AAGBI/Anaesthesia Small Research Grant
The successful applicants for the AAGBI/Anaesthesia Small Research Grant were:
Principal Applicant
Dr Matthew Mackenzie
Consultant Anaesthetist, East Surrey Hospital
Title
A simulator based randomised comparison of national guidelines for local anaesthetic toxicity versus modified versions
Amount
£11,790
Scientific Abstract
The Association of Anaesthetists of Great Britain and Ireland (AAGBI) produced a two-sided treatment guideline for the treatment of severe local anaesthetic systemic toxicity (sLAST) using 20% lipid emulsion (LE). It is based on laboratory studies showing superiority of "bolus plus infusion" delivery of LE but had not been evaluated in a simulated emergency. Simulator-based drills using this guideline have revealed difficulty following what appears to be a well-presented algorithm (authors personal observation). A "bolus only" approximation of the "bolus plus infusion" regime may provide a dose-time relationship that is closer to that originally intended by reducing cognitive load under stress and synchronising better with ALS guided CPR. We plan a pilot study to enrol and randomise approximately 30 anaesthetists to a standardised simulated sLAST scenario using one of three guidelines: The original, a bolus only modification, and the original information presented in the style of another National Guideline. Primary outcome will be deviation from the ideal cumulative LE dose over time as dictated by the original guideline. Secondary outcomes will include time to complete other critical tasks. Statistical advice was taken from the University of Surrey.
Interim Report from Dr M Mackenzie.pdf (171 KB)
Principal Applicant
Dr Henry Reynolds
Anaesthesia Leadership and Management Fellow, Bradford Royal Infirmary
Title
Does repeating a scenario after debriefing, in anaesthetic simulation training, improve acquisition on non-technical skills?
Amount
£3,000 jointly funded with the Society for Education in Anaesthesia UK
Scientific Abstract
Research questions
(1) Does a repetitive scenario simulation design (15 minute scenario, 20 minute debrief, 10 minute re-run first scenario) lead to demonstration of greater Anaesthetic Non-Technical Skills on a new scenario, compared with a single scenario design (15 minute scenario, 30 minute debrief)?
(2) Do trainees give higher feedback ratings on the repetitive scenario protocol compared with a single scenario protocol?
(3) Do trainees find a repetitive scenario an acceptable way to learn as measured by a semi-structured interview?
Background
Repeating a surgical procedure improves technical skills. A recent study suggested repeating paediatric resuscitation scenarios after debriefing, led to increased participant perception of knowledge and skills improvement.
Experimental design and methods
We will attempt to test all anaesthetic trainees at Bradford Royal Infirmary (hoping to recruit around 30) randomising them to repeat or single scenarios. The video-recorded 'new' scenario will be rated by 2 blinded examiners familiar with Anaesthetic Non-Technical skills assessment. The interview afterwards will consist of Likert scale rating and more open ended questions. Likert scale data and Anaesthetic Non-Technical Skills ratings will be analysed using a Mann Witney U test.
Progress
We have tested 16 trainees at Bradford Royal Infirmary and have video recorded both the first try at scenario 1 and the 'new scenario' (but not ant repeats of scenario 1). The benchmarking session has been written and dates have been set to run it.
The post scenario interviews (consisting of Likert scale rating and more open ended questions) have been conducted and audio recorded. Transcription of these is in progress and qualitative analysis will begin soon. Likert scale data and Anaesthetic Non-Technical Skills ratings will be analysed using a Mann Witney U test.
Principal Applicant
Dr David Smith
Consultant/Senior Lecturer in Cardiac Anaesthesia, University of Southampton
Title
Developing a clinical measurement of depth of anaesthesia using brain connectivity measures
Amount
£14,940
Scientific Abstract
Electrophysiological assessment of the adequacy of anaesthesia has the potential to improve clinical monitoring and the quality of anaesthetic delivery, by reducing the incidence of unintended awareness and optimising anaesthetic drug delivery. A number of electrophysiological measures for anaesthesia monitoring have been suggested, either using the processed EEG or evoked EEG responses, but the clinical uptake of these systems is low. A new approach is to use brain connectivity analysis. This approach aims to quantify the direction of information flow in the brain, building on the concept of information flow evaluated by Shannon entropy. Connectivity analysis has shown promise during propofol anaesthesia, but has not been compared to other established approaches such as the Bispectral index, Entropy, or auditory evoked potentials. The aim of this PhD project is to compare the effectiveness of brain connectivity measurements to those of other electrophysiological measures in discriminating responsive from non-responsive states during anaesthesia. We will also explore which measures of brain connectivity (coherence, Grainger Causality, Dynamic Causal Modelling) are most effective at discriminating patient states. Data will be recorded from awake volunteers and from patients undergoing clinical anaesthesia. For the clinical test group an isolated forearm approach will be used to indicate responsiveness.
First Year Report from Dr D Smith.pdf (159 KB)
Interim Report from Dr D Smith.pdf (307 KB)
Principal Applicant
Dr Alison Steven
Reader in Health Professions Education, Northumbria University
Title
An evaluation of the implementation and impact of a mentoring programme for Anaesthetists in the North East.
Amount
£6,997
Scientific Abstract
Mentoring is beneficial for doctors at all stages of their career and assists them in managing dilemmas, transitions and related expectations. Given current quality and safety issues mentoring is highly relevant in developing professional practice focused on patient-centred care and based in positive, supportive cultures in which concerns can be raised. This project will evaluate the implementation and impact of a mentoring programme for Anaesthetists in the North East. Both mentor development (learning the skills needed for mentoring) and a mentoring scheme (in which people engage in mentoring relationships and activities) will be evaluated using an established methodology.
Participants: The mentor development programme will involve ~20 participants; the number of participants on the scheme is as yet unknown but estimated as ~20.
Methods: Phase 1 uses an existing questionnaire to gather data regarding the mentor programme, the scheme, implementation, barriers and facilitators and the mentoring experience. This will serve as the sampling frame for 1:1 interviews (~20) to collect greater detail regarding barriers, facilitators and impact. The questionnaire will be modified and repeated towards the end of the study period. Data analysis will include descriptive statistics and NVIVO, a computer package which facilitates qualitative data analysis.
Final Report from Dr A Steven (177 KB)
Principal Applicant
Dr Stephen Wright
Consultant in Anaesthesia and Intensive Care, Newcastle upon Tyne Hospitals
Title
Introduction of real-time, mandatory recording of quality indicator data in anaesthesia recovery and regular feedback using statistical process control: the effect on clinician performance and engagement.
Amount
£14,921
Scientific Abstract
Following a general anaesthetic, the three commonest and most important adverse outcomes are inadvertent hypothermia, severe pain, and severe post-operative nausea and vomiting. Pilot data from one of the six recovery units in our Trust suggest that these quality indicators can be improved by regular feedback of individual comparative data to consultants. Despite this apparent success, a survey of the 34 participating consultants showed variable "buy in" to the project, with uncertainty over the accuracy of the data, and whether feedback had led them to change their behaviour. The
engagement of clinicians has been correlated with performance and with innovation in other areas of healthcare but there are only limited data in anaesthesia. The roll-out of a new perioperative electronic patient record provides a unique opportunity to collect high-quality data with mandatory completion of data fields. We propose to assess the effect of the introduction of real-time data collection and regular feedback using statistical process control methods on the level of performance and engagement of 100 consultant anaesthetists. Using an interrupted time series design we will assess the change in performance following the introduction of the quality improvement initiative. We will also assess whether engagement - assessed in part by the validated Medical Engagement Scale - predicts performance.
