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Operating Theatre Team

Come and join our New Forums!
Get up to date with the free online electrosurgery training from the MHRA. See the latest WHO Surgical Checklist adaptations for England and Wales from the National Patient Safety Agency.
Whatever you are looking for, from the latest medical device warnings, to products, courses or just something to laugh about from the world of surgery and anaesthesia, it’s all here in one place!

Theatreteam.co.uk is here for YOU, so tell us what you’d like to see!

A hospital’s “appalling” emergency care resulted in patients dying needlessly, the NHS watchdog has said.

About 400 more people died at Stafford Hospital between 2005 and 2008 than would be expected, the Healthcare Commission said.

It said there were deficiencies at “virtually every stage” of emergency care and managers pursued targets to the detriment of patient care.

Health Secretary Alan Johnson has apologised and launched an inquiry.

One of the worst examples of care cited in the watchdog’s report was the use of receptionists to carry out initial checks on patients.

‘Complete failure’

Despite the trust stating chief executive Martin Yeates had resigned earlier this month, it has now been revealed he is suspended on full pay while an independent inquiry takes place.

Chairman Toni Brisby resigned earlier this month and has not received further remuneration, the trust said.

Mr Johnson said a review of Mid Staffordshire NHS Foundation Trust, which runs the hospital, would be carried out, focusing on the years 2002 to 2007.

He said there would also be an independent review of the trust’s emergency care and he had asked the National Quality Board to ensure the early warning systems for underperformance across the whole NHS were working properly.

It is unacceptable that the pursuit of targets – not the safety of patients – was repeatedly prioritised – Shadow Health Secretary Andrew Lansley
Key problems at the hospital

Mr Johnson said: “On behalf of the government and the NHS I would like to apologise to the patients and families of patients who have suffered because of the poor standards of care at Stafford Hospital.

“There was a complete failure of management to address serious problems and monitor performance. This led to a totally unacceptable failure to treat emergency patients safely and with dignity.

“Local patients will want absolute certainty that Stafford Hospital has been transformed since this investigation began.”

The commission said that, while it was impossible to blame all of the the 400 extra deaths on the hospital’s care, some patients would have died as a result.

Julie Bailiey: “Our relatives didn’t stand a chance”

The investigation into the hospital, in Stafford, began in April 2008 after complaints from residents were backed up by statistics showing a high death rate.

The trust’s initial claim that its method of collecting data was to blame was rejected by the watchdog.

Its report cited low staffing levels, inadequate nursing, lack of equipment, lack of leadership, poor training and ineffective systems for identifying when things went wrong.

It said that:

* Unqualified receptionists carried out initial checks on patients arriving at the accident and emergency department
* Heart monitors were turned off in the emergency assessment unit because nurses did not know how to use them
* There were not enough nurses to provide proper care
* The trust’s management board did not routinely discuss the quality of care
* Patients were “dumped” into a ward near A&E without nursing care so the four-hour A&E waiting time could be met
* There was often no experienced surgeon in the hospital during the night

Eric Morton, interim chief executive, said lessons had been learned and that staffing levels had been increased.

The health secretary added: “The new leadership of the trust will respond to every request from relatives and carry out an independent review of their case notes. This will be an essential step to put relatives’ minds at rest and to close this regrettable chapter in the hospital’s past.”

The commission’s chairman Sir Ian Kennedy said: “This is a story of appalling standards of care and chaotic systems for looking after patients.

“There were inadequacies at almost every stage in the care of emergency patients.

“There is no doubt that patients will have suffered and some of them will have died as a result.

“Trusts must always put the safety of patients first. Targets or an application for foundation trust status do not lessen a board’s responsibility to its patients’ safety.”

Sir Ian added that a surprise inspection of the hospital in recent weeks found the trust had improved but it would continue to be monitored.

‘Definitive and damning’

Shadow Health Secretary Andrew Lansley said: “The public will be rightly shocked by the poor standards of care exposed at this hospital.

“It is unacceptable that the pursuit of targets – not the safety of patients – was repeatedly prioritised, alongside endless managerial change and a ‘closed’ culture, which failed to admit and deal with things going wrong.”

It is galling for patients and patients’ relatives and carers that their complaints were not believed – David Kidney, Stafford MP

Liberal Democrat Shadow Health Secretary, Norman Lamb, called for a “cultural change so that every part of this trust has open and transparent systems in place to ensure patient safety”.

A spokesperson for The Patients Association said: “How can any patient have trust in the managers and systems that have allowed this disaster to run and run?

“It is not enough for the chairman and chief executive to take the fall for this.”

David Kidney, Labour MP for Stafford, said the report was “both definitive and damning”.

He added: “It is galling for patients and patients’ relatives and carers that their complaints were not believed or were fobbed off with excuses and promises that the report shows were worthless.

“The commission’s report shows that their testimony is verified, their judgements of what was wrong vindicated.”

Bill Cash, Conservative MP for Stone, said: “There have been systemic failures in the organisation and I have asked for resolute action to be taken.”

Source: BBC Health News

At the end of each flight, they talk briefly about what went right, what went wrong and what could be done better.

Pilots say this brief and debrief system has reduced errors and made flying safer, and a growing number of NHS medics think this system should be adapted – to make surgery safer.

Avoiding errors

A report by researchers at the University of York claims that accidents, errors and mishaps in hospital affect as many as one in 10 in-patients – but that up to half of these were preventable.

