Practice Plus Group Hospital, Emersons Green

Dr Marco La Malfa, Care UK’s Clinical Director of Anaesthetics, has begun  training NHS teams composed of anaesthetists, surgeons, nurses and managers in the hospital’s revolutionary fast track pathways which can see people going home an hour after their operation.

During the last 18 months Dr La Malfa has trained 60 NHS visiting consultant anaesthetists in using a laryngeal mask with patients in spontaneous breathing, utilising Suprane (desflurane) as anaesthetic gas and Plasmalyte as IV fluid – a technique that not only allows the anaesthetic to be fine-tuned to the patient’s needs but also allows a patient to become conscious and responsive as soon as the surgery is complete. The technique is suitable for most day surgery cases carried out at the centre in Emersons Green including minor orthopaedic, gynaecology, urology, ear, nose and throat and general surgery.

Dr La Malfa said: “The feedback has been universally positive and there is now a waiting list for the training course. However, the visiting anaesthetists have asked us to show their theatre colleagues our strategy in order for them to understand and to smoothly transfer the Emersons Green pathway to their own hospitals.”

Traditionally patients arrive at a hospital early in the morning and wait, sometimes until late into the afternoon, before undergoing surgery. For some nervous patients this can prove distressing. “The Emersons Green way” sees people arriving for individual appointments close to their surgery time.

“This reduces anxiety levels amongst patients as well as being a great deal more convenient for them. Teamed with a fine tuned anaesthetic technique a patient can be ready to go home within two hours of arriving at the centre, feeling alert and confident as they have been able to talk to their surgeon after their surgery,” Dr La Malfa explained.

During the training sessions the healthcare professionals will meet patients before and after surgery as well as viewing what takes place in the theatre, following the patient journey throughout.

Dr La Malfa said: “During our fast track recovery training sessions, I explain the technique as we operate. This is an advanced technique and it is important that the anaesthetists understand the subtleties. I am delighted that Emersons Green Treatment Centre is able to lead the way nationally in a technique that really does improve the patient experience.”

Care UK’s clinical director of anaesthetics, Dr. Marco La Malfa, who is based at the centre, was presented with the gold award for his written presentation of a study into the benefits of using a standard dose of 40 mg 1% Chloroprocaine in people undergoing  surgery under spinal anaesthesia.

Dr Malfa explained: “We prefer to use local anaesthetics and/or regional nerve blocks when possible to remove the unpleasant effects and long down-time associated with general anaesthetics and to control the post-operative pain.

“We have always used local anaesthetics for spinal anaesthesia and, whilst medically very effective, often they were very unpredictable in terms of the duration of the block. For some, the effects could go on for three or more hours, delaying the time patients could begin to become mobile and leave the centre, or causing prolonged urinary retention followed by patient admission at the ward.”

In 2013, 1% Chloroprocaine became available in the UK and Dr La Malfa and his team began a trial in conjunction with Dr Robbie Erskine at Derby Nuffield NHS Hospital Trust. “We carried out a pilot of 50 patients in Bristol and 50 in Derbyshire,” he explained.

“Using the same protocol, the two centres did not liaise during the pilot so as not to inadvertently skew the results. We were delighted when, at the conclusion of the pilot, we found our results were identical.”

The surgical times were between three and 52 minutes and the average patient discharge time, after the end of surgery, was 83.5 minutes. Patient satisfaction levels were high and patients reported they were happy to be awake during the procedure and talking with the anaesthetists. They were also happy to be able to talk to the surgeon at the end of the surgery.

A second study at a Care UK centre also earned Dr La Malfa a bronze award. The 50-patient trial examined the use of a regional anaesthetic block for shoulder surgery, avoiding the utilisation of general anaesthesia

Dr La Malfa said: “It has been very successful: normally this type of surgery is performed under general anaesthesia in combination with a regional nerve block. We have proved that it is possible to perform shoulder surgery safely under nerve block only and with the patient awake during the duration of the surgery.

“There was high patient acceptance, shorter hospital stays, less total non-surgical intraoperative time, fewer postoperative interventions and no unplanned admissions or re-admissions for problems.

Patients reported that they had little or no pain and, for the more nervous patients, we were able to administer a low dose of sedative to keep them calm during the procedure.”

Delegates at the Scarborough conference also heard from Emersons Green consultant ophthalmologist Dr Teresa Anthony who has developed a ground-breaking one-stop alternative to standard cataract surgery, and from pharmacist Tauheed Ahmed on enhancing discharge efficiency - prescription of discharge medication in clinic.

Hospital director Pamela Mackie said: “I am incredibly proud of our talented team. They have shown the medical community just how innovative and patient-centred our centre is and I think Bristol should be very proud of having such a pioneering facility on its doorstep.”