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Simon Ash Profile picture
@OBsleepmerchant
May 16, 2023 • 10 tweets • 10 min read • Read on X
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Bill Kirkup presents on the independent investigation into East Kent Maternity Services at #Anaesthesia2023 #OBAnes ImageImage
Battled with how to put “In their own words…” together. 4 slides at a time doesn’t cut it. It was a very emotive experience. So I hope this works (Twitter Blue perk)
#Anaesthesia2023 #OBAnes (prelude to #OAA23ASM)
In their own words: FAMILIES.

Midwives, not nurses. They cut me open (@HofkampMichael @emilysharpe @ruthi_landau). He’s singing, then he died. We don’t talk about cesareans. Physician: I’m the doctor. Midwife: we won’t be doing that.

And that last one… apropos of @SQuashie’s… twitter.com/i/web/status/1…
In their own words: STAFF

Big egos, cliquey behaviour (OB, midwives). Made to look stupid. Dread going to work. A successful day: getting to car without tears. OB: hearsay & uncorroborated (until there are how many witnesses? How many errors?). Consultants refuse to come in.… twitter.com/i/web/status/1…
In their own words: AFTERMATH.

That first slide. I didn’t do my job, but I was handing over remember? That’s a PATIENT being asked if she could have done better. Discipline vs reflect. Cover ups. What caused suffering or extended suffering = lies. Grammar >>> #patientsafety. Why… twitter.com/i/web/status/1…
What happened:

Underlying failures - teaming (@AmyCEdmondson keynote from #SOAPAM2023 elsewhere on timeline); respectful workplaces; compassion and listening missing - replicated and repeated cycle of harm. (@SusannaStanford paraphrased in that quote)

Effects on care: most… twitter.com/i/web/status/1… ImageImageImageImage
MISSED OPPORTUNITIES - EIGHT separate clear opportunities to change course, learn, improve between 2010 & 2018. However, reports met with 3 F’s (disbelief, denial and deflection). Arrogance. Any review met with hostility. All is well, good enough.
#Anaesthesia2023 #OBAnes… twitter.com/i/web/status/1… Image
Action now: a different approach required, after an endless cycle of failures. Can’t assume restricted to East Kent (@DOckendenLtd has demonstrated that, hopefully not worse in Nottingham). No detailed operational recommendations- FOUR areas for action: none easy, all… twitter.com/i/web/status/1… ImageImage
Area 1: Maternity Signalling System. Plenty of data, no outcomes. Analyze poorly. Need 4 things. Accept natural variation, trends and outliers.

Area 2: Standards of Behaviour. Staff under strain ≠ excuse bad behaviour. Role models, not teaching. Can’t change vs won’t change?… twitter.com/i/web/status/1… ImageImageImageImage
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More from @OBsleepmerchant

Simon Ash Profile picture
May 9, 2024
@SQuashie presents an update on anesthesia for operative delivery. Declarations. Methodology and themes. #OAA24ASM #OBAnes

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Gastric USS. Oral rehydration has benefits over NPO wrt vasopressor use. #siptilsend safe, noting some patients have increased gastric volumes irrespective of starvation status. #OAA24ASM #OBAnes
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@SQuashie continues at a rapid pace. To DPE or not to DPE remains a question - 16min vs 19 min, is that 3 min clinically relevant? Esketamine for supplemental analgesia - >95% had psych effects, read @rjharrison79 editorial. #OAA24ASM #OBAnes
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Read 16 tweets
Simon Ash Profile picture
May 9, 2024
@Jamesocarroll presents an Update on Labour and Delivery. Disclosures #OAA24ASM #OBAnes

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How the lecture was put together. Screening. Themes. How to interpret the slides. Very Ostheimer-esque @Jamesocarroll #OAA24ASM #OBAnes


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@Jamesocarroll Clinical practice theme: intrathecal catheters & ADP. Intrathecal catheters: No decrease in PDPH, but reduction in EBP. 10mL intrathecal saline decreased PDPH & need for EBP. Of note, the percentage of epidurals requiring multiple attempts. #OAA24ASM #OBAnes

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Read 17 tweets
Simon Ash Profile picture
May 5, 2024
8am-ish in Denver and time for a much anticipated session: PDPH beyond the guidelines. Moderated by Dr Lisa Leffert, featuring @Ropivacaine, @euklaas, @sharonOzynger and @WouterSchievink at #SOAPAM2024 #OBAnes

(HT: @Ropivacaine, bless his heart, he knows I hate missing out)

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Hot off the Press? August 2023! @JAMANetworkOpen with quite an illustrious team including @Ropivacaine @robin_russell1 @KalagaraHari @LimGrapes @claralexlobo @noolslucas @NarouzeMD (please tag others if you have their handles?) #SOAPAM2024 #OBAnes

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Introduction, Methods and the 10 questions. #SOAPAM2024 #OBAnes

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Read 11 tweets
Simon Ash Profile picture
Jun 12, 2023
Next up at #CASAM2023 - fittingly keeping the most important academic session to last: #OBAnes
@ValZaph moderating the Maternal Experience and Outcomes: Improving the care we provide. @DrWesleyEdwards

Bookends the 1st #OBAnes session, on intrapartum pain at cesarean section… twitter.com/i/web/status/1… Image
Dr Christina Lamontagne kicks off the session with: Use of Dexmedetomidine in improving maternal experience and outcomes. Nothing to disclose. Then an important disclosure: All indications discussed are OFF LABEL in Canada. Objectives.
#OBAnes #CASAM2023 ImageImageImageImage
Why does Dr Lamontagne use a lot of dexmedetomidine (not only in #OBAnes mind)? Clinical pharmacology of dexmedetomidine (1): highly selective alpha-2 agonist; sedation WITHOUT amnesia at locus coeruleus. #CASAM2023 ImageImageImage
Read 9 tweets
Simon Ash Profile picture
Jun 11, 2023
Dr Ning Nan Wang introduces @harshamd5 to open the chronic pain session: Perioperative use of opioid in the context of Opioid Epidemic. #CASAM2023 ImageImageImage
The opioid crisis isn’t new - China probably remembers the Opium wars that helped establish a British foothold on the continent. Opioids and OUR crisis. Is what we fear the real crisis? Are opioid-related deaths due to surgical prescriptions? No, mostly due to street fentanyl.… twitter.com/i/web/status/1… ImageImageImage
Opioid use around the time of surgery. Understanding nociception vs pain. Does eliminating opioids during surgery make a difference - no definitive conclusions. #CASAM2023 ImageImageImage
Read 11 tweets
Simon Ash Profile picture
Jun 10, 2023
@DrLucieFilteau introduces @CMA_Docs president @AlikaMD for his keynote address at #CASAM2023 Image
@AlikaMD starts with the state of the 🇨🇦 health system, including a little history. #CASAM2023 ImageImage
The 🇨🇦 health system approach to problems, creating new problems as a result with a dangerous lack of interoperability. #CASAM2023 ImageImageImage
Read 12 tweets

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