1. Perioperative Medicine
Rob Stephens MD FRCA FFICM
Consultant in Anaesthesia
Thanks to Mark Edwards
UCLHospitals
NHS Foundation Trust
NHS

2. Perioperative Medicine
General
What is it?
Do we need it?
Future directions?
How do I do it?
Perioperative Medicine

3. Perioperative Medicine
General
Enjoy
Who’s happy?
Lots in 2 years
Do CV and chat
Perioperative Medicine

4. Perioperative Medicine
What is it?
Limited focus of conventional anaesthesia vs more interesting and complex perioperative overview.
PRE
PRE
INTRA
INTRA
INTRA
POST
Perioperative Medicine

5. Perioperative Medicine
What is it?
POST
PRE
INTRA
Risk assessment
Optimization
Care stratification
Consent
Quality
intraoperative care
Evidence-based
interventions
Critical care / ward
Pain
Fluid
Comorbidities
Enhanced recovery
Perioperative Medicine

6. What is it? Research Other specialities Process & quality improvement
Has nice overlaps with other areas. Feel much more an integral, multidisciplinary part of the hospital (like ITU) than sitting in theatre pushing propofol.
Perioperative Medicine

7. Perioperative Medicine
Do we need it?
“We do this stuff already…”
But…
“Epidemic” of higher risk surgery
Limited resources
Who is best placed to care for patients perioperatively?
Perioperative Medicine

8. Perioperative Medicine
Future Direction?
Threats:
Other specialities
Are our skills under-utilised?
Opportunities:
Improved patient outcomes
Profile of the profession
Education
More varied working life
Perioperative Medicine

9. Perioperative Medicine
Future Direction?
Uncertainties:
Practicalites
Boundries
Funding and Time
Skills and knowledge
Pathways
Perioperative Medicine

10. Perioperative Medicine
Future Direction?
The buzz around periop medicine – drop in about the RCoA workgroup, official statement from President in college bulletin recently
Perioperative Medicine

11. Perioperative Medicine
Future Direction?
“If we duck this challenge, others will not, and anaesthetists risk being sidelined from the activities we trained for so many years to perform.”
Grocott & Pearse, BJA 2012
Perioperative Medicine

12. Perioperative Medicine
How I did It
Luck, chatting, randomness, niche interests
Being part of a group
Clinical:
preassessment & interest in CPET
major adult surgery
lots of surgical critical care
Time out for research & MD
Relevant conferences & societies
Happy & forward thinking workplace/colleagues
Perioperative Medicine

13. Perioperative Medicine
How to do it?
Still a bit “DIY”, practical barriers
Part of a group
Preassessment and CPEx experience
Get involved; quality improvement / research projects make it tangible
Perioperative Medicine

14. Perioperative Medicine
How to do it?
Perioperative Medicine

15. Perioperative Medicine
How to do it?
Still a bit “DIY”, practical barriers
Part of a group
Preassessment and CPEx experience
Get involved; quality improvement / research projects make it tangible
Find out local outcomes,
Surgeons, physicians, nurses, others
Formal qualification?
UCL Cert / Dip / MSc Perioperative Medicine Sept 2014
Brighton, others
Perioperative Medicine

17. Perioperative Medicine
Summary
Exciting, evolving area
A logical development of what we already do
Up to you to form your own career path
More formal qualifications coming
Thank you
Perioperative Medicine