No abstract

Purpose of reviewThe purpose of this review is to evaluate the current recommendations for management of perioperative anaemia in patients undergoing thoracic surgery, present the impact of anaemia on outcomes in this patient population and suggest an algorithm for evaluating and treating anaemia preoperatively. Recent findingsAnaemia is a common medical issue noted preoperatively in patients presenting for thoracic surgery and carries significant morbidity. Preoperative anaemia increases the likelihood of receiving a perioperative transfusion, which represents a significant risk factor for morbidity and reduced disease-free survival in lung cancer patients presenting for thoracic surgery. It is also associated with longer hospital lengths of stay and increased risk for reoperation following lung transplantation. An algorithm-based approach to management of anaemia is beneficial and treatment with iron has been shown to reduce transfusions. SummaryPatients undergoing thoracic surgery have a high incidence of preoperative anaemia that increases the risk of transfusion and postoperative morbidity. Preoperative evaluation and tailored treatment based on the underlying cause of anaemia reduces the incidence of anaemia prior to surgery and decreases transfusion rates.

65 Background: Survivorship care is now being increasingly recognized as an important part of cancer care. The Commission on Cancer (CoC) Standard 3.3 now recommends 100% compliance in the delivery of Survivorship Care Plans (SCP) by 2019 to eligible survivors. However, there are no systematic ways of ensuring compliance of Care Plan delivery and assessing patient eligibility. There are also no standardized methods for documentation or data collection to ensure appropriate consolidation of information from the electronic medical record (EMR) to a SCP, to assess for patient eligibility for survivorship follow up, or to appropriately report on timely delivery and follow-up with Survivorship Programs. Methods: Our survivorship team worked closely with the Cancer Registry Program, nurse navigators, and Information Technology team to optimize our institution owned EPIC electronic medical records system to populate and consolidate information automatically into patient specific care plans. By having electronic care plans, we are able to deliver plans to all members of the care team and to the patients. We also created discrete methods of flagging eligible survivors and automated data reporting and collection to ensure compliance and timeliness of care plan delivery. Results: By optimizing our electronic medical records system and our workflow process for Care Plan delivery, we were able to increase our delivery compliance rate to 100%. We are able to track patients through their care delivery and appropriately refer to our survivorship program and track care plan delivery. Conclusions: The CoC has implemented new standards to encourage appropriate survivorship care delivery and proper communication for ongoing survivorship care and follow up. With these new standards comes the challenge of developing and implementing a system for creating, delivering and evaluating the delivery of SCP. For our team to provide quality survivorship care that is measurable, we have developed data analysis and reports through our EMR with assistance from our IT department. These improvements utilizing our IT and EMR more efficiently has provided us with the ability to achieve 100% care plan delivery compliance.

No abstract

aortic dissections was the critical care unit in the majority (n = 12, 67%) of centres, with 5 centres preferring theatre (28%). There was agreement from respondents that guidelines regarding the transfer of acute Type A aortic dissection patients would be beneficial.Discussion: This survey of UK cardiac centres shows that the majority of centres already centralise treatment of Type A aortic dissection patients by sharing responsibilities. Furthermore, it reflects the observation by the majority of ACTACC link persons that there may be room for improvement of a timely diagnosis, transfer times, monitoring, and training and experience of escorting personnel. In the future a national prospective audit of acute Type A dissection cases in the UK will be necessary to further assess timely diagnoses and quality of transfer-related variables in individual patients with the view of elucidating how to potentially reduce the high incidence of pre-hospital deaths of patients with acute Type A aortic dissection. This survey was conducted before the COVID-19 pandemic. A future audit would help to assess NHS treatment of acute Type A aortic dissections after the pandemic peak.References: Mahase E. Half of patients with acute aortic dissection in England die before reaching a specialist centre. Brit Med J 2020; 368:m304.