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Quality improvement report
Promoting low-flow anaesthesia and volatile anaesthetic agent choice
  1. Louise A Carter1,
  2. Molola Oyewole2,
  3. Eleanor Bates3,
  4. Kate Sherratt4
  1. 1Anaesthetic Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  2. 2Anaesthetic Department, Royal National Throat Nose and Ear Hospital, London, UK
  3. 3Anaesthetic Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  4. 4Anaesthetic Department, Royal Free London NHS Foundation Trust, London, UK
  1. Correspondence to Dr Kate Sherratt; katesherratt{at}nhs.net

Abstract

Background As doctors, we are increasingly aware of the financial implications of our practice. The need to work in a more conscientious, efficacious and cost-effective manner is greater than ever before. Environmental and financial benefits can be seen through employing the use of low-flow anaesthesia.

Aims This quality improvement project aimed to make anaesthetic practice more environmentally friendly and to reduce departmental spending. This could be achieved by promoting the use of low-flow anaesthesia and by encouraging isoflurane use where appropriate.

Methods All anaesthetic consultants and trainees were invited to fill out an initial questionnaire relating to their personal preferences and practices when conducting anaesthesia. There were specific questions relating to low-flow anaesthesia and isoflurane use. Our main measure of improvement was any decrease in the number of bottles of volatile agent ordered by the department from pharmacy. Monthly spot audits were conducted to assess gas flow rates and volatile agent use in theatre. Departmental spending figures relating to the purchase of volatile agent bottles were obtained from pharmacy. Information was then disseminated to anaesthetists on a monthly basis via a ‘low-flow board’, which showed pictorial and graphical representations of differing gas flows and volatile agent usage in relation to cost.

Results Our project showed a trend for the increased use of low-flow anaesthesia within the department. We also showed a decrease in the number of bottles of volatile agent ordered: 18% fewer bottles ordered compared with the same period the previous year. This represented a 25% decrease in total departmental expenditure on volatile agents despite an increase in theatre activity.

Conclusion Increasing awareness regarding anaesthetic choices and promoting low-flow anaesthesia and isoflurane use, translated into an overall decreased departmental spend on volatile agents without affecting patient care.

  • anaesthesia
  • cost-effectiveness
  • healthcare quality improvement

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2018-000479

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    Footnotes

    • Contributors LAC and MO contributed equally to this paper as joint first authors in terms of data collection and writing up both the first and revised drafts. Both conducted the monthly audits of anaesthetic volatile agent use and gas flow rates for the duration of the project. EB contributed to the initial idea behind this quality improvement project and devised a driver diagram that was passed on to KS and inspired her to take the project on in a robust manner. KS oversaw the quality improvement project as the supervising consultant and provided advice and liaison between the anaesthetic and pharmacy departments. KS also reviewed the initial and revised drafts of the manuscript and approved the final draft. Bryan O’Farrell (senior pharmacist, Intensive Care and Theatres, The Royal Free Hospital, London) provided tabular and graphical information regarding the pharmacoeconomics surrounding this quality improvement project.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.