On Thursday 17 January five young doctors will compete for the coveted title of Wesleyan RSM trainee of the year.
Meet the finalist | Dr Katie Samuel
RSM Orthopaedics Section
National practice of midstream urine testing preoperatively for elective orthopaedics – Is it worth the resources?
A career with a breadth of skills
Anaesthesia is Dr Katie Samuel’s chosen specialty. After studying medicine at the University of Nottingham she is now an ST6 in anaesthesia, based in Bristol, and sits on the Royal College of Anaesthetists’ Trainee Committee, and Chairs both TRIPOM (Trainees with an interest in Perioperative Medicine) and STAR group (Severn Trainee Anaesthetic Research). She has recently completed a fellowship in Perioperative Medicine at University College Hospitals London as part of out-of-programme training.
Asked about her choice of career, Dr Samuel said: “I chose anaesthesia for the breadth of skills and knowledge that you acquire, as well as the brilliant training programme. It is one of the few specialties where you work one-on-one with a consultant most days, have excellent support throughout your training, and have the confidence to look after the most unwell patients in the hospital.”
Focus on cost saving in the NHS
Dr Samuel’s work could make a significant contribution to cost saving in the NHS, which has been tasked with making £30 billion a year in savings through cost improvement programmes, while still maintaining quality of care with minimal interregional variation. Dr Samuel noted variation in the practice of midstream urine (MSU) testing preoperatively in elective orthopaedics for asymptomatic bacteriuria (bacteria in the urine), which was undertaken historically with the aim of preventing infection of implanted joint replacements on the basis of haematogenous spread from a distant site.
Beginning with a thorough literature review, Dr Samuel identified no evidence that treatment of symptomatic or asymptomatic bacteriuria prior to arthroplasty significantly reduces the incidence of prosthetic infection. This practice is therefore not evidentially led, but is still common practice with no clear national guidelines available. This has major financial implications for labour and procedural costs. With MSU testing alone costing £11 per patient, adopting an evidence-led practice of not routinely screening could save over £2 million annually.
With no studies or records of current UK practice, Dr Samuel and colleagues also conducted a national survey of preoperative MSU testing in elective orthopaedics, aiming to elucidate factors contributing to variations in practice and identify cost saving opportunities.
131 trusts took part in the survey, allowing Dr Samuel and her team to identify widespread variation in UK practice, with the majority performing MSU tests and treating positive results irrespective of symptoms, despite no evidence of benefit. Re-evaluating and standardising this practice could lead to significant national cost savings being made.
Translating the results into practice
Since this work was completed, changes in Dr Samuel’s local processes have been undertaken, which can be used to provide translatable savings for other trusts in the UK. The work has also lead to the review of preoperative urine testing for other specialties, including urology services. A new pathway of care is therefore being implemented preoperatively for urology patients, with expected gains for the trust both financially from process costs, but also in reducing cancelled operations. Balancing measures including surgical infection are currently also being collected, with interim results showing no increase in post-operative infections.
Tips for aspiring prize winners
Prizes such as those offered by the RSM give trainees the opportunity to showcase their work on a wider platform, as well as allowing the chance for recognition of the hard work that they’ve put in. For aspiring prize winners, Dr Samuel’s advice is to just enter. “Most of us worry that our work may not be good enough or that others won’t be interested in it,” she says, adding that imposter syndrome is extremely common among medics! “But if you work hard on something that you are genuinely interested in, then it always shows.”
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Dr Samuel: please talk to us! We issued an FOI request to all NHS Trusts and found urine specimens contamination varied from under 1% to over 70%. We have a low-cost system that guarantees midstream urine capture, valuable as much for orthopaedics as for AMR and routine screening, much evidence to prove efficacy. See Liquid Gold piece in Hippocratic Post, out earlier this week. Please do contact me [email protected]