Surveys

Survey Status: Closed

Survey Start Date: 10th December 2024

Survey Leads

Dr Prashanth Sadhahalli (Consultant Cardiac Anaesthetist) & Dr Gaurav Purwaha (Anaesthetic SpR), Nottingham University Hospitals NHS Trust

Background

We are establishing an enhanced care pathway for cardiac surgery in Nottingham University Hospitals(NUH). This aims to improve the patient pathway through their perioperative journey from  the time they are seen by surgeons for surgery until discharge. This pathway aims to look at prehab, nutrition, perioperative care ,analgesia and a bundle of nursing care packages. The aim of the pathway is to standardise best practices , empower people in making the right decisions and thus improving patient safety and satisfaction. The various specialties involved in cardiac surgical care (surgical, anaesthetic, ITU, nursing care, nutrition, Physiotherapy,  cardiac rehab and prehab) will look at best practices in their domain and distill those practices together in a streamlined fashion.

Rationale

The aim of the survey is to look at perioperative practice across the country focussing on preop nutrition, pain management protocols, the use of opioid and non opioid drugs both  on ITU and until discharge. This would help influence our decisions on methods of pain relief to incorporate in our pathway.  

NUH is an outlier in terms of hospital length of stay following cardiac surgery. We are hoping that implementing best practices from across the country we can help patient experience and also be able to feed back into further learning in this evolving area. 

This survey needs to be filled in by one relevant person in each cardiac centre (Linkman or a person  appropriately delegated to by the ACTACC Linkman).

Hypothesis

Use of standardised protocols for perioperative  care and analgesia will improve patient experience and safety.

Survey Status: Closed

Survey Leads

Dr Catalin Iulian Efrimescu, Anaesthesiology, Intensive Care, and Pain Medicine Department, Mater Misericordiae University Hospital

Information

We would like to invite you to participate in a society-approved, investigator-initiated survey that aims to examine the use of regional analgesia following cardiac surgery and cath lab procedures.

This project has several key objectives:

• Assess the extent and current practice of regional analgesia in cardiac surgery.
• Understand the attitudes toward the use of regional analgesia in this surgical speciality.
• Identify and evaluate the factors that pose barriers to the wider adoption of regional analgesia.
• Explore how these barriers can be addressed to improve practice in the field.

We are seeking the input of professionals employed in public and/or private institutions. If you work in both sectors (public/private) with differing clinical practices, we kindly ask you to complete the survey separately for each workplace.

Please note that if you have received this request through multiple channels, we ask that you respond to the survey only once.

The data will be published in a journal with a manuscript expected in February/March 2025.

Survey Status: Closed

Survey Leads

Simon Mattison, Consultant in Anaesthesia, Harefield Hospital, Tassos Antonogiannakis, Senior clinical fellow in Anaesthesia, Harefield Hospital, Anastasia Chatzistamati, Junior clinical fellow in ITU, Harefield Hospital.

Background

There was an audit carried out recently at our hospital looking at CXR immediately after thoracic surgery in Recovery. The finding was that without a specific clinical indication, the x-ray added nothing of value and didn't lead to any change in patient care. We were subsequently inspired to look at our practice for cardiac patients as well.

Rationale

Our current practice is to x-ray all cardiac cases shortly after admission to ITU with or without a clinical indication. Our assertion is that this is unnecessary and potentially detrimental from 3 perspectives. Unnecessary exposure to radiation, this is minimal but effectively, each patient is irradiated twice, once when they are x-rayed and again when the patient next to them is. There is the potential to delay fast track extubation, particularly if the radiographer is busy, e.g. with a primary angioplasty. There is a cost implication, we would potentially save the cost of up to 1000 CXRs per year. We are currently looking at 50 post-op patients to see if their day 0 x-ray changed their management in any way. Even if they are deemed unnecessary, there will be some local reluctance to change current practice, as there is a long tradition underpinning it. We are particularly keen to discover if other units are choosing not to x-ray their cases on admission and doing so safely, this would add weight to our argument and help facilitate a change in practice with the potential benefits outlined above. If other centers are interested, a nationwide initiative could be organized.

Hypothesis

An admission CXR for post-op cardiac patients is unwarranted, unless there is a specific clinical indication.

Outcome Measure

The bottom line was that in the absence of a clinical indication, there was no benefit in routinely x-raying low risk cardiac surgery patients on day 0 after admission to ICU/Recovery.

15 centres responded to the survey, of them 11 do not x-ray routinely on day 0 unless there is a clinical indication.

Reports from previous surveys