Implementation Toolkit

Establishing an EPOC unit requires clinical leadership, organisational commitment, and early engagement across teams. Before you start planning the physical space or staffing model, consider:

• Who will champion this at a clinical and administrative level?

• Is there leadership support from hospital management?

• Have you engaged ICU, surgical, and anaesthetic teams early?

• Do you have a plan for building the business case?ion text goes here

The physical environment shapes how your unit functions. Key decisions include whether to use single rooms or shared bays — each has trade-offs for infection control, staffing visibility, and patient cohort suitability. Your space should be located close to operating theatres and the post-anaesthetic care unit (PACU) where possible.

Staffing is one of the most complex aspects of setting up an EPOC unit. You'll need to determine your medical and nursing model from the outset.

For nursing, consider whether you'll draw from existing recovery staff, recruit dedicated personnel, or use a combination. Nurse-to-patient ratios should reflect patient acuity — starting at 1:2 and adjusting based on clinical need is a common approach.

For medical cover, anaesthesiologist-led care is central to the EPOC model. Clearly define on-site hours and after-hours availability from the beginning.

Not all postoperative patients are suitable for an EPOC unit. You'll need agreed admission and exclusion criteria before you open. Tools such as the NSQIP surgical risk calculator can help identify patients most likely to benefit — typically those at moderate risk of complications who are expected to be ward-ready within 24 to 48 hours.

Don't underestimate how much education referring teams need before your unit opens. Engaging preadmission clinic staff and anaesthetic teams early is key. A clear, simple referral pathway — whether by phone, email, or a shared calendar system — should be in place from day one.

Staff education is essential. Before opening, ensure your team is trained in arterial line management, vasopressor infusions, regional anaesthesia care, and advanced life support. A skills workbook and orientation programme will help identify gaps and build confidence.

Plan for a minimum of two supernumerary days for experienced staff, and longer for those newer to high-acuity care.

Continuous monitoring is fundamental to the EPOC model. Confirm that appropriate monitors are available in your space before opening. You'll also need to establish clinical protocols for common scenarios including hypotension management, emergency escalation, pain management, and deteriorating patients.

Define clearly whether your unit will call a code blue or an anaesthetic assist for emergencies — and make sure ICU and all relevant teams know the answer before you open.

Set up your data collection processes from day one. Recording outcomes, bed flow, and patient data is essential for quality improvement, staffing justification, and building the business case for your unit's future. Connect with the EPOC Network registry to contribute to and benefit from shared benchmarking data.

Go to registry →

No two EPOC units are identical. Our network includes clinicians who have set up units from scratch. If you'd like to speak with someone who has done it, we can connect you.

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