Welcome to the fourth issue of Cure&Care: Journal of Perioperative Medicine.
Patient safety is at the forefront of every physician’s mind. Current practices carry inherent risks, management of which is necessary to ensure the continued improvement of patient safety. Improvements to perioperative care should ultimately contribute to a lowering of morbidity and mortality. This can be achieved through the rehearsal and optimisation of standard practical techniques, familiarisation with best practice, and working within a team or adopting new approaches to care. In this issue we concentrate on patient safety in perioperative care, considering current best practice and the how best to refine the use of the resources we have at our disposal.
Inspired by safety protocols developed by the aviation industry over 75 years ago, use of the World Health Organization (WHO) Surgical Safety Checklist has been shown to reduce mortality and complications in surgical patients. As described in our ‘hot topic’ articles, the principles of the checklist are now being carried further into the perioperative setting, with checklists tailored to support ward rounds and specific types of surgery. However, despite the broad acceptance of the WHO Surgical Safety Checklist and the recommendations to use it, there are still some barriers to its implementation. Modifications to the checklist – which may drive optimisation and, ultimately, further improvements in patient safety – are also reviewed.
Surgical training (including the use of checklists) relies heavily on simulation. In this issue of Cure&Care: Journal of Perioperative Medicine, Professor Roger Kneebone and Dr Stefan Monk provide perspectives on the application of simulation in surgery and anaesthesiology, respectively. These expert interviews discuss several topics, including the selection of the most appropriate simulation approach to best serve the needs of trainees, and the practical requirements of designing and executing an effective simulation scenario. Looking to the future, they describe how innovative new technologies that are making simulation more portable and accessible have the potential to train integrated teams in a scenario that can span the full perioperative period.
Anaesthesia and sedation are focal points for patient safety. As anaesthesia carries risks of morbidity and mortality, we spoke with Professor Christopher Burkle, who highlighted the importance of describing these risks to patients in an individualised way, accounting for patient perceptions of risk during the informed consent procedure. We also spoke with Professor Alexey Pyregov, who gave us a country perspective about the issues of anaesthesia and sedation that are specific to obstetrics and gynaecology in Russia, and discussed the potential risks of complications, as well as best practice for monitoring.
In an expert opinion article, journal co-editor-in-chief Dr David Green discusses the advantages of multimodal monitoring in the perioperative period, particularly in regard to the increasing, high-risk elderly population. The article covers the shortcomings of current monitoring strategies, the most recent innovations in monitoring, and prospects for the future. To emphasise the importance of appropriate monitoring, Drs Bhavani Shankar Kodali and Ahalya Kodali provide case study examples of the use of capnography in emergency care and intensive care settings, as well as inside the operating theatre.
Postoperative delirium carries with it a risk of significant morbidity and mortality. In a second expert opinion article, Drs Suraj Yalamuri, Srinivas Pyati and Charles Brudney review current evidence on postoperative delirium, including diagnosis, treatment and prevention, as well as identifying future research needs.
The expanding Cure&Care community now has 856 members, who are all able to access a broad range of resources from the portal (www.cureandcareportal.com).The portal also provides the opportunity to share case studies and educational materials, as well as to discuss ideas and clinical cases. Members can also access electronic copies of all issues of the journal.
We hope that you find this fourth issue of Cure&Care: Journal of Perioperative Medicine both enjoyable and informative, with learnings you can take forward into your everyday practice to benefit patients and share with colleagues. We welcome your feedback and opinions on this issue, and your ideas for future issues, so if you would like to get in touch, please do so at email@example.com.
With warm regards,
David Green and Gudrun Kunst
King’s College Hospital, London, UK
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