Projects in progress

Browse the current projects underway within our department

A human factors approach to sustainability in healthcare: a qualitative case study of Entonox use in obstetrics in a Scottish Hospital

This project will act as a service evaluation, gaining qualitative data on the use of Entonox in obstetrics. The use of nitrous oxide in a medical setting has both occupational and environmental risks, therefore it is thought that a reduction in its use could be beneficial for staff health and environmental sustainability within the NHS. It will involve observations of Entonox use in the Labour Suite, alongside interviews with healthcare staff (± patients) about their use of Entonox as analgesia. The interviews will focus on attitudes towards Entonox use and opportunities/barriers towards the use of alternatives.

Contact Pavan Raju or Catherine Kelly for more details.

Acute Care Block Blended Learning Feedback AnalysisAccordion Item

The COVID-19 pandemic in the year 2020 has forced University of Dundee undergraduate education to develop and enhance distance learning methods. However, it is vital that the final years of Medical Student teaching remain practical and relevant to foundation doctor training. The Acute Care Block in year 4 is an essential block of training. The block includes face to face tutorials, practical workshops and clinical sessions to facilitate practical learning as much as possible. We have had to ensure social distancing and safety of tutors and students while maintaining a similar standard of delivery

In the available short duration, we developed a blended learning model. We have created virtual tutorials and recorded videos including demonstration of assessment of acute illnesses. Our practical workshops have remained accessible while maintaining interactivity, despite the added precautions.

In order to determine whether we have achieved the correct balance between safety and education we have requested written feedback from our current year 4 Medical Students. We would like to interview our previous year 5 students to ensure our current students are receiving the same quality and intensity of teaching. This is required to ensure we produce safe, competent and practically sound doctors.

Contact Fiona Watson or Pavan Raju for more details.

Establishing current anaesthetic practice during mastectomy in Tayside

To establish current day-of-anaesthesia management patients undergoing mastectomy in Tayside and compare to literature recommendations for day case mastectomy.

Contact Kirsty Soto for more details.

Evaluation of Mastery Learning Airway teaching programme

To evaluate the effects of introducing a mastery learning airway teaching programme into the induction timetable for new anaesthetic trainees (CT1)

Anaesthesia training has been significantly affected during the COVID-19 pandemic, with a reduction in elective anaesthesia and increased requirement for critical care provision. Of particular concern was the new anaesthesia trainees (CT1 level), who rely on elective anaesthesia lists to gain practice and competence in basic and advanced airway management. We introduced an airway Mastery Learning course into the induction timetable for our new start trainees. This focussed on a number of skills including pre-oxygenation, BMV, SGA insertion, intubation and FONA.

We would like to assess the impact of this training on the knowledge, understanding and confidence of the CT1s.

Contact Kirsty Wright for more details.

Improving Preoperative Information for Paediatric Surgery

This project aims to optimise pre-operative communication for patients and their families attending for elective surgery in Ninewells hospital, with sub-focus on the impact of COVID-19 on this process. There are currently no COVID updated ward leaflets and much of the pre-operative information is changing on a regular basis. Current online resources are disparate, and we predict, poorly advertised to service users. We aim to improve the accessibility of online resources to and to increase communication satisfaction rates for elective paediatric patients and families.

Contact Karen Pearson or Orla Thompson for more details.

Improving the quality of patient referrals to the surgical high depedency unit

This is a quality improvement project aimed at improving the referrals to SHDU in Ninewells Hospital in order to make best use of a limited resource. Primary outcome measure would be the mortality of patients following a referral into SHDU (whether admitted or not) and secondary outcome measure would be the 30 day mortality of these patients post-discharge from hospital including their discharge destination. Observed outcomes would be used with case histories to create case scenarios for anaesthetic registrars as well as to provide education to the surgical teams.

Data collection forms will be used to record patient CHI, reason for referral to SHDU and whether the patient is admitted or not. The data user will then use the CHI to access the electronic discharge document (EDD) to establish the primary and secondary outcome measures.

Contact Fiona Anderson for more details

Paediatric Peri-operative Paperwork Redesign

We aim to modify the current peri-operative pack to form create a more bespoke pack for minor surgery.

