Trauma is responsible for more global deaths annually than HIV, malaria and tuberculosis combined. Yet healthcare systems in many countries are missing out on life-saving treatments learned on the battlefield, according to a review by King’s College London and published today in the Journal of the Royal Society of Medicine.Medical advancements made by the military in times of conflict, are increasingly seen in the hospitals of high income countries but are being missed in poorer countries, where trauma is the leading cause of death in young people. Many innovations by frontline doctors in stabilising and treating severely wounded soldiers could be adapted for use in other healthcare settings.The review was conducted by the Centre for Global Health at King’s College London, in collaboration with the International Prevention Research Institute (IPRI). It calls for research and changes in policy to determine how innovations in military medicine can be transferred to civilian populations, particularly in low-resource regions where the more simple and cost-effective of these medical advances could be implemented.
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For some surgical procedures – such as the removal of varicose veins – the patient remains awake. Though safe, the patient can experience some pain and anxiety. But in a new study, researchers from the University of Surrey in the UK say simple methods of distraction could help ease such experiences.
To reach their findings, published in the European Journal of Pain, Prof. Jane Ogden and colleagues enrolled 398 patients who were due to undergo varicose veinsurgery.For this type of surgery, patients typically remain awake, receiving only a local anesthetic.The researchers note that previously, patients have reported unfamiliar feelings, sounds and smells during the procedure. Some have also reported feeling a burning sensation, while others have said listening to conversations about the procedure between the surgeon and nurse makes them feel uneasy. Patients have also reported feeling anxious during the surgery.
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The Royal College of Anaesthetists (RCoA) shared its vision for the future of perioperative healthcare provision across the UK. Speaking at a stakeholder event, President of the RCoA Dr J-P van Besouw said: “With more than ten million patients undergoing surgery each year in the NHS, approximately 15% of whom are deemed to be high-risk, a care pathway that can harness multi-disciplinary working, reduce variation and improve patient outcomes must be our goal.”
Health experts, including Celia Ingham Clark, Director for Reducing Premature Mortality, NHS England, highlighted the scale of the unmet need for the high-risk surgical patient and the future principles for a more efficient and effective care pathway, at the event attended by a cross section of health bodies.
J-P van Besouw said: “Lowering the rate of avoidable harm – associated with many preventable complications and deaths – will make a significant saving to the NHS annual surgical bill, which at present runs at around GBP16 billion. The College believes that improved perioperative care is an efficient and effective solution.”
The RCoA proposed that care pathways designed around the individual needs of the complex surgical patient and delivered by a multi-disciplinary perioperative care team would mean that patients should receive the most appropriate care possible. Anaesthetists are uniquely positioned to lead such teams and to ensure a better continuum of care for patients, before, during and after surgery. Such an integrated approach should minimise inappropriate care, reduce cancellations, complications and readmissions and ensure quicker recovery and discharge from hospital. Fundamentally patients should receive better quality care, and experience better outcomes at a lower cost.
As well as improved patient centered care, the economic case for change is an important factor to be considered. The NHS Five Year Forward view states that by 2020/21, there could be a mismatch between resources and patient needs of nearly GBP30 billion a year. Demand, efficiency and funding are the key considerations and the evidence would indicate that perioperative medicine would be a cost effective solution through the reduced costs of treating complications.
In driving this agenda the College stated that it intended to work collaboratively with stakeholders in primary care, other colleges, specialties and workforce planners in Health Education England (HEE) and the devolved nations, to develop and commission new standards of patient care, embed continuous data driven quality improvement into the care of surgical patients, and explore solutions to create an appropriate workforce for a sustainable future.
“We do not underestimate the challenges that we face in delivering this agenda,” said J-P van Besouw. “We are asking colleagues, policy makers and commissioners to share this vision and to use the resources that we have developed, including a short animated film [http://www.rcoa.ac.uk/periopmed/animation], to start the conversation on what perioperative practice should look like and to work with us to develop integrated pathways of care, based on the many existing examples of excellent perioperative practice from across the UK.”
Adapted by MNT from original media release