A very interesting article and comments, arguing that although Consultant numbers have increased, Consultant productivity has decreased due many systemic factors including workforce planning (including lack in increase in nurses), social and community care capacity limiting patient flow, and capital e.g. lack of ICU beds, IT infrastructure.
Many questions are raised though, such as how can ‘productivity’ be a accurately and meaningfully measured in a useful and comparable way in such a complex system. Also, how does one account and value ofter features such as quality and safety? It’s complex!
Take home messages:
In the elderly, hypotension is BAD. Keep MAP>55 and systolic no more than 10% less than baseline systolic. Consider running pressor infusion c.f. obstetric spinals
Always consider regional, BIS, no/less opioids (though not at expense of adequate analgesia)
Consider heavy prilocaine for hips & knee – if surgeon is experienced/quick
Oxycodone > morphine
Predict and treat delirium. HELP principles. Might be context specific therefore do better in own home. Involve geriatricians.
New anticoagulants – ideally need 73 hours but is balance of risk (given that mortality with #NOF increases per day)
Prehabilitation (exercise!). Not just walking. Remember strength training (stand from siting) and balance (stand on one leg with eyes closed)
EPOCH take home themes: data = power, engage and involve everybody, have a systems thinking approach, develop leadership & project management skills
Use frailty scoring systems e.g. Edmonton Frail Score
From the RCOA ‘QI and Patient Safety’ day one definition was:
a formal approach to analysis of performance and systematic efforts to improve it
Take home messages:
Set a clear aim
Map the process
identify the primary and secondary drivers (which are ideally evidence based)
Identify and collect data: primary outcome measures, proceess measures, balancing measures
frequent & low volume data collection -> run charts
frequent PDSA cycles/iterations
give feedback/charts to those on shop floor
When choosing a project align with departmental/trust/wider strategies
Engage people. MDT. give people ownership
Put yourself in their shoes and think ‘what is in it for them?’
Develop systems that will improve quality and that are sustainable
make it easier to do the right/best thing. Change the system/processes.
Look at successes (internally and externally), not just failures.
Financial argument – safety often saves money e.g. cost of managing complications, litigation