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Found 29 results
  1. News Article
    Police have launched an investigation into the deaths of patients following heart operations at an NHS hospital, the BBC has learned. Documents seen suggest patients suffered avoidable harm - and that in some cases their death certificates failed to disclose that the procedure contributed to their deaths. One woman's operation at Castle Hill Hospital near Hull - that should have taken no more than two hours - has been described as a "disaster" by one medic. She spent six hours in surgery and lost five litres of blood - all while under local anesthetic. But none of this was mentioned on her death certificate, which recorded her as dying from pneumonia. Her family were also not told what had happened. The documents raise concerns about the care that 11 patients received during a TAVI - Transcatheter Aortic Valve Implant - a procedure to replace a damaged valve in the heart, similar to adding a stent. The department's TAVI mortality rate at the time was three times higher than the UK average, something patients and families were also unaware of. The NHS body that runs Castle Hill, the Humber Health Care Partnership, told the BBC it had delivered improvements suggested by the Royal College of Physicians (RCP). In a statement, it said it was happy to directly answer any questions from the patients' families. Read full story Source: BBC News, 4 June 2025
  2. Content Article
    Aortic valve replacement (AVR) is a life-saving procedure for symptomatic severe aortic stenosis (AS), which relieves symptoms, increases life expectancy and improves quality of life. Little is known about the rate of AVR provision by gender, race or social deprivation level in the NHS across England. However, a large analysis examining AVR on the health service in England – the first of its kind – reveals striking inequalities in its provision. Women, black and Asian people, and those living in the poorest parts of the country are much less likely to receive the life-saving procedure, the study shows. “In this large, national dataset, female gender, black or south Asian ethnicities and high deprivation were associated with significantly reduced odds of receiving AVR in England,” the authors wrote. Dr Clare Appleby, a consultant cardiologist at the Liverpool Heart and Chest hospital NHS foundation trust and an author of the study, said public health initiatives to understand and tackle these inequalities should be prioritised. “Severe symptomatic aortic stenosis is a serious disease that causes mortality and reduces quality of life for patients,” she said. “Left untreated it has a worse prognosis than many common metastatic cancers, with average survival being 50% at two years, and around 20% at five years.” Further research and public health initiatives to understand and address inequalities in the timely provision of AVR are important and should be prioritised in England.
  3. News Article
    The family of a man who needlessly died after a 12-hour delay in surgery have called for changes at a troubled NHS trust as regulators expressed alarm about patient safety and waiting times. The Care Quality Commission (CQC) upgraded the surgery department at the Royal Sussex county hospital in Brighton from “inadequate” to “requires improvement” at a time when it is at the centre of a police investigation into dozens of patient deaths, allegations of negligence and cover-up. In their report, the regulator expressed concern about already long and lengthening waiting times, repeated cancelled operations and staff shortages that could compromise safety. The inspection report comes as the Guardian can reveal the trust apologised and settled with the family of Ralph Sims, who died aged 65 after heart surgery in April 2019 when doctors failed to act appropriately to a drop in his blood pressure. Sims, who was a keen runner, suffered a drop in blood pressure and developed an irregular heart rhythm eight hours after surgery to replace an aortic valve at the hospital. An internal investigation into Sims’ treatment acknowledged that hospital staff failed to “recognise the significance of the fall in blood pressure”. University Hospitals Sussex NHS foundation trust, which runs the hospital, accepted that the father of three should have returned to surgery to identify the cause of his deterioration. Instead, medics decided that he should be observed overnight. Due to another emergency case, an angiogram was not carried out on Sims until just before noon the following day – 12 hours after the drop in pressure. The delay caused irreversible – and avoidable – heart muscle damage, leading to his death five weeks later. The family said: It added: “Whilst the trust has apologised to our family it feels hollow. Ralph’s death was entirely unnecessary, and despite the issues in his care, it took the trust several years to apologise.” Read full story Source: The Guardian, 14 February 2024