Currently all children attending for surgery have their patient journey recorded on a peri-operative pack. This comprises 22 pages, including a 8 page paediatric in patient drug TPAR. Most paediatric surgery is day case and is minor, with many operations (e.g. MRI, endsoscopy, dental) having little or no scrub staff involvement and requiring fast track recovery.

We aim to tailor the pack to meet the needs of minor surgery and introduce a short form drug carded to reduce paper and the administrative workload.

Contact Simon Crawley for more details.

Paediatric Regional Anaesthesia Follow up

Paediatric regional anaesthesia can provide safe and affective analgesia intra-operatively and post-operatively, reducing opiate requirements and associated side effects. Currently we offer regional anaesthesia for a wide variety of general and orthopaedic elective cases.

Consent for regional anaesthesia is taken on the day of surgery, we hope to provide more information for parents prior to the day of surgery, to help them make an informed and shared decision. This will likely be in app or online resource that is easily accessible as part of their theatre journey.

We have no formal follow up after discharge home for paediatric cases who have a regional technique performed. This would be of benefit to determine if the procedures performed are benefitting our patient population and also whether there is sudden onset of pain once the regional technique has worn off or any side effects, residual block concerns.

We now have a dedicated ultrasound machine in the paediatric theatre suite which we would like to log activity for US guided regional anaesthesia is recommended compared to landmark techniques.

Contact Karen Pearson for more details.

Postoperative agitation in paediatric exodontia lists

Emergence delirium (ED) is a well described complication in paediatric general anesthesia (GA) with an incidence of atleast 20%. Exodontia lists in Ninewells take place in a remote site with the three bedded post anaesthetic care unit (PACU) being immediately adjacent to theatre. Distressed children from the previous case can impact on the experience of the next induction. Clonidine reduces the incidence of ED and has been part of some consultants routine practice for some time with positive feedback from PACU staff. Infrequent practitioners in these lists have concerns over its impact on patient flow through PACU due to potential slower emergence. We aim to assess clonidine’s impact on emergence using the validated Watcha score and its impact in PACU throughput.

Contact Callum Taylor for more details.

Roll out of new NR fit spinal needles

With the planned roll out of the new NR fit spinal needles and kit. Trainees are needed to help with identifying the locations where the current whitacre spinal needles are kept, to aid with their safe removal from clinical areas once the roll out occurs, in Ninewells, Perth and Stracathro.

Trainees will also help set up some tea trolley training around the planned roll out.

Contact Craig Cumming or Harriet Briggs for more details.

Tiel cadaver interscalene training and shoulder surgery outcomes

To assess the ability of anaesthetic trainees to learn and retain procedural mastery over interscalene block for shoulder surgery following training on the Tiel cadaver.

Project outline To rake a cohort of novice anaesthetists and train them to perform interscalene blocks on the Tiel cadavers. They then performed the block on an appropriate theatre list under direct consultant supervision at 2 different time points with their performance recorded and rated by eye tracking metrics and expert raters.

Contact Amy Sadler for more details.

TIVA and environmental sustainability – could we be doing better?

To ascertain broadly what practices Tayside anaesthetists employ when using total intravenous anaesthesia, with a slant on environmental sustainability.

By now we know that TIVA leaves less of a carbon footprint than using volatile anaesthetic gases. But can we improve our practice further? This short, anonymous questionnaire will ask clinicians about various aspects of their TIVA practice to ascertain how people are using TIVA and if we can make it even more environmentally friendly.

Contact Katie Watson or Tim Smith for more details.

The effect of Mastery Learning on airway management training to novice anaesthetists

To assess the effectiveness of Mastery Learning in the training of airway management to novice anaesthetists compared to traditional ‘hands on’ bedside methods.

All current core trainee’s (CT1 and CT2) will be interviewed by year 5 medical students using pre-written open ended questions aimed at exploring their experiences of how they were taught airway management. CT1’s received Mastery Learning Simulated Teaching methods whilst CT2’s received more traditional ‘hands on’ bedside teaching. The interviews will be recorded and qualitative analysis conducted to assess the personal outcomes of each trainee’s experience.

Contact David Johnstone for more details.