TopMedTalk

This piece explains how the "Getting It Right First Time" (GIRFT) project got off the ground. How does it help improve quality of care within the NHS reduce unwarranted variations, bring efficiencies and improve patient outcomes? This piece gives you the detail.

Led by frontline clinicians, who are experts in the areas they review, hear how the project helps to manage services on a daily basis; sharing best practice between trusts, GIRFT identifies changes that help improve and change an institution's procedures and cost savings.

The GIRFT website is here - https://gettingitrightfirsttime.co.uk/

Further listening regarding GIRFT can be found here: https://www.topmedtalk.com/rcoa-13-the-girft-getting-it-right-first-time-project/

Presented by Anna Batchellor, trained in anaesthesia and Intensive Care Medicine (ICM) she works in Newcastle upon Tyne; past President of the Intensive Care Society, past Dean of the Faculty of ICM, past member of Council of the Royal College of Anaesthetists. One of the first formal trainees in ICM in the UK she co-authored the curriculum for training in ICM for the Certificate of Completion of Training. She developed the Advanced Critical Care Practitioner Programme to help us fill the enormous hole appearing in critical care staffing. She tried to retire in June 2016 and managed to spend a year working part time before being hijacked by the Getting It Right First Time (GIRFT) programme.

"The predominant emotion was fear..."; this piece is essential listening for every TopMedTalk listener who really cares about the experience of their patients. Hear what it was like to participate in the pioneering, tailored exercise training programme, The Encourage Trial. Also, find out about "the Buddy Scheme" and how becoming a member of a local support group: SPICOS (Support for People Impacted by Cancer of the Oesophagus and Stomach) led to it.

Could a 'Buddy', volunteers who have been in a similar situation and have agreed to be a point of contact for patients and their families, be able to offer reassurance and support at your practice?

Someone your patient can rely on who can honestly say to them; 'Yes, I know exactly what you mean, I know exactly how that feels'.

The Macmillan Cancer Support website is here: https://www.macmillan.org.uk/

Presented by Mo Cottrell, a retired nurse who underwent a 5 week course of Chemoradiotherapy followed by successful surgery for Oesophageal Cancer at Southampton General Hospital in January 2017.

The patient experience can be quite passive and, as a result, people can lose temperature quickly. The consequences can be very negative, this conversation revolves around how you can keep your patients warm. This piece is taken from a longer conversation to be found here: https://www.topmedtalk.com/live-from-the-iseh-part-1/

This edition of TopMedTalk was recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum.

The conversation features Professor Monty Mythen and his guest Mark Harper, Consultant Anaesthetist at Brighton and Sussex University Hospitals, with a research interest in the prevention of perioperative hypothermia and the use of cold water adaptation for theraputic purposes.

This piece is a fascinating overview of Australia and New Zealand's Emergency Laparotomy Audit - Quality Improvement (ANZELA-QI). It works as an update on the initiative, provides all the background you need including explanations regarding, structure, organisation and additional support as well as answering key questions such as: Do we need it? How do you join and what happens when you do?

A link to the slides for this talk is here: http://www.anzca.edu.au/documents/03-ben-griffiths_anzela-qi-an-update.pdf

Presented by Ben Griffiths, consultant anesthetist at Auckland City Hospital, anaesthetic lead for ANZELA-QI.

This piece discusses how the contributors are driving better perioperative care in their clinics; the importance of getting patient records in advance; ERAS for obstetrics; challenging opioid use with the multimodal pain management; shared decision making in pain management; the importance of clear communication pathways and patient literacy.

This podcast features Desiree Chappell interviewing; Dr Ellen Flanagan, anaesthesiologist and medical director at the Duke preoperative assessment testing clinic, Dr Attila Kett, anaesthesiologist and Chairman at St Peter's University Hospital at New Jersey and Lynn Reede, CRNA and chief clinical officer at the (AANA) American Association of Nurse Anaesthetists.

Frailty is a common condition which has been topical in geriatric medicine for some time but now it is appearing in the surgical and anaesthetic literature. This talk explores how our understanding and discussion has improved regarding a condition that is still yet to have a clear, universally accepted, definition. How do we build a patient's physical reserve? What is the best way to conceptualise frailty? Are there any universal treatments available?

Presented by Dr Jugdeep Dhesi, Clinical Lead, POPS and Consultant Geriatrician, Guys and St Thomas' NHS Trust.

This piece focuses on the article "The malnourished surgery patient, a silent epidemic in perioperative outcomes?" which you can find here: https://journals.lww.com/co-anesthesiology/Abstract/2019/06000/The_malnourished_surgery_patient__a_silent.23.aspx

The Perioperative Quality Initiative is here: www.poqi.org

Presented by Desiree Chappell with Monty Mythen and their guests Jeroen Molinger, Clinical Medical Exercise Physiologist at Duke University Medical Center, Department of Anesthesiology & ICU and John Whittle, assistant Professor at Duke University Medical Centre.

In short; Post-Op recovery in less than 3 days with over 90% mobilised on day 1.

This in depth discussion relates to the consensus paper from the Perioperative Quality Initiative, see link below. It focuses on: outcomes, length of stay and DREAMS (Drinking, Eating and Mobilising) within hours after major surgery- all key measures of compliance and success in an Enhanced Recovery Program.

Monty Mythen and Joff Lacey with Mike Grocott presenting with contributions from Dr Julie Thacker, Colorectal Surgeon from Duke University and President of the American Society of Enhanced Recovery and Dr Tim Miller, Anesthesiologist from Duke University.

POQI website is here: http://www.poqi.org

For further CME read the paper in Perioperative Medicine:

https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-017-0062-7

Attend our next meeting: http://www.ebpom.org/EBPOM-USA

This piece is taken from a longer discussion here: http://www.topmedtalk.com/aser-ebpom-2017-pod-two-live-from-washington-dc/

"The father of prehabilitation" reflects on where the discipline is now and where it used to be, from new kid on the block to being touted now as the word of the moment. How has this change come about? Is it the focus value based care? Is it the fact we're becoming more patient focused?

Is it fair to say this is an evidence led focus brought about by more information and understanding regarding long term patient outcomes?

Further discussion includes frailty, engaging patients in their prehabilitation and educating patients. This talk gives a wealth of powerful practical techniques which will help you to continue to provide the sort of high quality healthcare your patients and institutions expect.

This piece gives you a fantastic overview alongside some interesting insights and suggestions as to what the future might hold and where things can be improved.

Presented by Franco Carli, Professor of Anesthesia at McGill University and Associate Professor in the School of Dietetics and Human Nutrition at McGill University, Staff anesthesiologist at the McGill University Health Centre.

Prehabilitation is about planned pathways, preparing our patients for a journey which we as practitioners have already travelled. 4.2 million deaths are attributable to surgery each year globally, this presents a huge opportunity to improve the world for those who focus on perioperative surgery and prehabilitation. On the financial side, complications from surgery are proven to put costs up.

It's now widely accepted that perioperative medicine is the future of anaesthesia, how do we help the discipline evolve smoothly as it moves in this direction? The multidisciplinary aspect and the move away from the silo approach to healthcare is important, as is the challenge of the profession expanding out into 'population health'. With this in mind how might training evolve? What opportunities are about to be unlocked as a result of both big data, wearables and genoimcs?

For more information on "Getting it right first time" (GIRFT) go here: https://www.topmedtalk.com/rcoa-13-the-girft-getting-it-right-first-time-project/

Presented by Mike Grocott, Professor of Anaesthesia and Critical Care Medicine, University of Southampton.