BJA: British Journal of Anaesthesia

Checklists, checklists everywhere! Love them or hate them, since the introduction of the WHO surgical safety checklist there has been a tsunami of checklists affecting clinical areas of a hospital near you. Whilst there is good evidence that the WHO surgical safety checklist has been effective at improving patient safety, this same does not necessarily apply for the day surgery cannulation checklist-bundle branded QI by infection control. Much of the criticism raised cites poor construction and inclusion of irrelevant items, resulting in checklist fatigue and poor compliance. In this podcast we speak to Dr Ashley de bie Dekker, whose PhD work involves the construction of intelligent dynamic checklists, aimed at integrating patient data from multiple sources to produce context-sensitive and patient specific checklists.

Imagine you are sitting on the runway, waiting to take off to your holiday destination. As you begin to taxi the pilot announces that there is an engine warning light flashing, but that in his experience this almost always amounts to nothing and both him and co-pilot have made a pragmatic decision to proceed, given that the flight was already running late. In anaesthesia, one of the most fundamental decisions we take is whether or not to anaesthetise someone, something that can be relatively simple or profoundly complex given the circumstances. However, there are situations you would think that as a body of responsible professionals we would all agree on. Research from Oxford suggests that this may not be the case and that there is in fact a good deal of difference of opinion, particularly when it comes to matters of patient safety. In this podcast we talk with lead author Paul Greig about his interesting and thought-provoking work looking at risk tolerance in anaesthetists.

Children requiring urgent but simple surgery is a common place phenomenon that can sometimes wreak havoc on the best planned emergency list. Operating on children in an urgent capacity can be logistically difficult outside tertiary centres and is not help

There has been an increasing realisation that the majority of complications from high risk surgeries are not due to technical failings in either the operating theatre or anaesthetic room, but from medical complications occurring out on the wards. 'Failure to rescue' has become part of critical care lexicon and with it, an awareness of the financial burden associated with treating morbidity associated with high risk surgeries. Over the last three years there has been an explosion of interest in perioperative medicine both as a solution to this problem and as a means to improving the quality of surgical care experienced by all patients. Accompanying the article on the multi-disciplinary team approach to the high risk surgical patient published in this month's BJA, Dr David Walker, director of the Masters programme in perioperative medicine at UCL, addresses some of our hopes, fears and maps out a possible future for this exciting new speciality.

Probably one of the most talked about changes in the 2015 DAS guidelines will be Plan D. Whilst on a very basic level the recommendations have not altered, the emphasis on how to practically manage a 'can't intubate, can't oxygenate' scenario are quite a shift from many anaesthetist's current approach. Dr Ravi Bhagrath from The Royal London Hospital explains the rationale, research and most importantly, walks us through the new 'scalpel, bougie, tube' technique DAS now recommend.