  4. Event
    Future Surgery, brings together surgeons, anaesthetists and the whole perioperative team. Designed specifically to meet the training needs, promote networking and develop a stronger voice for all surgical professionals and their multidisciplinary teams in perioperative care. Our CPD accredited speaker programme explores disruptive technology, connectivity, human factors, training and research to support the transformation of the profession and the improved care and safety of patients. Future Surgery is the biggest gathering of surgical and operating theatre teams with over 110 expert speakers – in keynote sessions, panel discussions and workshop sessions, covering all that is new in the field of surgery. Register
  5. Event
    until
    Join BD this live educational event designed to promote discussions on the following topics: An overview of the latest evidence-based prevention measures of HAI (SSI). Essential bundles of an effective infection prevention and control program management in cardiac surgery. Review of the sustainable change in practice within operating room. The event is designed for cardiac surgeons, infection control and nurses who are interested in learning more about new techniques and methodologies to minimise some of the most challenging post-operative complications, with an opportunity to debate and share opinions with peers through live discussions with internationally renowned faculty. Register
  6. Content Article
    Since 2015 Quomodus has developed the digital course 'Diathermy – a practical guide to electrosurgery' for surgeons and other professional users of electrosurgery. The 30-minute course covers the history of electrosurgery, indication and proper use, adverse effects and complications associated with the use of diathermy. The course has been tested and quality assured by health professionals in Scandinavia. The course is flexible, user friendly and applies to all models of diathermy equipment currently on the market.
  7. Content Article
    Getting It Right First Time (GIRFT) is designed to improve the quality of care within the NHS by reducing unwarranted variations. By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as the reduction of unnecessary procedures and cost savings. 28,000 cardiac surgery and 69,000 thoracic operations are carried out every year in England. Following visits to the 31 cardiothoracic centres in England, the report makes 20 recommendations to help improve processes, practice and patient outcomes. Watch a short video summary of the report.
  8. Content Article
    The surge in the need for invasive ventilation during the covid pandemic has required the provision of intensive care beds in London to be reallocated. NHS England have proposed the formation of a Pan‐London Emergency Cardiac surgery (PLECS) service to provide urgent and emergency cardiac surgery for the whole of London. In this initial report, the Department of Cardiac Surgery, St Bartholomew's Hospital, outline their experience of setting up and delivering a pan‐regional service for the delivery of urgent and emergency cardiac surgery with a focus on maintaining a COVID‐free in‐hospital environment. In doing so, they hope that other regions can use this as a starting point in developing their own region‐specific pathways if the spread of coronavirus necessitates similar measures be put in place across the United Kingdom
  9. Content Article
    This report summarises some of the key findings from the full 2020 National Cardiac Audit Programme (NCAP). It provides useful background information and highlights what you can do to help improve cardiac health for you and your friends and family. It includes answers to some frequently asked questions and links to where to go for more information or support. The report covers: Heart attack (myocardial infarction) Percutaneous coronary intervention Aortic valve replacements Adult cardiac surgery Heart failure Arrhythmia (cardiac rhythm management) Congenital heart disease COVID-19 and its impact on cardiovascular care.
  10. Content Article
    Covid-19 has had a lasting impact on cardiovascular care since the outbreak began. The British Heart Foundation has predicted that the number of people in England waiting for care and diagnosis could more than double within two years, peaking at around 550, 385 in January 2024 if the NHS doesn't get the funding it needs. In order to provide a stronger and more resilient health system that supports healthcare staff, a cardiovascular strategy for England to support recovery from the Covid-19 pandemic is needed.