One doctor who has trialled the brief and debrief system in two units at his hospital says incidents were reduced by between 30-50% over the period they used it.

It runs crossways to our culture and training Surgeon Peter McCulloch

Mr Peter McCulloch, a surgeon at Oxford’s John Radcliffe Hospital, said his experience showed the system worked – but there was some resistance within the NHS.

“Various people in various parts of the country are trying to introduce this kind of team training and Scotland are actually ahead of England in this.

“But it runs crossways to our culture and training.

“We are trained to believe that we know what is going on, take the major decisions and keep an eye on everything, which is impossible for any human being.

“If you have been trained in this culture that instils in you that everything is your decision and responsibility, and it is very hard to stop and listen to your junior trainee who might tell you that you are doing something wrong.”

Briefing procedure

He said they had introduced the briefing technique in surgery to prevent recurrent strokes, where a blocked artery in the neck is cleared, and keyhole gall bladder surgery.

“We have had episodes where we have done a briefing for a procedure that required a certain piece of equipment, and the theatre nurse has said ‘Mr X has that so you can’t’.

“Without the briefing we might have found that out halfway through the operation and been really stuck, and we would have either had to open the patient up or delay.

“I also know of cases for surgery to prevent strokes where the anaesthetist was just about to give the wrong drug, which would have been potentially fatal, but one of the team piped up and said not to do it.

“Everybody must do team-work training in the air industry right from being a baby pilot in training – we are only at the start of that process in surgery, but I think it is an exciting prospect if we could get this built into the system.”

Team work

Trevor Dale, a retired airline pilot and trainer said: “For airline pilots team work is mandatory and has been for several years.

“We must do what we call ‘crew management resource training’ and airline pilots can effectively terminate their career if they can’t work effectively in a team.

“There is quite a large movement in attempting to use this style of training message for healthcare.

“In aviation before every take-off and every landing the crew, and sometimes the cabin crew, will discuss what to do if all goes well and how to deal with any unplanned emergencies that can conceivably go wrong.

“They are trying to get everything sorted out in advance.

“Operating theatre teams generally don’t do that, so when they are faced with problems -which they almost inevitably are, making assumptions about what to do can be very dangerous.”

John Black president of the Royal College of Surgeons, said it is vital that the whole operating team work together.

“The college takes best practice from many other industries and applies it to surgical training. Being a good team-leader is not just about what the surgeon does but about ensuring that the whole team works effectively.”

Surgical procedures could soon be helped along with tiny robots, according to researchers.

Miniaturisation of motors has not kept pace with that of electronics, leaving such tiny robots with no means to get around in the body.
See the video

Now, research reported in the Journal of Micromechanics and Microengineering has demonstrated a motor about twice the size of a human hair.

The motors could be used to power mini robots to fly around inside the body.

Some surgical procedures are hindered by the size or inflexibility of current instruments. For example, the labyrinthine network of blood vessels in the brain prevents the use of catheters threaded through larger blood vessels.

Researchers have long envisioned that trends of miniaturisation would lead to tiny robots that could get around easily in the body.

The problem until now has been powering them.

Conventional electric motors do not perform as well as they are scaled down in size; as they approach millimetre dimensions, they barely have the power to overcome the resistance in their bearings.

This has been the significant bottleneck in the development of microtechnology such as tiny surgical robots, according to James Friend at the University of Monash in Australia.

“If you pick up an electronics catalogue, you’ll find all sorts of sensors, LEDs, memory chips etc that represent the latest in technology and miniaturisation,” he says.

“Take a look however at the motors, and there are few changes from the motors available in the 1950s.”

Push to turn

To address that, research in recent years has seen the use of so-called piezoelectric materials. These are typically crystals that expand and contract when a voltage is applied to them.

That makes “linear motors” – which simply move back and forth at high frequency – easy to produce, and Professor Friend published work last year about a motor the size of a grain of salt.

But for real motion within the body, the micro-motors need to be able to rotate.

Many kinds of bacteria, for instance, have tail-like structures called flagella. Rotating the flagella at their base whips them into a helical structure that propels them through fluid.

The new research leverages this same approach, by transforming the linear motion of tiny piezoelectric motors into rotation.

That is accomplished by coupling the motors to a structure with a helix-shaped cut in it. Because the structure is held in place along the helical groove, a push at one end is turned into a rotation.

The researchers’ prototype measures is a quarter of a millimetre wide – not much more than a couple of hairs side-by-side, and 70% smaller than the previous record holder.

And the fact that it is a conceptually simple, self-contained approach is promising for future applications, says Metin Settl, who heads the NanoRobotics Laboratory at Carnegie Mellon University.

“All the other concepts to do this are very complex,” he says.

“We can already use electromagnetics and external coils to spin them inside a liquid, but then you need all these off-board coils.

“The advantage of this concept is having an on-board rotary actuation,” he says. “This could make for a mobile robot with no other equipment.”

However, experts in such microelectromechanical systems from QinetiQ told BBC News that while the prototype provides impressive performance in a lab, its efficiency in moving through fluids is yet to be demonstrated.

If it proves successful, however, the approach could be used in applications outside the body, according to Professor Setti.

“These are high-frequency, lightweight motors, and those are specifications that would be advantageous for flying robots too.”

Source: BBC News