Haresh Mulchandani

Haresh RCoA.PSPP2015..8 Name: Dr Haresh Mulchandani  

Event: RCoA PSPP

Amount raised: £1,200

Patient safety is at the heart of the medical profession, and improving practice is essential to empowering colleagues to provide the best care.

We recently caught up with patient safety advocate, Dr Haresh Mulchandani, Orthopaedics/Trauma and Simulation lead at Homerton Hospital to discuss the recent Patient Safety in Perioperative Practice (PSPP2015) conference he organised in collaboration with the Royal College of Anaesthetists (RCoA), and this is what we learned.

What motivated you to support Lifebox®?

I always wanted to support Lifebox as I think it is a fantastic charity, which has identified a great need, the global oximetry gap and identified a smart and low cost solution to it. Since I don’t bake cakes, I decided to organise conferences instead, and donate the proceeds to Lifebox.

Where did your interest in patient safety develop?

My interest in patient safety stems from my work in Medical Simulation: I did a fellowship in it at Barts Health, and since 2011 have been lead for Simulation at my own hospital in the East End of London, Homerton Hospital.

Over the years I have realised that Medical Simulation, although it encompasses part task trainers (in fact that is all surgeons can think about when I mention Simulation to them- laparoscopic trainers and the like), is about much more than that: It is about using your resources optimally to manage medical crises, and the non-crisis work too: To effect changes for the better, it also has to be about how to change work processes and environment, and how to ask for additional resources to improve outcomes- essentially, I realised all of these actions simply were there to improve patient safety- no more, no less.

Thus I decided to change the emphasis of this training work from Simulation to calling it “Patient Safety” work- it makes people pay much more attention, as no one argues against the fact that striving for improved patient safety and care is what we should all be doing.

What is your experience in low-resource settings?

My experience in low-resource settings was with an extremely rewarding and eye-opening stint I did with Medicins Sans Frontieres (MSF) as a final year specialist registrar, in a rural part of Colombia.

Here I saw that even within a country with world-class medical facilities in the big cities (if you can afford them), there were massive inequalities in healthcare provisions across the country.

Very little was reliable in the poorly resourced rural area I worked in, with no unified minimum standards of clinical practice like you would get across the British Isles- not only could you run out of drugs, but even basic pieces of equipment like spinal needles and laryngeal masks (which were of the reusable sort- and reused far beyond the recommended maximum 40 times). Electricity supply was erratic, and, rather bizarrely for a tropical region (where there was frequent heavy downpours), we would from time to time not any have running water either (so would have to use water stored in barrels).

The electricity supply did not seem to charge or supply the monitors reliably either, and getting the monitoring equipment to charge or work was a considerable source of stress. Hence I have seen at first hand how having a robust and reliable monitor such as a Lifebox pulse oximeter would be a great boon in the hot, dusty, humid and erratically electricity supplied parts of the globe.

Despite these problems the people I met there were amongst the happiest I have met anywhere- they always had plenty of time to chat.

You recently supported Lifebox through RCoA PSPP – what is the event about? Why is it important for UK trainees?

I run an annual Simulation / Patient Safety conference at my own hospital every December, and for the last couple of years we have donated all of the proceeds from the conference to Lifebox. This conference was designed to appeal to all involved in clinical care – doctors, nurses and allied healthcare professionals.

In 2014 and 2015 I decided to bring some of these Patient Safety ideas to a conference at the RCoA – hence “Patient Safety in Perioperative Practice” was born. I wanted to bring to a wider anaesthetic audience some of the themes about Patient Safety, which really is a science all to itself: We are very good as doctors at finding out what the best treatment is for patients, but seem to be lagging behind in making sure those best treatments are all delivered in the best way possible to patients, and that all our hospitals are high reliability organisations (HROs)- like other high risk industries, such as nuclear power and aviation.

As anaesthetists we are often the early adopters of better methods of doing things, and the RCoA & AAGBI have led the way globally in terms of education and setting standards. The conference explored error theory, what it is like to be a patient safety lead in a large Trust, Crisis Resource Management (CRM) tips, the cognitive science behind patient safety, the use of checklists, lessons from aviation, how the national audit projects fit in to improving patient safety, and the future of patient safety. About half of the speakers were not anaesthetists, bringing their own specialist knowledge to share with us.

The conference this year started with a patient’s voice- the mother of a patient who died from medical misadventure gave an extremely moving and thought provoking speech on how errors were made leading to her young son’s untimely demise, the fallout of the event on all people involved, and how she subsequently became involved with the World Health Organisation (WHO) promoting patient safety. I really do hope this will be a start of a trend of having more patient voices heard at medical conferences, as they bring the reason why we are all gathered together to improve things sharply into focus.