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Publication Introduction and assessment of video consultation in the pre-operative assessment clinic(Wiley, 2021-09-22) Malins, Cathryn; Murdoch, Henry; Malins, Cathryn; Murdoch, Henry; Medical and DentalFollowing the emergence of COVID-19, the ability to assess patients in their own home, minimising unnecessary risk, whilst maintaining quality of service, is desirable. Published work on use of video in the pre-operative assessment pathway shows patient and provider satisfaction is high [1] and video consultations provide a safe and effective alternative to outpatient appointments for appropriate patients [2]. The Trust is participating in a national video consultation pilot study; the ‘Attend Anywhere (AA) Service’. Our objective was to implement and embed a video consultation service in the pre-operative assessment clinic (POAC). We aimed to establish and evaluate the service over a 4-month period. Methods The pre-existing AA platform and funding was used, equipment sourced, author trained and video calls trialled. A training programme for anaesthetists and nurses, and standard operating procedures and patient information were developed. Video calls were offered to all patients requiring anaesthetic consultation after completed POAC nurse appointments. Data were collected from patient and clinician surveys following each call. Results Between June and September 2020, 42 calls were booked which received clinician and patient feedback for 22 (52%) and 14 (33%), respectively. All patients felt able to communicate everything they wanted to clinicians. Ninety-three per cent (13/14) of patient responses rated the video call the same or better than previous face-to-face (F2F) appointments. All patients gave excellent feedback and would take up further virtual appointments if offered. Over 50% (8/14) of patients saved over 1 h and > 30 miles of travel. Sixty-eight per cent (15/22) of clinician responses were highly satisfied with the service, rating 4 or 5/5. Seventy-three per cent (16/22) rated the video call the same or better than F2F. The set-up was usually < 5 min (14/22). Ratings for technology correlated with clinicians rating for all other aspects of the survey including overall satisfaction. Comments highlighted issues with technology. Discussion We successfully established a new video consultation service in the POAC. Significant time, financial and lifestyle [C2] benefits were realised by patients. Successful interventions included identifying and training a nurse champion in the POAC to support anaesthetists and identification of appropriate patients. The number of calls and quality of service was limited by technology and patient preference; however, overall satisfaction was high, with clinicians and patients rating it the same or better than the F2F interaction. References 1. Wong DT, Kamming D, Salenieks ME, Go K, Kohm C, Chung F. Pre-admission anesthesia consultation using telemedicine technology: a pilot study. Anesthesiology 2004; 100: 1605–7. 2. Shaw S, Wherton J, Vijayaraghavan S, et al. Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study. Health Services and Delivery Research, 2018; Jun: no. 6.21.Publication The applicability of commonly used predictive scoring systems in Indigenous Australians with sepsis: An observational study(Public Library of Science, 2020-07-22) Hanson, Josh; Smith, Simon; Brooks, James; Groch, Taissa; Sivalingam, Sayonne; Curnow, Venessa; Carter, Angus; Hargovan, Satyen; Brooks, James; Medical and DentalBackground Indigenous Australians suffer a disproportionate burden of sepsis, however, the performance of scoring systems that predict mortality in Indigenous patients with critical illness is incompletely defined. Materials and methods The study was performed at an Australian tertiary-referral hospital between January 2014 and June 2017, and enrolled consecutive Indigenous and non-Indigenous adults admitted to ICU with sepsis. The ability of the ANZROD, APACHE-II, APACHE-III, SAPS-II, SOFA and qSOFA scores to predict death before ICU discharge in the two populations was compared. Results There were 442 individuals enrolled in the study, 145 (33%) identified as Indigenous. Indigenous patients were younger than non-Indigenous patients (median (interquartile