  11. News Article
    Almost 100,000 people with serious heart problems, including some “living on borrowed time”, are enduring long waits for potentially life-saving NHS care because hospitals are so busy. Some of them are in such poor health they will have a heart attack and die as a consequence of facing such “dangerous” long delays, the British Heart Foundation has warned. The number of patients in England being forced to wait more than the supposed maximum 18 weeks for cardiac treatment has trebled since Covid-19 struck, from 32,186 in February 2020 to an unprecedented 96,321, a BHF analysis of published NHS England data shows. They are waiting for procedures such as having a stent or balloon inserted to reopen a blocked artery, a pacemaker or implantable defibrillator fitted, or open heart surgery, including bypasses or valve replacement operations. Others urgently need to have an echocardiogram, CT or MRI scan to help doctors decide on treatment. Dr Sonya Babu-Narayan, a consultant cardiologist who is also the BHF’s associate medical director, said: “Cardiac care can’t wait. Without timely treatment, heart patients may be living on borrowed time.” “Tens of thousands of people feel in limbo, waiting many months or even years for cardiac surgery, invasive heart procedures or important diagnostic tests. During this time they could quite quickly become much sicker, and tragically some could even die before they can receive the heart care they so desperately need,” she added. Read full story Source: The Guardian, 16 June 2022
  12. News Article
    Junior doctors have been prevented from returning to scandal hit heart surgery unit previously criticised over “toxic” culture, The Independent has learned. A coroner defended cardiac surgery at St George’s University Hospital, criticising an NHS-commissioned review into 67 deaths that warned of poor care. However, The Independent has learned the unit received a critical report from Health Education England (HEE), the body responsible for healthcare training, just last year. The NHS authority was so concerned about culture problems and “inappropriate behaviour” within the unit that it took away the junior doctors working there. This is the third time HEE has intervened since 2018, when the unit was criticised in an independent review for having a “toxic” culture. In a statement, Professor Geeta Menon, postgraduate dean for South London at Health Education England, said: “HEE carried out a review of cardiac surgery at St George’s University Hospital in July 2021 and concluded that further improvements were required to create a suitable learning environment for doctors in training. "Unfounded’ NHS criticism and investigation caused unnecessary deaths at London heart surgery unit “We continue to work closely with the trust to implement our requirements and recommendations and will reassess their progress this summer. HEE is committed to ensuring high quality patient care and the best possible learning environment for postgraduate doctors at St George’s.” The Independent understands that a report issued in December, following the HEE visit, identified problems of “inappropriate behaviour”, poor team working from consultants and raised concerns the culture problems previously identified at the unit persisted. Read full story Source: The Independent, 14 May 2022
  13. Content Article
    The Inquiry into the management of care of children receiving complex heart surgery at the Bristol Royal Infirmary. View all of the material published throughout the course of the Inquiry.
  14. Content Article
    Following the inquest into the death of former patient Amy Allan and the subsequent Preventing Future Deaths report given to Great Ormond Street Hospital for Children, Chief Executive Matthew Shaw would like to outline how the hospital is learning from this and what action has been taken to address the concerns that have been raised. Following a review of the events that led up to Amy’s death Great Ormond Street Hospital have already made changes to practice: They have improved the way clinical information is shared between different specialist teams, to make sure staff have as comprehensive a picture as possible when making complex decisions about a patient’s treatment. They now use a single log-in electronic patient record system which means staff can quickly access clinical information about a patient and have the right information at the right time, rather than routinely having to use multiple systems. They have improved consultant availability. This means there is more consultant time for each patient being looked after in our paediatric intensive care unit. They have introduced a new process to make sure the care of patients, like Amy, who have both complex spinal and heart conditions is routinely considered by the hospital’s specialist joint cardiology committee.
  15. Content Article
    The president of the Vascular Society of Great Britain and Ireland, Chris Imray, has issued a letter to Vascular Society members on the COVID-19 virus and vascular surgery, offering “general principles” on vascular patients and COVID-19, elective surgery and outpatients, urgent vascular surgery, trainees, other specialities, the appropriate use of scarce resources, documentation, personal safety, mental health and burnout, research, clinical training/education, and audit. Imray stresses that “local decision making is key.
