P36
SURVEY OF THE ASSOCIATION OF PAEDIATRIC ANAESTHETISTS OF GREAT BRITAIN AND IRELAND (APAGBI) LINK-NETWORK ON CONFIDENCE AND CAPABILITIES IN PAEDIATRIC ANAESTHESIA IN NEW AND ESTABLISHED CONSULTANTS
L. J. Hulatt, University Hospitals Plymouth NHS Trust, UK
Introduction and Aims
The APAGBI maintains a network of Link-representatives (mostly departmental paediatric anaesthetic leads) in hospitals throughout the country. The aim of this survey was to gather opinions on the following themes:
- perceived capabilities with respect to paediatric anaesthesia
- impact of the COVID-19 pandemic on paediatric anaesthesia services, caseload and skill-maintenance
- impact of the increased emphasis on paediatric training in the Royal College of Anaesthetists (RCoA) 2021 training curriculum on the confidence of newly qualified consultants.
Methods
Link-representatives were sent an email link to a Microsoft Forms survey which ran from April to July 2023. Responses were anonymous. Results were collated using Forms.
Results
69 responses were received – a 50% response rate.
Paediatric anaesthetic capabilities:
- 71% of general hospital respondents report skill challenges.
- 51% report confidence concerns.
- 36 hospitals reported a lower age limit for elective surgery: from 3months to 3 years - majority clustering at 6months or 1year of age.
Pandemic effects:
- 43% of respondents reported reductions in the number of children anaesthetised – most frequently amongst Specialist Children’s Hospitals.
- 25% reported a reduced range of services provided to children.
- 45% of non-Children’s hospitals reported having less theatre capacity allocated to paediatrics - 40% reporting prioritisation of adult work as a limiting factor.
Education and training:
- 61% of respondents agreed that paediatric anaesthesia is a challenging specialty for newly qualified consultants.
- As many respondents agreed as disagreed that the increased emphasis on paediatric anaesthesia in the 2021 RCoA curriculum will improve confidence in newly qualified consultants.
Discussion and Conclusion
Despite survey limitations, such as the risk of response bias, these results collate national opinions and identify themes.
They provide further evidence of reduced paediatric exposure for anaesthetists in non-specialist centres. Pre-existing trends of centralisation continue, exacerbated by pandemic effects. Reduced exposure leads to skill and confidence concerns for generalist anaesthetists. The NAP7 report1 highlights that 88% of paediatric resuscitations require anaesthetic input – reinforcing the importance of skill maintenance for on-call anaesthetists.
In 2023 the pandemic continued to impact on the provision of paediatric anaesthesia. The GIRFT report “Closing the Gap”2 demonstrates a 6-10% lag of recovery of paediatric services compared with adult services. This survey suggests that re-prioritisation of adult work and staffing issues continue to have significant effects.
Paediatric anaesthesia remains a challenging specialty for newly qualified consultants. The lower age limits reported for elective surgery are relevant when considering the anaesthetic training curriculum which requires new CCT holders to be capable of anaesthetising down to 1 year of age. There are mixed views on the effects of these changes on the confidence of new consultants. This survey revealed more positivity about the skills of newly qualified consultants compared to the 2016 APAGBI Opinion Survey.
References:
1 At the heart of the matter. Report and findings of the 7th National Audit Project of the Royal College of Anaesthetists examining Perioperative Cardiac Arrest. NAP7: Perioperative Cardiac Arrest | The Royal College of Anaesthetists (rcoa.ac.uk)
2 Closing the gap: Actions to reduce waiting times for children and young people. Sept 2023
GIRFT – NHS England. Closing-the-gap-Actions-to-reduce-waiting-times-for-children-and-young-people-FINAL-V2-September-2023.pdf (gettingitrightfirsttime.co.uk)