range (IQR) 53 (43–60) versus 65 (52–73) years, p = 0.0001) and comorbidity was more common (118/145 (81%) versus 204/297 (69%), p = 0.005). Comorbidities that were more common in the Indigenous patients included diabetes mellitus (84/145 (58%) versus 67/297 (23%), p<0.0001), renal disease (56/145 (39%) versus 29/297 (10%), p<0.0001) and cardiovascular disease (58/145 (40%) versus 83/297 (28%), p = 0.01). The use of supportive care (including vasopressors, mechanical ventilation and renal replacement therapy) was similar in Indigenous and non-Indigenous patients, and the two populations had an overall case-fatality rate that was comparable (17/145 (12%) and 38/297 (13%) (p = 0.75)), although Indigenous patients died at a younger age (median (IQR): 54 (50–60) versus 70 (61–76) years, p = 0.0001). There was no significant difference in the ability of any the scores to predict mortality in the two populations. Conclusions Although the crude case-fatality rates of Indigenous and non-Indigenous Australians admitted to ICU with sepsis is comparable, Indigenous patients die at a much younger age. Despite this, the ability of commonly used scoring systems to predict outcome in Indigenous Australians is similar to that of non-Indigenous Australians, supporting their use in ICUs with a significant Indigenous patient population and in clinical trials that enrol Indigenous Australians.Publication 1299 Observational Study of The Use of Spinal Anaesthesia As an Alternative to General Anaesthetic For Ureteroscopy During The COVID-19 Pandemic(Oxford University Press, 2021-10-12) Longshaw, Anna; Gallagher, William; Dickinson, Andrew; Gallagher, William; Dickinson, Andrew; Medical and DentalNo abstract availablePublication Writing's on the wall: improving the WHO Surgical Safety Checklist(BMJ Publishing Group, 2021-01) Cushley, Claire; Knight, Tom; Murray, Helen; Kidd, Lawrence; Knight, Tom; Murray, Helen; Kidd, Lawrence; Medical and DentalBackground and problem: The WHO Surgical Safety Checklist has been shown to improve patient safety as well as improving teamwork and communication in theatres. In 2009, it was made a mandatory requirement for all NHS hospitals in England and Wales. The WHO checklist is intended to be adapted to suit local settings and was modified for use in Gloucestershire Hospitals NHS Foundation Trust. In 2018, it was decided to review the use of the adapted WHO checklist and determine whether improvements in compliance and engagement could be achieved. Aim: The aim was to achieve 90% compliance and engagement with the WHO Surgical Safety Checklist by April 2019. Methods: In April 2018, a prospective observational audit and online survey took place. The results showed compliance for the 'Sign In' section of the checklist was 55% and for the 'Time Out' section was 91%. Engagement by the entire theatre team was measured at 58%. It was proposed to move from a paper checklist to a wall-mounted checklist, to review and refine the items in the checklist and to change the timing of 'Time Out' to ensure it was done immediately prior to knife-to-skin. Results: Following its introduction in September 2018, the new wall-mounted checklist was reaudited. Compliance improved to 91% for 'Sign In' and to 94% for 'Time Out'. Engagement by the entire theatre team was achieved 100% of the time. Feedback was collected, adjustments made and the new checklist was rolled out in stages across all theatres. A reaudit in December 2018 showed compliance improved further, to 99% with 'Sign In' and to 100% with 'Time Out'. Engagement was maintained at 100%. Conclusions: The aim of the project was met and exceeded. Since April 2019, the new checklist is being used across all theatres in the Trust.Publication Regurgitation and aspiration(Elsevier, 2021-08-13) Ashford, Amy; Eastaugh-Waring, Tracey; Ashford, Amy; Eastaugh-Waring, Tracey; Medical and DentalRegurgitation and aspiration remains one of the major complications of general anaesthesia. Aspiration is defined as oropharyngeal or gastric content entering the airway below the level of the vocal cords. This can cause morbidity and mortality by direct effects of the particulate, acid-related damage and bacterial pneumonia. It occurs largely in patients with risk factors although occasionally in patients that are low risk. Anaesthetic