AAGBI/Anaesthesia Research Grants

University College Cork, Ireland

Title
Performance and Error Metrics for Ultrasound Guided Popliteal Nerve Blocks (USpNB)

Amount
£4,724

Scientific Abstract

Background:
Medical error may be the third leading cause of death in the US (1). Current changes in
workplace training of doctors have decreased training time which can lead to increased numbers of medical errors.

In order to mitigate performance related risks to patients, proficiency based progression has shown to decrease procedure based errors by 20-50% (2-5). We propose to define the procedure based metrics of ultrasound guided popliteal nerve blocks based off earlier work at our institution (6-8).

Aims & Methodology:
1. Definition of Metrics
A panel of experts will define the steps of the procedure (metrics) and allow creation of an assessment tool.

2. Validation through Delphi Process
The defined metrics will be tested for face and content validity by a Delphi process to ensure a consensus is reached on each defined metrics and error.

3. Construct Validity and Inter-rater reliability
The assessment tool will be tested in a clinical setting to test for construct validity and interrater reliability.

Outcomes:
The creation of an objective, unambiguous assessment tool for ultrasound guided popliteal nerve blocks validated by experts in the field. This can then be utilised in a proficiency based training programme for USpNB.

Chelsea & Westminster Hospital NHS Foundation Trust

Title
Pain Assessment in Intensive Care: a qualitative investigation of health care professionals perceptions, values and attitudes towards pain assessment and management in the intensive care unit (The PAINT-2 Study)

Amount
£4,090

Scientific Abstract

Background:
Pain assessment is performed inadequately in UK intensive care units (ICUs), despite the existence of validated tools. Assessing pain can improve patient satisfaction and clinical outcomes, with poor pain management leading to deleterious physiological and psychological consequences. There is widespread failure to adopt guidance on pain assessment in ICU by nurses and our recent study revealed that ICU physicians do not use validated behavioural pain assessment tools and rarely record information about pain.

Aims:
To understand healthcare professionals' perceptions, values and attitudes towards ICU pain management and to identify individual or cultural barriers to effective management. This will inform a larger body of work to develop national guidelines and clinical interventions to improve patient pain-related outcomes.

Methods:
Semi-structured interviews of healthcare professionals working in ICU, from ICUs that participated in our previous study (with baseline pain assessment practice data), stratified by occupation, speciality, seniority and type of ICU. Grounded theory analysis will be used to identify themes to develop an online quantitative national survey to improve generalizability of results.

Output:
This data will facilitate quality improvement projects in participating centres and inform future work to develop a clinical intervention, education package and UK guidelines for pain management in ICU.

Papworth Hospital NHS Foundation Trust

Title
RITA - The Response to Iron Treatment in Anaemia study. A pilot study to examine the effect of intravenous iron in women with borderline anaemia undergoing cardiac surgery

Amount
£15,750

Scientific Abstract

The definition of anaemia differs between women and men; haemoglobin <120 g/L and <130 g/L respectively. In the surgical patient, pre-operative anaemia is associated with increased mortality and morbidity. Therefore, women with a haemoglobin level 120-130 g/L (defined by us as borderline anaemia) are regarded as non-anaemic but may in fact be exposed to increased risk. The most common cause of pre-operative anaemia is iron deficiency and we know that treatment of iron deficiency in anaemic women results in an improvement in quality of life. A retrospective study showed that women with borderline anaemia were transfused more and had prolonged hospital stay. A number of NHS institutions already routinely treat women with borderline anaemia and iron deficiency by administering intravenous iron. In this prospective observational study, we propose collecting data from 63 women with borderline anaemia who are treated with intravenous iron as part of their NHS care, in order to assess benefit in terms of quality of life and increase in haemoglobin level before surgery. If effective, we plan to use the results from this study to help plan a randomised controlled trial looking at patient outcomes after intravenous iron in women with borderline anaemia.

Plymouth Hospitals NHS Trust

Title
Cognitive Monitoring in Planned Arthroplasty Surgery Study (COMPASS)

Amount
£9,900

Scientific Abstract

Cognitive decline following surgery in the elderly is common, yet remains incompletely understood. It is unclear whether there might be a similar decline had surgery (and anaesthesia) not occurred. Characterisation of cognition requires labour intensive serial psychological assessments: accordingly studies to date are limited to small patient cohorts with a long interval between tests and a lack of appropriate controls. CogTrack ©, an online battery of cognition tests performed in about 20 minutes, is validated for serial remote cognition monitoring in elderly patients and may overcome these limitations.

Several thousand hip or knee replacements are performed annually for elderly patients across the six NHS
Trusts covered by our anaesthetic trainee research network. In collaboration with a research network of referring GPs, patients, an industry partner and cognition experts we plan a "light touch" approach to remotely monitor their cognitive function: 5 serial assessments over an 11 week perioperative window. A control group of spouses or age matched people approached in primary care will similarly spaced assessments.

This initial feasibility study will check the accessibility, fidelity and acceptability of our methodology in our target population. Pilot data will be used to inform a potential future large multi-centre study.

Leeds Teaching Hospitals

Title
Drug Allergy Labels in the Elective Surgical population (DALES) A RAFT Project

Amount
£11,808

Scientific Abstract

Drug allergy labels are important in the peri-operative period, with antibiotics, analgesics and sedatives accounting for a large proportion of all reported allergies. Labels are unfortunately frequently misattributed to side-effects or non-allergic phenomena; this can cause harm through unnecessary drug avoidance or use of less effective/more toxic alternatives. An example is 'penicillin allergy'; this label is associated with increased C. difficile, MRSA and VRE infection1, longer hospital stays and increased mortality2,3, and yet only 5% of the labels are correct when patients are tested4.

Prevalence of drug allergy labels, and their impact on peri-operative prescribing and outcomes, has never been examined in the UK elective surgical population. A 3-day UK-wide observational study will be delivered by trainee-led research groups affiliated to the Research and Audit Federation of Trainees. Allergy labels will be noted, with details of the reported allergy determined from structured patient interviews. Same-day follow-up of patients with β-lactam, non-steroidal anti-inflammatory drugs (NSAID) and opioid allergy labels will establish the impact of these allergy labels on selected post-operative outcomes.

During the study period, a survey of anaesthetists will be conducted to explore attitudes towards drug allergy labelling, and the impact of these labels on peri-operative prescribing habits.