Virtual Exhibition of EBPOM-Asia/ASM 2020

Congratulations to the following lucky draw winners:
Dr. King-Lik CHENG
Dr. Wing-Sum LI
Dr. Jin Ai Jean Marie LIM

Speakers

Prof. Carol PEDEN
Adjunct Professor of Clinical Anesthesiology, Keck School of Medicine, University of Southern California, United States of America

Professor Carol Peden MB ChB, MD (Res), FRCA, FFICM, MPH is an Adjunct Professor of Anesthesiology at the University of Southern California and at the University of Pennsylvania and is Chair of the American Society of Anesthesiologists Perioperative Brain Heath Initiative. She has expertise in designing and leading improvement and innovation projects around the world and was named Public Health Innovator of the year in 2016 by Harvard School of Public Health for her work to improve outcomes in high risk surgical patients.  She gained her QI fellowship at the Institute for Healthcare Improvement (IHI) in Boston and with the Health Foundation in London. She was a co-founder of the UK National Emergency Laparotomy Audit (NELA) and is a member of the International ERAS USA Board. She has been awarded the Macintosh Professorship and the Humphry Davy medal by the Royal College of Anaesthetists.


Abstract
Quality Improvement in Perioperative Care: What Works and What Doesn’t?

In this talk I will discuss the basics of quality improvement in perioperative care.  Reflecting on extensive experience running QI projects around the world I will provide practical tips on how to be effective and build projects that not only are successful but can be sustained. I will also discuss barriers and pitfalls to success. Tools and techniques I will mention, include process mapping, PDSA cycles, change management and the importance of communication, and measurement tools.  Practical examples will be given from work including emergency laparotomy and the Perioperative Brain Health Initiative.

Key References:

The Royal College of Anaesthetists Quality Improvement Compendium. 2020.  Editors Chereshneva M, Johnston C, Colvin J and Peden CJ. https://rcoa.ac.uk/sites/default/files/documents/2020-08/21075%20RCoA%20Audit%20Recipe%20Book_Combined_Final_25.08.2020_0.pdf

Jordan LC, Cook TM. Cook S-C, Dalton J, Collins K, Scott J, Peden CJ.  Sustaining better care for patients undergoing emergency laparotomy. Anaesthesia 2020 https://doi.org/10.1111/anae.15088

Aggarwal G, Peden CJ, Mohammed MA et al; Emergency Laparotomy Collaborative.
JAMA Surg. 2019 Mar 20:e190145.

Peden CJ, Moonesinghe SR. Measurement for improvement in anaesthesia and
intensive care. Br J Anaesth. 2016 Aug;117(2):145-8.

The Perioperative Brain Health Initiative: What Can You Do?

In this session I will present a background to the American Society of Anesthesiologists Perioperative Brain Health Initiative, of which I am Chair.  I will present the demographics and data on the incidence of delirium and delayed neurocognitive recovery. Delirium is the commonest postoperative complication in patients over 65 years of age undergoing surgery and is likely to be preventable in at least 40% of cases.  Despite this fact data shows that few anaesthetists (at least in the US) take any of the preventative actions recommended in major guidelines. I will discuss how to start your own local Perioperative Brain Health Initiative and some of the practical issues that arise, how to start screening patients for cognitive dysfunction preoperatively, what information to give patients and their families and  how to involve colleagues across the perioperative spectrum.  I will provide links to resources so that you can begin to take action to reduce the incidence of this common complication.

Key references:

  • The ASA Perioperative Brain Health Initiative Website.  https://www.asahq.org/brainhealthinitiative
  • Decker J and Peden CJ.  Anesthesiologists and Perioperative Brain Health: practical things you and your institution can do to help protect cognitive function in older patients undergoing surgery. Anesthesiology News October 2020 https://www.anesthesiologynews.com/Review-Articles/Article/10-20/Practical-Ways-to-Protect-Cognitive-Function-In-Older-Patients-Undergoing-Surgery-Anesthesiologists-and-Perioperative-Brain-Health/60797
  • Rubin DS, Peden CJ. Preoperative Frailty and Cognitive Dysfunction Assessment: When Will We Answer the Call to Action? Anesthesiology  October 14, 2020. doi: https://doi.org/10.1097/ALN.0000000000003579
  • Mohanty S  et al. Optimal perioperative management of the geriatric patient: A best practices guideline from the ACS NSQIP and American Geriatrics Society. J Am Coll Surg 2016; 222:930-47
  • Berger M  et al. Best practices for postoperative brain health: Recommendations from the Fifth International Perioperative Neurotoxicity Working Group. Anesth Analg 2018; 127:1406-13
  • Hughes CG et al. ASER and POQI Joint Consensus Statement on Postoperative Delirium Prevention. Anesth Analg. 2020;130(6):1572-90.

 

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