In January 2022, almost exactly a year after the two hospitals merged, surgical teams from Guy’s and St Thomas’ came together with their counterparts at the Royal Brompton and Harefield to carry out a number of life-saving operations. Without the teams working together to pool their resources in this way, some of these patients would have faced very dangerous delays to the urgent treatment they needed.
Here, the two cardiac surgeons who worked on those patients, Mario Petrou (Royal Brompton and Harefield) and Kamran Baig (Guy’s and St Thomas’), talk about their collaboration.
What operations have you been doing?
Kamran: Primarily we've been performing urgent cardiac surgery operations. We classify patients according to their urgency in terms of the clinical symptoms and their underlying disease conditions. So these are patients who are categorised as priority two – ‘P2s’ – and the patient we operated on today, for example, had severe coronary artery disease. He was actually admitted to Guy’s and St Thomas' with symptoms of chest pain, diagnosed with a heart attack, and he had quite severe coronary artery disease that needed to be treated with a bypass. So this is what we performed today and it was very smooth, very successful. And we've just transferred the patient now to intensive care.
The vast number of operations that have been done have been similarly a combination of aortic valve operations or coronary bypass operations and I'm pleased to report that the procedures have gone very smoothly and the patients have had excellent outcomes.
What are the advantages to working across two hospitals?
Mario: I think there are a lot of potential gains with a tremendous opportunity for the organisation to collaborate and integrate our clinical services. We are really just at the beginning of this process, and right now the challenges of the pandemic have made it very difficult to treat some of our patients in a timely fashion. So in an effort to try and do just that, we have identified the most time-critical patients on both sides – at Guy’s and Thomas's and at Royal Brompton and Harefield – and once we've triaged them we say, well, where are the resources, where is the capacity available, regardless of which site, to enable us to treat the patients at the earliest opportunity.
Kamran: Since we've had the merger, we have in fact started working more closely together but we are still operating individually on three different sites. And so this actually has been the best interface, where we have actually come as a group to the same site to do an operation, as surgeons and nurses, and we've interacted directly with our counterparts who have been very welcoming and very accommodating and supportive in that, which adds a personal touch. It's important for us to learn how things are done differently, and we able to offer the patient better, efficient care and overall, it's been very successful.
Do you think this kind of collaboration might become the norm and not just be a one-off due to particular pressures?
Mario: Yes, I think so. There are tremendous opportunities for us to look at the strengths and best practice that exist on the different sites, the clinical and surgical strengths, sub-specialisation, patient pathways, waiting list management, etc. and to see whether we can integrate more of those strengths. So, my hope is that when the pandemic is over, we will continue to work in this collaborative way – not just for the encouragement of professionals to work cross-site per se, but specifically so that our patients can gain new benefits.
For example, when we carry out coronary artery bypass grafting, we harvest the saphenous vein from the leg region in order to construct the bypass grafts and there are two ways of doing that. There is the ‘open’ technique where patients have quite a long incision along the length of the leg, or there’s the ‘keyhole’ or endoscopic approach. The latter is far more attractive to patients as there is significantly less post-operative pain and the incidence of wound infection is much lower.
At Royal Brompton and Harefield, we've offered ‘EVH’ – or endoscopic vein harvesting – to our patients for several years now. It's a mature programme led by our surgical care practitioners and it's embedded in our service. We have started the process of sharing this experience with colleagues at Guy’s and St Thomas' and the hope is that we'll eventually be able to practice EVH endoscopic vein harvest across all three sites.
Kamran: I'm happy to say we’ve actually been collaborating for a number of years in different pathways, especially in the critical care pathway. There's been collaboration for example in the Extra-Corporeal Membrane Oxygenation service (ECMO), which has laid the foundations, and we've been having collaborations in multidisciplinary meetings such as, for instance, a shared aorta vascular multi-disciplinary team between Guy’s and St Thomas', Brompton and Harefield and also King’s Health Partners. So we've undergone some collaboration already.
Have there been any challenges or barriers?
Kamran: In recent times there's been a lot of challenges and one of the underlying factors why we've ended up struggling to do cases and operations is because of the fact that there's been a shortage of essential intensive care nurses and scrub nurses. And so one of the things we can do by working closer together and to support the staff is by giving them new opportunities to see different things. I think it will help boost morale and can show the team members different ways of working and improve their collegiality.
Mario: We have recognised some of the challenges and patient safety is the most important consideration when introducing some change in practice. For example, to simply ‘parachute’ a theatre team from one environment into another when they have never worked in the second environment can be extremely challenging and we were very cognisant of this.
In order to risk-manage this particular issue we put in place a buddy system. Surgical and anaesthetic colleagues from Guy’s and St Thomas' were buddied up with counterparts from the Brompton so that when they arrived there was a period of orientation before they started operating on patients. Then on the day of surgery, the teams would link up to help with simple logistical issues such as issuing of security passes, changing rooms, scrub areas, coffee room, etc. During the day when the operations got underway GSTT colleagues were supported by RBH staff in the event of anything untoward happening. Mercifully this has not yet arisen, but we continue to keep the safety net in place.
You can find out more about the collaboration, and hear from other members of the hospitals' cardiovascular team, in the video below.