  16. Content Article
    Medtech companies are continually developing new medical devices and products for use in healthcare, and ensuring that each one is safe to use should be the top priority of every company. In this anonymous blog, a nurse shares their experience of being employed by a start-up producing a new piece of equipment for use in cardiac surgery. They soon discovered their values did not match up, as the company prioritised getting their new product to market above patient safety. The writer talks about the personal cost of repeatedly speaking up for safety and describes the importance of working for an employer that sees patient safety as the top priority and recognises that it goes hand in hand with commercial success. I started out my career as a critical care nurse and was seconded quite early on to specialise in extracorporeal membrane oxygenation (ECMO). I received excellent training and felt really fortunate for the opportunity to be working in that specialty, one which is highly complex and has a critical focus on patient safety. Within a couple of years of practice, I was seconded from my role nursing critically ill adults and asked to join another hospital where I received further intensive training to become a clinical perfusionist. As a perfusionist in theatre I was in charge of maintaining the patient's life during surgery. Operating the artificial heart and lungs, I supported the surgeons while they performed open heart procedures on babies. It was a demanding and rewarding role, and it required absolute focus on what I was doing and a total awareness of my patient’s every single metric, at all times. I loved looking after the most vulnerable patients and felt so privileged to play a critical part in improving lives. Several years into my career, I had the opportunity to move into the medical device industry. At that stage of my life, I had different personal priorities and medtech offered a range of options to allow me more flexible work while still advancing patient care. I also had a passion for medtech, as companies don't often invest in developing products for the most vulnerable patient groups unless there is a commercial gain. So I was keen to take my advocacy, skills and expertise to the commercial world to make a difference. I worked for a number of companies that aligned with my values, clinical skills and really enjoyed my new career, which often involved interesting conversations and finding creative solutions to problems in partnership with clinicians. At one point, an opportunity arose to join a start-up company that was developing a digital version of a critical piece of equipment for use in cardiac surgery. I couldn’t have been more excited—the idea of having a modernised, digitally-connected machine with automated safety features was amazing and very much needed, as no one had innovated in this space for a very long time. I could see how transformative it could be in improving safety and efficiency for patients undergoing bypass surgery. I began working at the company and in the first couple of weeks it became clear to me that their objective was to get their new device ready for market at pace. I could ask lots of questions as ‘the new person’ and enquired about how the product would be tested when we launched it and who would be looking after the process. I was told not to worry about it, and to focus only on managing the product to the point where it had everything the clinicians needed. I fully trusted that process. The day finally came when the device got the CE mark, which the company had managed to deliver just days before new medical device regulations came into force. Huge celebrations followed and the management team announced that we were going to commence using the device on patients in the coming weeks. I thought, “Hang on a minute, I haven’t even seen this device used in testing yet!” I asked whether there were plans to run a pilot or use it for research purposes first and I was told this was not needed and not going to happen. I had concerns that some safety features we had discussed in the initial plans for the device weren’t ready yet. I was told not to worry about them—and the priority was getting the device into the clinical space immediately. Running a bypass case has often been likened to flying a plane. The most critical time points are running on, maintaining flow, temperature and pressure and then safely disengaging at the end of surgery. Safety protocols are well defined and I had reservations at this point about the device, as I could see that in its current iteration, it did not meet typical safety standards. Two weeks after the CE mark was granted, my line manager informed me that a hospital had identified a patient and wanted to use the machine, and I was being sent to assist. I was appalled, the machine wasn’t even completely built yet. I raised my concerns in an email as I knew that the device was missing a critical safety feature that I knew would in normal circumstances meant the procedure would not go ahead. The safety feature that was missing was responsible for ensuring safe levels of blood were in circulation at all times. Without this feature there is the very real risk of causing a patient’s death or major brain damage during the procedure. There’s no going back from that, and if the patient were to be harmed, it would be the perfusionist who would be held professionally and legally responsible. There have been historical negligence cases that have referenced this feature and highlighted how essential it is to patient safety. I knew that there were a number of other safety features that were also not at the standard you would want them to be as a clinician. At this point, I had been working at the company for two months and I realised that we did not share the same values. I walked into the theatre where the surgery was to take place to find one of my clinical colleagues who also worked for the company shaking their head. They were unsure how we were going to