Journal of Perioperative Practice

The following is a personal reflection of my experience of interactions with hospital staff and how that has impacted on my own attitudes and practices in studying to become an operating department practitioner (ODP).

This article is a reflective account of a near miss that happened in clinical practice during a particularly busy operating list. This critical incident highlights issues that can arise from a breakdown of communication between members of a multidisciplinary team and demonstrates how ineffective teamwork can jeopardise a patient's safety and wellbeing. It emphasises the effects of human factors on professional performance and how they can contribute to mistakes and misconducts. It also stresses the importance of reporting patient safety incidents so that the lessons can be learned and future practice improved.

Identifying ‘high risk’ (>5% mortality score) emergency general surgical patients early, allows appropriate perioperative care to be allocated by securing critical care beds and ensuring the presence of senior surgeons and senior anesthetists intraoperatively. Scoring systems can be used to predict perioperative risk and coordinate resources perioperatively. Currently it is unclear which estimate of risk correlates with current resource deployment. A retrospective study was undertaken assessing the relationship between deployment of perioperative resources: senior surgeon, senior anesthetist and critical care bed. The study concluded that almost all high risk patients with high POSSUM mortality and morbidity scores had a consultant senior surgeon present intraoperatively. Critically unwell patients with higher operative severity and perioperative morbidity scores received higher care (HDU/ICU) beds postoperatively, ensuring that they received appropriate care if their condition deteriorated. Therefore POSSUM scoring should be used perioperatively in emergency cases to coordinate appropriate perioperative care for high risk general surgical patients.

The aim of this audit was to assess the impact of dedicated upper limb trauma lists on the hospital stay and satisfaction of patients treated operatively for upper limb injuries. In first audit, we reviewed the data of 52 consecutive patients with upper limb injuries treated on the routine trauma lists. Accordingly, a new pathway of dedicated upper limb trauma lists was introduced whereby patients presenting with injuries were safely discharged home with written instructions regarding arrangements for surgery. The audit loop was then closed by collecting data of 78 consecutive patients treated using the new scheme. Dedicated upper limb trauma lists have reduced our in-patient stay without affecting the care and outcomes for our patients. The lists also improved patient satisfaction as arrangements for surgery were more convenient.

Joseph Lister (1827–1912) was the father of modern surgery and, in particular, of today's orthopaedic surgery. Before Lister, surgeons seldom opened into a joint or performed an open operation for failed reduction or malunion of a fracture. Indeed, most surgical teachers condemned such procedures because of the almost invariable complications of wound suppuration, pyaemia prolonged illness and often death.