2020 Annual Review: Our clinical quality and research work

COVID-19 Guidance Hub

In March 2020, working in collaboration with the Faculty of Intensive Care Medicine, the Intensive Care Society and the Association of Anaesthetists, we developed the joint anaesthesia and ICM COVID-19 Guidance Hub.

The hub met the urgent need for up-to-date national clinical information, guidance and resources that our respective members needed to better understand and manage COVID-19.

The site continues to attract a high volume of traffic and, across 2020 the hub had:

• 1.1 million page views
• over 425,000 unique visitors
• accessed across the UK and five continents.

The hub has attracted widespread praise from NHS England and NHS Improvement Medical Director, Professor Stephen Powis, Sir Christopher Wormald, the Permanent Secretary to the Department of Health and Social Care, and the Scottish and Welsh governments.

Supporting anaesthetic departments

The availability of our clinical volunteers due to the pandemic impacted all our activities and in particular the Anaesthesia Clinical Services Accreditation (ACSA) and research programmes.

Despite this, we continued to see ACSA growing from strength-to-strength, with 72 per cent of NHS organisations now registered with the scheme and 38 NHS anaesthetic departments gaining accreditation.

To support departments online, we piloted the delivery of remote classroom sessions, offered all registered departments a video conference to discuss bespoke issues, and conducted ACSA-themed webinars to replace our face-to-face regional events.

We were also delighted to launch the new  online portal for our ACSA community in 2020. This will enable anaesthetic departments to track their progress across the standards and engage more pro-actively with the College team.

In 2020, we saw a move to online Advisory Appointment Committees and in response, we updated our guidance to hospital departments, allowing greater flexibility. This may be a trend that persists beyond the pandemic. 

Raising the standards in quality improvement

Since the first edition in 2000, the College’s ‘Audit Recipe Book’ has provided a popular manual of audit topics for anaesthetists. We were therefore delighted to launch the new edition: Raising the Standards: RCoA Quality Improvement Compendium. The new edition provides comprehensive recipes for quality improvement and audit in all subspecialties of anaesthesia. It links to national audit and quality improvement priorities in anaesthesia, such as the National Audit Project recommendations, the Perioperative Quality Improvement Programme (PQIP) and the National Emergency Laparotomy Audit (NELA). We are grateful to the editors and 120 volunteers who have written the chapters. 

Safe Drug Management in Anaesthetic Practice was published in September 2020 with the Association of Anaesthetists in response to patient safety concerns as well as the safety and wellbeing of healthcare professionals.

The College and the Association continued to work closely under the umbrella of the Safe Anaesthesia Liaison Group and successfully delivered its Patient Safety Conference in October.  A recruitment campaign was launched for regional safety leads to share and spread best practice and support anaesthetists undertaking patient safety work.

Delivery of research in a challenging and changing landscape

2020 was a challenging year for the Health Services Research Centre (HSRC) as reflected in the reduction of non-COVID-19 research activity across the country.

Data collection for NAP7, examining perioperative cardiac arrest, has been pushed back to May 2021, although an off shoot of the NAP7 work, the Anaesthesia and Critical Care Covid Activity Survey was launched, looking at the effects of COVID-19 on surgical activity and workforce pressures.

Data collection picked up for both PQIP and the Children’s Acute Surgical Abdomen Programme towards the end of 2020.  A set of COVID-19 specific questions have been agreed across all HSRC projects, while we have also sought to reduce the datasets to reduce the data burden.

A new clinical trial VITAL led by the University of Warwick and UK Perioperative Medicine Clinical Trials Network will compare inhalation and intravenous anaesthesia methods to determine how soon patients return home after surgery. The VITAL trial will partner with PQIP to use the same data collection procedures.

NELA was extended by another two years in December 2020 and published its sixth annual patient report in 2020 showing improvements in care continue to save hundreds of lives and more patients are going home early after emergency bowel surgery. However, elderly and frail patients are not receiving recommended levels of care, with a need for greater participation by geriatric teams across the UK.

The National Institute of Academic Anaesthesia (NIAA) ran one rather than the usual two rounds of grant applications in 2020 due to COVID-19. There was a record number of applications, taking the total grant funding awarded on behalf of the NIAA's funding partners to over £11 million since its inception.

Teamwork

More than ever, our thanks go out to all the volunteers who under the most difficult and challenging circumstances have continued to participate in our clinical and research projects, which is a huge testament to the spirit of our anaesthetic and perioperative care teams.

Leading the way in perioperative care

The Centre for Perioperative Care (CPOC) continued to grow in stature and further its ambition as the pre-eminent cross-specialty centre leading the perioperative agenda. Its impressive work has included several collaborative initiatives with national bodies, resources for patients and CPOC-led sessions at EBPOM’s international perioperative conference which attracted over 8,000 delegates from more than 70 countries.

In November 2020, it published its first strategy and vision as well as a series of ground-breaking evidence reviews that help make the case for perioperative care, and laid the foundations for CPOC’s current policy projects.

In collaboration with the Faculty of Intensive Care Medicine, CPOC published clinical standards and guidelines for ‘Enhanced Perioperative Care’ and collaborated with the British Association of Day Surgery and Getting it Right First Time (GIRFT) to develop the new ‘National Day Surgery Delivery pack’.

CPOC has also published guidance for adult patients and young people having an operation during COVID-19. The Centre’s Delivering on Opportunities for Better Health and Perioperative Care in the COVID-19 Era is an opinion piece on how dramatic changes in services amidst the pandemic provides the opportunity to redesign surgical pathways and deliver perioperative care.

We are grateful for all the hard work of our partners and we were particularly pleased to welcome the Royal College of Paediatrics and Child Health, the Faculty of Public Health and trainee representation from the Academy of Medical Royal Colleges to the CPOC Board in 2020.