TopMedTalk

"Data is key and having champions is key"

This piece provides a truly transatlantic in-depth perspective on an area of opportunity highlighted by our needs in the wake of COVID 19; now more than ever true enhanced recovery after surgery (ERAS) is essential. Optimising value, reducing the need for return visits, decreased length of stay, there is almost no aspect of perioperative medicine and enhanced recovery that is not going to be crucial for our institutions in the near and present future. A data driven approach makes it clear, there is no other way forward.

Also in this podcast a fascinating dive into one of our favorite topics, goal directed fluid management. How have the terms "restricted" and "liberal" evolved over the years? What should we make of the new evidence that ha come in over the last few years?

Hear how these challenges are being met in this exclusive conversation, generously supported by Deltex Medical.

Presented by Desiree Chappell and Monty Mythen with their guest Michael Scott, M.B., Ch.B. Professor of Anesthesiology at the University of Pennsylvania

"If I were to develop a simple uncomplicated urinary tract infection, I may well be able to continue to go to work as I was being treated for that illness but if an older frail patient develops a similar uncomplicated urinary tract infection, that can be a very significant illness, that patient may well be unable to walk or transfer as they could"

Frailty in the perioperative period - what is it, what is it not and how do we work with and manage it before, during and after an operation so as to increase the value of care to our patients?

The opening article refered to in this piece is here: https://journals.sagepub.com/doi/full/10.1177/1756287220916614

The British Geriatrics Society "Fit for Frailty" document is here: https://www.bgs.org.uk/resources/resource-series/fit-for-frailty

More information on Perioperative medicine for older people undergoing surgery (POPS), an award winning geriatrician led service and the first of its kind in the UK, go here: https://www.guysandstthomas.nhs.uk/our-services/ageing-and-health/specialties/pops/overview.aspx

Presented by Jude Partridge, consultant geriatrician POPS, honorary senior lecturer, King's College London, Chairs the British Geriatrics Society POPS SIG.

"It's useful to reflect on what SNAP-2 EPICCS might offer us in the brave new world that we find ourselves in with Coronavirus"

The 2nd Sprint National Anaesthesia Project: Epidemiology of Critical Care after Surgery (SNAP-2 - EPICCS) study launched in March 2017 around the UK. More than 2,200 investigators at more than 250 sites across the UK were signed up to take part. The observational study collected data on all patients undergoing inpatient surgery during a one-week period (21 March to 27 March) in UK NHS hospitals.

What is the scale of the problem; when it comes to cancellation of inpatient surgery surgery, with a specific lens on critical care capacity? What about the value of higher levels of post operative care for high risk surgical patients? What are the essential ingredients for higher intensity post operative care?

Also, learn about some of the organically developed solutions that have come around to capacity issues for high risk surgical patients in the NHS and overseas. As well as this hear how we might select patients to be admitted to higher levels of care; the methods that we might use for risk stratification of inpatient surgical patients and what we think the potential benefits of post operative high levels of care could be. Do we have any data to support the notion that critical care confers benefits on post surgical patients?

The website is here: https://www.niaa-hsrc.org.uk/SNAP-2-EpiCCS

More on SNAP-2 is here: https://www.topmedtalk.com/what-is-snap-2/

Presented by Ramani Moonesinghe, OBE, Professor of Perioperative Medicine at University College London (UCL), Hon Consultant in Anaesthesia, UCLH.

Patient safety, as a priority, is assumed to be at the heart of medical practice. Yet still, preventable harm and death occurs in our profession, how do we change this and how do we make the changes we implement last? Can safety and avoidable harm be somehow hardwired into the culture of what we do in a way similar to that of the airline industry?

This popular and refreshing talk is presented here after it was a big hit at the Chicago 2020 conference organised by Evidence Based Perioperative Medicine (EBPOM). For more check out www.ebpom.org

Presented by Mike Ramsey, Chair of the Board of Directors of the Patient Safety Movement Foundation (PSMF), Chair of the Department of Anesthesiology at Baylor University Medical Center in Dallas, Texas.

This roundtable discussion tackles questions from the online audience and is the third part of a longer discussion. It follows on from "The value proposition in perioperative medicine | EBPOM 2021 Las Vegas", if you'd like to hear that go here: https://topmedtalk.libsyn.com/the-value-proposition-in-perioperative-medicine-ebpom-2021-las-vegas

How do we as practitioners deliver value? How does 'population health' fit into the picture? How long before and after surgery are we invested in managing? What's the key point to start a perioperative medicine program in a low income country with no incentives at all; how do you approach the hospital financial department?

Presented by Desiree Chappell, introducing her panelists Linda Groah, CEO, Executive Director of the Association of periOperative Registered Nurses (AORN) and Amy Stout, Operating Partner at Cranemere and Interim President of Clinical Services at NorthStar; alongside contributions from additional contributors from the previous session, Jim Grant, Senior Vice President and Chief Medical Officer at Blue Cross Blue Shield of Michigan and Mike Englesbe, Darling Sr. & Cyrenus G. Darling Jr. Professor of Surgery, Michigan.

