SummaryWe performed a retrospective case note review to identify the major complications of epidural analgesia occurring after surgery at our hospital. By cross-referencing the radiology, microbiology and patient information management system databases, we identified patients who had undergone either spinal magnetic resonance imaging or a lumbar puncture within 60 days of surgery in the period from January 2000 to December 2005. Review of these case notes identified six cases of epidural abscess, three of meningitis and three of epidural haematoma. Symptoms of epidural abscess or meningitis developed a median of 5 days after epidural catheter removal. Methicillinresistant Staphylococcus aureus was the predominant pathogen. Epidural haematoma symptoms developed while the epidural catheter was in place. These symptoms were initially attributed to the epidural infusion. Diagnostic delays contributed to adverse neurological outcome in three patients. This study suggests that leg weakness is a critical monitor of spinal cord health. A national database is needed to establish a more accurate estimate of the incidence of major complications and to identify relevant risk factors. Epidural analgesia can provide excellent pain relief and may decrease patient morbidity after major surgery [1][2][3]. However, this technique has significant risks including epidural abscess, meningitis and epidural haematoma. The reported incidence of these complications may be an underestimate, as it is based on case reports [4][5][6][7][8][9][10][11]. In January 2000, we started a survey to determine the incidence of these complications in patients receiving epidural analgesia after surgery in our hospital. MethodsThe survey took place from January 2000 to December 2005 and had Local Research Ethics Committee approval. At the end of each year we gathered data retrospectively from four sources: 1 The acute pain service: to identify all patients receiving epidural analgesia after surgery. 2 Microbiology department: to identify all cerebrospinal fluid (CSF) samples, epidural site swabs or epidural catheter tip specimens.3 Patient information management system (PiMS): to identify all patients undergoing surgery. 4 Radiology department: to identify all spinal magnetic resonance imaging (MRI) scans. Each source was asked to provide the patient's surname, forename, hospital number and date of birth, and where relevant the date of the procedure or specimen. The patient information management system also provided details of the operation performed and the surgical speciality.The data were imported into a database (ACCESS, Microsoft, Seattle, WA). As the acute pain service dataset did not include the hospital number or date of birth, we were unable to identify all patients undergoing investigation within 60 days of epidural analgesia. However, by cross-referencing the PiMS, microbiology and radiology data, we identified those patients who had undergone either a spinal MRI or relevant microbiological investigation within 60 days of surgery. The hospit...

This is a repository copy of Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. The Lancet. ISSN 0140-6736 https://doi.org/10.1016/S0140-6736(18)32521-2 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ ReuseThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) licence. This licence only allows you to download this work and share it with others as long as you credit the authors, but you can't change the article in any way or use it commercially. More information and the full terms of the licence here: https://creativecommons.org/licenses/ Implications of all the available evidenceDespite the success of some smaller projects, there was no survival benefit from a national quality improvement programme to implement a care pathway for patients undergoing emergency abdominal surgery. To succeed, large national quality improvement programmes need to allow for differences between hospitals and ensure teams have both the time and resources needed to improve patient care.

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A standardised colour code for user-applied syringe labels for anaesthetic drugs exists in the USA, Australia, New Zealand and Canada. In the UK, there is none. Consequently, an assortment of colour codes for syringe labels is available in the UK. We conducted a postal survey of the 285 College Tutors of the Royal College of Anaesthetists to establish their local syringe drug labelling system and their views on a national, standardised colour code. We found that that 96% of departments currently use coloured syringe drug labels. Of these, 98% use the 'Medilabel' scheme. The College Tutors felt that a standardised colour code for labels is required (94%), that the Association of Anaesthetists or the Royal College of Anaesthetists should be involved in the choice of scheme (76%) and that the scheme chosen should be international (65%). There was a majority feeling that the opinions expressed were representative of other members of the College Tutors' departments. We conclude that a national standard for drug labels is required and that a choice will have to be made between the 'international' scheme and the currently dominant Medilabel scheme.

In this large pragmatic study, ANH did not affect allogeneic transfusion rate in major gastrointestinal surgery. Preoperative haemoglobin, blood loss, and transfusion protocol are the key factors influencing allogeneic transfusion.