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Posts Tagged ‘Anaesthesia’

It’s worth keeping in mind why we do it

By Katherine Teale - 11th December 2011 10:32 pm

As I get older, I realise there are more and more things I don’t understand - for instance, how to do long division without a calculator, and whether it’s a good or bad thing to be in the EU.

It’s a bit strange, I think, that so many people seem to be absolutely sure about this quite complex economic issue, particularly readers of our tabloid press, although I do think that before being able to participate in any referendum about Europe, voters should have to be able to name at least five countries in it. That would reduce voter numbers substantially. Come to think of it, I would no more trust the view of the man on the street on membership of the EU, than I would ask him to take my appendix out.

Things have got so depressing this week that’s I’ve decided to stop watching the news, and restrict my media contact to Classic FM, nature programmes, and anything by Jane Austen. Even natural history programmes are problematic in our house - we couldn’t watch the Frozen Planet together, as it was too upsetting for my daughter - nature is too grizzly for today’s sanitised youth, I’m afraid.

As far as work goes, I’ve decided to keep my head down and just do what I can in my own small corner - and very satisfying it is too. Last week I had three patients on my theatre lists with NYHA stage 3 heart failure - there are few things more satisfying than successfully seeing such high risk patients through their surgery, especially when it’s witnessed by a colleague who, when letting me out for a very welcome coffee-break, was visibly impressed by my (for once) spectacularly effective supraclavicular brachial plexus block.

This week’s gloom was lightened by the successful outcome of two patients who came to theatre with agonising trigeminal neuralgia, and left pain-free.

I do think we sometimes need reminding about how fortunate we are to be doing a job which doesn’t involve sitting at a computer terminal for hours on end. It might be physically demanding and involve too much getting out of bed in the small hours, but the rewards still sometimes bring a tear to my eye. Whatever happens out there in the wider world, to our pensions and salaries, and whether we end up working for Spire, Circle, or United Health, we can still go on doing our best for the patient in front of us.

We won’t always make a difference for the better, and even if we do they won’t always be grateful - but it’s what makes the job worth doing. And when I lose sight of that, will be the time to hang up my laryngoscope. Merry Christmas.

Tags: Anaesthesia
Posted in Katherine Teale | 3 Comments »

Q: What time does theatre start at? Part II

By Caroline Whymark - 1st June 2011 9:41 am

OK, so maybe I was having a bad day. As Kathy Teale pointed out, the system can work but the key is that you need buy in from all parties. I agree.

But, currently all parties feel sold out.

The fact of the matter is that only a few years ago there was a true team spirit working well in theatre and it has disappeared due to the removal of incentives which made this natural, uncontrived multi-disciplinary team work well together.

Whether it’s being good for the whole year waiting for Santa to come, or a Waiting List Initiative payment on a Saturday morning, incentives work.

Let me explain. As an SHO I arrived in a new hospital. Saw all my patients on the morning of surgery then went to theatre and got everything ready. Wandering into the communal coffee room shared by all ranks of staff I was offered a scone and coffee. “What time does theatre start?” I asked concerned that it was already 8.50 and we’d never get through the list. There was surprise in the room at this question. “When Sister tells us it’s time” was the answer.

The motivation to work hard became obvious very quickly. Speeding through the first couple of cases was rewarded with a team wide sit down (with more scones). The forces were revitalised and momentum stayed high until lunchtime when again the team stopped for a break. With the home straight in sight, it was common to cut short the lunch break to get on with the remainder of the list. As the light at the end of the list grew brighter and brighter so did our spirits, for we were heading for an early finish. If we were done by 4, we were rewarded by being able to leave at 4. All of us.

Fast forward to 2011. It is no surprise that everyone waits for everyone else and no one starts the ball rolling. It is in no one’s interest to finish early. If we speed through the day and finish at 3.30pm the nurses merely get redeployed to another theatre or given extra cleaning duties. They are paid until 5 pm and so will be there until 5pm.

The anaesthetist usually gets asked to help with a couple of quick trauma cases and it’s the same for the surgeons. If they get through the work more efficiently they have to explain their perceived under utilisation of theatre time to management and be told to list more cases in future.

I am not saying this is wrong. What I am saying is that there are pros and cons to everything and management style is no different. If you want a time centred workforce, you will get a time centred workforce. They will turn up on time, expect their (often unpaid) breaks and stay until clocking off time. Productivity will be defined by the rate limiting step in the system. But a little bit of give and take from one side will be reciprocated by the other and may well achieve a lot more for a lot less.