get through the procedure as the device wasn’t functioning to a standard they felt comfortable with. However, management said we had to go ahead with the case as the surgical team was ready and the patient had consented. I again told them how uncomfortable I was and emailed my line manager expressing my concerns that going ahead was unethical and unsafe, and highlighted that my reputation as a clinician was also on the line. I told them we needed further testing on the device before it could be used on a patient. The answer was simply, “No, we’re doing it.” So I watched as they operated on this patient—I didn’t sign in as a member of the team or touch the patient. During the procedure, I saw multiple safety mechanisms that were not calibrated or ready for use. Three times I saw the blood level drop below the acceptable limit, which increases the risk of small air bubbles entering the brain. This would have been mitigated if the safety sensor was in place. Low circulating blood volumes can cause embolisms; even if the patient doesn’t have a complete stroke, micro bubbles entering the brain can cause patients to wake up and be not quite right. After the procedure, I had no idea whether that patient recovered well, all I heard was the celebration of a job well done. The following week, I found myself without a job. I was told that my performance was substandard and would no longer be employed by the company. As an experienced subject matter expert brought in to advise a fledgling company on how to create and deliver a device that meets the standard of excellence required, it’s devastating to be told that none of what you know matters. What I experienced was the ultimate gaslighting in a toxic work environment. The company had no concept or real care for patient outcomes. It was a really difficult time personally and it was difficult to find another job opportunity. The medical device industry can be fairly ruthless, and a gap on your CV looks bad. I had to really lean into my network during that time and the more people I spoke to about my experience, the more I realised that what I had lived through wasn’t an uncommon occurrence. When I got back on my feet, I started my own clinical consultancy. It focused on giving medtech companies that were really invested in safety the best possible opportunity and access to get it right, first time. Eventually I found myself in a role where safety is invested in from a commercial perspective. It was a surprise to me that such roles existed, but on my journey I discovered some companies do have a strong and real sense of purpose, and a just culture. A focus on patient safety can and does coexist with commercial success, in fact it relies upon it. I am now thriving and confident in an organisation that is values-based, purpose driven and strives to be better every day. The company where I lost my job is still operational. It has had to deal with many problems to get the product right. A lot of skilled people’s knowledge has finally been accepted into making it work better. However, many people have been unnecessarily harmed along the way, both patients and healthcare workers. Medtech is on a bit of a journey at the moment in terms of ethics and compliance—although things have improved we’re not quite there yet. At the moment, we still have non-experts designing products for therapy areas they don’t truly understand. Without clinicians in the room we won't get the context and human factors aspects right. The goal is to close the gap so that clinicians are co-designing and co-delivering to ensure patient safety. At its core, any solution needs to be focused on the patient and their experience, and how it will help clinicians to do their job better. As healthcare professionals, we are the experts to safely deliver innovation that makes a difference. When you live through an event like this, you do lose confidence and start to question your own judgement. But now in retrospect, I’m more sure than ever that you have to trust your gut when you feel that something isn’t right. When you find yourself working for an employer that empowers you and creates the psychologically safe space to speak up, it’s worth holding on to that. Because the medical device industry is embedded in healthcare, greater opportunities to be more collaborative will drive and support the safe future of healthcare.
  17. Content Article
    Andrew Guillaume was admitted to Warwick Hospital on the 6 June 2023. Following a review, it was agreed that the likely diagnosis was severe aortic stenosis requiring an urgent Consultant to Consultant referral to University Hospitals Coventry and Warwickshire (UHCW) cardiology team. However, no referral was made as the Consultant was unable to get through to the switchboard at UHCW, so Mr Guillaume remained at Warwick Hospital. Subsequently his condition worsened and on the 16 June 2023 a plan was made to update the cardiothoracic surgery team at UHCW to expedite his surgery, but again they were unable to reach the team through the switchboard. Mr Guillaume was admitted to the unit on 19 June 2023, but sadly died on 20 June 2023 due to a further sudden deterioration in his condition. The Coroner noted her matter of concern in the case was the inability of Consultants and staff to get through to the switchboard at UHCW on two occasions. She stated that a previous incident in which a similar concern had been raised, which had led to provision of an emergency GP phone number, that can be used by the clinical teams at South Warwickshire University NHS Foundation Trust, which is manned 24 hours a day and is prioritised over other calls. However she noted that the Cardiology team had not been aware of this, nor did they have the telephone number. The Coroner also noted that Mr Guillaume was not discussed at the Multi-Disciplinary Team meeting with UHCW on 9 June 2023, as the referral had not been completed. She said that had the referral been completed, the team at UHCW could have prioritised the patient’s transfer.
