Search

Climate change is a healthcare emergency. Carbon dioxide levels in the atmosphere have been greater than 350 parts per million (ppm) since 1988. If you’re younger than 37 years old, your whole life has been spent in carbon dioxide excess.

In collaboration, the Faculty of Intensive Care Medicine, Intensive Care Society and UK Critical Care Nursing Alliance, alongside Brighton University, are taking action.

Together, we are developing a ‘Recipe Book’ to share actions in critical care units to reduce energy use, reduce waste and improve sustainability.

Mrs Shivalkar was a 78-year-old patient with debilitating co-morbidities scheduled for elective revision hip surgery at a stand-alone surgical unit without Level 2 or 3 care facilities. 

The surgical procedure was prolonged, and intraoperatively there was prolonged significant hypotension. In recovery this hypotension continued, but despite this the patient was discharged to the ward, where she sustained cardiac arrest. 

After delayed transfer to a facility with critical care, she was found to be in multiple organ failure with a profound metabolic acidosis, leading to a further cardiac arrest from which, tragically, she died.
The coroner, finding concerns regarding preoperative risk assessment and poor communication between the surgical team and anaesthetist, issued a Report to Prevent Future Deaths to the RCoA and the Royal College of Surgeons for action.

In my last update, I mentioned that the College has been addressing some financial challenges.  

We are committed through our current five-year plan to manage the College’s resources with care, and to ‘ensure the College is resourced and equipped to carry out its strategy: now and in the future’. One of our core values is being open and responsive, and in that spirit I am keen to share with you our current financial position, and what we are doing to improve it.

When I returned to my role as a CR&I/RCoA perioperative quality improvement programme (PQIP) fellow, I found this came with unique expectations and required planning. Hopefully by sharing what I learnt, it will help those who are returning to work after a period of leave, especially those returning to job roles that do not necessarily fit the norm.

Returning to work: general things to consider

When RTW there are key dates and tasks to consider. Table 1 details some of the things that need to be arranged and when these need to be done. There are also many resources to consult (see below ). Using these in conjunction with your hospital policy is a good starting point.

In recent years, ‘mental health awareness’ and ‘wellbeing’ have been hot topics in almost all facets of life. It goes without saying that I was pleased to see this ethos entering into the mainstream. However, a recent incident while on call left me questioning whether this ethos had translated into my workplace.

In the early hours of an August morning, a cardiac arrest call came through on my bleep. I arrived to find chest compressions being performed on an 11-week-old baby. I was immediately filled with dread, anxiety, and confusion. As with many district general hospitals with limited paediatric service, the vast majority of sick children are diverted elsewhere, so I was not expecting to see a child. I remember feeling totally out of my depth. It had been a while since I’d dealt with paediatric patients, and I’d certainly never participated in a real paediatric arrest. 

Once the immediate shock subsided, I assumed the default position and took over the airway. It was at that point that I could see and feel the baby up close. I’d seen this colour in a child before, and knew this wasn’t going to end well. As I held that baby’s face, ventilating him, I became conscious of my racing thoughts: ‘Am I doing this right?’… ‘I think I’m going to cry’… ‘No one else is crying, get a grip’… ’Thank goodness the registrar is here’… ’This baby is not going to make it’…