Perioperative service capability framework for Victoria

The Perioperative service capability framework outlines minimum standards for perioperative care in Victoria and recognises the range of complexity of procedures and patient needs.

It applies to planned perioperative services delivered across Victorian health services.

The framework outlines minimum requirements for clinical workforce, infrastructure, equipment, and clinical support services across six levels of capability. The levels range from Level 1 for low complexity office-based procedures to Level 6 for the most complex procedures.

The framework emphasises the importance of integrated healthcare networks across regions and the state to meet the diverse care needs of communities.

Aims

The framework aims to:

• Ensure safe, high-quality perioperative care is delivered at the right time and right place.
• Increase transparency of health service perioperative activity for the health services, the community and the Department of Health.
• Assist health services and the Department of Health to plan future service delivery based on community needs.

Guiding principles

The framework follows key principles, including:

• safe patient-centred care is delivered as close to home as possible
• the needs of different patient cohorts are met
• consultation, referral, and transfer processes between services of different capability are in place
• health service capabilities are clearly communicated to people accessing the service, the community and other service providers.

Using the framework

• The framework categorises perioperative services into 6 levels and outlines minimum standards for each level.
• Each level builds on the capabilities of the previous one, with level 6 offering the highest complexity services.
• The procedural complexity and perioperative risk (patient and anaesthetic complexity) that can be safely managed increases with each level.
• Each health service campus will complete a self-assessment and capability levels are published online.
• Capability frameworks should be viewed in conjunction with other key documents, particularly the Victorian Health Services Performance Monitoring Framework, the Department of Health Policy and Funding Guidelines and the Safer Care Victoria clinical governance framework.

Determining and monitoring perioperative capability levels

Every 2 years, health services will be required to complete a self-assessment questionnaire via an online platform. This will help the Department of Health to work with each health service campus to confirm their perioperative capability level. The self-assessment questionnaire will be available from February 2024. Further information and support will be provided closer to this time.

Once capability levels are determined for each health service campus they will be published on the department’s website.

As the system steward, the Department of Health is responsible for regular performance monitoring of public health services. The perioperative capability levels will be monitored on an ongoing basis in partnership with Safer Care Victoria, as part of routine performance conversations.

Perioperative capability self-assessment

Victoria has committed to providing transparent information to patients and communities on the capability levels of health services. To support this process, the self-assessment has been developed as an online tool for health services to evaluate the scope of perioperative service capabilities by:

• reviewing aspects of their perioperative care provision against the minimum criteria outlined in the framework.
• identifying any gaps in their perioperative services and how these may be addressed to meet their anticipated perioperative service capability level.

Access to the tool is by an individualised link for each health service campus. Each campus must complete a self-assessment. The link/s will be emailed to the CEO of each health service for distribution to the campus delegate responsible for compiling the response.

Health services will have 4 weeks to complete the self-assessment.The CEOs final endorsement and submission of responses is due on 22 March 2024.

See the Perioperative capability self-assessment fact sheet for more information.

Inclusion of emergency surgery

Emergency (unplanned) surgery requires extra availability of staff (on-call rostering) and a workforce complement that can accommodate this. The volume of planned procedures that are delivered at a campus can impact the availability and scope of practice of clinicians who are available to manage emergency perioperative care. Therefore, descriptors for managing emergency procedures commence at higher-level services and, where possible, patients should be transported to those services to receive appropriate care.

In exceptional circumstances, where a patient may be at risk of serious harm if urgent treatment is not provided at a given campus, it is expected that the best available care is provided.

Surgery reform program

The Perioperative service capability framework aligns with the Victorian Government's broader efforts, including the Planned Surgery Reform Blueprint, which seeks to improve planned perioperative health services by promoting greater access, safety and equitable outcomes. The framework supports the surgery reforms’ pillars of change by:

• enhancing safe and high-quality perioperative care
• optimising health service efficiency with improved partnerships and system planning development
• strengthening system stewardship through increased transparency across the system.

If through the surgery reform program, a campus seeks to expand its complement of perioperative services, it should take into account the requirements of the framework.

Different perioperative capability levels for adult and paediatric services

At a given campus the perioperative capability levels may differ for adult and paediatric services.

The perioperative care needs for paediatric patients are different to adult patients. To determine levels, it is important to identify the required scope of healthcare, the workforce and clinical requirements for both adult and children’s services. For this reason, capability frameworks may establish separate capability levels for adults and children tailoring requirements to the specific needs of each group.

Surgical termination of pregnancy

The framework assigns the appropriate levels for the provision of surgical termination of pregnancy with the guiding principles ensuring that the perioperative care needs of patients are met safely with respect, privacy and dignity. A policy guideline will be developed to further support and guide safe and quality termination services for women.

Statewide designated perioperative clinical services

If your health service campus is a level 6 service, in addition to the expected perioperative services it may also offer statewide designated perioperative clinical services.

The scope of the Perioperative capability framework does not extend to the designation of highly specialised clinical services that have been agreed at a site level for state-wide service provision. Rather, it relates to the minimum standard that is expected of all hospitals operating at a given capability level.

Download the framework

The abridged version of the Perioperative service capability framework, is presented in a horizontal format to assist health services in completing section 2 of the self-assessment.

Indicative procedure lists

There is no widely accepted and validated system for classifying the complexity of surgical procedures. The examples given, drawn from different specialties, are intended to provide an indicative guide only and do not replace clinical judgement.

Fact sheets for consumers and health services about the framework