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Pursuing excellence in our services for members

Member service is the focus of the first year of our Five-Year Commitment. We want to provide the right services to you at all stages of your career and deliver a programme of improvement so that your experience of the College is the best it can be.

I fully appreciate that there are some areas where we need to do better – you have told us where we need to improve, and we have been listening, acting and improving wherever we can. Our response time is one example. We have made it a priority to respond to your enquiries in a more timely way and to reduce the number of outstanding emails, particularly those relating to training.

Read the latest letters submitted by members in the January 2023 Bulletin.

The concept of ‘complexity’ is synonymous with healthcare systems and is becoming increasingly prevalent in perioperative care. Advancing surgical technologies and approaches are driving the complexity of operations. 

On record waiting lists, there is a growing mix of co-morbidity, polypharmacy, and multisystem issues such as frailty. We must however, avoid a reciprocal increase in the complexity of perioperative pathways as an attempt to manage these challenges. Introducing individual clinics for each long-term condition, with each one arranging a raft of blood tests and investigations, can be overwhelming for patients and healthcare professionals. Messages can get lost in the milieu of appointments, and important work can be duplicated or missed entirely leading to disengagement with the pathway. In order to manage complexity, perioperative care pathways must simplify the message of optimisation, empower patients, and support its workforce to deliver holistic, evidence-based multidisciplinary care.

‘May you live in interesting times’ has a heavy degree of irony at present. However, It is my honour to write my first piece as fifth dean of the Faculty and following our historic public statement, made in conjunction with the RCoA, of plans to start work to develop a UK College of Intensive Care Medicine.

I work as an intensive care medicine consultant in Sheffield, and a recent Diplomates Day photo of four happy ICM specialty registrars from my region brought home to me why it is right to start this work now. All four of them identify as ‘intensivists’, but two are single ICM CCT specialty registrars, one is dual with respiratory medicine, and one is dual with anaesthesia. Intensive care medicine as a stand-alone medical specialty is maturing, and it is inevitable that we should look to a future as an independent college which directly represents the interests of an increasingly diverse group of fellows and members and of the patients we treat.

Perioperative Journal Watch is written by TRIPOM (trainees with an interest in perioperative medicine) and is a brief distillation of recent important papers and articles on perioperative medicine from across the spectrum of medical publications.

Authors:

• Dr Hugh Tulloch, CT3, Medway NHS Foundation Trust
• Dr Samantha Black, RCoA Patient Information Lead
• Dr Caroline Pocknall, Consultant Anaesthetist, Ashford and St Peter’s Hospitals NHS Foundation Trust
• Dr Caroline Ellis, CT2, Ashford and St Peter’s Hospitals NHS Foundation Trust

Prehabilitation is a collection of methods that aims to improve outcomes in surgery by optimising the patient’s condition prior to their operation.^1,2 Increasing surgical wait time has led to calls for a change in the perception of waiting lists to seeing them as ‘preparation lists’. Preparation is multifactorial, and one aspect of it is psychological prehabilitation.³ Research into psychological prehabiliation has identified modifiable characteristics in patients and shown that targeted interventions can improve their experience and surgical outcomes.^1,4

One such modifiable characteristic is preoperative anxiety, which has been shown to be linked to increase in postoperative pain and increased length of stay.^2,4 The first Sprint National Anaesthesia Project (SNAP-1) indicated that, for patients, anxiety was the worst part of having an operation.⁵ While high-quality evidence is missing from the literature, a 2016 Cochrane meta-analysis did identify improvements in surgical outcomes as a result of psychological interventions.⁴