Author(s) Wilson A.; Lie J.
Source Anaesthesia; Jan 2020; vol. 75 ; p. 66
Following the recommendations of the Francis report, it has been NHS policy that all hospital patients have a named consultant responsible for their care to ensure patient safety. Many theatre lists are run by non-autonomous SAS grades (NASG) who, although they are the lead anaesthetist for their list, have a designed consultant supervisor .
At East Lancashire Hospitals NHS Trust (ELHT), there is a designated duty anaesthetist at both Royal Blackburn Teaching Hospital (RBTH) and Burnley General Teaching Hospital (BGTH).
Methods The audit was conducted as per the Cappuccini test guidance produced by the Royal College of Anaesthetists . Twenty elective lists conducted by NASG over 2 weeks were identified at ELHT. The NASG was asked who is supervising you and how would you get hold of them if you needed them now? I then checked that I was able to contact the consultant myself and then asked the consultant the following four questions: which lists are you currently supervising, in which surgical specialty are they working currently, do you know of any issues that the NASG are concerned about and if they required your help would be able to attend?
Results The NASG knew 19/20 of the names of the duty anaesthetists and all of them knew how to get in contact with the consultant if required, which was by a designated deck phone. I was able to get in contact with all the duty anaesthetists. The duty anaesthetist was aware of 15/20 lists and knew the specialities for 14/ 15 of the lists they were aware of. There were no issues reported and all duty anaesthetists said they were able to attend if required for the lists they were aware of (15/15); however, for two of the lists (same supervisor/session), the duty anaesthetist was carrying the registrar bleep due to sickness so would have been less available than usual. Discussion The results show that the NASG knew who the duty anaesthetist was and how to contact them. This is most likely due to the fact that there is a designated duty anaesthetist at both RBTH and BGTH, who is not attached to a specific theatre list, but has the responsibility of supervising all theatres including the NASG and giving assistance when required. The knowledge of the duty anaesthetist of the lists they were supervising was lower, RBTH and BGTH are large departments with 11 and 14 theatres, respectively, which likely factors into this score. All duty anaesthetists said they would be able to attend if required with the one example of slight difficulty due to carrying the registrar's bleep due to sickness.
Author(s): Doherty C.; Bowler M.; Perkins R.; Neal R.; English C.; Cooke J.; Wyatt M.; Atkinson D.; Moore J.; McGrath B.A.; Bates L.; Monks S.; Bruce I.A.; Bateman N.; Russell J.
Source: Anaesthesia; Nov 2018; vol. 73 (no. 11); p. 1400-1417
Publication Date: Nov 2018
Publication Type(s): Article
Available at Anaesthesia - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Temporary and permanent tracheostomies are required in children to manage actual or anticipated long-term ventilatory support, to aid secretion management or to manage fixed upper airway obstruction. Tracheostomies may be required from the first few moments of life, with the majority performed in children < 4 years of age. Although similarities with adult tracheostomies are apparent, there are key differences when managing the routine and emergency care of children with tracheostomies. The National Tracheostomy Safety Project identified the need for structured guidelines to aid multidisciplinary clinical decision making during paediatric tracheostomy emergencies. These guidelines describe the development of a bespoke emergency management algorithm and supporting resources. Our aim is to reduce the frequency, nature and severity of paediatric tracheostomy emergencies through preparation and education of staff, parents, carers and patients.Copyright © 2018 Association of Anaesthetists
Author(s): Waqar-Uddin H.; Wilson J.; Habgood M.
Source: Anaesthesia; Jul 2018; vol. 73 ; p. 121
Publication Date: Jul 2018
Publication Type(s): Conference Abstract
Abstract:Around 160,000 hip and knee replacements are performed every year in the UK . Numerous studies across surgical specialties have shown that pre-operative anaemia is associated with longer length of stay (LoS) in hospital and higher mortality . It has been recommended that patients who present for elective surgery and are found to be anaemic pre-operatively, their operation should be postponed until the anaemia has been investigated and treated adequately. A cut-off of 130 g.l-1 has been suggested . At the same time, the UK Blood Transfusion service has introduced the 'two sample rule' so patients who require transfusion need two blood samples. Our aim was to assess whether our service was functioning well in identifying patients with anaemia and optimising them prior to surgery.
Effect of beta-blockers on perioperative outcomes in vascular and endovascular surgery: a systematic review and meta-analysis.
Author(s): Hajibandeh, S; Antoniou, S A; Torella, F; Antoniou, G A
Source: British journal of anaesthesia; Jan 2017; vol. 118 (no. 1); p. 11-21
Publication Date: Jan 2017
Publication Type(s): Journal Article
Abstract:To investigate the role of perioperative beta-blocker use in vascular and endovascular surgery. We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. The review protocol was registered with International Prospective Register of Systematic Reviews (registration number:CRD42016038111). We searched electronic databases to identify all randomized controlled trials and observational studies investigating outcomes of patients undergoing vascular and endovascular surgery with or without perioperative beta blockade. We used the Cochrane tool and the Newcastle-Ottawa scale to assess the risk of bias of trials and observational studies, respectively. Random-effects models were applied to calculate pooled outcome data. We identified three randomized trials, five retrospective cohort studies, and three prospective cohort studies, enrolling a total of 32,602 patients. Our analyses indicated that perioperative use of beta-blockers did not reduce the risk of all-cause mortality [odds ratio (OR) 1.10, 95% confidence interval (CI) 0.59-2.04, P = 0.77], cardiac mortality (OR 2.62, 95% CI 0.86-8.05, P = 0.09), myocardial infarction (OR 0.89, 95% CI 0.59-1.35, P = 0.58), unstable angina (OR 1.34, 95% CI 0.41- 4.38, P = 0.63), stroke (OR 2.45, 95% CI 0.89-6.75, P = 0.08), arrhythmias (OR 0.76, 95% CI 0.41-1.43, P = 0.40), congestive heart failure (OR 1.12, 95% CI 0.77-1.63, P = 0.56), renal failure (OR 1.48, 95% CI 0.90-2.45, P = 0.13), composite cardiovascular events (OR 0.88, 95% CI 0.55-1.40, P = 0.58), rehospitalisation (OR 0.86, 95% CI 0.48-1.52, P = 0.60), and reoperation (OR 1.17, 95% CI 0.42-3.27, P = 0.77) in vascular surgery. Beta-blockers do not improve perioperative outcomes in vascular and endovascular surgery. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: firstname.lastname@example.org.Database: Medline
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