PROM implementation for elective surgery patients in Australia, applying the “AusPROM Recommendations”

* The PROM being used for data collection is the Quality of Recovery 15 item tool (QoR-15). The QoR-15 PROM is a 15 item short-form and it was based on the 40 item QoR-40. The QoR-15 has 15 items each rated on a 11-point scale from 0-10, with a maximum score of 150. It takes 2.4 minutes to complete and has reported good validity, reliability and responsiveness. There is evidence that the QoR-15 can be used from pre-surgery up to 24 hours to 7 days post-surgery, as a measure of change over time. The minimal clinical important difference of the QoR-15 is 8.0. The PROM will be collected electronically. An email or text will be sent to the patient with a link to a survey containing the QoR-15 questions. It is expected that the survey will take up to 5 minutes to complete (2.4 minutes for the QoR-15 questions and another 2-3 minutes for additional questions on surveys for the pilot sites). The PROM data is collected independently of any other hospital data or health professional clinical assessments. * Observation: Pre and post surgery PROMs. PROMs are observed at three timepoints - the week prior to surgery, the week following surgery and four weeks following surgery. * Exposure: elective surgery * Barriers and enablers will be from the staff perspective. To obtain the staff perspective the Delphi technique will be utilised with health professional staff. This will involve three separate 1 hour focus groups (via videoconference) where barriers and enablers are discussed, and a consensus process is used to establish the AusPROM implementation recommendations. To develop the set of “AusPROM” implementation recommendations, data from Phase I and II will be combined. This will see data from Phase I influencing Phase II, and likewise, data from Phase II will influence the latter stages of Phase I. Phase I and Phase II will run in parallel and will occur over a 12 month duration (Phase I over the full 12 months and Phase II over the first 8 months of this period). They are detailed below: Phase I: Development of the "AusPROM" implementation recommendations. Phase I is an iterative process and it extends the duration of the 12 month study. Phase I informs, and is informed by, Phase II. Informing the "AusPROM" implementation recommendations is a co-design process involving medical and nursing staff (3 focus groups of 1 hour duration via video conference over 12 months). Phase II: Feasibility testing phase. Phase II involves: (i) pre-testing the survey at 1 pilot site (n=100) for technical feasibility, and (ii) testing the survey at 4 pilot sites across 3 states of Australia (n=800) for response rate feasibility and patient acceptability and this is informed by focus group 1. Phase II will adopt the early recommendations which come from Phase I as will collect patient acceptability feedback and this will further inform the "AusPROM" implementation recommendations. SEQUENCE OF EVENTS: a) Patients (part of Phase II): Pre-testing at one site over six weeks; within a month of this concluding this will be followed by: b) Staff (part of Phase I): Focus group 1 (1 hour duration via video conference); within a month this will be followed by: c) Patients (part of Phase II): Piloting at 4 sites over 3 months; within a month of this concluding this will be followed by: d) Staff (part of Phase I): Focus group 2 (1 hour duration via video conference); within a month this will be followed by: e) Patients (part of Phase III): Implementation across all 30 sites over 3 months (Phase III is NOT a part of this current trial registration process as it will be registered on the ANZCTR separately - this is just noted to give context to the sequence of events); within a month of this concluding this will be followed by: f) Staff (part of Phase I): Focus group 3 (1 hour duration via video conference).