Developing perioperative care in Northern Ireland

Enthusiasm for perioperative care has grown in Northern Ireland over the past 18 months with two perioperative care regional leads being appointed and the development of a fellowship at Belfast City Hospital, which has already successfully produced three fellows.

Working as a perioperative medicine fellow here in Belfast, I have had the opportunity to be involved in developing relationships with the multidisciplinary team (MDT), particularly breaking down the metaphorical barrier between anaesthetists and surgeons, that is the surgical drape. I regularly attend the regional surgical multidisciplinary meetings and pre-assessment clinics. I have been embraced as part of the MDT with regular attendance at surgical grand rounds, where the expertise of an anaesthetist has been warmly welcomed to advise and educate in areas of patient care that the surgical specialty maybe unfamiliar with, such as complex pain issues.

With the evolvement of the perioperative medicine fellowship, there has been a welcome change of attitude towards the anaesthetist stepping outside the operating theatre and onto the wards, something that has been embraced by the surgical teams at Belfast City Hospital. I have also been developing clinical and communication skills in pre-assessing complex surgical patients, independently, which some anaesthetists say they do not get exposure to until they become consultant.

Examples of further multidisciplinary and non-clinical opportunities and challenges presented to me include writing enhanced recovery protocols, developing a postoperative delirium pathway, hosting a research trial, taking an active role in a national quality improvement programme, how to drive quality improvement in the NHS, and leading education in topical issues in perioperative care. This has given me an insight into the role of other medical professionals, who can seem invisible when you are in theatre.

There are challenges in healthcare unique to Northern Ireland, with surgical waiting lists significantly longer than the rest of the UK, significant medical and nursing staff shortages, nurses soon to go on strike from beginning of December to the early months of 2020 and a government that is not currently sitting to make key decisions.

While the majority of anaesthetists in Northern Ireland are members of the Colleges and Societies in the UK, it can feel that national policies and guidelines can be difficult to implement in our region due to our different legislation and funding system.

A fixed budget is allocated annually between the five Health and Social Care Trusts, not through a tariff framework as in England. Increasing demands can make it difficult for departments to engage in new initiatives. The responsibility for pre-operative optimisation of surgical patients can therefore be difficult to establish, particularly between an over-stretched primary care system and the surgical centres – for example who should investigate and initiate treatment for pre-operative anaemia?

However, Northern Ireland is keen to stay in line with current evidence and healthcare policies that are implemented in the UK. Belfast City Hospital is excited to soon be joining in the Perioperative Quality Improvement Project and is already involved as a host centre to research trials.

As with the rest of the UK, Northern Ireland is experiencing critical staff shortages, which is impacting on the perioperative care of the surgical patient. However, despite the pressures on the health system, I have been encouraged to see the enthusiasm, innovation and commitment the MDT has for developing perioperative pathways to improve care for the surgical patient.

I am excited to be involved in the development of perioperative care and play my part in helping it evolve in Northern Ireland. Future developments that would help to drive the College’s objectives would be the expansion of the POM Leads role to all anaesthetic departments in Northern Ireland and the funding of anaesthetic sessions to formally integrate anaesthetists into the post-operative care of patients.

Dr Alison Blair