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Author: Dr Carolyn Johnston, Consultant Anaesthetist and Deputy Medical Director, St George’s Hospital; Chair of QI working group

During the early days of the COVID-19 pandemic, the UK government talked about their goal of delivering ‘shots in arms’ as the ultimate goal of the vaccine efforts. This wasn’t an exercise in expanding scientific knowledge or customising production, but the aim was clearly stated as being to deliver those advances to citizens in order to prevent them from becoming patients.

A large number of lives were saved by rapid development and national deployment of the new vaccines: the success of the vaccine programme is a reminder to us all how knowledge without application will not improve care.

The HSRC portfolio of projects creates a huge amount of knowledge that has the potential to improve care for our patients, but this knowledge remains potential unless we implement the recommendations of the various reports and use the rich datasets created to inform us of the most pressing areas for improvement in our clinical pathways.

Authors:

• Dr Andrew Kane, NAP7 Fellow, ST7 in anaesthesia, South Tees NHS Trust
• Professor Tim Cook, RCoA Director of the National Audit Projects, Consultant in Anaesthetics and Intensive Care Medicine, Royal United Hospitals, Bath
• Dr Jas Soar, NAP7 Clinical Lead, Consultant in Anaesthetics and Intensive Care Medicine, Southmead Hospital, Bristol

After a delay due to Covid, we are pleased to say we are in the final stages of NAP7. The baseline and activity surveys are complete and being prepared for publication. The NAP7 panel is working hard to digest all possible learning from the case registry. Here we provide a brief update, with the full report coming in late 2023. We are hugely appreciative of the contribution of all anaesthetists.

The largest NAP yet

Perioperative cardiac arrest has seen the most cases reported of any NAP. The large number of cases reported is an indication of the ability of UK anaesthesia to successfully come together and focus on an important patient-focused issue, and also shows the incidence of perioperative cardiac arrest is greater than events forming the focus of previous NAPs.

Authors:

• Dr Olly Boney and Dr Cliff Shelton, PCPIE Group co-chairs
• Jenny Dorey and John Hitchman, PCPIE Group lay members

We go behind the scenes of the NIAA’s Patient, Carer and Public Involvement and Engagement Group (aka the ‘PCPIE' Group) to speak to some of its members about their work and how they believe it benefits research.

Dr Olly Boney and Dr Cliff Shelton, what does PCPIE do?

OB: In a nutshell, we review research proposals and provide feedback from a patient and/or carer perspective.

Our membership is very diverse, and most members have a completely non-clinical background so they are well placed to appraise studies through a patient-focused lens and suggest improvements to a study’s design to make it more patient-friendly.

Authors: Dr Martha Belete and Dr Eleanor Warwick, PQIP Fellows

The Perioperative Quality Improvement Programme has been running since 2016 and wouldn’t be anything without our collaborators. We would like to thank them all for their hard work.

Despite the COVID-19 pandemic having a massive impact on research studies, we are now well into our recovery and are thrilled that recruitment is gathering momentum and that we have more sites joining us. So far, more than 150 hospitals have been involved, with more than 39,000 patients recruited! It is an exciting time for PQIP. Below we have detailed three of the areas we have been focused on, but if you would like to read about our other activities or get involved please visit our website. We are also part of the Associate Principal Investigator scheme for those who want to develop skills in leading research projects locally.

Author: Dr Alistair McNarry, RCoA Airway Leads Advisor

It may seem that we have been reporting on the HSRC-DAS-University of Nottingham collaboration on the UK eFONA Registry for a very long time. However, I am delighted to say that, a bit like a jigsaw puzzle, all the pieces are finally starting to slot together.

Data-sharing agreements have now been signed between the HSRC, the University of Nottingham and the Difficult Airway Society. This complements the memorandum of understanding signed between the HSRC and DAS last year.

Authors:

• Dr Anna Simpson ST7 Anaesthetics, Bristol Royal Infirmary
• Dr Neil Botting CT3 Anaesthetics, Worthing Hospital
• Dr Joe Hetherington ST6 Geriatric and General Internal Medicine, Guy’s and St Thomas’ NHS Foundation Trust
• Hannah Wilson Consultant Anaesthetist, Bristol Royal Infirmary
• Dr Claire Swarbrick SNAP-3 Fellow Specialty Registrar, Royal Devon and Exeter Hospital
• Dr Jude Partridge Consultant Anaesthetist, Guy’s and St Thomas’ NHS Foundation Trust
• Dr Patrick Thorburn Consultant in Anaesthetics and Intensive Care Medicine, Worthing Hospital

The Associate Principal Investigator (API) scheme is a new initiative from the National Institute of Health Research (NIHR) which aims to formalise research involvement for those not normally exposed to research in their day-to-day jobs.

The aim is to help develop health professionals to become the Principal Investigators (PIs) of the future. It is a six-month, in-work training opportunity providing practical research experience in order to learn what it is like to deliver an NIHR portfolio study at a local level guided by an enthusiastic PI.¹ It has endorsement from 16 Medical Royal Colleges, including the Royal College of Anaesthetists, and at present there are 330 studies eligible for the scheme, which can recruit one API per site every six months.

Welcome to the autumn edition of the Bulletin.

As I write this, there is a sombre atmosphere as the funeral arrangements for Queen Elizabeth II proceed, and I want to take the opportunity to pay my respect to her and to her devotion to duty in this editorial. Although it was not unexpected, I was surprised how deeply her death affected me – I felt keenly what a historic moment the death of the longest-serving monarch in British history, and the second-longest in world history, was.

This is also my last editorial as editor of the Bulletin as I take on the vice-president’s robe and hand the Bulletin role to one of my colleagues. It has been a pleasure, and I have very much enjoyed the challenge of curating, commissioning, and advising our authors. I am so proud of the achievement as we head towards a much better digital version of the Bulletin, and I particularly want to thank the publishing co-ordinators, Anamika and Mandie, for the support, encouragement, chasing and cajoling they have done. Without them the Bulletin would be a shadow of what it is.

I recently listened to two anaesthetists talking in a coffee-shop queue. One was of a certain age and clearly exasperated at having to contemplate the supposed burnout levels in my generation of anaesthetists in training. He simply couldn’t understand it. After all, in his day they worked hundred hour weeks! ‘Bloody snowflakes’, he reflected. The other nodded gravely.

‘Snowflake’ is a term commonly wielded by our elders to bludgeon what they deem to be a fragile, over-sensitive and under-resilient youth of today. A people unable to cope with life. It does however require a certain amount of historical amnesia to use this slight without some irony catching in the throat. Did they not enjoy rock bottom housing prices, free higher education and high levels of job security, only to then preside over their decimation?

As I sit down to write this article, I am very much aware that today is the anniversary of the death of my mother. A strong-minded, intelligent and, above all, proud woman, her greatest fear as she became increasingly physically frail was a loss of dignity, something she had witnessed in the slow demise of her own mother.

From middle age onwards, she wrote me detailed letters describing what she would and would not tolerate as she got older, and instructing me, the only doctor in the family, to do everything possible to help her to die peacefully when the intolerable became manifest. Sadly, the law forbade such measures and, despite receiving excellent care in her failing years, she suffered much of the indignity that she most feared before passing.