Search

Programmed time should be available in job plans to support appropriate attendance at multidisciplinary team meetings and preoperative assessment clinics.

Participation in morbidity and mortality and governance meetings, and participation in audit and development of local protocols, should be supported in the job plans.

The following guidelines should be held and be easily accessible:

• management of lumbar drains
• postoperative management of blood pressure following a carotid endarterectomy (CEA)
• emergency ruptured AAA.^37,45

All departments undertaking major vascular surgical cases should organise regular multidisciplinary audit meetings with vascular surgeons and radiologists. These should occur in addition to departmental clinical governance meetings.⁴⁶  Regular audit or evaluation of the following aspects of vascular patient care may include:

• survival of and complications in patients undergoing surgery, including review of unexpected outcomes
• survival in patients...

It is recommended that individual vascular anaesthetists register with, and contribute to, the UK national audit database (National Vascular Registry),⁴⁶  which incorporates a section dedicated to ‘anaesthesia’ as developed between the Vascular Anaesthesia Society of Great Britain and Ireland and partnership organisations. The systems needed to provide the necessary data should be available and supported.

Departments should facilitate the collection of data required for anaesthetists undertaking major vascular cases to keep a personal logbook.

Where new quality improvement initiatives are being considered for patients undergoing vascular procedures, an appropriately conducted impact evaluation is recommended before  commencement. This should involve all local stakeholders likely to be affected, ideally including patient representatives. An appropriately conducted pilot evaluation, with clearly defined outcome measures, may be appropriate prior to consideration of full-scale implementation.

It is important to engage in a shared decision-making process with patients to discuss the risks and benefits of scheduled or elective major vascular surgery. Details should be explained to the patient in an appropriate setting and in language they can understand. Patient information materials should be made available to support the patient’s decision with regard to choices on anaesthesia...

These discussions should occur well in advance of planned surgery to allow reflection and informed decision-making. All such discussions should be documented, although it is still necessary to give relevant explanations at the time of the procedure.

Options for anaesthesia and all aspects of perioperative care, including risks and benefits, should be discussed with the patient by the responsible anaesthetist.