Greener Operations: Sustainable Peri-Operative Practice PSP Question Verification Form

The purpose of this Question Verification Form is to enable Priority Setting Partnerships (PSPs) to describe clearly how they checked that their questions were unanswered, before starting the interim prioritisation stage of the process.

The JLA requires PSPs to be transparent and accountable in defining their own scope and evidence checking process. This will enable researchers and other stakeholders to understand how individual PSPs decided that their questions were unanswered, and any limitations of their evidence checking.

Name of the PSP

Greener Operations

Please describe the scope of the PSP

Peri-operative practice, which for the purposes of this project is defined as care provided from or in the secondary care setting to patients who may benefit from surgical management, including:

• pre-operative assessment and optimisation (e.g. pre-operative clinic)
• counselling and shared decision-making (including on decisions regarding the appropriateness of surgery, and different approaches to peri-operative management)
• pre & postoperative hospital care (including outpatient, ambulatory, virtual and inpatient care)
• intra-operative management (including surgical and anaesthetic techniques)
• both clinical (e.g. surgical and anaesthetic techniques) and non-clinical (e.g. energy, water, waste management and recycling) aspects
• the implementation of these practices within organisations / departments
• achieving positive peri-operative outcomes

Please provide a brief overview of your approach to checking whether the questions were unanswered

Questions submitted by patients and clinicians to the survey were collated and categorised into indicative questions. These indicative questions were agreed on by the Steering Group. The verification process aimed to determine which of these questions are unanswered by research to date.

Our search strategy was stepwise starting with the most reliable sources and working down. This enabled answered questions to be identified efficiently.

The following process was followed for each question:

1. Guidelines (NICE, SIGN, Royal College, or Professional association) were reviewed to determine whether they covered that question. If they did, then evidence behind the guidelines was reviewed. Where this evidence was low-quality, e.g. observational research or expert consensus, this was discussed with the steering group to determine whether to consider the question answered or unanswered.
2. Cochrane reviews were searched using keywords specific to each question. Where a review called for further research, the question was not considered answered. If the systematic review was older than 5 years old, recent studies were also searched to ensure the question had not been answered more recently.
3. Database searches on OVID and Google Scholar were conducted to identify systematic review not conducted by the Cochrane Collaboration, using keywords specific to each question. If the systematic review was older than 5 years old, recent studies were also searched to ensure the question had not been answered more recently.
4. Ongoing and future systematic reviews were reviewed on registries (e.g., Cochrane protocols and PROSPERO - https://www.crd.york.ac.uk/prospero/). These were used to identify questions that may be answered in the coming years. The aim was not to exclude questions at this stage but to take these into account to help refine the questions for the interim workshops and prioritise those taken to the final workshop.

Please list the type(s) of evidence you used to verify your questions as unanswered

National Guidelines (NICE, SIGN, Royal College, or Professional association)
Systematic Reviews (including Cochrane)
If systematic reviews were older than 5 years, recent studies were reviewed
Ongoing and future reviews were logged

Please list the sources that you searched in order to identify that evidence

Systematic review evidence found via:

• Cochrane (https://www.cochranelibrary.org)
• OVID (databases included Pubmed, CINAHL, AMED, BNI, EMBASE, HBE, Medline, and PschINFO);
• Google Scholar (https://scholar.google.co.uk);
• Published UK national guidelines – NICE, SIGN
• Published UK college or professional association guidelines from professions involved in peri-operative care (as defined in our protocol).

What search terms did you use?

Keywords of each question were used in each database and tailored to each question.
Examples of keywords were:

• (surg* or peri-op* or oper*) and (sustain* or waste or recycl* or environ*)
• Infection control and sustain*
• (sustain* or environ*) and (packaging or equip* or material) and (surg* or peri-op* or oper*)

Please describe the parameters of the search (eg time limits, excluded sources, country/language) and the rationale for any limitations

• All guidelines were in English. All studies were included however, recent evidence in the last 5 years was seen to be stronger than older evidence.
• The search was limited to English only for clinical guidelines.
• No language limitation for systematic reviews or studies.

Names of individuals who undertook the evidence checking

• Max Clayton-Smith
• Hrishi Narayanan
• David Jones
• Clifford Shelton
• Partner organisations involved in the PSP

On what date was the question verification process completed?

5th April 2021

Any other relevant information