The BMJ Awards 2018: Anaesthesia and Perioperative Medicine Team of the Year

Emergency laparotomy bundle

Laparotomy for acute bowel problems has a mortality rate as high as 25%. But research in 2013, in which Royal United Hospitals Bath collaborated with three other centres, showed that adhering as closely as possible to a “bundle” of seven precepts can greatly reduce that figure, says Lesley Jordan, consultant anaesthetist and patient safety lead at the trust.

They include preoperative risk assessments, goal directed fluid therapy, consultants performing both surgery and anaesthesia, critical care postoperatively, and getting the patient into theatre as fast as possible, within a target of two to six hours.

“As a result of this research we knew the bundle worked,” she says. “But by 2015 I wasn’t sure we were really following it any longer. The person who led the project had been seconded out and the data wasn’t being collected very accurately or in a timely fashion. Mortality had increased.”

A renewed focus on the bundle turned the situation around. Data were recorded by a team member at the time of surgery and entered into the National Laparoscopy Audit. “We can use it to feed back promptly on any area where we’re missing targets. Since April 2017, 80% of patients get the full bundle of care. Mortality is now 6.5%, about half the national average, and length of stay is down by two days on average. It’s now routine practice and we estimate we are saving ten lives a year.”

Managing complex surgical pain

Some patients are more prone to postsurgical pain than others. Anxious before surgery, they are often slower to mobilise afterwards, says Elaine O’Shea, consultant anaesthetist at Royal Bournemouth and Christchurch NHS Trust, where 1200 knee and hip replacements are performed every year.

The team …