The drive to improve clinical care and productivity in the NHS has required an innovative approach in the use of the resources and skills of the workforce. With rapidly evolving technology, surgical and anaesthetic techniques, concentration is increasingly being placed on improving patient focused pathways, aiming to return patients back to normal activities as soon as possible. The article highlights the exciting new perioperative role developed at University Hospitals Coventry and Warwickshire (UHCW) NHS Trust in the care of patients undergoing laparoscopic cholecystectomy. It includes the history and development of the post and its current impact in improving the care of patients.

The operating department like many other areas within healthcare is diversifying its workforce. Several new, advanced and extended roles have been integrated within the team. This article briefly outlines historical and current developments which have influenced the operating department workforce. It focuses on the following: Surgical Care Practitioner, Physician Associate, Anaesthesia Associates formerly known as Physician Assistant in Anaesthesia, Surgical First Assistant, Assistant Theatre Practitioner and Nursing Associates, highlighting the professional regulators, education and training, qualification and continuing professional development requirements.

Weight Loss Surgery (WLS), including sleeve-gastrectomy (SG), results in significant weight loss and improved metabolic health in severe obesity (BMI ≥ 35 kg/m²). Previous studies suggest post-operative health benefits are impacted by nutrient deficiencies, such as Vitamin D (25(OH)D) deficiency, while it is currently unknown whether nutrient levels may actually predict post-surgery outcomes. As such, this study investigated whether 25(OH)D levels could predict metabolic improvements in patients who underwent SG. Patients with severe obesity (n = 309; 75% female) undergoing SG participated in this ethics-approved, non-randomized retrospective cohort study. Anthropometry, clinical data, 25(OH)D levels and serum markers were collected at baseline, 6-, 12- and 18-months post-surgery. SG surgery resulted in significant improvements in metabolic health at 6- and 12-months post-surgery compared with baseline, as expected. Patients with higher baseline 25(OH)D had significantly lower HbA1c levels post-surgery (p < 0.01) and better post-surgical T2DM outcomes, including reduced weight regain (p < 0.05). Further analysis revealed that baseline 25(OH)D could predict HbA1c levels, weight regain and T2DM remission one-year post-surgery, accounting for 7.5% of HbA1c divergence (p < 0.01). These data highlight that higher circulating 25(OH)D levels are associated with significant metabolic health improvements post-surgery, notably, that such baseline levels are able to predict those who attain T2DM remission. This highlights the importance of 25(OH)D as a predictive biomarker of post-surgery benefits.

Criteria Led Discharge (CLD) provides an opportunity to improve in-patient flow by bringing the time of patient discharge earlier in the day. CLD is an intervention that creates clinical criteria and parameters for safe patient discharge. Used effectively, it can aid the delegation of decision-making from senior decision-makers to appropriately registered clinical practitioners. Despite national guidance regarding the implementation of CLD, it remains sporadic in some healthcare settings and is not embedded into discharge practice. We aimed to develop a survey tool to understand the patients’ characteristics and opportunities for criteria-led discharge in acute hospital settings. We hypothesised the survey tool would engage multidisciplinary staff, demonstrate opportunities for CLD development, and cultivate data on patient characteristics suitable for CLD. This paper describes the development of a point prevalence patient survey tool and the opportunities for CLD. Multi-centre study with participatory co-design using multi-methods (operational and participatory action research) to sequentially develop the point prevalence survey tool, with feasibility testing. Feasibility was guided by eight developmental phases: acceptability, demand, practicality, implementation, adaptation, integration, efficacy, and expansion. User testing, through facilitated co-design enabled feedback from healthcare staff for the tool reiterations. Categorical data were analysed descriptively. Change theory was employed to understand the associated organisational elements: Capability, Opportunity, Motivation, and Behaviours (COM-B). A point prevalence survey tool capable of illuminating the characteristics and opportunities of patients potentially suitable for CLD was developed. The tool stimulated multidisciplinary team engagement at pace and scale across 39 organisations, involving 83 hospital wards. 47% (mean) of patients 2174 surveyed occupying hospital beds were suitable for a CLD. There was almost equal opportunity across elective and non-elective care, with the greatest opportunity in discharge pathways 0 and 1. This study authenticates the point prevalence survey tool through multicentre, multi-professional testing and application. It demonstrates the opportunities and characteristics of patients hypothetically suitable for CLD. Application of the survey tool is a sustainable and generalisable mechanism to regularly appraise the opportunities and promote communication about CLD. Staff indicated that the tool provided an acceptable and innovative approach to challenging patient discharge scenarios and consider the suitability of patients and condition groups for CLD.

The increased use of complementary and alternative medicine within our society requires us as professionals to educate our patients and ourselves as to the potential risks of taking herbs and vitamins. Herbs may be natural, but natural does not always equate to safe, and so this article provides a review of the literature and potential risks that herbs pose to surgery. Therefore we should encourage patients and health professionals alike to consider herbs as natural drugs and treat accordingly.