Delivering SNAP-3 on the ground: cross-speciality collaboration in practice
In March 2022, we were offered the opportunity to join the research team for SNAP-3, a national multi-centre study examining the relationship between frailty, multimorbidity, delirium and perioperative outcomes. All patients aged 60+ having surgery over a 7 day period were invited to participate in the study with the aim of enrolling 10,000 participants nationwide. To allow this rapid recruitment to happen, cross specialty collaboration was required on each recruiting site. We therefore wanted to share our reflections from our time on the GSTT SNAP-3 research team.
Working on SNAP-3 provided a welcome shake up to the normal routine. For 2 weeks, we embraced the anaesthetic lifestyle with pre-8am starts and a doubling of our caffeine consumption. We re-discovered the strictly organised environment in theatres, a sharp contrast to the often-chaotic wards.
The unlikely alliance of geriatric medicine juniors and the anaesthetic team resulted in a mixing of skill sets ideal for running the study. Anaesthetic insider knowledge of theatres allowed us to reach all eligible patients on busy lists, and we often required their help deciphering anaesthetic charts and explaining specific intra-operative management. We contributed our experience communicating with older patients living with frailty, a practical knowledge of post-operative care on the wards, experience with the identification of delirium and familiarity with assessment tools and an ability to rapidly complete frailty scores from memory.
The nature of the study, with a high-volume recruitment period, necessitated an 'all-hands-on-deck’ approach. A mutual respect was fostered early between specialties and persisted throughout. As physicians, we advocated for the inclusion of patients despite their dementia (even though less straightforward to recruit) because it is precisely these patients who are the most vulnerable and tend to be under-represented in research.
The opportunity to follow patients from the hours before surgery, up to a week following, was valuable and, in some ways, humbling. We were able to observe first-hand the emotional journey experienced by a patient: from the surgical admissions lounge ‘match day’ mixture of nerves, excitement and worry, to the reassurance at discharge, with all the varied emotions that fell in between. The lasting effect from the COVID pandemic was palpable in patient’s stories of multiple cancellations and the subsequent impact of prolonged symptoms in many cases.
As medical trainees, it was great to see a preoperative study looking specifically at frailty and delirium as these are ‘bread-and-butter’ issues for medical teams. We often see cases of post-operative delirium on-call, especially when providing geriatric medicine support on surgical wards. Patients and their families frequently have questions about their individual risk of delirium or becoming more dependent post-operatively and hopefully following SNAP-3, we will be able to better answers those questions and target and tailor interventions for those most at risk.
Our main reflection on this experience was that SNAP-3 is a fantastic advert for the benefits of trans-disciplinary working: it demonstrated to us how we can both learn new skills and achieve collaborative outcomes when stepping out of our usual spheres of work. Getting a first hand insight into the planning, organisation and delivery of a large study like this is something we will all take forward into our careers. This experience has demonstrated the importance of collaborative working to provide a holistic approach to patient care, and the importance of high quality research examining issues important to patients.
SNAP-3 is generously supported by the Royal College of Anaesthetists (RCoA) and is being jointly managed by the Health Services Research Centre (HSRC) and the University of Nottingham.