NHS England – 16th May 2024
The Delivery plan for recovering urgent and emergency care was published in January 2023. Setting out a 2-year action plan from April 2023, it is backed by a £1 billion improvement package and £200 million ambulance fund, with the ambition of reducing the time people spend in A&E or waiting for ambulances to arrive.
This letter and guidance highlight the progress made over 2023/24 in delivering the actions set out in the delivery plan.
Annually the NHS in England procures and disposes of 32.3 million (m) airway devices purchased for £56.9m. These devices are used for general anaesthesia and includes 18m supraglottic devices (SGDs), 5.3m endotracheal tubes (ETTs), 4.4m tracheostomy tubes and 2.9m laryngoscope blades. Here we discuss the origins of single use airway devices and suggest routes toward responsible and sustainable alternatives.
Further information – Single use airway devices: Harms and solutions
BTS and BSHI 2023
Solid organ transplantation represents the best (and in many cases only) treatment option for patients with end-stage organ failure. The effectiveness and functioning life of these transplants has improved each decade due to surgical and clinical advances, and accurate histocompatibility assessment. Patient exposure to alloantigen from another individual is a common occurrence and takes place through pregnancies, blood transfusions or previous transplantation. Such exposure to alloantigen’s can lead to the formation of circulating alloreactive antibodies which can be deleterious to solid organ transplant outcome. The purpose of these guidelines is to update to the previous BSHI/BTS guidelines 2016 on the relevance, assessment, and management of alloantibodies within solid organ transplantation.
Read the guideline – Detection of alloantibodies in solid organ (and islet) transplantation
RCoA – may 2024
Executive summary
■ NHS waiting lists are at crisis levels. Anaesthetists are key to addressing this, as most operations cannot take place without an anaesthetist and there is clear evidence that the UK needs more of them.
■ The UK has a shortage of 1,900 anaesthetists (14%). We estimate that this prevents 1.4 million
operations and procedures taking place each year.
■ The NHS currently lacks a plan for training enough doctors in specialties such as anaesthesia, but such a plan is urgently needed.
■ Measures must also be taken to boost retention, including better rest and refreshment facilities.
■ Anaesthetists play a leading role in initiatives to boost NHS efficiency, such as turning waiting lists into preparation lists, which can reduce surgical complications and cancellations and reduce length of hospital stay.
■ Start-up costs to these initiatives are a barrier. We recommend a £100 million ‘NHS efficiencies transformation fund’ to overcome initial financial obstacles
Further information – Anaesthesia: solutions for an NHS in crisis
intensive Care Med (2024) 50:493–501
An implantable left ventricular assist device (LVAD) is indicated as a bridge to transplantation or recovery in the United
Kingdom (UK). The mechanism of action of the LVAD results in a unique state of haemodynamic stability with diminished arterial pulsatility. The clinical assessment of an LVAD recipient can be challenging because non-invasive blood pressure, pulse and oxygen saturation measurements may be hard to obtain. As a result of this unusual situation and complex interplay between the device and the native circulation, resuscitation of LVAD recipients requires bespoke
guidelines. Through collaboration with key UK stakeholders, we assessed the current evidence base and developed
guidelines for the recognition of clinical deterioration, inadequate circulation and time-critical interventions. Such
guidelines, intended for use in transplant centres, are designed to be deployed by those providing immediate care of
LVAD patients under conditions of precipitous clinical deterioration. In summary, the Joint British Societies and Transplant Centres LVAD Working Group present the UK guideline on management of emergencies in implantable LVAD recipients for use in advanced heart failure centres. These recommendations have been made with a UK resuscitation focus but are widely applicable to professionals regularly managing patients with implantable LVADs
Anaesthesia Reports 2024, 12, e12293doi:10.1002/anr3.12293
We conducted a prospective observational service evaluation across the United Kingdom on the use of total intravenous anaesthesia(TIVA)forobstetricsurgerybetweenNovember2022andJune2023.The primary aim was to describe the incidence of TIVA for obstetric surgery within participating units, with secondary aims to describe maternal and neonatal postoperative recovery indicators. Of 184 maternity units in the United Kingdom, 30 (16%)contributed data to the service evaluation. There were 104 patients who underwent caesarean delivery under TIVA and 19 patients had TIVA for other reasons. Infusions of propofol and remifentanil were used in 100% and 84% of cases, respectively. Fifty-nine out of 103 live neonates (57%) required some form of respiratory support. Of the neonates with recorded data, 73% and 17% had Apgar scores<7 at 1 and 5 min respectively. No neonates were recorded to have Apgar scores<7 at 10 min. Further prospective research is required to investigate the impact of obstetric TIVA on maternal and neonatal outcomes and inform best practice recommendations
Read the article – service evaluation of obstetric total intravenous anaesthesia in the United Kingdom
BAPM – 24 Apr 2024
This document sets out standards for safely managing the neonatal airway in neonatal services in the UK. The document focuses on unit capability and aims to ensure that a safe service is always available.
The purpose of this document is to
This framework complements the existing BAPM Framework for Practise on Managing the Difficult Airway in the Neonate.
Association of Anaesthetists Trainees – Published: April 2024
Anaesthetic training in the UK continues to be among the longest and most challenging in the world. This produces
a workforce of highly talented, skilled, and experienced senior anaesthetists who are able to tackle the ever-evolving
challenges that we face in the NHS and healthcare. However, balancing a high quality training experience which promotes longevity and wellness within our workforce alongside the growing nature of problems with our healthcare infrastructure is a very real and present challenge. This document aims to do three things:
Read the report – Anaesthetic training in the UK
GIRFT – January 2024
Many aspects of inpatient orthopaedic trauma services have improved considerably over recent years. This is consequent of a virtuous circle of combined engagement and efforts of clinicians and management, available data, and guidelines on what works best.
This report aims to build on these successes to date by reducing unwarranted variation across the whole breadth of
orthopaedic trauma pathways. Critically, our aim is to do this regardless of the type of fracture a patient experiences and, in doing so, ensure trauma care is more equitable.
Concurrently, a main priority for this report is improving clinical governance to enable continual improvement across the pathway, prioritised as necessary based on the data locally available. A common theme throughout our deep dive visits to trusts has been the clear need for 24/7 multidisciplinary governance of the whole pathway, as it operates for patients, with any fracture. We have seen wide variation in how effectively colleagues from the range of disciplines involved in care of the orthopaedic trauma patient communicate and collaborate with each other to deliver, monitor, govern and improve the pathway. We hope this report provides illustration of how multidisciplinary governance can work well, and highlights governance arrangements that can be used. Using this approach, and the rest of this report’s recommendations, we expect providers and systems will progressively deliver a service that:
is more equitable;
is more responsive to best practice guidance;
continuously reduces unwarranted variation.
We have summarised our findings and recommendations below, following the same structure as the main body of the report.
We have set out ten recommendations (although some recommendations cover more than one area) based on the extensive discussions we have had with the system, as well as supporting data, and best practice guidelines. More detail on each recommendation – including how they can be achieved, and how outcomes against them can be tracked – are found in the corresponding sections of this report. We have also identified two areas for further work
Read the report – Adult Orthopaedic Trauma – GIRFT Programme National Specialty Report
Critical Care News 