Tags: Anaesthesia, Surgery, WLI
Posted in Caroline Whymark | No Comments »

Pain management: Experts call for greater pain assessment in hospitals as 65% of patients report problems

Evidentia - 27th May 2011 10:18 am

Nearly two-thirds of the hospital in-patients who took part in a survey had experienced pain in the last 24 hours and 42% of those rated their pain as more than seven out of ten, where ten was the worst pain imaginable, according to a recent issue of the Journal of Clinical Nursing.

Although eight out of ten patients had been asked about their pain levels by staff, less than half of those had been asked to rate their pain on a simple numeric scale.

Researchers from Uppsala University, Sweden, studied 759 patients aged from six weeks to 95, with parents completing the surveys for the younger children. “Pain is a natural part of many medical conditions, but it can have a negative affect on quality of life, how successful treatment is and the patient’s prognosis,” says lead author Dr. Barbro Wadensten, associate professor in the Department of Public Health and Caring Sciences at the University.

Q: What time does theatre start at? A: Er…

By Caroline Whymark - 21st May 2011 10:16 pm

“What time does theatre start at?” was the first item on the agenda when we anaesthetists were invited to a meeting by the ‘lean team’ running our improved theatre efficiency, Kaizen-type project. The whole meeting was typified by the fact that we never got beyond this item. But why should this be a difficult question to answer? The theatre lists clearly state ‘0830hrs’. Job plans generally start at 0815 or 0830 in anaesthesia. Most of us naively assume that means we start anaesthetising the first patient at 0830hours. What else could it possibly mean?

Well, in this new, patient safe lean way of working it can mean many things, or can actually have no meaning at all. In days gone by we did indeed turn up early to check machines, draw up the drugs and start with the first patient at 0830. More recently things are less straightforward. On a typical list, for example, the anaesthetist turns up at 0815 to prepare. All the theatre staff are ‘having breakfast’ followed by cigarette as ‘they started work’ at 0800.

Nothing is prepared in theatre because they aren’t sure which case we’ll be doing first, they need to see the surgeon. The anaesthetist nips round to the day surgery unit which functions more and more each day as a same day admission lounge and sees the first two patients for the list who arrived at 0730. The others are due to arrive at 1100, then noon, and finally at 1300 to reduce the amount of time they are ‘kept waiting’ for their operation.

This means the list needs to stop while surgeon and anaesthetist return later in the day to mark the correct side, establish their various fasting states and deal with the unexpected problems. Back to theatre, 0845, “can we get the first patient round?” the anaesthetist asks. Of course not. “We’ve not seen the surgeon yet,” state the theatre staff. Fair enough. “I’ve seen him”, the anaesthetist ventures, ever hopeful of getting the list started, “he’s in the admission area consenting and marking the two patients who have arrived”.

Now we need to wait for him to come to theatre so we can have the ‘team huddle’. 0900, surgeon arrives and the huddle begins. Everyone introduces themselves and that goes smoothly as we all know each other having worked together on this list for the past five years. Then, onto the first patient, confirmed as being the first name on the list, having the operation described on the list, with the routine set of equipment available. I comment that he’ll take 20 seconds to be knocked off to sleep. I don’t feel the need to explain my decision making processes when formulating my anaesthetic plan. I have 15 years experience in weighing up the risks and benefits as they pertain to individual patients and feel that dealing with those problems is my job, my responsibility, with the anaesthetic nurse or ODP being informed and prepared on a need to know basis.

We continue by huddling the second patient and then abruptly stop. The following four patients have not yet arrived. The surgeon cannot confirm the correct side of the planned surgery. I hope the patients will have been to the pre-assessment clinic, found it in good working order and have no special considerations. But we don’t know. Shall we just get started then? Shall we re-huddle at regular intervals? Again in the afternoon? Not bother? No one is sure and several of the staff are on half days anyway so lose interest.

The box on the form gets ticked that we have indeed performed the huddle and the first patient is brought to the anaesthetic room. It is 0910hours. Is that our start time? Or is when eventually the knife gets to the skin? The latter of course only happening after the surgical pause, and that’s a whole other story.

It’s going to be a long day…

Tags: Anaesthesia, Surgery
Posted in Caroline Whymark | 2 Comments »

Surgery patients at risk in drug research scandal

Telegraph - 4th March 2011 8:28 am

Millions of NHS patients have been treated with controversial drugs on the basis of “fraudulent research” by one of the world’s leading anaesthetists.

Joachim Boldt is at the centre of a criminal investigation amid allegations that he may have forged up to 90 crucial studies on the treatment. He has been stripped of his professorship and sacked from a German hospital following allegations about his research into drugs known as colloids.

Guidelines for British anaesthetists regarding colloids - used to boost blood volume in patients undergoing surgery - are being revised after it emerged that four of the key studies on which they were based are to be formally retracted.

