Anaesthesia 2014, 69, 785–798
dioxide could be saved by changing activities related to the packaging of medical equipment alone. We need many more studies like this one, so that we can better focus both our use of limited resources, and our attention on things that really matter for the provision of high quality and sustainable patient care. E. Lear M. Davies Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK Email: [email protected] No external funding and no competing interests declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesia correspondence.com.
References 1. McGain F, Algie CM, OToole J, et al. The microbiological and sustainability effects of washing anaesthesia breathing circuits less frequently. Anaesthesia 2014; 69: 337–42. 2. NHS Sustainable Development Unit. NHS Carbon Reduction Strategy for England: Saving Carbon, Improving Health. 2009. http://www.sduhealth.org.uk/documents /publications/1237308334_qylG_saving_ carbon,_improving_health_nhs_carbon_ reducti.pdf (accessed 03/04/2014). 3. NHS Sustainable Development Unit. Update: NHS Carbon Reduction Strategy for England: Saving Carbon, Improving Health. 2010. http://www.sduhealth. org.uk/documents/publications/126469 3931_kxQz_update_-_nhs_carbon_reduc tion_strategy.pdf (accessed 03/04/2014). doi:10.1111/anae.12733
Training anaesthetists about quality improvement Murray is to be commended on his work improving outcomes after 796
Correspondence
emergency laparotomy [1]. As he comments, the initiatives described come not before time, as it is well known to most anaesthetists that this group of patients receive poorer care compared with patients undergoing similar elective procedures. An important point raised concerns the need to employ the right tools and techniques in order to implement the results of any (national) audit. Murray rightly extols the importance of quality improvement science in achieving change by using series of small changemeasurement cycles, as has now been well proven in medicine, as in other industries [2, 3]. We recently conducted a workshop for anaesthetists about the use of driver diagrams to plan quality improvement. Our worked example happened to be based on the National Emergency Laparotomy Audit and, anecdotally, it was clear to us that very few senior colleagues are equipped to be able to lead or take part in quality improvement activity, in contrast to more junior colleagues who are now required to complete a quality improvement project as part of their Foundation Year competencies [4]. In our opinion, there is an urgent need to train more senior clinicians in quality improvement science, rather than allow a further 20 years to pass without significant improvements in care. This will require a modest investment in time and resource, although much is available free online. Quality improvement workshops are now being organised via the Royal College of Anaesthetists, but we would also like to direct clinicians towards courses and tools
developed by the Institute for Health Improvement, BMJ Quality and the Health Foundation. M. Wittenberg National Medical Director’s Clinical Fellow, NHS England and British Medical Journal, London, UK Email: [email protected] J. Leitch Quality Unit, Scottish Government, Scotland, UK No external funding and no competing interest declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesia correspondence.com.
References 1. Murray D. Improving outcomes following emergency laparotomy. Anaesthesia 2014; 69: 300–5. 2. Farrell C, Hill D. Time for change: traditional audit or continuous improvement? Anaesthesia 2012; 67: 699–702. 3. Peden CJ, Rooney KD. The Science of Improvement as it relates to quality and safety in the ICU. Journal of the Intensive Care Society 2009; 10: 260–5. 4. Academy of Medical Royal Colleges. The UK Foundation Programme Curriculum. http://www.foundationprogramme.nhs. uk/download.asp?file=FP_Curriculum_ 2012_WEB_FINAL.PDF (accessed 09/04/ 2014). doi:10.1111/anae.12745
Use of intramuscular morphine in trauma patients The primary pharmacological choice of analgesia for management of moderate to severe pain on the battlefield remains intramuscular (i.m.) morphine. Current UK Armed Forces policy ensures that
© 2014 The Association of Anaesthetists of Great Britain and Ireland
dioxide could be saved by changing activities related to the packaging of medical equipment alone. We need many more studies like this one, so that we can better focus both our use of limited resources, and our attention on things that really matter for the provision of high quality and sustainable patient care. E. Lear M. Davies Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK Email: [email protected] No external funding and no competing interests declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesia correspondence.com.
References 1. McGain F, Algie CM, OToole J, et al. The microbiological and sustainability effects of washing anaesthesia breathing circuits less frequently. Anaesthesia 2014; 69: 337–42. 2. NHS Sustainable Development Unit. NHS Carbon Reduction Strategy for England: Saving Carbon, Improving Health. 2009. http://www.sduhealth.org.uk/documents /publications/1237308334_qylG_saving_ carbon,_improving_health_nhs_carbon_ reducti.pdf (accessed 03/04/2014). 3. NHS Sustainable Development Unit. Update: NHS Carbon Reduction Strategy for England: Saving Carbon, Improving Health. 2010. http://www.sduhealth. org.uk/documents/publications/126469 3931_kxQz_update_-_nhs_carbon_reduc tion_strategy.pdf (accessed 03/04/2014). doi:10.1111/anae.12733
Training anaesthetists about quality improvement Murray is to be commended on his work improving outcomes after 796
Correspondence
emergency laparotomy [1]. As he comments, the initiatives described come not before time, as it is well known to most anaesthetists that this group of patients receive poorer care compared with patients undergoing similar elective procedures. An important point raised concerns the need to employ the right tools and techniques in order to implement the results of any (national) audit. Murray rightly extols the importance of quality improvement science in achieving change by using series of small changemeasurement cycles, as has now been well proven in medicine, as in other industries [2, 3]. We recently conducted a workshop for anaesthetists about the use of driver diagrams to plan quality improvement. Our worked example happened to be based on the National Emergency Laparotomy Audit and, anecdotally, it was clear to us that very few senior colleagues are equipped to be able to lead or take part in quality improvement activity, in contrast to more junior colleagues who are now required to complete a quality improvement project as part of their Foundation Year competencies [4]. In our opinion, there is an urgent need to train more senior clinicians in quality improvement science, rather than allow a further 20 years to pass without significant improvements in care. This will require a modest investment in time and resource, although much is available free online. Quality improvement workshops are now being organised via the Royal College of Anaesthetists, but we would also like to direct clinicians towards courses and tools
developed by the Institute for Health Improvement, BMJ Quality and the Health Foundation. M. Wittenberg National Medical Director’s Clinical Fellow, NHS England and British Medical Journal, London, UK Email: [email protected] J. Leitch Quality Unit, Scottish Government, Scotland, UK No external funding and no competing interest declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesia correspondence.com.
References 1. Murray D. Improving outcomes following emergency laparotomy. Anaesthesia 2014; 69: 300–5. 2. Farrell C, Hill D. Time for change: traditional audit or continuous improvement? Anaesthesia 2012; 67: 699–702. 3. Peden CJ, Rooney KD. The Science of Improvement as it relates to quality and safety in the ICU. Journal of the Intensive Care Society 2009; 10: 260–5. 4. Academy of Medical Royal Colleges. The UK Foundation Programme Curriculum. http://www.foundationprogramme.nhs. uk/download.asp?file=FP_Curriculum_ 2012_WEB_FINAL.PDF (accessed 09/04/ 2014). doi:10.1111/anae.12745
Use of intramuscular morphine in trauma patients The primary pharmacological choice of analgesia for management of moderate to severe pain on the battlefield remains intramuscular (i.m.) morphine. Current UK Armed Forces policy ensures that
© 2014 The Association of Anaesthetists of Great Britain and Ireland
