Anaesthetic department
The SWLEOC core anaesthetic team consists of nine substantive consultants together with visiting anaesthetists and intensivists from each of the four base hospital sites.
The anaesthetic services include all aspects of high-quality peri-operative patient’s care;
There is a virtual, nurse led pre-operative assessment clinic for elective patients. However, highrisk patients are seen by our consultant anaesthetists in dedicated clinics, and this forms the backbone of pre-operative optimisation and planning post-operative care including high dependency and critical care for the high-risk surgical patient.
The Centre has six operating theatres and surgery takes place across six days.
SWLEOC provides a comprehensive anaesthetic service for upper and lower limb surgery for patients with multiple comorbidities and those undertaking complex major joint surgery including revision surgery.
In addition, SWLEOC provides a wide range of services in various sub-specialties including young adult hip service, sports surgery, spine, and foot and ankle services.
Our success comes from high quality staffing, well developed patient pathways and comprehensive data systems which enable ongoing quality improvement and assurance.
The Centre has a consultant-led PACU which is one of the most successful parts of the model of care at SWLEOC. It is both a recovery and a critical care area and now also serves as a day case unit for day case joint replacement. This contains 10 beds fully equipped for HDU and ITU care where we can use vasopressors and invasively monitor blood pressure and cardiac output primarily for frail patients and those undergoing extensive surgical procedures.
Patients with complex medical needs may stay in PACU for longer, where they are looked after by specialist nurses and supported by the resident consultant intensivist. Our consultants input goes to further support patients on the ward who may benefit from more intensive support and to provide regional blocks for acute pain management.
The multidisciplinary team functions very effectively with daily MDT ward rounds (Intensivist, Physiotherapy, Pharmacist and nursing staff).
- To provide high quality consultant delivered care to patients including the 1:8 on call rota (transferring patients to tertiary centres);
- weekly anaesthetic/MDT/M&M meetings;
- actively providing support to the Pre-Operative Assessment Department;
- to provide teaching and training at undergraduate and postgraduate level and to supervise and train the juniors;
- proactive involvement in the department’s clinical governance agenda and take on leadership roles to support continuous learning and improvement, thereby abiding by the clinical and corporate governance policies of the Trust;
- to liaise with clinicians and managers within and outside the department to address any issues arising that may affect the services;
- to participate in relevant audit and quality assurance processes; and
- to communicate with local GPs when deemed necessary.
SWLEOC is an NHS treatment Centre established by the four South West London Acute Trusts in 2004 to deliver strategic change in the delivery of planned orthopaedic care. The centre provides high quality, cost efficient, elective orthopaedic services amongst the best in the world. It remains an innovative and unique service.
The team interacts with all necessary specialists and services, including surgeons, radiologists, cardiologists, haematologists, GPs, laboratories etc.
- Operating Theatres;
- PACU;
- wards.
The IT systems used are those of the main Trust as well as those specific to SWLEOC. These include electronic Preoperative Assessment software (LifeBox), Patient Management Systems (Bluespier), Clinical Management System (iSOFT), Picture Archiving & Communication System (PACS) (Sectra IDS7).
All anaesthetics (Regional/GA) takes place in theatre as there aren’t anaesthetic rooms in our theatre complex. Each two theatres are joined up by a small preparation room enough for a small sink and few cupboards. If I had the opportunity to build from scratch, I would have a dedicated anaesthetic room for each theatre together with single fully equipped and staffed Block room.
It would be vital to identify a core group of anaesthetists and intensivists that are appropriately motivated to provide such a service.
I would strongly encourage the deanery to involve trainees’ exposure and practice as an opportunity for regional fellowships.
Recruiting new consultants has always been a challenge as a subspecialty.
Relying heavily on our bank of highly trained consultant colleagues from the four base trusts. We have recently employed a speciality doctor in anaesthetics.
- Day case arthroplasty pathway has been so vital in improving the outcome and efficiency. Although, enhanced recovery was embedded in our anaesthetic practice from the outset, having day zero arthroplasty pathway got all teams involved in patient’s care onboard; the anaesthetic part included pre-operative assessment and optimisation and set up expectations together with low volume central neuraxial local anaesthetics, no opioids intrathecally, and post operative analgesia standardisation;
- PACU model with 24/7 consultant intensivists residents;
- weekly MDT/M&M meetings discussing challenging cases and agreeing plans going forwards;
- having even a small department with core anaesthetists from the outset has made a huge impact in setting up the standards and reviewing challenges together with the vital communications within other specialties;
- daily on call anaesthetic consultant oversees running the floor and troubleshooting together with inter/intra hospital transfers of critically ill patients;
- having all this in place has enabled us to care for a wide spectrum of patients and with multiple co-morbidities.
Staff
Consultant (Consultants led service; one anaesthetic middle grade is employed by the centre).
Grade/Band: Consultant >9.
9 core substantive consultant anaesthetists supported by 8 visiting anaesthetic consultants from the four base hospital trusts. PACU is covered 24/7 by another 18 consultant intensivists on a bank basis.