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When emergency cases are booked, they must be able to access theatre in an appropriate time frame. Assessing the operational pressure on the emergency theatre is a complex calculation considerate of the number of cases booked, their acuity, and expected duration. 

The National Emergency Laparotomy Audit (NELA) uses a classification for surgical urgency based on the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) and Surviving Sepsis.¹

• 1: Immediate (<2 hours)
• 2a: Urgent (2–6 hours)
• 2b: Urgent (6–18 hours)
• 3: Expedited (>18 hours).

Authors:

• Dr Hamish McLure, Medical Director (Professional Standards and Workforce Development) and Consultant Anaesthetist, Leeds Teaching Hospitals NHS Trust
• Dr Natalie Drury, Consultant Anaesthetist and Anaesthesia Associate Lead, Leeds Teaching Hospitals NHS Trust

The pandemic has generated a staggering backlog, with more than 7 million patients waiting for care. In order to treat these patients in a timely way, we need to increase our work rate beyond pre-pandemic levels but with our current workforce and model of care, this will be difficult. 

Fatigue, burnout, repeated acute illnesses and a punitive tax system mean we have a fragile workforce with minimal capacity or interest in additional work. RCoA workforce data shows little to be optimistic about, with a projected gap of 11,000 anaesthetists by 2040. This demand cannot be met without a massive increase in training numbers. Given the pressures in virtually every other specialty, this is unlikely.

Dyslexia is not just a learning difficulty affecting reading and writing; it can be related to difficulty processing and remembering information such as phonological processing, rapid naming, working memory, processing speed, and the autonomic development of skills.¹ 

Up to 10% of the population is estimated to have dyslexia. The newer term ‘neurodivergent’ is postulated to be the wider term, encompassing having cognitive functioning different from what is seen as ‘normal’,² and it includes dyslexia.

Authors: Dr Martha Belete and Dr Eleanor Warwick, PQIP Fellows

The Perioperative Quality Improvement Programme has been running since 2016 and wouldn’t be anything without our collaborators. We would like to thank them all for their hard work.

Despite the COVID-19 pandemic having a massive impact on research studies, we are now well into our recovery and are thrilled that recruitment is gathering momentum and that we have more sites joining us. So far, more than 150 hospitals have been involved, with more than 39,000 patients recruited! It is an exciting time for PQIP. Below we have detailed three of the areas we have been focused on, but if you would like to read about our other activities or get involved please visit our website. We are also part of the Associate Principal Investigator scheme for those who want to develop skills in leading research projects locally.

Round one

Our path towards accreditation started back in 2014. We felt we were a good and forward-thinking department, but the challenge was (a) is it true? and if so (b) could we prove it? 

The ACSA process gave us the platform and the tools to provide assurance that we had the policies, and personnel in place, but also highlighted the gaps that had developed over the years. Our original involvement with ACSA and subsequent accreditation in 2018 was a positive experience. ACSA gave the department a common purpose and an opportunity to involve the whole theatre community in reviewing how we work and why we do what we do. We took pride in benchmarking ourselves against nationally agreed standards and opening the department up to external scrutiny. That said, our accreditation in 2018 was not the end of the story.

Perioperative Journal Watch is written by TRIPOM (trainees with an interest in perioperative medicine) and is a brief distillation of recent important papers and articles on perioperative medicine from across the spectrum of medical publications.

At Nottingham University Hospitals (NUH), it was felt that for our patients with cardiovascular disease, obtaining a preoperative cardiology assessment and perioperative management strategy was prolonging non-cardiac surgery waiting times. 

This was especially compounded by the surgical backlog and increased demand on preoperative services following the COVID-19 pandemic. In order to streamline the assessment process and facilitate safer surgery, a joint cardiology-anaesthesia multidisciplinary team (MDT) meeting was established.

The global problem

It is no surprise that underlying cardiovascular disease can contribute significantly to perioperative morbidity and mortality, with cardiac events being the leading cause of such.¹ Almost half of adults aged over 45 years undergoing major non-cardiac surgery have at least two cardiovascular risk factors, and conditions such as coronary heart disease, heart failure and arrhythmias put patients at increased risk of cardio- and cerebrovascular events in the immediate postoperative period.²

Generative artificial intelligence (AI) describes technology that can create new content, including text, images and audio, based on patterns and structures learnt from existing data. Large language models (LLM) are types of generative AI models that are trained on vast amounts of online data and employ natural language processing, designed to mimic human language and communication. 

Since the release of ChatGPT 3.5 by OpenAI in November 2022, there has been a significant rise in interest in and development of LLM chatbot technology, which has become increasingly sophisticated. Now other companies, such as Google, have developed LLM AI technology integrated into search engines via plug-ins.

ChatGPT, and other AI chatbots, have not been designed for (or licensed to) provide medical information and advice. Despite ChatGPT usage policies dictating that medical and health advice without review by a qualified professional may significantly impair safety and wellbeing, the policy is not prohibitory. Therefore there’s increasing concern regarding the unregulated ‘off licence’ use by members of the public.

• Dr Stuart Connal, Specialty Registrar in Anaesthesia, North Central London Deanery

Perioperative Journal Watch is written by TRIPOM (trainees with an interest in perioperative medicine – tripom.org) and is a brief distillation of recent important papers and articles on perioperative medicine from across the spectrum of medical publications.