Posted by: ayrshirehealth | February 27, 2013

Reanimation – Defining Quality Health Care by @bigflip14

Reanimation – Defining Quality Health Care

Wand2Reanimation is a term you don’t hear very much in Health Care circles in the UK.

It is used much more often with regard to magic and the performance of amazing feats, like bringing someone back to life, usually with a powerful wizards wand in hand.  This on the face of it is not something mere muggles (non magic folk) like us would engage in within the NHS.

Département d’Anesthésie et de Réanimation

A quick look across to Europe however, gives us a different picture and possibly a different perspective. Within the specialty of Anaesthesia, there are some differences in the way we describe ourselves.

In the UK, we have Departments of Anaesthesia. In the USA, this becomes Anesthesiology.

EUDépartement d’Anesthésie et de Réanimation (most of them affiliated to SFAR – Société Française d’Anesthésie et de Réanimation). In some countries, the term Réanimation specifically refers to the practice of Intensive Care Medicine.

Is reanimation something the continental European anaesthetists are particularly great at and we are not?  Well, I don’t think that is true at all.

Intensivists and routes out of hospital 

As an anaesthetist and Intensivist, I would not contemplate starting an elective case, no matter how complicated the case is likely to be, without having a clear enough plan of how I might get them back out of the hospital.  This becomes even more crucial in emergency cases, and for some patients this may take time and a stay in the intensive care unit, but the aim remains to “reanimate” the patient.  I have recently been asking the question of my colleagues – “When would you not be happy to start a difficult case?”.  This question goes very much to the heart of the matter.  In each case, there was a lengthy discussion on how they would get the patient back to their normal state of health. For the patient with cardiac and respiratory failure, this may well be a slow “reanimation” back to their normal level of activity.

To answer this question myself, I would be much less likely to take on a case if I genuinely thought that I might be the last face the patient ever sees. So for me, the likelihood of successful reanimation is vital.

So, in the interest of solidarity with our European Union partners and in the interest of clarity of the description of my specialty maybe we should now be called the Departments of Anaesthesia and Reanimation.

Reanimation and Acute Medicine.

Having looked at reanimation within my specialty, I began to think that this really should apply to all acute specialties, and should be the first thought of any clinician looking at a patient on their admissions to hospital.

After all, the patients come to the hospital, whether referred by GPs or self-presenting, because of an acute deterioration in the health and well being resulting in a degree of incapacitation and while expert diagnosis and therapeutic genius is a good thing, reanimation and a return to normal activity has to be the main focus.

….So I looked up the definition of “Reanimate”, and it is as follows

1. To restore to life; resuscitate.

2. To give fresh vigor, spirit, or courage to.

3. To stimulate to renewed activity.

Quality strategyThis fits well into the Quality Agenda and should be encouraged.

It turns out we have had Estimated Dates of Discharge as part of the management plan on admission for a while now.  I suspect this is similar to the concept of reanimation I’ve tried to describe with regard to anaesthesia. Reanimation and Discharge Planning are effectively trying to achieve the same thing for patients though I suppose as usual, anaesthetist are working to a much quicker timescale than acute physicians.

PCHCThe one question we need to ask our patients is – “What is it that bothers you the most about being here”.  We may be able do some amazing things, but to get someone back to their normal activity, we need to know what their normal activity is.

In a very scientific environment therefore, it would seem that reanimation is a bit of an art.  After all, no two people are the same.

We’re all getting better and more sophisticated at managing acutely ill patients year on year, and I’m sure we all recognise the fact that we are continuing to take on cases that a few years ago would not have been possible to manage.

I’ve often wondered if anaesthetists were from Mars and physicians were from Venus. We may well be, but clearly we are all into the magical art of Reanimation.

Our blogger this week:

@bigflip14 (Dr Philip Korsah) is an Associate Medical Director, Anaesthetist and Intensivist in NHS Ayrshire & Arran

Next week:

@KathEvans2 guests blogs on the value and impact of engaging with children and young people in healthcare, for Ayrshirehealth.

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Responses

  1. […] Reanimation – Defining Quality Health Care by Dr Philip Korsah on the Ayrshire Health blog. […]

  2. […] New South Wales. Back in Scotland, on the Ayrshire Health blog, Dr Philip Korsah was considering Reanimation – Defining Quality Health Care. I think that many of us who have ever had acute conditions that needed a stay in hospital would […]

  3. […] the final Ayrshirehealth blog Phil Korsah’s post is Re-Animation – defining quality in healthcare.  As an intensivist and anaesthetist Phil, and colleagues, are often responsible for making […]


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