Dr Helen Saunders, Consultant Anaesthetist takes a look at the role of heavy drinking in the medical world.
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An update from the patient information team on new resources to help you meet the challenges of preoperative assessment.
Authors:
- Dr Samantha Black, RCoA Patient Information Lead
- Dr Lucy Connolly, Clinical Trust Fellow, Medway NHS Foundation Trust
- Elena Fabbrani, RCoA Patient and Public Involvement Manager
Over the past months, the patient information team has been busy creating new resources and collaborating with a wide range of partners to create innovative content to help you meet the challenges of preoperative assessment.
Helping you ‘make every contact count’
A child presenting for surgery provides an excellent occasion for health promotion, with the results of the PErioperAtive CHildhood obesitY (PEACHY) study showing that 24% of children presenting for surgery are overweight or obese. It has never been more important to address the physical health of children at every opportunity, ‘making every contact count’, especially in light of the surgical backlog and our ever-growing waiting lists that we are all too aware of.
This article tells us why increasing support for SAS anaesthetists will cultivate a more resilient and skilled workforce, fostering enhanced patient care and organisational success.
SAS doctors play a pivotal role within the anaesthetic workforce, and it is imperative for organisations to establish robust support structures to nurture their professional development. Unlocking the full potential of each SAS doctor not only benefits them personally, but also augments the services they provide and ultimately enhances patient care.
SAS doctors are crucial in anaesthesia, necessitating robust support structures for their growth. Unleashing their potential both benefits them personally and enhances patient care. Vital support includes that of an SAS tutor, a trust local negotiating committee representative, and an SAS advocate. The Guidelines for the Provision of Anaesthesia Services (GPAS) define exemplary departments and highlight non-clinical attributes vital for success. Notably, roles like ‘SAS clinical lead’ and ‘SAS mentor’ empower SAS doctors for self-determined career paths.
Dr Liu and Dr Taylor, Junior Clinical Fellows at Guys' and St Thomas' Hospitals discuss the challenges and opportunities of implementing perioperative medicine services for patients living with frailty.
It's also associated with other risk factors for poor outcomes, including multimorbidity, sarcopenia and disability. Despite the prevalence of these conditions, current perioperative pathways are not always tailored to high-risk, older surgical patients, resulting in unacceptable variation in access to and quality of care across the UK.
Comprehensive geriatric assessment (CGA) can be used to assess and optimise frailty, multimorbidity and other age-related syndromes, reducing postoperative morbidity and mortality with proven cost-effectiveness. Implementing CGA-based perioperative services is therefore key in delivering high-quality and cost-effective care of older people undergoing surgery.
The fourth national trainee-led research project of the Research and Audit Federation of Trainees (RAFT) is well into the development stage. We will investigate patient-reported outcomes after day-case surgery, including data on the quality of recovery, pain, and analgesia in the first week after surgery.
Dr Daniel Conway tells us about CPOC’s work in developing a new multiprofessional and medical curriculum in perioperative care.
Across the UK, great perioperative care is being delivered by a range of professionals from different clinical backgrounds.
Many of these professionals receive some formal training in perioperative care during their careers, but many do not. Many anaesthetists recognise that optimal perioperative care is crucial in reducing the number of people waiting for surgery, improving outcomes when they do have surgery, and optimising long-term health.
To do this, we need a skilled multiprofessional workforce with consistent training and education. NHS England therefore contracted the Centre for Perioperative Care (CPOC) to develop a multiprofessional medical curriculum in perioperative care. CPOC – a cross-specialty collaboration which works with patients and partner organisations to promote and develop perioperative care – is ideally placed to harness the expertise of professionals and patients, reflecting both users and providers of perioperative care.
Professor Andrew Smith and Dr Olusola Oladosu provide suggestions to help colleagues at all levels become familiar with videolaryngoscopy.
The Difficult Airway Society (DAS) recommends awake tracheal intubation as a primary airway management technique in people with difficult airways. It can be achieved either by fibreoptic bronchoscopy or videolaryngoscopy. However, in our experience, despite the guidance, anaesthetists are sometimes reluctant to perform either.
While it’s useful to be able to perform both techniques depending on what’s needed for the patient, videolaryngoscopy requires fewer technical skills and can be applied with a comparable success rate and safety profile to fibreoptic intubation. Furthermore, the more commonly the procedure is undertaken, the more that anaesthetists and the wider anaesthesia and theatre teams come to regard it as a straightforward, almost ‘everyday’ event. This creates a virtuous circle where it then becomes even easier to consider and perform.
With this in mind, we suggest that anaesthetists should be introduced to awake video intubation early in their career. Seeing that airway management can take place without general anaesthesia opens up a range of possibilities and gives them further confidence for managing the various patients that could present with anticipated and unanticipated difficult airways.
North Bristol NHS Trust tells us how they’re making a meaningful impact towards a net-zero NHS, showing us that small changes can be huge.
Healthcare systems account for up to 4.4% of the world’s carbon footprint, and it is well established within hospitals that operating theatres are some of the most energy-intensive spaces.
The NHS has recognised the impact it makes towards climate change by setting an ambitious target to reach net-zero of carbon emissions by 2045. This means a reduction in current levels of carbon emissions by at least 80% by 2036.
Within North Bristol Trust, we organised a Green Operating Day to implement carbon-saving measures rooted in the Intercollegiate Green Surgical Checklist and the Green Surgery Report to test the feasibility of implementing these measures across three neurosurgical theatres and 10 operative cases.
Dr Claire Shannon, President outlines what's coming up in 2025 and why it's important to support each other and work as part of a great team.
Dr Claire Shannon, President outlines what's coming up in 2025 and why it's important to support each other and work as part of a great team.
Happy New Year to you all. I know many of you will have been working over the festive period, but I hope you also had some time to catch up with friends and family and take a well-earned break.
Winter is never an easy time in the NHS. During the more challenging times of the year, I’m always particularly grateful for the support of my colleagues and the benefits of working as part of a great team. I hope that’s true for you too as we look to the year ahead.
Dr Nishant Kalra and Dr Amit Prakash tell us about their CESR programme at Addenbrooke’s Hospital.
CESR (Certificate of Eligibility for Specialist Registration) programmes now called the ‘portfolio pathway’ have become popular among many trusts. With more than 2,000 LED & SAS doctors in the UK, there is a growing need for structured CESR programmes to ensure a successful application via the portfolio pathway.
In 2019, we initiated the CESR programme at Addenbrookes Hospital. This is a three-year structured programme based upon the RCoA curriculum for already experienced anaesthetic CESR aspirants, with dedicated educational supervision and an ARCP-like process. Now, with six years of running, the programme has proved to be an excellent platform for achieving successful registration on the GMC specialist register, as it mirrors the GMC and RCoA requirements for CESR. So far, five out of six CESR fellows have been successfully appointed to substantive consultant posts within the UK.