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Authors: 

• Dr Ishan Wijesinghe, Registrar Anaesthetics, Medway Maritime NHS Foundation Trust
• Dr A C Ruwanmali De Silva, Consultant Anaesthetist, Medway Maritime NHS Foundation Trust

We’re very proud that Medway Maritime Hospital's CEPOD team recently achieved notable recognition for their quality-improvement project with the highly commended prestigious national HSJ Award. This accolade highlights the innovative efforts aimed at enhancing patient safety and outcomes in emergency surgical care.

Dedicated operating theatres for emergency surgery, often referred to as CEPOD theatres, were introduced in the early 1990s to enhance the quality and safety of emergency surgical care. However, the efficient use of CEPOD theatres remains a persistent challenge. The process of ensuring that emergency patients are taken to the theatre promptly and safely is highly complex and depends on a multitude of factors. Our project at Medway Maritime Hospital sought to identify specific inefficiencies within this process and aimed to implement targeted improvements to optimise the utilisation of theatre time.

We conducted our quality-improvement project in two phases.

Advancing and promoting anaesthesia research is one of the College’s four core charitable aims, and this issue of the Bulletin offers a snapshot of how we are delivering on that commitment. 

As you know, translating evidence into meaningful improvement in clinical practice can be just as challenging as getting a research project off the ground. That’s why dissemination is a crucial part of our research agenda. Our message needs to be understood by those who can act upon it.  

Tracking a direct line from research findings to their impact on clinical practice can be difficult, but those connections are there. Forgive me for sharing an anecdote in an issue focused on evidence, but as I write this, I’ve just been reading NHS England’s Urgent and Emergency Care Plan, and a couple of things jumped out. 

Author: Jenny Westaway, Chair, PatientsVoices@RCoA

How well do you think your patients understand that information collected in their medical records could be used for other purposes, such as research, audit and planning services?

Do you think they would be comfortable or apprehensive? How do you feel about it? This subject – patients' data expectations – has occupied me for many years. Most researchers, understandably, are occupied by data quality, completeness, linkability, comparability, and more. However, for research projects to be successful, we must understand what patients and the public want from them.

It’s critical to get it right. There is so much public benefit that can be reaped through the use of patient data to identify and evaluate new treatments, to check the quality of care, and to plan and improve services. 

Author: Alice Simpson, Perioperative Care Manager, Centre for Perioperative Care (CPOC)

Every year, thousands of patients face unexpected complications after surgery – many of which could have been prevented.

Perioperative complications remain a significant burden on patients and the NHS, with 12% of UK operations resulting in complications. The challenge isn’t the lack of evidence, but the need for systematic implementation of perioperative optimisation.

To drive change, CPOC has launched the Seven Interventions Hub, a practical resource consolidating best-practice UK guidelines and newly developed resources from CPOC.

Author: Dr John O’Rourke, Academic Clinical Fellow in Anaesthetics (ACFST3); Vice-Chair (Anaesthesia) for RAFT, York and Scarborough Teaching Hospitals NHS Foundation Trust

With more than 4,000 resident anaesthetists in the UK, many of whom are involved in research through formal training programmes, fellowships, special interest areas (SIAs), or taking on projects alongside clinical work, the potential for collaboration and networking is huge.

The Research and Audit Federation of Anaesthetic Trainees (RAFT) is an umbrella organisation that brings together networks of resident anaesthetists from across the UK who have an interest in research. Supporting and leading collaborative research is at the core of RAFT, and this is no better demonstrated than in our fourth national project, the ‘POPPY’ study, investigating outcomes after day surgery.

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