1994 Annual Report

RECOMMENDATIONS

Arising from discussions and review of the draft 1994 report at a SASM Council meeting.

1. Complete involvement of Orthopaedic and Thoracic surgery should be sought.

2. Completion of the SASM forms is an important educational exercise and should be a combined consultant/trainee activity where possible.

3. Local and national guidelines on the use of ITU/HDU are urgently required. Prior discussion between surgeons, anaesthetists and ITU staff before embarking on major surgery should establish a clear management pathway and reduce communication difficulties.

4. There is a need for more ITU/HDU beds and establishment of these units where none exist.

5. The post-operative management of seriously ill patients in general wards requires urgent review, giving consideration to the shorter working hours and increased use of crossover cover and inexperience of house officers and surgical trainees. A multidisciplinary approach involving surgeons, anaesthetists and physicians should be explored. In the short term, local guidelines are required with increased consultant involvement. There is a clear indication from this audit that an inter-collegiate working party to examine this issue is needed.

6. Junior surgeons and anaesthetists must discuss with consultant staff all emergency patients undergoing major surgery and all patients of ASA grade of 3 or more, before surgery.

7. Central venous pressure monitoring should be used more extensively, accepting that insertion of lines carries with it a small risk.

8. The Universities and Royal Colleges are encouraged to emphasise the importance of the following in undergraduate and postgraduate training - · management of fluid balance · post-operative ward care · spinal anaesthetic techniques · anastomotic technique

9. The regular use of agreed DVT prophylaxis regimes, taking account of the recent SIGN guideline.