes and clinical presentations. Understanding these differences is essential for healthcare providers to offer effective care and improve patient outcomes. Read on to find out more...

We will now consider the risk factors for delirium, especially in the context of high-risk surgery and bring this back to how you would use this learning in your clinical work.

Since the introduction of ERAS, perioperative nutrition has been thrown to the forefront of our care bundles. Here, we introduce how we approach feeding in POCU and what to do when patients can't eat after surgery.

This week we have introduced the very important concept of patient frailty. We hope we have got you thinking about how we can reduce the risk of cognitive dysfunction in our high-risk population and link in your knowledge on ERAS.

Building on what we have learnt in the first two week, we are now going to look a bit more closely at the airway and breathing aspects of POCU care, including assessment and management. Enjoy!

This chapter looks at the management and monitoring of a patient's airway after surgery, ensuring that it remains clear and functional to prevent complications such as respiratory distress or airway obstruction during recovery.

Assessing the patient's airway...this is one of the most important skills in airway management. How comfortable are you with the 'Look, Listen, Feel' approach?

Pulmonary complications can be common in the postoperative period and we must be vigilant when monitoring patients breathing. Here, we explore common breathing emergencies and management of these.

This has been a big week of learning as airway and breathing are large topics which are very important in the postoperative period. Take a minute to reflect on the concepts of assessment and management of these emergencies.

Building on what we have learnt about airway and breathing, we now need to take a closer look at the cardiovascular system. We start with physiology, cardiovascular assessment and the management of complications.

Cardiovascular physiology can sometimes be a bit complicated and overwhelming. In this chapter, we hope to break these concepts down into bitesize chunks. If you have any questions, you can pop a question in the discussion forum.

Major surgery can often challenge the cardiovascular system/ Here, we discussion some of the cardiovascular complications and how to recognise and manage them.

You may have be used to using cardiac output monitoring to guide perioperative fluid therapy. This chapter introduces these techniques and the evidence for goal-directed fluid therapy.

We hope this has improved your understand and confidence with some of these more complicated concepts. If you have any questions or want to explore in more detail, write these down in the discussion boxes and we can try and help.

We think you'll agree that pain is the most common complaint in the postoperative care unit. Therefore, we felt it was important to dedicate a full week to the assessment and management of pain to help equip you to deal with this.

You will come across many types of pain in the perioperative period and all patients will feel and describe this differently. As perioperative practitioners we need to learn how to explore this with patients and help manage.

Opioids and the use of adjuvant analgesia is a key area of postoperative care and ties in closely with the ERAS principles. This chapter introduces the controversies surrounding opioids and how we can manage this clinically.

Regional analgesia techniques are increasingly popular and you will see more and more patients in POCU who have benefitted from this. Here, we look at what they are, how to monitor them and their complications.

This week we have looked at a much more clinical side of POCU. A clear understanding of perioperative pain and the different ways we can manage it is key - we hope this helps!

This week we will explore thoracic, upper GI, liver, colorectal. urology and major gynaecological surgery. This will include a summary of the anatomy, high-risk surgical procedures and important aspects of their perioperative care

This chapter aims to consider the medical comorbidites that thoracic patients may present with and how we can enhanced their recovery on the POCU.

Upper GI surgical patients are some of the most high-risk that you will encounter on POCU. Join us in this chapter to talk about the what, why and how of Upper GI perioperative care.

Not all centres will care for patients undergoing liver surgery but some of the principles of care are worth reading about anyway, if you are interested.

A comprehensive overview of a patient group that you will commonly care for in POCU including stoma care, nutrition and ERAS for colorectal patients.

Urology patients are unique as they are often frail and can present with multiple comorbidities. Read on to discover more about the types of operations they may face and how you can support them in POCU.

We have used the example of a gynaecology patient to talk a little more about anaemia in the postoperative period and how we can optimise the frail patient

We hope that you have found this week interesting and relevant to your clinical practice. We will continue this clinical tour of surgical specialities next week, so read on to find out more.

It is crucial that you are familiar will the ENT/MaxFax procedures cared for on the POCU. These patients can have complex airways and encounter unique complications if not monitored closely.

In this speciality chapter, we will discuss the PACU care of patients undergoing a craniotomy: the key aspects of physiology and the common problems for these patients in the postoperative period, and dealing with common issues.

An small but fascinating chapter on some of the endocrine surgeries cared for on POCU.

Vascular patients can be incredibly co-morbid and carry some of the highest perioperative risk that you will see on POCU. Here, we discuss these patients as case studies which we hope will be relevant to your clinical practice.

A comprehensive look at the pre-, intra- and postoperative care of orthopaedic patients - both elective and emergency. How does enhanced recovery fit into this? Is this something you are used to thinking about in your hospital?

We have included this chapter on obstetric patients as we are caring for an increasing number of complex antenatal and postnatal women in our enhanced care areas. This may not apply to you in which case feel free to move on.

That concludes our two week journey through the surgical specialities. We hope that you have found this interesting and relevant to your practice and that you can now apply your new knowledge to improve patients enhanced care.

So, what does life working in POCU look like? This is a really interesting chapter which brings everything together and also goes through a comprehensive A-E assessment for you to use as a structure whilst working in POCU.

A really important topic is how and what to document at the bedside in POCU, including observation charts and also discharge planning.

We should consider that many of our patients will be unable to care for themselves int he immediate postoperative period. Keeping patients safe at the bedside and ensuring their wounds are appropriately managed it key.

Another key aspect of working in POCU relates to the administration of medicines - a daily routine which is crucial for the care of each patient and that, rightly so, follows strict safety and quality protocols.

Patient experience is a key aspect of their wellbeing and can significantly affect the speed and success of their recovery. Here, we talk about how we communicate with patients and their families during their POCU stay.

This module is a brief overview of distinct situations that, while not exactly routine, are fairly likely to occur in POCU, and for which a POCU practitioner will always be ready.

This chapter introduces the transfer checklist and uses a clinical scenario to ensure you are confident managing the transfer of a critically unwell patient.

This brings us to the end of our 'Road to Recovery'. We hope you have enjoyed the past 8 weeks and have gained an insight into life in POCU. We hope you take what you have learnt back to your clinical work to inspire others!