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​GPs urged to consider blood pressure when referring patients for surgery

GPs are being urged to only refer patients for elective surgery if their blood pressure has been recorded at below 160/100mmHg in the past 12 months, under new guidelines aimed at cutting the number of operations cancelled because of high blood pressure.

The guidelines – from the British Hypertension Society and Association of Anaesthetists of Great Britain and Ireland – also call on GPs to make sure they include blood pressure readings in all referral documents, saving time and avoiding unnecessary cancellations because of high blood pressures recorded once the patient has gone into hospital for the operation.

GP recordings will provide the confirmation needed for surgeons to proceed with surgery, removing the requirement for readings in secondary care, the organisations argue.

The guidelines have been introduced to establish one formal document that can be used ‘as a benchmark’ for all GPs to know what readings are appropriate when referring patients for elective surgery.

Prior to the guidelines, it was found that the lack of agreement between primary and secondary care over acceptable blood pressure readings led to confusion and ‘frustration’, with up to 100 operations a day being cancelled because of high blood pressure readings taken in hospitals.

The document was put together using feedback from a range of experts including GPs and anaesthetists as well as views taken from patient groups.

Dr Terry McCormack, GP and co-chair of the guidelines working party said: ‘We wanted to create a common sense document that everybody can use as a benchmark.

‘Blood pressure readings need to come from primary care where there is already recognition that this is the best place to have it done.’

He added: ‘It shouldn’t be too big of an ask for GPs to include blood pressure in a referral document - these guidelines are intended to make both GPs’ and patients’ lives easier.’

Read the guidelines in full 




Readers' comments (9)

  • Good idea, but have been sending this information with every referral routinely for decades, as I'm sure most others do. Sometimes hospital dont read the info that accompanies the referral, other times the patient's blood pressure goes up at the clinic, perhaps they're stressed, or forget their tablet, or decide not to take their tablets, who knows! Damn these people for not having the same blood pressure every day!

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  • PS now I have actually read the guidance and its actually pretty good. If the hospital follow this then far fewer punters will be bounced by the pre-admission nurse

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  • My frustration is the number of patients who get bounced back and taken off the list by pre-op assessment clinics for single readings that are even below the 160/100 mark accepted by anaesthetists. Pre-op nurses should pass forward to anaesthetists and not back to GP and should not cancel surgery unless they have evidence of poor BP control above 160/100 in the preceding months.

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  • better still why don't we do the surgery as well, may as well whilst we're there doing the rest of the pre-op assesment?

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  • Fair enough, I've seen too many patients have their pathway 'stopped' due to a one off raised bp after getting the third degree from the pre assessment nurse.

    Of course I never refer someone 'for surgery', I only refer for further expert advice and management from someone whose treatment options include surgery, but that's another discussion.

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  • I get what this is saying - but - patient has abdominal pain, might need surgery, might not. Surely the decision to operate is with the surgeon. This might be an obvious answer / question - can they not do blood pressures in clinic?

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  • Although I sympathise with the hospitals with regarding to sending back patients for BP control, the problem now is Pre op clinics are now run by newly qualified Nurses who run it by the book and don`t recheck B.P on opp arm or after 5 minutes if B.P very slightly raised and send them back to the GP. Most patients are anxious when they go for the same so this causes trouble. when they are sent back the clock starts all over again and get one more payment for outpatients!
    Since at the point of referral the need for surgery may not be obvious and also the time duration between referral AND EVENTUAL SURGERY it doesn't make a difference if the BP was normal when we refer as its likely to change anyway.
    Also some patients think they should not take Rx when going for preop! (just like some say I didn`t take paracetamol because I wanted you to see my fever etc!).
    This maybe helped by explaining it clearly in the pre op appt sheet.
    Dumping it on GP`s is the worst thing to do.
    We need a HRG tariff for the same.

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  • Any decent anaesthetist can turn BP up and down as easily as the volume on their iPad. High bp is just an excuse to delay surgery and manipulate waiting time targets.

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  • @4:56 - I think it is because the patient may be more likely to have isolated reactive high BP when in hospital.

    What should actually happen is the BP is taken in the hospital clinic, if raised the hospital organises a home BP monitor, the hospital interpret the results then makes a decision about surgery.
    But even I think that is too much to ask.
    I don't mind putting the BP on the referral, have done so routinely for a long time.

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