Preoperative clinics-how can they be improved?

In the last 20 years there have been major changes in systems and processes for the assessment and preparation of patients having planned elective surgery. Although these changes have varied in different countries, health systems and hospital types, hospitalbased multidisciplinary preoperative services with clinics are becoming increasingly accepted as an integral part of surgical patient care'. These changes have been accompanied by a shift from traditional models of surgical care towards planned, protocolised processes, including day of surgery admission and approaches such as 'enhanced recovery after surgery'. The widespread implementation of these new peri-operative systems represents a paradigm shift in surgical care.