technique should be adjusted depending on the patient's risk of aspiration with rapid sequence induction considered in high-risk patients. Recognition and appropriate management of aspiration is essential.Publication Survey on the implementation of the European training requirements in anaesthesiology(Lippincott, Williams & Wilkins, 2024-01-23) Langenecker, Sibylle; Bielka, Kateryna; Rees, Ted; Oremus, Kresimir; Rees, Ted; Medical and DentalNo abstract availablePublication Reverse suprainguinal fascia iliaca block to facilitate continuous catheter infusion with simultaneous hip spica application(Elsevier, 2024-09-19) Wilson, Caroline; Collins, Joanna; Gilbert, Alice; Seal, Philippa; Pearson, Annabel; Collins, Joanna; Medical and DentalNo abstract availablePublication Indigenous Australians critically ill with sepsis: Characteristics, outcomes, and areas for improvement(Elsevier, 2024-01-11) Hargovan, Satyen; Groch, Taissa; Brooks, James; Sivalingam, Sayonne; Bond, Tatum; Carter, Angus; Brooks, James; Medical and DentalBackground: Aboriginal and Torres Strait Islander Australians have amongst the highest incidence of sepsis globally. Objective: The objective of this study was to describe the characteristics, short- and long-term outcomes of non-Indigenous, Aboriginal Australian and Torres Strait Islander Australians admitted with sepsis to an intensive care unit (ICU) to inform healthcare outcome improvement. Methods: A retrospective cohort study of 500 consecutive sepsis admissions to the Cairns Hospital ICU compared clinical characteristics, short-term (before ICU discharge) and long-term (2000 days posthospital discharge) outcomes. Cohort stratification was done by voluntary disclosure of Indigenous status. Results: Of the 442 individual admissions, 145 (33%) identified as Indigenous Australian. Indigenous and non-Indigenous Australians had similar admission Acute Physiology and Chronic Health Evaluation-3 scores (median [interquartile range]: 70 [52-87] vs. 69 [53-87], P = 0.87), but Indigenous patients were younger (53 [43-60] vs. 62 [52-73] years, P < 0.001) and were more likely to have chronic comorbidities such as type 2 diabetes (58% vs. 23%, P < 0.001), cardiovascular disease (40% vs 28%, P = 0.01), and renal disease (39% vs. 10%, P < 0.001). They also had more hazardous healthcare behaviours such as smoking (61% vs. 45%, P = 0.002) and excess alcohol consumption (40% vs. 18%, P < 0.001). Despite this, the case-fatality rate of Indigenous and non-Indigenous Australians before ICU discharge (13% vs. 12%, P = 0.75) and 2000 days post hospital discharge (25 % vs. 28 %, P = 0.40) was similar. Crucially, however, Indigenous Australians died younger both in the ICU (median [interquartile range] 54 (50-60) vs. 70 [61-76], P < 0.0001) and 2000 days post hospital discharge (58 [53-63] vs. 70 [63-77] years, P < 0.0001). Conclusions: Although Indigenous Australians critically ill with sepsis have similar short and long-term mortality rates, they present to hospital, die in-hospital, and die post-discharge significantly younger. Unique cohort characteristics may explain these outcomes, and assist clinicians, researchers and policy-makers in targeting interventions to these characteristics to best reduce the burden of sepsis in this cohort and improve their healthcare outcomes.Publication An exploration of the cognitive and affective processes for anaesthetists when performing an emergency front of neck airway(Wiley, 2024-10-07) Kidd, Lawrence; Wegrzynek, Paulina; Newell, Chris; Wainwright, Elaine; Kidd, Lawrence; Medical and DentalEmergency front of neck airway (eFONA) is a potentially lifesaving but very high-stress procedure. We explored the cognitive and affective processes involved via semi-structured interviews with 17 UK anaesthetists who had attempted eFONA within the previous two years. Thematic analyses generated two meta-themes: ‘Making the decision is the hardest part; the doing is easier’ and ‘What helps make the decision?’. We found concerns around scrutiny, lack of a flat hierarchy, unfamiliarity with the situation and the lack of a model for transitioning to eFONA. Culture change, using a shared mental model, priming and emotional disengagement, assisted with eFONA decision-making. Conclusions and implications for practice are presented.