About this toolkit

The purpose of this guideline is to provide NHSScotland with advice on assessment and isolation of adult and paediatric patients prior to all elective surgery.

The overarching aim of this guideline is to protect patients, as it is known that patients with unsuspected COVID-19 infection undergoing surgical procedures have a very poor outcome. A secondary aim is to contribute to limiting nosocomial transmission of COVID-19 infection. This guide is not intended to apply to patients attending for purely endoscopic procedures.

The evidence-base is not robust and is subject to change as new evidence emerges.

IOS App:  Link

Android App: Link

This software is an informational and educational resource. It is not a medical device as defined by the Medical Devices Directive

SIGN (Scottish Intercollegiate Guidelines Network): SIGN was formed in 1993. Its objective is to improve the quality of health care for patients in Scotland by reducing variation in practice and outcome, through the development and dissemination of national clinical guidelines containing recommendations for effective practice based on current evidence.

The membership of SIGN includes all the medical specialties, nursing, pharmacy, dentistry, professions allied to medicine, patients, health service managers, social services, and researchers. The work of SIGN is supported by an Executive.

SIGN is part of the Evidence Directorate of Healthcare Improvement Scotland and core funding from Healthcare Improvement Scotland supports the SIGN Executive, and expenses and costs associated with guideline development projects. SIGN is editorially independent from Healthcare Improvement Scotland and the Scottish Government which ultimately funds Healthcare Improvement Scotland.

Digital Health and Care Institute (DHI): The Digital Health and Care Institute is a health and care innovation centre based in the University of Strathclyde. It is  funded jointly by Scottish Government Digital Health and Care and the Scottish Funding Council. DHI plays a pivotal role in inspiring, enabling and combining industry and academic expertise with service, business and technical innovation to create person-centred digital health and care innovations. DHI focuses on shifting the balance of care from a traditional treatment model, through the development of digital health and care innovations that focus on prevention, early detection, post event care and independent assisted living.

DHI leads and manages the national Decision Support Programme on behalf of Scottish Government, as a core objective within Scotland’s Digital Health and Care Strategy. The app and website have been built using the Right Decision Service tools which DHI has developed as a key deliverable for the national programme.

Clinical Contributors

NHS Greater Glasgow and Clyde Library Network:  The NHSGGC Library Network provides library and information services to all staff working within NHSGGC and its partner organisations.

As part of the National Decision Support Programme, NHS GGC Knowledge Services provide knowledge management expertise to support use of Right Decision Service tools.

Tactuum Ltd –Tactuum is a software company based in Glasgow, with an office in the US. Tactuum’s mission is to improve healthcare services through the delivery of digital services supporting healthcare providers and patients. Tactuum provides  the technology and digital expertise to deliver Right Decision Service tools for the National Decision Support Programme.

The content within this app/ website is based on current evidence and best practice, however it is intended to be applied alongside sound clinical judgement. As such, Healthcare Improvement Scotland is not responsible or liable for any diagnosis or management decision made on the basis of the information provided via this app/website.

Use of this app within patient care settings should always be in accordance with local policies and guidance with regard to clinical practice and mobile device usage.

Healthcare Improvement Scotland is not responsible for the content of any external websites listed, nor do they endorse any commercial product or service mentioned or advised on in any of these websites.

All use of this resource is subject to Scots law and the jurisdiction of the Scottish courts and is subject to this disclaimer. Any views given on the app/website are not necessarily those of Healthcare Improvement Scotland or anyone connected with us.

Copyright information for the sources of content within this app/website is shown below.

1) Scottish Intercollegiate Guidelines Network (SIGN). COVID-19 position statement: Reducing the risk of postoperative mortality due to COVID-19 in patients undergoing elective surgery Edinburgh: SIGN; 2020. [cited 21 Aug 2020]. Available from: https://www.sign.ac.uk/media/1822/elective-surgery_v2.pdf

Copyright of this evidence review is retained by SIGN. Users may download or print copies for their own use and may photocopy guidelines for the purpose of implementation.

The review is licensed under the Creative Commons Attribution-Noncommercial-NoDerivatives 4.0 International Licence. This allows for the copy and redistribution of SIGN guidelines as long as SIGN is fully acknowledged and given credit. The material must not be remixed, transformed or built upon in any way. To view a copy of this licence, visit https://creativecommons.org/licenses/by-nc-nd/4.0/

Please cite the review as: Scottish Intercollegiate Guidelines Network (SIGN). Guideline title. Edinburgh: SIGN; Year. [cited dd mmm yyyy]. Available from URL: http://www.sign.ac.uk

Users wishing to use reproduce or republish SIGN material for commercial purposes must seek prior approval for reproduction in any medium by completing the form at https://www.sign.ac.uk/media/1558/sign_copyright_request.pdf. Applicants for such permission should be aware that:

• SIGN resources do not endorse specific products.
• Reproduction of SIGN material must be verbatim.
• Within marketing material there must be a clear separation between any SIGN material and product specific information or marketing.
• SIGN does not endorse in any way derivative or excerpted materials based on these guidelines, and it cannot be held liable for the content or use of any such adapted products.
• The use of the SIGN name or logo for the purposes of advertising or implied endorsement of any derived product or service is strictly forbidden.

Content last updated: The SIGN team are to update this section every time an update is carried out.

The CMO COVID-19 position statement: Reducing the risk of postoperative mortality due to COVID-19 in patients undergoing elective surgery was first published on 21 August 2020 and updated on 10 February 2021. This guidance will be reviewed and updated as new evidence emerges.

Technical maintenance and updating of the app is carried out by Tactuum Ltd and funded through the national decision support programme led by the Digital Health and Care Institute.   

The app is compliant with:

• Android and Apple accessibility standards for native mobile apps.
• From September 2020, the website will be compliant with WC3A 2.0 Standards.

• The app is supported by Android 4.4 or later and iOS 8.0 or later devices.
• The website is optimised for use on both desktop and mobile devices in the following browsers - IE9+, Chrome, Edge.