Anaesthesia
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Editorial
Kicking on while it's still kicking off - getting surgery and anaesthesia restarted after COVID-19.
Cook and Harrop-Griffiths survey the damage of a health system stretched to its limits in response to the UK's COVID-19 crisis, and how elective surgery could be carefully recommenced – particularly considering that the pandemic is far from over.
"....this has been achieved ‘by the skin of our teeth’ and until very recently, the threat of insufficient ICU beds, ventilators, and the need for triage were all anticipated: a few hospitals were overcome by the surge of critically ill patents."
They highlight several priorities as the NHS looks to return to a 'new normal' of healthcare provision:
- Support ICU needs of those with COVID.
- Make hospitals safe for patients both with and without COVID.
- Returning staff and services to pre-pandemic areas as possible.
- Protect staff with adequate personal protective equipment.
- Appropriate surgical case triage.
"Having weathered the COVID‐19 storm, we are now being asked to assess the damage done, pick up the pieces and rebuild. However, this storm will rage for many months. Flattening the epidemic curve does not reduce the total number of cases but spread their burden over a longer period of time..."
Of particularly note is the challenge of ensuring COVID positive patients do not undergo non-essential surgery, known to be associated with a high post-operative mortality. They explore the complexities of pre-operative isolation and testing (PCR or CT), and the inherent limitations of these.
summary"The move from a health service focused on one single disease to one that continues that challenge while also addressing all the other health needs of the population may be even harder than that the crisis phase that preceded it."
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Maternal mortality rates in low-middle income countries remain high, with sub-Saharan Africa accounting for two-thirds of global maternal deaths. Inadequate staff training is one of the main contributors to anaesthesia-related deaths and the Association of Anaesthetists developed the Safe Anaesthesia from Education course in collaboration with the World Federation of Societies of Anaesthesiologists to address this training gap. We aimed to evaluate the impact of this course among Kenyan participants. ⋯ Eighty-four of the 103 participants were observed in their workplace and capability, opportunity and motivation-behaviour framework was used to study the barriers and facilitators to practice change. Psychological capability and reflective motivation were the main factors enabling positive behaviour change such as team communication and pre-operative assessment, whereas physical and social opportunity accounted for the main barriers to behaviours such as performing the surgical safety checklist. Our study demonstrates that the Safe Anaesthesia from Education obstetric course is relevant in the low-resource setting and may lead to knowledge translation in clinical practice.