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The NHS is responsible for emissions equivalent to 25 megatonnes of CO₂, approximately 5% of the UK’s carbon footprint.^1,2 Healthcare is key to the UK’s COP26 target to reduce the national environmental footprint, with ambitions for a net-zero NHS by 2040.² Anaesthetic gases are a key contributor of NHS emissions, being responsible for 2% of the total NHS footprint.¹ Pressure to reduce the environmental impact of anaesthesia is therefore growing.

SAS doctors play a pivotal role within the anaesthetic workforce, and it is imperative for organisations to establish robust support structures to nurture their professional development. Unlocking the full potential of each SAS doctor not only benefits them personally, but also augments the services they provide and ultimately enhances patient care.

SAS doctors are crucial in anaesthesia, necessitating robust support structures for their growth. Unleashing their potential both benefits them personally and enhances patient care. Vital support includes that of an SAS tutor, a trust local negotiating committee representative, and an SAS advocate. The Guidelines for the Provision of Anaesthesia Services (GPAS) define exemplary departments and highlight non-clinical attributes vital for success. Notably, roles like ‘SAS clinical lead’ and ‘SAS mentor’ empower SAS doctors for self-determined career paths.

In this issue, we focus on revalidation guidance for doctors returning to clinical practice after a period of absence. This is an issue which our helpdesk receives a number of enquiries about.

The revalidation cycle typically allows for short periods of absence during a five-year cycle. Some types of supporting information – such as colleague and patient feedback – don’t need to be collected each year, and where doctors have been unable to collect sufficient supporting information, their responsible officer may recommend a deferment of their revalidation to the GMC in order to allow them sufficient time to address these gaps.

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.

The NIHR-HTA funded Continuous rectus sheath Analgesia in eMErgency LaparOTomy (CAMELOT) is another trial led by the Perioperative Medicine Clinical Trials Network (POMCTN) that is currently open for recruitment. 

The study aims to find out whether adding rectus sheath catheters (RSCs) to standard analgesia provides better pain relief, fewer side effects and complications, and greater satisfaction for patients undergoing emergency laparotomy. It will also determine whether RSCs are safe and cost-effective. All POMCTN trials are registered with the NIHR Associate Principal Investigator (API) scheme. In this article, one of our trainees shares her experience working on the CAMELOT study.

We hope that this work will not simply add another metric to NELA reports, but will also provide useful information to clinicians, patients and organisations involved in the planning and delivery of emergency surgical care.

The NELA risk-prediction tool was designed to be used to adjust for differences in case mix between Centres but has additionally become an increasingly important tool to support shared decision-making. Population-level risk (as estimated by the NELA risk calculator) can provide a starting point for collaborative discussions, which combine data on risk with patient-specific clinical information and personal wishes.

Authors:

• Dr Ee-Neng Loh, Anaesthetic NELA fellow
• Ms Lyndsay Pearce, NELA Surgical/ Research Lead
• Dr Sarah Hare, Deputy Director RCoA Centre for Research and Improvement 

Email the NELA team

The challenges of providing care for an aging surgical population require no further introduction. Perioperative clinical teams are often managing surgical patients with multiple complex co-morbidities, higher levels of frailty, and poorer physiological reserve.

In the eighth annual report of the National Emergency Laparotomy Audit (NELA), we found that more than half of the patients undergoing emergency laparotomy (EL) were 65 years old or more, and that around 20% were aged over 80 years.¹ Despite improvements in perioperative care, one in ten patients die within 30 days of their surgery and mortality risk doubles in patients living with frailty.^1,2 Are we doing more harm than good by subjecting these patients to surgery?

Despite national improvement initiatives, such as the National Emergency Laparotomy Audit (NELA), clinical outcomes for older people have remained significantly worse than for their younger counterparts. Frailty confers additional complexity, with risk of mortality and morbidity persisting up to 12 months following surgery, and one-third of this group requiring new or additional social-care support following surgery.¹

Shared decision-making around emergency laparotomy is challenging for both patients and clinicians. When reflecting on decision-making, older patients have indicated that potential long-term quality of life implications, including loss of independence, are more of a priority than numerical mortality-risk assessment tools.² Yet, patient-reported measures are not routinely collected within NELA, nor reflected widely in research studies. ‘Perioperative care of older people living with frailty’, published by the Centre for Perioperative Care and British Geriatrics Society, highlights research into patient experience as a key recommendation.³ 

FICM’s Professional Affairs and Safety Committee (FICMPAS) is one of the three large committees of the FICM board. The major focuses of work are, as our name suggests, professional affairs and safety. We have seen important developments in both areas.

In safety there is a new look Safety Bulletin, developed by Dr Peter Hersey. Short; one paragraph, case-reports of safety incidents are shared with commentary and hyperlinks to additional information. The safety incidents come from the National Reporting and Learning System (NRLS), though Dr Hersey is working to be able to draw from a wider source of incidents.