  18. News Article
    A heart patient has been left fearing for his health after his life-saving operation was cancelled due to a major cyber attack on London NHS hospitals. Russell Ashley-Smith, 81, is waiting for complex open heart surgery at King’s College Hospital in Denmark Hill, south London, without which he may only have up to two years to live. More than 200 emergency procedures were cancelled due to the ransomware hack earlier this month. Mr Ashley-Smith said: “I understand if I don’t [have the operation] it’s terminal. Doctors said you’ll live for one to two years with declining health and become less and less capable of doing things like walking. “I would become more dependent on my wife, and more dependent on being taken somewhere by car if I wanted to go outside. I would be unable to make music – I play the cello and the piano – all the things I like doing and I don’t want to be a couch potato." As well as operations, thousands of patient hospital appointments had to be cancelled across Guy’s and St Thomas’ Foundation Trust and King’s College University Hospital NHS Foundation Trust due to the cyber attack. The NHS admitted on Friday it would take months for services to recover even once the attack has been resolved, as staff will have to rebook patients for appointments and operations. Read full story Source: The Independent, 19 June 2024
  19. Content Article
    This briefing examines the results of a US study which showed that 80% of patients that have an infection from a cardiac implant are not treated according to clinical practice guidelines, increasing their chances of death from infection. When patients with implantable cardiac devices have an infection, current guidelines state that these devices should be removed, however, this did not happen for the majority of the 1,065,549 Medicare patients included in the study that had a cardiac implant infection between 2006 and 2019.
  20. Content Article
    CORESS is an independent charity, which aims to promote safety in surgical practice in the NHS and the private sector. CORESS receives confidential incident reports from surgeons and theatre staff. These reports are analysed by the Advisory Board, who make comments and extract lessons to be learned. Aiming to educate, and avoid blame, CORESS calls on surgeons to recognise a near miss or adverse event, react by taking action to stop it happening and then report the incident to CORESS so that the lessons can be published. Every month CORESS highlight's one of the cases reported for you to consider the issues raised and read the experts comments. The focus of CORESS is on detecting and learning from no-harm, near-miss and low harm events encountered during routine surgical practice. The programme collects reports of such events, analyses them and disseminates the learning contained within them to a wide surgical audience and other agencies involved in Patient Safety matters. These events are known collectively as ‘Accident Precursor Events’ or simply ‘Precursors’. See previous reports below. Summer 2021 - Unrecognised limb ischemia following trauma, differences of opinion in management for tongue laceration, lack of communication in patient discharge, consequences of service disruption during the COVID-19 Pandemic, systems and communications errors leading to orthopaedic Never Event, too slick by half. Winter 2020 - Missed pulmonary embolism, gastrectomy kit miscommunication, leaking gastrostomy, fatal pulmonary embolus after renal cancer surgery, ureteric injury, PICC line misplacement, CVP line causing haemothorax. Summer 2020 - Thoracic outlet surgery complications, missed breast tumour in pooled case, abscess confusion, injection error, fall from grace, atypical thromboses.
  21. Content Article
    The Resilient Surgeon is a podcast by The Society of Thoracic Surgeons in the US. In this episode, Dr Michael Maddaus interviews Dr Amy Edmondson, a scholar of leadership, teamwork and organisational learning. Dr Edmondson defines psychological safety as a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns or mistakes. It makes a team a safe place for interpersonal risk-taking. In this podcast, she explains how psychological safety is the key to unlocking high quality conversations that result in improved team outcomes.
  22. Content Article
    Patients are facing increased delays at almost every stage of their NHS treatment, as the health system struggles to find the resources to deal with demand. The latest data shows waiting lists across England have surpassed record highs every month for two years running, one of many major challenges currently facing the NHS. But what impact does this have on ordinary people trying to access the NHS in 2022? Through a combination of interviews with health professionals and analysis of official data, the Guardian has plotted the journeys of four fictional patients through their NHS journey and how waiting times have changed at each stage of their treatment and recovery.
