AAGBI/Anaesthesia Departmental Project Grant
The successful applicants for the AAGBI/Anaesthesia Departmental Project Grant were:
Dr Shruti Chillistone
Research Fellow, Division of Anaesthesia & Intensive Care,
University of Nottingham
Handing over care on patient discharge from critical care ward to
the general ward: a multi-professional, multi-level solution
Nice Guideline CG050 (July 2007) highlighted the need for research on transfer of patient care within the hospitals. The transfer from critical care to the general ward can be problematic due to poor communication, inadequate transition process, and lack of relevant detail. Most local practices ignore the requirements of a comprehensive transition of care, or the complexity of information transfer between different professionals (i.e. consultants, junior doctors, nurses, physiotherapists, pharmacists). In this project, we will explore the underpinning principals of effective transition of care with an aim to develop a comprehensive handover process from critical care to the general ward. We will use a triad of qualitative methods (observations, semi-structured interviews and Focus Groups). We will explore the areas for development in the existing processes, and define barriers and enablers to their implementation. A modified Delphi process will be used to synthesize end user opinion, and develop a comprehensive handover process. This study will be Step1 of a 3-step project. Step 2 will pilot the feasibility of using the comprehensive multi-level, multiprofessional handover in typical NHS setting, and Step 3 will be a multicentre trial evaluating its effectiveness in improving patient outcome (readmission rate, length of hospital stay and inhospital mortality).
First year progress report from Dr S Chillistone (12 KB)
Dr Niraj Gopinath
Consultant, Department of Anaesthesia & Pain Management, Leicester
Comparison of analgesic efficacy of posterior transversus abdominis plane (TAP) catheters with epidural analgesia in patients undergoing laparoscopic colorectal surgery
Background: The benefits of adequate postoperative analgesia after abdominal surgery include a reduction in the postoperative stress response, reduction in postoperative morbidity and in certain types of surgery, improved surgical outcome. Single shot posterior Transversus Abdominis plane (TAP)block have been shown to provide analgesia after abdominal surgery. Till date there have been no clinical trials reported on the efficacy continuous posterior TAP catheter infusions after lower abdominal surgery. Pilot data from our centre show that posterior TAP catheter infusions can be a viable alternative to the two standard techniques for postoperative analgesia after lower abdominal surgery, namely epidural and opioid based analgesia. Before the posterior TAP catheter infusions gain widespread acceptance, they have to be compared against epidural analgesia which is considered the gold standard technique for providing postoperative pain relief after lower gastrointestinal surgery.
Methods: Randomized controlled trial in 70 patients during first 48 hours after surgery. The primary outcome is visual analog scale pain score on coughing at 24 hours after surgery. Secondary outcomes measured include pain score at rest, nausea score and date of discharge from hospital.
Dr Christopher Hawthorne
Clinical Research Fellow and ST5 Anaesthesia, Academic Unit of Anaesthesia, University of Glasgow
The relationship between transcranial bioimpedance and invasive intracranial pressure measurement in traumatic brain injury patients
Raised intracranial pressure (ICP) is associated with poor outcome following traumatic brain injury. The Brain Trauma Foundation recommends that ICP should be monitored in all salvageable patients with severe traumatic brain injury and an abnormal CT scan. However, ICP is typically measured using invasive pressure monitors that have associated risks. We postulate that bioimpedance measurements made across the skull will provide a noninvasive estimate of ICP in traumatic brain injury patients. Bioimpedance is dependent upon intracellular swelling and the size of the extra cellular space, as is intracranial compliance. As there is a well-defined exponential relationship between ICP and intracranial compliance, there should also be a definable relationship between ICP and transcranial bioimpedance. We describe a single centre observational study with the aim of defining the relationship between transcranial bioimpedance measurements and invasively monitored ICP in patients with traumatic brain injury. Patients will be receiving invasive ICP monitoring as part of their routine neurointensive care management. Transcranial bioimpedance measurements are entirely non-invasive and will have no influence on clinical care.