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In this issue we’re focusing on research, highlighting a small selection of the education and information resources available to you, our members. We showcase some of our work to support high-quality healthcare research and hope you find these resources useful.

The anaesthetic department at the Royal Devon and Exeter Hospital started a mixed social hockey team during the summer months. Critics who preferred non-team sports argued the organiser was trying to boost his weak CV prior to future consultant applications, but the main aim was always to have fun!

The ‘DrEaMing’ care bundle supports patients to Drink, Eat and Mobilise within 24 hours of major surgery. This simple, patient-centred intervention is associated with decreased length of stay for patients and a lower rate of late postoperative complications.¹ 

Supported by the RCoA and Getting It Right First Time (GIRFT), DrEaMing is a Commissioning for Quality and Innovation (CQUIN) indictor, and was recently updated for 2023/2024. Containing the core features of more complex enhanced recovery pathways, DrEaMing aims to revitalise the quality-improvement (QI) efforts aiding patients’ recovery after surgery.

A positive collaborative culture, with cohesive working between the whole surgical multidisciplinary team, is essential for DrEaMing to become a sustained standard of care. The perioperative team are fundamental in delivering DrEaMing, but the other important party that can drive QI are the patients themselves!

Find out the latest appointments approved, and with sadness we record the deaths of some of our fellows. 

Read the latest letters submitted by members in the January 2023 Bulletin.

I'm the RCoA’s Dinwoodie Simulation Fellow and an ST5 anaesthetist in training in the Thames Valley region. I’m pleased to take the opportunity to update you on some exciting developments in simulation.

Anaesthetics was an early pioneer in utilising simulation, recognising its benefits in rehearsing uncommon emergencies and how it can be used to develop non-technical skills. Anaesthetists in training can now expect simulation-based education to feature frequently throughout their training as they develop skills and practise the management of critical incidents, and it will continue to feature throughout our careers. Anaesthetists are also frequently seen delivering the simulation-based education, whether that is for peers or other members of the multidisciplinary team. Simulation as an educational tool has many guises, including part-task trainers to rehearse a skill before performing on a patient, sessions in a dedicated simulation suite and, most recently, immersive technologies such as virtual reality.

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.

The Royal College of Anaesthetists has undertaken a two-year national project in collaboration with The Healthcare Improvement Studies (THIS) Institute to use new approaches to improve the time it takes for patients to have emergency bowel surgery.

The time taken for patients to get to the emergency operating theatre remains a stubborn problem, despite many years of research and national guidance emphasising the importance of prompt surgery to reduce morbidity and mortality.

The diagnostic and treatment pathways are complex – involving clinicians from emergency medicine, anaesthesia, surgery, critical care, radiology, and often other specialties. Patients also require resources like CT scanners and operating theatres that are often in short supply. Thinking about the multiple steps each patient must traverse, it is no surprise that they often don’t get speedy access to the operating theatre.

In the last Bulletin issue, ACSA reviewed the achievements of the scheme upon its 10^th anniversary. We continue to reflect now by celebrating anaesthetic departments who have been accredited and re-accredited over the last year. They share their experiences in their own words.