  23. Content Article
    In this review, Jane Carthey and colleagues discuss human factors research in cardiac surgery and other medical domains. The authors describe a systems approach to understanding human factors in cardiac surgery and summarise the lessons that have been learned about critical incident and near-miss reporting in other high technology industries that are pertinent to this field.
  24. Content Article
    A monthly journal for all operating theatre staff covering surgical and anaesthesia news. 2024 February issue The post-anaesthetic care of a patient following impacted wisdom tooth extraction New Inquiry: NHS Leadership, Performance and Patient Safety Pensioner goes home within hours of having heart valve replacement surgery A student’s Reflection on an experience within the obstetrics theatre Multidisciplinary clinical hub at Cardiff Met offers new vision for healthcare delivery January issue The change in practice of aortic procedures following the introduction of hybrid theatre in a tertiary centre. Evolving heart surgery education is crucial to equip surgeons with the skills to match the technology. A case study detailing the postoperative recovery of an elective patient. Why managing NHS waiting lists is about safety, not just numbers. Keeping an eye on bad behaviour in the operating theatre. Reducing oxygen levels for children in intensive care will save lives, new study shows. Navigating burnout in healthcare: A critical examination of operating theatre staff in the UK. 2023 December issue Royal Papworth patient is first recruit to new ‘blood powder’ heart surgery research trial. A simple guide to the Patient Safety Incident Response Framework (PSIRF). The post-anaesthesia care of an elective inguinal hernia repair patient. Surgical teams at Southmead Hospital carry out 24 robotic-assisted gynaecology procedures in two days. New deep learning challenge to estimate breast density from mammograms. Retained swabs following invasive procedures: Themes identified from a review of NHS serious incident reports. November 2023 Workplace ostracism is clearly associated with healthcare workers’ job satisfaction, stress and perceived health. London operating department practitioner advocacy pilot project. How to share decision-making about major surgery for people at high risk of complications. Proportion of people from Black, Asian and minority ethnic communities registering to donate on the NHS Organ Donor Register is on the rise Trends in cancer. The world’s first collection of brain metastasis living samples will help treat each patient with the most effective therapy for them. Children’s Surgery Magic October 2023 A reflection on my learning as an individual and as part of a team during my second-year anaesthetic placement. Region-wide AI deal to help tackle waiting lists across nine NHS trusts. North Tees and Hartlepool NHS Trust uses RealWear headsets for training. Patients treated sooner thanks to Joint Working to Improve Orthopaedic Care. “Embracing Sustainability in the Operating Theatre: The Shift to Reusable Scrub Caps”. September issue Serious hazards of transfusion (SHOT) report warns of alarming increase in transfusion errors and harm to patients. Doctors cut waiting list for breast cancer surgery patients. Study reveals surgeons need to improve how they communicate with patients about new procedures. Professor Sir Terence Stephenson, "all NHS trusts must use barcodes to locate high-risk devices". Nurses’ intentions to quit increased during the pandemic despite their high resilience. August issue Most common medical claims: How to avoid malpractice allegations. Report recommends packaging and labelling change to prevent implant ‘never event’. New guidance on safe injection practice in hospitals emphasises the importance of prefilled and labelled syringes in avoiding medication errors. Progress with the new hospital programme. Advancements in minimally invasive surgery: Techniques, instruments, and patient outcomes. July issue NHS must accept accountability and learn from mistakes. Simulation based education in healthcare higher education: In what ways does it impact perceived clinical confidence, knowledge, and skills acquisition in student Operating Department Practitioners? Risk reduction in endo-tracheal tube fixation. Historic plan launched to move Wales towards zero deaths from bowel cancer. Taking higher-than-recommended doses of Vitamin D for five years reduced the risk of atrial fibrillation. As complications from cosmetic tourism rise, UK and Turkish plastic surgeons unite to issue consumer guidelines. New research highlights opportunities to improve care of patients having major surgery. June issue How to THRIVE in the Operating Theatre Preoperative optimisation: The effect of prehabilitation interventions on