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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’.

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.