"Look at it from where is the patient, and what's best for the patient; I think that the other answers follow and yes, it is higher quality, yes, there can be some opportunities for cost savings; even if it 'breaks even' if the patients are happier, isn't that worth moving into the concept and proving that it does make a difference?"

The value proposition is an essential element of advocating perioperative care; we know it provides safer, better quality outcomes but how do we translate that into a language that both patients, fee payers and providers can all understand?

This piece follows on from "The size and scope of the problem with Jim Grant & Mike Englesbe | EBPOM 2021" Las Vegas, if you'd like to hear that go here: https://topmedtalk.libsyn.com/the-size-and-scope-of-the-problem-with-jim-grant-mike-englesbe-ebpom-2021-las-vegas

Presented by Desiree Chappell, introducing her panellists Linda Groah, CEO, Executive Director of the Association of periOperative Registered Nurses (AORN) and Amy Stout, Operating Partner at Cranemere and Interim President Clinical Services at NorthStar; alongside contributions from additional contributors from the previous session, Jim Grant, Senior Vice President and Chief Medical Officer at Blue Cross Blue Shield of Michigan and Mike Englesbe Darling Sr. & Cyrenus G. Darling Jr. Professor of Surgery, Michigan.

"When I heard Sol Aronson, speak about perioperative medicine as 'population health', for me, it was like a eureka moment because our platform within Michigan is really an unmatched place to kind of realize that vision."

This piece asks the question; "why do we need perioperative medicine"? The answer is illustrated with a real success story where practitioners realise the value proposition it unlocks for their patients every day. Hear how it is achieved and why it is so important.

Presented by Desiree Chappell with her guests Jim Grant, Senior Vice President and Chief Medical Officer at Blue Cross Blue Shield of Michigan and Mike Englesbe, Darling Sr. & Cyrenus G. Darling Jr. Professor of Surgery, Michigan.

If you enjoyed this piece you'll love TopMedTalk's exclusive and ground breaking series POET: Perioperative Enhancement Team "Perioperative medicine is population health": https://topmedtalk.libsyn.com/poet-601-perioperative-medicine-is-population-health

This question and answer session was a highlight of EBPOM London 2020, it works as a standalone piece or as a companion piece to this talk here: https://topmedtalk.libsyn.com/ebpom-2020-london-am-i-safe

The discussion follows themes outlined in the presentation as our online audience asked a series of questions.

Some of the questions included in the discussion are "How should leaders deal with anxiety both in themselves and their team? What is the evidence on perceived command gradient in residents and the fear of looking inadequate in front of peers and superiors? Bad for patients, versus bad for me? The people at the top end, the older people within an organization, are often the most resistant to culture change, yet they have the most influence over culture, any advice? What defines the people who are ready for change?"

Conversational in tone this piece was first heard on the "TopMedTalk stage" at Evidence Based Perioperative Medicine (EBPOM) for more details go now to www.ebpom.org

Presented by Monty Mythen and Desiree Chappell with Lee Fleisher, Emeritus Professor of Anesthesiology and Critical Care, University of Pennsylvania.

"So in all these ERAS programs, you need a physician champion, a nurse champion, a coordinator; then we brought our pharmacist in - I will not start rounds without a pharmacist. I refuse. I won't start because the pharmacist is integral ... it's just you need that multidisciplinary team"

This piece is a question and answer session prompted by the address our guest gave during EBPOM Chicago. Both the online audience and the team challenge our speaker to explain more. If you missed the address TopMedTalk has it for you here: https://topmedtalk.libsyn.com/daniel-engelman-updates-in-cardiac-ebpom-chicago

Presented by Desiree Chappell and Monty Mythen with Daniel Engelman, Cardiac Surgeon, Medical Director of the Heart, Vascular and Critical Care Units at Baystate Medical Center, Associate Professor of Surgery at The University of Massachusetts - Baystate, Associate Professor-Adjunct at Tufts University School of Medicine. He president and co-founder of the ERAS® Cardiac Society.

This piece is a question and answer session with questions from the online audience.

What do we think is the clinical care difference that having an elevated level of monitoring and more people around of all all sorts? Why is it good for our patients? As regards admissions to your campus care area; what criteria do you use? Do we need rapid critical care expansion in countries with very few beds? Could the enhanced care wards, in their approach, be compared with the post anaesthetic care unit? Would you cancel or postpone a cancer patient's operation, if not enhanced care or post operative critical care bed available? If you feel it is essential, if you feel the operation essential?

Presented by Mike Grocott, Professor of Anaesthesia and Critical Care at the University of Southampton and Lee Fleisher, Emeritus Professor of Anesthesiology and Critical Care, University of Pennsylvania with Ramani Moonsinghe, Professor of Perioperative Medicine at University College London (UCL), Hon Consultant in Anaesthesia, UCLH, Mike Swart, Consultant in Anaesthesia and Critical Care Medicine at Torbay Hospital and advisor to the UK Department of Health for the Enhanced Recovery Programme and 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. 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.