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A need for change

In the video Dr David Walker discusses the need for a change in the way we deliver perioperative care to patients.
We need to evolve new models of care for three reasons. I think we have to be responsive to the population we’re serving. The patients are getting older, there’s no question of that. And you’ve probably learned that already. The second thing, which is important of course, that with with age comes morbidity. The patients we are looking after nowadays in the perioperative period are sicker than they’ve ever been. They come with all sorts of problems, diabetes, heart disease, lung disease, obesity. These are the things that are challenging us in medicine. And I guess the final thing I’d call the surgical ambition. Today surgeons are offering operations to patients where there was once no hope of a cure.
So we want to be very much a part of that journey making patients better. So those three things are the challenges for us in perioperative medicine for the future.
Yeah. I think in defining a new pathway of care. We have to be careful not to throw the baby out with the bathwater. There are some elements of great care. I would say if pushed, that some of that excellent care is fragmented. It lacks cohesion, and it’s a sort of one size fits all legacy system, which tries to adopt one model of care for all patients. And what we know, if we know anything, is that there are a sub-population, termed high risk patients, who are not well served by this sort of standard of care.
So I think if we’re looking to criticise what exists, we have for a number of years through really good, first class, national and institutional reports, well-characterised this high risk population, who make up the majority of the mortality and morbidity, but in terms of absolute numbers are small. We’ve characterised that population, but we’ve failed to blend and deliver and develop new models of care which would better support them to better outcomes.
So what are we going to do about it? I don’t it’s a glib answer to say we’d start with some basics. We need to emphasise the importance of clinical leadership at the bedside. We need to understand the importance of good communication and teamwork. I know that sounds simple, and everybody says the same old thing. But it’s true. What might we bolt onto those principles of good medical care? Well the appetite to inform what we do through good local data, good national data, the appetite for engaging with your own data, and seeing if you can make an improvement locally. But I don’t think we’ve done that well enough as a profession to date.
And also, I think it’s really important that we engage with the best evidence. And not just taking the best evidence, translating the best evidence. And it will be no surprise to you as an educationist, I think the important thing is not just teaching best evidence, but how that evidence washes out at the patient bedside, translating into better care for patients. So those are the elements of things I think, going forward, will be important, certainly in the early years of a new specialty, termed perioperative medicine, trying to make an impact on patient outcome.
Professor David Walker is the course director for the UCL Perioperative Medicine Master’s Programme and a Consultant in Anaesthesia and Intensive care at University College London Hospital. In this video he discusses the need for a change in the way we deliver perioperative care to patients and why the traditional models of care no longer work for all of our patients.
In the video he specifically talks about high risk surgical patients and how we can improve care for this group. In the upcoming few steps we will look at key reports on the high risk surgical patient and how organisations are already looking at ways to improve outcomes.
In Week 2 we will look more closely at risk assessment and identifying the high risk surgical patient.
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Perioperative Medicine in Action

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