DAY CASE SURGERY
off dead or self-harm. A Royal College of Anaesthetists’ snapshot survey showed that 39% of anaesthetists wish to reduce working hours and 18% are considering stopping work altogether. (Source: Medical Workforce Census 2020) “There will be a crisis if we don’t get this right,” commented Prof. Cook. He highlighted a paper by Professor Neil Greenberg, titled: ‘Going for growth: an outline NHS recovery plan post COVID-19’.5 In this paper, Greenberg commented:
“A poorly implemented post-COVID-19 plan, leading to seemingly false promises of support or of time to readjust to the new normal or managers making high work demands on staff who have been working ‘flat out’ has the potential to derail staff support efforts to date and to cause serious psychologically harm. Put another way, the unwritten psychological contract between NHS staff, their managers, and the public, has been that staff members will give their all to save lives and in return the nation will give them the support, and time they need, to be able to recover.” “Psychological wellbeing for anaesthetists and critical care staff is not just a useful ‘add on’. It is vital and something that needs to happen,” said Prof. Cook. “Most psychological distress occurs after a crisis, not during it, and we are yet to reach the end of this.”
Sustaining the perioperative and critical care workforce and capacity will require workforce planning on a local, regional and national basis. In addition, the resumption of planned surgery will need to accommodate the training needs of all doctors in training of all specialties.
“Many doctors in training will have had their training impacted, during the past year, and their needs must not be forgotten,” said Prof. Cook. He added that planned surgery requires reliable and consistent supply chains of drugs and equipment, while
A study by Greenberg et al has revealed very high rates of psychological harm among healthcare workers due to COVID-19
changes in surgical condition or perioperative health and fitness will necessitate further work-up, consent or shared decision-making for many patients. The period in which this takes place could provide an opportunity for planned rest and recuperation for critical care and perioperative staff. In conclusion, he highlighted a quote by Mark Udall (a mountaineer and US senator): “You don’t climb mountains without a team; you don’t climb mountains without being fit; you don’t climb mountains without being prepared; and you don’t climb mountains without balancing the risks and rewards...”
Recovery: defaulting to day surgery Professor Tim Briggs CBE, national director for clinical improvement at NHS England and chairman at Getting It Right First Time (GIRFT), went on to discuss: ‘Why and how should you default to day surgery to
maintain elective pathways’. Pre-COVID, GIRFT’s clinically-led programme led to a reduction in length of stay for TKR/THR, a reduction in appropriate arthroscopy rates, a reduction in emergency readmissions, lower revision rates, a year- on-year reduction in litigation claims, less unwarranted variation, and lower costs. Overall, the orthopaedic pilot resulted in improved outcomes, helped free up bed capacity, and improved theatre productivity and efficiency. GIRFT has now become a national programme, with over 40 specialties and 12 national reports published. It is having a significant impact on quality improvement. One of the key focus areas has been the perioperative medicine workstream. “We know there are huge variations in day case rates. Day case surgery is better for patients and better for the service,” commented Prof. Briggs. “We need to understand why this variation exists,” he continued, adding: “We need to maximise our day case rates if we are going to improve our efficiency and provide patients with their surgery at the correct time. As we know, COVID-19 has hit surgical activity hard and, in London, the impact has been particularly profound – in April 2020, we were only doing 11% of ‘business as usual’, but all regions have been affected.”He reported that more than 300,000 patients are waiting more than 52 weeks for surgery, with orthopaedics and ophthalmology accounting for the two largest groups in the elective backlog. However, he pointed out that the situation is much worse than this – COVID-19 has resulted in a hidden backlog of more than 4.5 million unreferred patients [since the conference this has now increased to 5.1 million as of 10 June 2021]. Many patients have stayed
AUGUST 2021
WWW.CLINICALSERVICESJOURNAL.COM l 63
▲
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88
