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Traffic lights for emergency theatre escalation

Dr Adrian Jennings, Consultant Anaesthetist, and Dr Kavaladeep Jabbal, ACCS CT4 Anaesthetics at Russels Hall Hospital, Dudley discuss their innovative ‘traffic light’ system.

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).

When the anaesthetist is informed of a request for neuraxial analgesia (and the circumstances would be suitable for this type of analgesia) the anaesthetist should attend within 30 minutes of being informed. Only in exceptional circumstances should thi...

When the anaesthetist is informed of a request for neuraxial analgesia (and the circumstances would be suitable for this type of analgesia) the anaesthetist should attend within 30 minutes of being informed. Only in exceptional circumstances should this period be longer, and in all cases attendance should be within one hour.  This should be the subject of regular audits.27,115

Anaesthesia may be required for radiotherapy, to facilitate patient positioning and to alleviate pain. Owing to the unique nature of the procedures involved in radiotherapy, the remoteness of the location and the lack of direct access to the patient, o...

Anaesthesia may be required for radiotherapy, to facilitate patient positioning and to alleviate pain. Owing to the unique nature of the procedures involved in radiotherapy, the remoteness of the location and the lack of direct access to the patient, only anaesthetists familiar with the therapy should embark on anaesthesia for these patients.48,50 The anaesthetic should be provided...

Chapter 5: Guidelines for the Provision of Emergency Anaesthesia Services 2024

All efforts should be made to ensure that anaesthetists in training receive adequate experience in emergency anaesthesia, and completion of workplace-based assessments should be supported.1 Departments should monitor the frequency and the nature of non-theatre calls to establish whether the anaesthetists in training receive appropriate support and training and the patients receive adequate care. Departments should use this...

Initiating and maintaining change and quality improvement as a resident doctor

Dr Tara Keogh looks at how resident doctors can try to implement change and make meaningful contributions while training.

It is not an understatement to say that resident doctors in training often face significant challenges when attempting to implement change initiatives. As they rotate through multiple hospitals, they may struggle to establish rapport and trust with established staff, making it difficult to garner support for new ideas. 

The fast-paced environment, heavy workload and burden of exams and portfolio, can leave little time for trainees to engage in the necessary discussions or meetings to advocate for change. Additionally, the hierarchical structure of medical training can inhibit resident doctors from voicing their ideas as they may not feel respected enough to have influence.

‘Safety and Quality Improvement’ is one of the generic professional domains throughout the anaesthetic training programme. Trainees are expected to conduct local quality-improvement projects, in addition to participation in regional or national projects.