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The key challenge is achieving meaningful improvements in a patient's condition without introducing delays to time\u2010sensitive surgery, which may be required in a matter of hours. Optimisation can be considered in two parts: that of the patient's condition; and that of the care pathway. Optimising the patient's condition is less about improving long\u2010term pathology, and more about correcting physiological derangement, such as electrolyte and fluid balance, blood loss, prompt treatment of sepsis, and ensuring appropriate continuation of medication in the peri\u2010operative period. Optimising the care pathway involves ensuring that the system is designed to deliver reliably the appropriate interventions, such as prompt antibiotics, and access to computed tomography scanning and the operating theatre with minimal delay.<\/jats:p>","DOI":"10.1111\/anae.14514","type":"journal-article","created":{"date-parts":[[2019,1,3]],"date-time":"2019-01-03T02:33:56Z","timestamp":1546482836000},"page":"100-107","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Pre\u2010optimisation of patients undergoing emergency laparotomy: a review of best practice"],"prefix":"10.1111","volume":"74","author":[{"given":"T.","family":"Poulton","sequence":"first","affiliation":[{"name":"Health Service Research Centre National Institute of Academic Anaesthesia London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Murray","sequence":"additional","affiliation":[{"name":"Anaesthetic Department James Cook University Hospital Middlesbrough UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the National Emergency Laparotomy Audit (NELA) project team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,1,2]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2011.07046.x"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9208"},{"key":"e_1_2_8_4_1","unstructured":"NELA Project Team.The Fourth Patient Report of the National Emergency Laparotomy Audit RCoA London.2018.www.nela.org.uk\/reports(accessed 02\/08\/2018)."},{"key":"e_1_2_8_5_1","unstructured":"Healthcare Improvement Scotland.SIGN 104. 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