Boldt, 57, was regarded as a leading specialist in intravenous fluid management, and his work was widely published.

He claimed to have proved that colloids were as safe as other, similar treatments despite earlier studies showing them to be more dangerous. Boldt’s alleged forgeries date back up to a decade.

“Revolution” in anaesthetic use in Wales

BBC Health - 9th August 2010 2:04 pm

Doctors in Swansea say they have transformed the way they carry out complex operations by using a new nerve block instead of general anaesthetic.

By targeting injections using ultrasound, patients who would have needed days in hospital can have surgery and be sent home within hours.

The pain relief technique is currently being used for hand and arm operations. The nerve block - a regional anaesthesia - has been developed in the day surgical unit at Singleton Hospital. It is different to a local anaesthetic in that it works on the nerves affecting the whole arm, rather than a part of it.

The local health board said the process saves money, with less risk for patients.

Anaesthetics: new chronic pain guidelines published in the United States

Evidentia - 10th July 2010 8:04 am

The American Society of Anesthesiologists Task Force on Chronic Pain Management has updated its chronic pain guidelines.

The new recommendations are designed to help clinicians who treat pain. The objectives are to optimise pain control, enhance physical and psychological well-being, and minimise adverse outcomes. Richard Rosenquist, from the University of Iowa Hospital, Iowa City, led the 12-member task force of anesthesiologists in both private and academic practice.

UK’s reputation for research and innovation under threat

By Mike Broad - 24th June 2009 1:59 pm

On the face of it, the staffing levels of medical clinical academics in medical schools have improved.

The annual staff survey published recently by the Medical Schools Council shows a 1% increase in the clinical academic staffing level over the 12 months to July 2008. The total of full time equivalents was 3,032 - the first time 3,000 has been topped in eight years.

However, a closer look at the data reveals that academic staffing is ageing, increasingly top heavy, male dominated and has been decimated in a number of specialties that were once academic strongholds.

Professors make up the greatest proportion of all medical clinical academics in post in medical schools, an increase in real terms of 27% since 2000. In contrast, the number of clinical lecturers in post has fallen by 386 – which represents 47% - for the same period.

Fortunately, there are some signs of a recovery in clinical lectureships with an increase in numbers of 6% for the second consecutive year.

The Medical Schools Council is particularly concerned that 58% of the clinical academic workforce is aged over 45. It fears that leadership skills and experience are being lost through retirement with insufficient recruitment in the lower grades.

A spokesperson said: “Existing schemes to support young researchers in accessing the clinical academic career pathway must continue to receive support.

“The Medical Schools Council is working with partner organisations to improve careers advice for students, to raise the profile of academia as a career pathway and to develop a tracking mechanism that will capture the pipeline of the future clinical academic workforce.”

Women continue to be under represented at senior clinical academic grades. Just 13% of clinical professors are female. The report calls for action to be taken to increase the attractiveness of an academic career for women, particularly with the increasing female intake into medical school.

On the positive side, the gender, ethnic and age diversity of staff is improving among younger members.

The survey shows that research in the specialties of pathology, paediatrics and child health, and anaesthesia is under threat. At lecturer grade, there has been a decline of more than 50% in staffing levels in eight specialties since 2000.

It’s worse in paediatrics, with a 60% reduction in the number of lecturers between 2000 and 2007.

Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health, said: “We exhort the government not to leave this to the free market and individual universities. Money must be ring-fenced for training posts for academic paediatricians.

“The terms and conditions should also be made more attractive and nationally uniform to address the fact that the majority of paediatric trainees are women and career breaks and maternity leave are major issues which deter them currently.”

Generally, the number of clinical academic consultants has remained relatively steady at around 2,300 full time equivalents, whereas the number of NHS consultants has increased by 40% since 2000 to a total of 39,3000 in 2007.

Professor Peter Furness, president of the Royal College of Pathologists, believes there are not enough opportunities to experience research in run through training.

He said: “We’ve had staff shortages in providing the services - so those entering training know they’ve got a consultant job at the end whether they’ve done research or not. Research just delays their appointment as a consultant which is a disincentive to doing it.”

The college is working to engage trainees in research but, for significant improvement, Furness believes national policy and funding have to change. For pathology, he hopes NICE’s stated intention to expand its remit to cover diagnostics could lead to a renaissance in research.

The Medical Schools Council warns that without new mechanisms to support training and research both the quality of patient care and our ability to educate the next generation of doctors will be severely compromised.

In the bigger picture, the UK’s position as a world leader in medical innovation and research is under real threat.

Tags: Anaesthesia, Paediatrics, Pathology, Research
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