20 YEARS OF CS J
Reflecting on two decades in healthcare
As TheClinical Services Journal celebrates its 20th Anniversary, this special edition reflects on the changes observed in the acute sector during the past two decades. As the editor, spanning 15 of these years, Louise Frampton shares her reflections on some of the transformations she has witnessed, the highs and lows, and what she has learnt along the way…
When I joined the journal in 2007, the magazine had already taken its ‘first steps’ and had grown into an ‘inquisitive five-year- old’, eager to assert its identity. I had the pleasure of watching the journal grow and mature into a well-respected 20-year-old – still eager to learn, evolve and to make an impact. The journal has matured, and I have celebrated my own half a century, but – as the NHS continues to demonstrate after 74 years of service – there is always something new to discover, to learn, and to innovate. Looking through the archives at the first editions, it is clear there are certain aspects of healthcare that haven’t changed much at all (and arguably some that still need to), while other aspects – such as technology – have changed immeasurably. The seismic shift in digitisation is just one example of how the landscape can change when there is the will and investment to support innovation. There have been cultural, political, and ideological shifts too and I will aim to cover some of these in this whistle-stop tour, back in time…
Operating theatres So, what was high on the agenda in the early 2000s? Patient safety and hospital- acquired infections were top priorities, as they are today. The very first edition of CSJ, published in November 2002, raised the issue of how perioperative patient warming can reduce the risk of surgical site infection and reduce complications. Patient warming to prevent inadvertent hypothermia later became part of NICE guidance, in April 2008,1
and it is now widely understood to
be best practice. However, twenty years after the subject first appeared in CSJ, I still hear that patient warming is not performed well across some hospital Trusts and too many patients are leaving the operating theatre in a state of
CSJ THE CLINICAL SERVICES JOURNAL 2002 – 2022 ANNIVERSARY EDITION
hypothermia. A recent study by Tanner et al, in 2021, for example, found that around one third of patients who had their temperature recorded in the anaesthetic room, the operating room and the recovery unit were hypothermic.2
Compliance with active warming in the operating room was found to be good,
with 96% of hypothermic patients given a forced air warming blanket (Bair Hugger), but less so in the recovery unit (47%). In addition, data showed that patients having ‘short’ operations (on average: 1 hour 16 mins) were less likely to be given active forced air warming, compared with patients having ‘long’ operations; 24% vs 93%. Despite having ‘short’ operations, 48% of these patients who were not given active warming were hypothermic on admission to the recovery unit.2
I have had the pleasure to watch Judith
Tanner speak at a number of conferences; she is an engaging and passionate champion for improvement. But perhaps the most impactful findings that she has shared, to date, have included the personal testimonies of patients whose lives have been significantly affected by surgical site infection. Hearing their harrowing stories of pain, suffering, strained relationships, changed lives, and financial difficulties, is a stark reminder of why compliance with key aspects of surgical site infection prevention bundles – such as patient warming – is vital every time.3 Nevertheless, there has been one major development that has helped surgery become much safer. The WHO safe surgery checklist (published in 2008) was mandated in the NHS in 2009, and use of the Checklist has been shown to reduce the rate of deaths and surgical complications by more than one-third. It has had a staggering impact on patient outcomes. If I had to single out one ‘new intervention’ that transformed healthcare, it would be this….4 There was deep resistance at the start5
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The Clinical Services Journal, Issue 1, November 2002.
16 l
WWW.CLINICALSERVICESJOURNAL.COM
change is always challenging, but studies suggest completion rates are now pretty good in the UK. Not all aspects of the checklist are well-adhered to, however, so
NOVEMBER 2022
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