ObjectivePatient experience is one of the three pillars of quality in healthcare; improving it must be a key aim if we are to make the overall quality of the healthcare we provide better.MethodsWe devised a quality improvement project to improve the patient experience of elective surgery. We conducted surveys of patients and assessed their experience by using semistructured interviews and patient questionnaires. We gathered data about their overall satisfaction, fasting times and their communication with staff. We used this information to inform strategies aimed at improving patient experience.ResultsOur initial results showed that patients who had their operations later in the day were significantly less likely to report a positive experience. We found the main reasons for this were long waiting times, poor communication and prolonged fasting. We implemented changes over ‘Plan, Do, Study, Act’ cycles, including (1) staggering patient arrival times, (2) introducing the concept of the 'Golden Patient', (3) having a single point of contact on the day surgery unit to communicate between theatre staff and patients, (4) using the WHO checklist to finalise list order, and (5) altering patient information letters to include the possibility of a wait on the day of surgery.ConclusionThis project increased the percentage of patients reporting an ‘Excellent’ or ‘Good’ experience from 65% to 96%. In addition to improving our patients' experience, our project has also delivered shorter waiting times, better dissemination of information and fewer patients reporting hunger or thirst.

Background Crouzon and Pfeiffer syndromes are rare genetic disorders characterized by craniosynostosis, exorbitism, and maxillary hypoplasia. Patients with these syndromes frequently require general anesthesia for various diagnostic and surgical procedures and may present a challenge to anesthetists with regard to airway management. Aims The primary aim of this study was to determine the incidence, timing, and management of perioperative upper airway obstruction in infants and children with Crouzon and Pfeiffer syndromes. The secondary aim was to determine the degree of difficulty in performing endotracheal intubation. Methods A retrospective review of 812 anesthetic encounters in 67 patients was conducted. The following were recorded: timing and management of episodes of perioperative upper airway obstruction, from induction of anesthesia to discharge from recovery, degree of difficulty with laryngoscopy using the Cormack‐Lehane grading system and number of intubation attempts required, patient demographics, respiratory comorbidity, surgical procedure, and anesthetic airway management techniques. Results Upper airway obstruction at induction of anesthesia was very common, with an incidence of 31% (167/542 anesthetic encounters affecting 54 patients). In a quarter of these incidents, bag‐valve‐mask ventilation was challenging, but a laryngeal mask airway was almost always effective. Upper airway obstruction on emergence from anesthesia was less common, with an incidence of 2.7% (14/515 anesthetic encounters affecting 10 patients). Contributing factors included patient comorbidity (obstructive sleep apnea, nasal stenosis) and the nature of surgery (craniofacial or airway procedures). Intubation was rarely difficult in this cohort, with 85% of laryngoscopies rated Cormack‐Lehane grade 1 or 2 (n = 373), and 89% of intubations successful on the first attempt (n = 306). Conclusions Upper airway obstruction at induction of anesthesia is common in patients with Crouzon and Pfeiffer syndrome. These patients are likely to present some difficulties with perioperative airway management, especially bag‐valve‐mask ventilation, but rarely endotracheal intubation.

Viscoelastic tests provide a global and dynamic assessment of the coagulation system and thus are becoming increasingly relied upon in the perioperative period. Many clinicians are unfamiliar with viscoelastic testing, so this article provides an overview of their use and interpretation in the management of perioperative bleeding.

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