Search

Authors:

• Dr Geevithan Kumaran, CT2 Anaesthetics
• Dr Alice Yearwood, CT2 Anaesthetics, Central London School of Anaesthesia

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.

Authors:

• Dr Rachael Brooks and Dr Eleanor Warwick, PQIP Fellows and Anaesthetic Registrars, University College London Hospital
• Dr James Bedford, former PQIP fellow and Consultant Anaesthetist, University College Hospital NHS Foundation Trust
• Professor Ramani Moonesinghe, PQIP Chief Investigator

In 2023, the Perioperative Quality Improvement Programme (PQIP) is launching new postoperative morbidity variable life adjusted display charts (pomVLAD) for all sites recruiting patients undergoing colorectal surgery. Having previously been run as a pilot study in 10 hospitals, the quality-improvement dashboard has been refined and will now provide all sites with near-real time, risk-adjusted morbidity monitoring accompanied by the display of a number of key enhanced-recovery quality-improvement (QI) targets. 

For sites recruiting patients of other surgical specialties, there is also a newly developed QI dashboard which does not incorporate risk-adjustment. Dr James Bedford explains how they can be used to stimulate QI initiatives in your local hospital.

Author: 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.

Author: 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.

Delivering training is a complex process. One of the disconnects that crops up between the FICM and intensivists in training is fuelled by the constraints of how the curriculum is delivered. While there are aspects of training that we can adjust, we are very much constrained by the GMC, which is our statutory body for training.

The past two years as editor have been an honour, and I very much enjoyed reading and reviewing the broad range of interesting articles – from personal experience through to evidence-based initiatives. 

That is what makes the Bulletin so unique, there is an article (or I would hope more!) to suit the interest of each reader. This issue, as is traditional with the autumn issue, focuses on research and innovation within our specialties.

As the first female editor of the Bulletin of ethnic minority descent, it is heartening and relevant to close my tenure with a guest editorial centred on the NIHR’s Race Equality Framework. Ensuring equitable recruitment into research through a framework such as this, underpinned in co-development with those with lived experience, is a significant move forward towards equity and inclusion. Note: I emphasise equity, rather than equality. As a series of specialties, my heartfelt vision would be that, from patient recruitment through to opportunities in research and innovation, we achieve equity – access for all.

A new year signals a new Editor for the Bulletin, and it gives me immense pleasure to welcome you to the January 2023 edition. As I write this, the UK’s NHS is experiencing winter pressures, nurse strike action seems imminent, purple seems the new black in terms of hospital bed status, and elective surgical recovery targets seem an insurmountable challenge. It would be easy to feel discouraged, but a new year always heralds new hope.

Scrolling through the articles in this Bulletin, I am filled with delight at the examples and opportunities for change during these uncertain times. Innovation has long been the forte of our specialties – doing things differently, more efficiently, and more safely for the betterment of patient care. Whether it is the small tweaks made to TIVA settings, the slight adjustment of the ultrasound image during a nerve block, or refining the ergonomics of running an operating theatre list or ICU ward round, continuous improvement is innate to our specialties and specialists.

The success of an anaesthetic is traditionally judged by our ability to safely get our patient through an operation. Yet, the more evolving challenge of our specialty is identifying those patients at high risk of postoperative complications where the best course of action may be no surgery at all. A further challenge is that of empowering patients to consider the available evidence to make the best decision for their circumstances.

Shared decision-making, whereby patients and clinicians collaborate to make the best evidence-based decision within the context of the patients’ values, is recognised as a vital component of perioperative care. The benefits of shared decision-making are accepted by NICE and the Centre for Perioperative Care (CPOC), yet evidence suggests we may not be doing it as well as we should. A recent CPOC survey showed that 39% of patients desired more support or information regarding treatment choices. In another study, 14% of patients expressed regret, and said that they would not have had surgery had they understood the risks and alternatives. View the ‘three-talk’ model of shared decision-making suggested by CPOC.

Whether you are producing a report, a poster, or even revising your hospital’s anaesthetic charts, colour choice is important.

Choosing colours

A colour wheel is a simple tool to help choose colours and shades (Figure 1). Analogous colours are adjacent to one another, and generally combine well. Likewise, complementary colours (those opposite one another) work. Triadic schemes are based on three equally spaced colours, while quadratic schemes use four. Colour combinations found in nature are also considered pleasing.

The National Emergency Laparotomy Audit (NELA) has been a real success story – engaging with clinical teams and feeding back high-quality comparative process and outcomes data to improve care.^1,2,3 As NELA enters its second decade, it is important to look at persisting challenges as well as successes, and consider where improvement efforts should now be concentrated. This article highlights three areas of emphasis from Year 10 (2023) of the audit.

Infection and sepsis management

Successive NELA reports have highlighted failings in this area – with many patients recorded as having sepsis at admission and/or at time of the decision to operate (DTO), but seemingly poor timeliness of care in terms of both antibiotic administration and definitive source control. Closer examination reveals potentially missed opportunities to streamline decision-making ‘upstream’ of the DTO. Year 8 data³ shows that the median time from arrival in hospital to arrival in theatre for those with sepsis at time of arrival was 15.6 hours. Fewer than a quarter of those with sepsis on arrival at hospital received antibiotics within an hour. This finding might be partially explained by an over-interpretation of the term ‘sepsis’.