This document outlines the local governance structures that are required in each hospital to support the preassessment service. A lead anaesthesiologist is required in each hospital to chair the Preassessment Service Operational Group, which will consist of representatives from all the specialties contributing to the work of the preassessment service. A section on workforce planning allows the number of essential staff required for the service to be determined depending on the numbers of patients attending the hospital for elective surgery. The number of staff allocated to the preassessment service will be dependent on the size and resources of the hospital concerned. Appropriate resources and staffing for preassessment services will be required for the proposed new surgical hubs and new elective hospitals that are being planned by the HSE. The nominated lead anaesthesiologist will be responsible for the application of recognised guidelines for the preassessment service, education of the staff and for the regular audit of the service. The lead anaesthesiologist will liaise with preassessment services in the Health Regions or Hospital Group (HG) with a view to standardisation of practice and sharing of educational resources.

P.6 Appropriate risk assessment screening and assessment of functional capacity are important components of preassessment, particularly for patients in ASA grades III or IV, or for any patient undergoing major surgery. A selection of assessment tools is described in this document, the use of which should be agreed at local level. Prehabilitation involves assisting the patient to become physically optimised prior to their operation as this improves outcomes. This includes addressing malnutrition, excess weight, anaemia and encouraging appropriate exercise to improve physical fitness. Lifestyle advice regarding smoking, alcohol and recreational drug consumption is important. Preparing the patient to have a positive psychological attitude towards their surgery is also helpful and this may include breathing exercises and visualisation techniques to reduce anxiety. The preassessment service provides an opportunity to encourage patients to take measures to optimise their general health preoperatively which will assist in their postoperative outcome.

P.16 The RCoA’s FitterBetterSooner programme https://rcoa.ac.uk/patients/patient-information-resources/preparing-surgery-fitter-better-sooner provides a useful resource for prehabilitation. Preoperatively, lifestyle modifications (e.g. smoking, alcohol consumption, recreational drugs, advice on nutritional status/weight management etc.) should be discussed with the patient. Nutritional screening should be made for intermediate or major surgery, anaemia should be treated and the risks of venous thromboembolism should be assessed and reduced.