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Find out the latest appointments approved, and with sadness, we record the deaths of some of our fellows.

Author: Dr Maya Sussman, Anaesthetic Senior Clinical Fellow, Guy's & St Thomas' NHS Foundation Trust; RCoA Patient and Public Involvement Fellow

The Patient and Public Involvement team at the RCoA regularly develops patient information resources to help individuals prepare for elective surgery.

These materials aim not only to improve recovery, but also to use the ‘teachable moment’ of surgical preparation to promote healthier lifestyles and long-term wellbeing.

As surgical waiting times grow, there’s an increased drive to use this period for positive health interventions. However, we realised we didn’t fully understand how healthcare professionals, particularly anaesthetists, were using our resources in practice.

To explore current attitudes, behaviours, and barriers to supporting patients psychologically and emotionally before surgery, we decided to launch a survey through the College.

Author: Dr Claire Swarbrick, Royal Devon and Exeter Hospital NHS Trust Anaesthetics 

More than 2,500 local investigators across 214 hospitals who took part collectively contributed to recruiting 7,134 patients.

The project comprised two surveys and a large cohort study:

• the organisational survey aimed to describe the existing perioperative medicine services available for older surgical patients in the UK and the Republic of Ireland (ROI)
• the medical registrar survey aimed to describe the numbers of older surgical patients referred for urgent medical review outside of the existing perioperative medicine services
• the cohort study is a prospective observational study which aimed to recruit all older patients undergoing a surgical procedure in the UK during a five-day period in March 2022. From comparing our cohort with NHS and National Audit Project data, we believe that we have captured a representative sample of our target population – older surgical patients.

Authors: 

• Dr Amrit Dhadda, Anaesthetics ST7, Cardiff & Vale University Health Board
• Dr Nathan Riddell, Anaesthetics Fellow, Obstetric Bleeding Study UK (OBS UK)
• Dr Sarah Bell, Co-Chief Investigator, Obstetric Bleeding Study UK (OBS UK)

Bleeding during and after childbirth (postpartum haemorrhage) is the most common complication of childbirth, with around 50,000 women in the UK losing one litre or more of blood per year.

Substantial variations in postpartum haemorrhage (PPH) management exist, with national inquiries highlighting the need for improvements in care. However, we know that effective management requires teamwork between midwives, obstetricians, anaesthetists, healthcare support staff, and haematologists.

The vital role of the anaesthetist as part of a well-functioning maternity multidisciplinary team (MDT) has recently been emphasised, particularly during emergencies such as PPH in which skills in the resuscitation of critically unwell patients are required. We believe this also provides the opportunity for anaesthetists to take more active roles in leading maternity research and quality improvement.

Author: Dr Carolyn Johnston, Clinical Lead on the Improving Timeliness to Emergency Laparotomy Project (THIS Collaboration)

The time taken for patients to get to the emergency operating theatre remains a stubborn problem despite many years of research and national guidance emphasising the importance of prompt surgery to reduce morbidity and mortality. 

We are using new methods to tackle this problem, so we can improve outcomes for our sickest patients. Over the last year, we’ve been working to understand some of the underlying reasons for delays in emergency general surgery.

Gathering data

Authors: 

• Dr James Durrand, RCoA Centre for Research and Improvement Fellow; Perioperative Quality Improvement Programme (PQIP); Resident Anaesthetist (ST6), South Tees Hospitals NHS Foundation Trust
• Dr Eimhear Lusby, Honorary Research Fellow, University College London; ST6 Anaesthetist, University Hospitals Sussex NHS Foundation Trust
• Dr Adam Hunt, MPhil/PhD Student, University College London and Resident Anaesthetist, The Royal Marsden NHS Foundation Trust
• Professor S Ramani Moonesinghe, PQIP Chief Investigator

The circumstances in which we are born, grow, live, work and age profoundly influence our health. These complex, reciprocal, and dynamic interactions begin in utero and develop continuously throughout life.

Recognition that socioeconomic deprivation drives poorer health was fundamental to the establishment of the UK NHS in 1948. The key causal relationships and how to intervene in them have been debated since then.

Seventy-five years later, people from more deprived backgrounds still experience less beneficial interactions with the NHS. Individuals present later and with more severe disease. Unhealthy behaviours, including smoking, physical inactivity and poor diet, are more common and often cluster. In turn, rates of chronic ill health and multimorbidity are higher. Wider advances in key disease areas have been unevenly distributed across socioeconomic groups. Consequently, deprived patients continue to die younger.

Author: Dr Dhruv Parekh, FICM Board Member and Academic Lead

Research activity is beneficial to patients, enabling earlier diagnosis, effective treatments, and care pathways.

More ‘research-active’ hospitals have lower mortality rates, an effect that isn’t limited to research participants. This benefit extends to healthcare professionals, helping to develop solutions for real NHS problems and increasing job satisfaction.

The pandemic thrust our specialty into the spotlight, and our workforce weren’t only at the forefront of delivering clinical care, but also of recruitment to practice-changing studies. Research leaders from our specialty made impactful contributions to develop this evidence and lead the response.

Our full selection of back digital issues will keep you up-to-date and informed on what’s happening in our specialty. We hope you continue enjoying your membership magazine.