Regional anaesthesia education for consultants and specialists in the UK: a mixed-methods analysis.

BACKGROUND: Regional anaesthesia plays an important role in perioperative care, but gaps in proficiency persist among consultants and specialists. This study aimed to assess confidence levels in performing Plan A blocks among this cohort and to examine the barriers and facilitators influencing regional anaesthesia education. METHODS: Utilising a mixed-methods design, we performed a quantitative survey to gauge self-reported confidence in performing Plan A blocks, coupled with qualitative interviews to explore the complexities of educational barriers and facilitators. UK consultant and specialist anaesthetists were included in the study. RESULTS: A total of 369 survey responses were analysed. Only 22% of survey respondents expressed confidence in performing all Plan A blocks. Specialists (odds ratio [OR] 0.391, 95% confidence interval [CI] 0.179-0.855, P=0.016) and those in their roles for >10 yr (OR 0.551, 95% CI 0.327-0.927, P = 0.024) reported lower confidence levels. A purposive sample was selected for interviews, and data saturation was reached at 31 interviews. Peer-led learning emerged as the most effective learning modality for consultants and specialists. Barriers to regional anaesthesia education included apprehensions regarding complications, self-perceived incompetence, lack of continuing professional development time, insufficient support from the multidisciplinary team, and a lack of inclusivity within the regional anaesthesia community. Organisational culture had a substantial impact, with the presence of local regional anaesthesia champions emerging as a key facilitator. CONCLUSIONS: This study highlights persistent perceived deficiencies in regional anaesthesia skills among consultants and specialists. We identified multiple barriers and facilitators, providing insights for targeted interventions aimed at improving regional anaesthesia education in this group.

Adopting the day surgery default in the provision of lumbar discectomy and decompressive surgery.

INTRODUCTION: Provision of day case spinal procedures in the UK is below expected standards and there is a need for the creation of guidance and patient pathways to address this. Here we present a day case lumbar discectomy protocol and evaluate its impact at our institution. METHODS: A new pathway (incorporating defined selection criteria, patient education, anaesthetic protocol and discharge prescriptions) was implemented for all suitable patients within a single surgeon's cohort. Day case rates for lumbar discectomy were compared before and after implementation. Patient feedback was collated using a patient-reported experience measure. RESULTS: Eighteen of 23 patients selected as suitable via the pathway successfully underwent day surgery, leading to an increase in lumbar discectomy day case rates from 25% to 69% at our institution. Nearly all patients were satisfied with their experience, although a significant proportion felt provision of postoperative analgesia could be improved. CONCLUSION: We present a day surgery pathway for lumbar discectomy that is safe and effective. This could be more widely implemented to increase day case rates.