Search

Author: Dr Dave Murray, Consultant Anaesthetist South Tees NHS Trust; Chair NELA

The National Emergency Laparotomy Audit (NELA) is 10 years old this year, so this is a timely point to review progress, highlight achievements, and look at the persisting challenges ahead.

In the beginning

NELA was commissioned in 2012. One of the key pieces of evidence to support its funding was the paper published by the Emergency Laparotomy Network.¹ This observational study of more than 1,800 patients highlighted a 15% mortality rate, but with a nine-fold variation in mortality across the 35 trusts. Consultant presence was 74% for surgeons and anaesthetist presence was 64%. Half the patients were admitted to critical care, and patients returning to the ward had a 6.7% mortality rate.

Authors:

• Dr Natalie Constable, ST6 Anaesthetic Registrar, Department of Anaesthesia, UHBW Foundation Trust, Bristol
• Dr Fiona Oglesby, ST6 Anaesthetic Registrar, Department of Anaesthesia, UHBW, Bristol
• Dr George Bainbridge, Anaesthetic Clinical Fellow, Department of Anaesthesia, UHBW, Bristol
• Dr Helen Howes, Consultant Anaesthetist, Department of Anaesthesia, UHBW, Bristol
• Dr Rachel  McKendry, Consultant Anaesthetist, Department of Anaesthesia, UHBW, Bristol

The Bristol Royal Infirmary’s Difficult Airway Response Team (DART), developed in 2017, is a successful, innovative, cross-specialty response unit designed to expedite the arrival of clinical expertise and advanced equipment to the patient’s bedside in complex airway emergencies. Five years following DART’s inception, we intend to highlight the challenges intrinsic to maintaining the service and how we have attempted to overcome these. 

Read the latest letters submitted by members in summer's Bulletin.

Wellbeing is a fashionable term at present and for some will cause instant eye-rolling. We sympathise with this reaction – the word has a lot of unhelpful connotations including, probably most problematically, that it offers yet another opportunity to fail at something else in your life. You are already overwhelmed by work and home stressors, and now you’re also not getting your wellbeing right and that’s why you’re struggling.

Please know this gentle advice comes from a place of compassion and acknowledgement of the wonderful job you all do. After everything anaesthetists have had to deal with over the last few years, we tip our hats to the courage and resilience of our profession.

Here are some top tips for anaesthetist wellbeing (in no particular order):

Authors:

• Dr Natalie Silvey, ST7 Anaesthetics, London School of Anaesthesia; DAS Trainee Representative
• Dr Moon-Moon Majumdar, ST5 Anaesthetics, London School of Anaesthesia; DAS Trainee Representative
• Dr Abhijoy Chakladar, Consultant Anaesthetist, University Hospitals Sussex NHS Foundation Trust; DAS Surveys Co-ordinator
• Dr Barry McGuire, Consultant Anaesthetist, Ninewells Hospital and Medical School, Dundee; DAS Immediate Past President

‘Her death was wholly avoidable and was contributed to in major part by neglect.’

This was the conclusion of the coroner examining the death of Mrs Glenda Logsdail following her death from hypoxic-ischaemic encephalopathy after an unrecognised oesophageal intubation.

Her death, like those of Sharon Rose Grierson and Peter Saint in 2016, has placed this issue at the forefront of safety strategy within the anaesthetic community. Following Glenda Logsdail’s death, the coroner issued a Regulation 28 report to prevent future deaths: several teaching aids and educational materials were released in the subsequent six months. We wanted to establish what was being done in individual departments to prevent unrecognised oesophageal intubation.

Had your head buried very deeply in the sand for most of the last decade? Then it may have escaped your attention that the UK has cleaved itself away from the European Union. But fear not! The College and the Association of Anaesthetists are both still represented on the European Board of Anaesthesiology (EBA), the Anaesthesia section of the European Union of Medical Specialists.

Known by its French acronym, UEMS is a non-governmental organisation created in 1958 in the same year as the European parliament. The aims of UEMS are to improve patient care throughout Europe by developing and supporting excellence in specialist medical training and practice and, as a by-product, to promote free movement of medical specialists around the EU.

The UEMS represents more than 1.6 million specialist doctors from 41 countries:

• full UEMS members – EU countries plus Iceland, Norway, Switzerland, UK
• associate members – Armenia, Israel, Serbia, Turkey, Ukraine
• observer countries – Georgia, Iraq, Lebanon, Morocco, Tunisia.

Dr Andrew Sharman shows us that rotational training, while offering a broad range of training opportunities, doesn’t come without its challenges and tells us what the Faculty is doing to overcome them.

Another year goes by, and again I am humbled by the resilience and resolve of our resident doctors.

Last year, responses to our intensivists in training (IiT) survey were overall very positive for ICM training, with resident doctors appreciating their trainers. Also, our regional advisors survey demonstrated how much excellent work is ongoing across the country. Exam and regional teaching courses, mentoring programmes, and the offering of a variety of Special Skill Years (SSYs) are just some examples of an ever-growing list of successes.