Department of Anesthesiology Yurong Yan
From March through June, 2016, I participated in an international training project organized by The International Emergency Management Society(TIEMS)，hence obtained the opportunity to go to Imperial College Affiliated Hammersmith Hospital for further study, which has become a unforgettable experience in my life.
1. Imperial College and its affiliated hospitals
Imperial College, founded in 1907, is one of the European IDEA alliance members. Its research level is extensively acknowledged as one of the tops in the UK, and it is famous for education in engineering, medicine and business. British education has been called the “three pillars”, liberal arts at the University of Oxford, science at the University of Cambridge, and engineering at the Imperial College. Imperial College is one of the first largest academic research institutes which has carried out cooperative projects with China. On October 21, 2015, President Xi Jinping visited Imperial College.
Imperial College has five affiliated hospitals, the Charing Cross Hospital, the Saint Mary’s Hospital, the Hammersmith Hospital, the Queen Charlotte’s and Chelsea Hospital，the Western Eye Hospital, all of which are prestigious hospitals in the UK.
2. The NHS in Britain
In Britain, every hospital has a sign of the NHS (National Health Service), which has guaranteed the British national public healthcare for decades.
The NHS was founded in 1944, and it is still one of the most important parts of the British social welfare system. It provides free services and basic health care for all citizens. The NHS advocates “universal” principle, that is, no matter how much one’s personal income is, the NHS provides comprehensive free medical services for him.
There are also some shortcomings in the NHS, such as insufficient funds, low efficiency, etc. In general, the average waiting time in the emergency department is one hour; routine outpatient appointment waiting time is about two weeks; the waiting time for surgery is about two months.
3. British doctor training
Medical students after a 5-year undergraduate study will become junior doctors. After another 5-year strict training, a junior doctor will grow out to be a specialty registrar, and finally a consultant.
4. Clinical study
My study at Hammersmith Hospital focused on anesthesia for cardiac and thoracic surgeries. More than 1000 cardiac and thoracic surgeries are completed each year at Hammersmith Hospital. Each anesthetist team is staffed with a consultant, a junior doctor and a nurse, when the operation is just finished, the circulating nurse will sterilize all the instruments, clear up the rubbish and get everything ready for the next operation. Meanwhile the next patient will be anaesthetized, so the process is connected closely. My learning experience can be summarized as follows:
(1)I was most impressed by their high sense of responsibility. Patients and medical personnel relationship is friendly and harmonious; the medical staff pay close attention to every detail of every patient. (2) There are many advanced medical facilities in the operating room such as anesthesia breathing machine, monitor, blood gas analyzer, TEE, and so on, all of which are of high quality, latest model and multiple functions. (3)Operation safety checking is carried out very strictly to ensure patients’ safety. (4) Reliable insulation measures are provided for patients. Every patient’s temperature is monitored persistently. According to the results，corresponding measures will be taken to adjust the temperature to the physiological state. There are a lot of insulation devices to help patients to maintain body temperature, such as blood transfusion, infusion heating apparatus，blowing-type heater， and so on, which can reduce complications possibly caused by low body temperature during the operation. (5)Stretch hose and the application of intermittent pneumatic compression devices are used for each patient to prevent the formation of deep vein thrombosis. (6) In order to alleviate edema, reducing intraoperative intravenous infusion mainly through vasoactive agents are used to maintain hemodynamic stability. All in all, although there is no obvious difference in anesthesia techniques between us, their whole preoperative management is better than ours, therefore many kinds of complications are reduced, and patients can recover more quickly, similar to our domestic practice.
5. Future plan:
(1) We should learn more internationally advanced theories and knowledge through a variety of methods and apply what we have learned to practice, such as to develop the TEE in cardiac surgery.
(2) To optimize working process, for example, building anesthesia room at our hospital to solve the problem of inefficiency between continuous operations.
(3) We should do our best to minimize the pain of the patients by improving service quantity, optimizing the service process and providing more convenience.
(4) We can take more measures to help the patients recover more safely and quickly, such as strengthening the body temperature monitoring, improving heat preservation, wearing medical stretch hose or intermittent pressure aeration devices, and so on.