SurgiCheck / Perioperative risk governance
Definition
Perioperative Risk Governance
Perioperative risk governance is the discipline of handling pre-operative risk information in an explicit, sourced and recorded way: every flagged risk has a source, an owner, a resolution state and a retrievable history. It governs how risk information is handled. It does not decide for the clinician.
What is governed
- Which risks are surfaced. Predefined rules, each linked to a cited guideline or a documented local protocol, evaluate patient-reported and clinician-verified information.
- Who has to act. Each flag follows a pathway (INFO, VERIFY, REVIEW or DEFER) that states what kind of action is expected.
- What must be resolved before a decision is recorded. An open hard stop, an open VERIFY item or an unacknowledged REVIEW item prevents a clean "proceed" from being recorded.
- How exceptions are authorised. Where an override is permitted, it needs a second, distinct authoriser and a written rationale of at least 20 characters.
- What is kept. Each clinician decision is stored as an immutable, timestamped revision, together with the engine and rule-set version and the flags that were shown at that moment.
Governance compared with decision support
| Question | Often framed as decision support | Framed as governance |
|---|---|---|
| What does the system produce? | A recommendation or a score | Source-referenced flags routed to a role |
| Who decides? | Can be unclear at the point of use | Always the clinician, recorded with a rationale |
| What happens to exceptions? | Often informal or free text | Dual-authorised override with mandatory rationale |
| Can the decision be reconstructed later? | Depends on the system | Yes: flags, engine version and rule-set version are stored with the decision |
The four pathways
| Pathway | Meaning | Clearing |
|---|---|---|
| INFO | Documented for the record. No action blocks the decision. | Clears automatically |
| VERIFY | Data or an assessment must be confirmed or recorded by the clinician before a risk pathway can be set. | Must be resolved |
| REVIEW | A documented review or plan is required (surgeon or anaesthetist). | Acknowledged; dual-authorisation override where marked |
| DEFER | Recommends deferral and reassessment. | Hard stop clears only when inputs change; overridable DEFER clears by dual-authorised override or re-evaluation |
What it is not
- It does not diagnose, prescribe or make surgical decisions. Output is never "fit" or "unfit for surgery": the proceed or postpone decision is made by the surgeon, anaesthetist, patient and, where relevant, the prescribing physician.
- It is not machine learning. The rules are deterministic and readable, and the same input always produces the same flags.
- It does not replace clinical judgement or the clinician's verification of patient-reported data, which is mandatory before a decision is recorded.
Whether software of this kind is a medical device depends on its intended purpose, claims, functionality and jurisdiction. A formal UK/EU qualification and classification assessment for SurgiCheck is in progress; clinics should take independent regulatory advice for their own jurisdiction.