the postoperative recovery of cancer patients undergoing colorectal surgery – Literature review and discussion based paper. Surgeons must tackle three global health challenges to save lives. “PERUSE before you Infuse”. Artificial Intelligence could speed up heart attack diagnosis, SurgiBox: Ukraine’s SurgiBox Project has been successfully demonstrating safe surgery to patients around the world May issue Reducing mortality in emergency surgery: Focussing minds through a national clinical audit in the NHS. Majority of NHS trusts do not offer training to prevent sexual harassment, study finds. Handwashing during ‘normal times’ can reduce burden of respiratory disease. The Surgical Education Checklist as a tool to improve teaching within the operating theatre. April issue NatSSIPs 2 Sequential Steps: The NatSSIPs Eight – Flowchart. Mobile operating theatre helping drive down waiting times in Yorkshire. Why hospitals and ICBs are seeking new intel to find hidden high-risk patients on waiting lists. March issues NHS Scotland first in world to ‘clean up’ anaesthetic gases. New standards to Improve the safety of invasive procedures in the NHS. Researchers suggest novel cutpoints for diagnosing cardiac hypertrophy in adolescents and young adults. NHS patients targeted to reduce risks as they wait for hospital treatment. February New standards to improve the safety of invasive procedures in the NHS. Delphi Study Round Three – A study across NHS England hospital trust operating theatres. Crash and burn(out) – Aviation-style safety checklist and confidential helpline for surgical community to prevent mental health crisis. A Wound Care Study: has the pandemic led to new and improved ways of working? HSIB investigation: Access to critical patient information at the bedside. Artificial intelligence, Patient safety and achieving the quintuple aim in anaesthesiology. January Delphi Study Round Two – A study across NHS England hospital trust operating theatres. Intercollegiate green theatre checklist Local Interventions to support the recovery of elective surgery at the University College London Hospitals department of theatres & anaesthesia. 2022 December issue Delphi Study Round One – A study across NHS England Hospital Trust operating theatres. Managing NHS backlogs and waiting times in England. Steroid injections worsen knee arthritis, according to two new studies. First robotic hysterectomy completed in Wales. World’s first algae-based local anaesthetic another step closer to reality. How new bacterial species siscovered in Asian soil could help battle against antibiotic resistance November issue New research calls for all health and care staff to be trained in AI Reducing noise in operating theatre improves children’s behaviour after surgery, study finds Brain tumour patient operated on awake while playing saxophone No difference between spinal versus general anaesthesia in patients having hip fracture surgery finds study October issue Why are intra-operative surgical Never Events still occurring in NHS operating theatres? Radical rethink needed to improve safety in health and social care. World Anaesthesia Day 2022: History, significance, celebrations and theme. £4 million “space-age” operating theatre will help bring down eye surgery backlog. Two thirds of nurses choosing between food and fuel as cost of living bites and one in five turn to food banks. ‘An inspirational story’: Hartlepool cleaner changes career to become hospital nurse. September issue Service evaluation of the current World Health Organisation’s Surgical Safety Checklist in spine surgery at the University Hospitals of Derby & Burton. Could this lead to a change in NHS Improvement? The Anaesthetic Gas Scavenging System Project. Cancelled operations could be prevented by an earlier anaemia test and time to prepare. The top 10 things experts need you to know about screening during Gynaecological Cancer Awareness Month September 2022 £35.5m for New Friarage Hospital Operating Theatres. New robotic surgical system revolutionises patient care at UHCW. Insourcing: Giving NHS operating theatre teams a helping hand. Arterial stiffness raises blood pressure in adolescents via insulin resistance. Birmingham’s Public Health Chief is among sector leaders to receive university honours,
  25. Content Article
    This article, published in BMJ Quality and Safety, examines the relationships between non-routine events, teamwork and patient outcomes in paediatric cardiac surgery. Structured observation of effective teamwork in the operating room can identify deficiencies in the system and conduct of procedures, even in otherwise successful operations. High performing teams are more resilient, displaying effective teamwork when operations become more difficult.
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