Interview with Scarlett McNally
Can you tell me about yourself and your job role?
I have been a Consultant Orthopaedic Surgeon in Eastbourne for 20 years. I am Deputy Director of the Centre for Perioperative Care. I am also an Honorary Clinical Professor at Brighton and Sussex Medical School.
Can you tell me why you are speaking at Anaesthesia & Critical Care, what you will be speaking about and a sneak preview of your session?
I will be speaking about "How everyone can get perioperative care working better". This is about why and how. We all know how difficult it is when patients are cancelled because things are discovered late, or when patients have complications that might have been preventable. There is overwhelming evidence about how to get things to work better. The three big wins are: optimisation of patients before surgery, working differently across teams and having clear pathways.
- Seven things help prepare people for surgery and reduce complications by around 50% and reduce bed stay, even making more people 'day-case-able'. These are: exercise, nutrition, smoking cessation, alcohol moderation, medication review, improving mental health/psychological preparation and physical practicality preparation
- Working across teams means detecting problems early and sharing skills across professions, meeting together, analysing data together, agreeing processes and sharing core knowledge. This includes having good information for patients.
- Having pathways means deciding what the common general steps should be, so that a lot of care can be nurse-led and protocolised, with standard preparation advice. It also means that complex patients can be identified for individual review with a senior clinician. It requires really good Shared Decision Making about the Benefits, Risks, Alternatives and 'do Nothing" option means and how patients can optimise. These spell BRAN. We need clarity with staff and with patients.
I will suggest how every person can get started with all this. For example, attending an audit meeting of another specialty, writing patient information leaflets together, getting performance data, using patient information leaflets to educate administrative staff or clinical support staff.
Why is this topic important to be speaking about?
Good perioperative care is better for patients, staff and the service. It gives better results for patients. It is also more efficient and saves beds, unexpected complications and costs. It is better for staff - with less moral injury and a nicer working environment.
It is also hard to get started. I will be giving tips about motivational interviewing (eg https://movingmedicine.ac.uk/consultation-guides/condition/adult/periop-in-development/) and highlighting all the resources at www.cpoc.org.uk.
What are you looking forward to about Anaesthesia & Critical Care 2022?
It is good to see everyone and explain the details. Each person attending has their own experience, but they can adapt the ideas in the session to their own setting afterwards. I also want lots of people to sign up to the newsletter at www.cpoc.org.uk and follow us on Twitter @CPOC_news and @scarlettmcnally!