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Background: In South Africa, the doctrine of informed consent (introduced by the South African courts, Cape Provincial Division) dictates that all reasonable patients be told of material risks and alternative options before consenting to medical treatment or procedural interventions. The reasonable patient standard requires that a patient be told of all material risks that would influence a reasonable person in determining whether or not to consent to the treatment. Regional anaesthesia, including peripheral nerve blocks (PNBs), provides a plethora of benefits to patients undergoing surgery but, due to potential risks involved, also requires informed consent. Studies have shown that South African anaesthetists do not regularly obtain adequate informed consent for these procedures. We implemented a quality improvement project to facilitate and enhance documented informed consent in our setting. Methods: A prospective quality improvement project was established at Groote Schuur Hospital, Cape Town, including all PNBs performed in two-week blocks before and after the introduction of a standardised regional anaesthesia informed consent form. The primary outcome, comparing the incidence of documented informed consent between the two groups, was assessed with the McNemar's test for differences in proportions. Regression analysis was used to explore the effect of prespecified confounders (such as documented consent taken, benefits discussed, alternatives discussed, complications discussed and whether autonomy was documented). Results: In total, 39 and 43 patients were included in the pre- and post-intervention groups, respectively. In our setting, anaesthetists were 4.16 times (95% confidence interval (CI) -6.67 to -2.98, p < 0.001) more likely to take documented informed consent when provided with a standardised form. The incidence of documented informed consent improved from 7.7% to 60.5%. Regression analysis showed that these confounders influenced the recall of the PNB consent and discussed benefits and complications. Overall, recall was mostly influenced when benefits were discussed with patients (95%CI -20.023 to -14.64, p < 0.001). Conclusion: Documentation of informed consent for PNBs in our setting is poor. A standardised consent form can facilitate the documentation of consent significantly. Patient recollection of the consent process also improved, specifically when benefits were discussed. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) is becoming part of the standard skill set of the modern-day anaesthetist. There is limited knowledge regarding the availability of ultrasound (US) and POCUS skills in South Africa. There may be barriers to adopting US in many institutions. Methods: An observational cohort questionnaire was distributed via an online REDCap survey. All doctors practising anaesthesia in South Africa were eligible. Recruitment was done via an email link that was sent to South African Society of Anaesthesiologists (SASA) members. Non-SASA members were recruited via departmental mailing lists or social media. Results: Of the 580 respondents, 478 were SASA members (response rate 22.9%, confidence interval 3.94) and 102 were non- SASA members. In total, 571 surveys were suitable for analysis, 397 (69.5%) respondents had more than five years anaesthesia experience, 558 (97.7%) of respondents worked in hospitals that have US machines available, and 76.7% had US readily available after hours. Respondents used US mostly for central venous catheter (CVC) insertions (77.9%), regional anaesthesia (82.3%), and cardiac and lung assessments (26.4% and 17.7%, respectively). It is used much less frequently for neuraxial anaesthesia (1.4%). Of the respondents, 382 (66.9%) had received US training, only 198 (34.7%) felt confident in their US skills, and 482 (84.4%) wish to have further US training. The two most significant barriers to US were lack of equipment and lack of training at postgraduate level. Conclusion: South African anaesthetists work at institutions where US equipment is generally available, and most practitioners want to incorporate US in their practice. However, anaesthetists feel insecure with respect to their skills and indicated that they wish to receive further training. Efforts should be made to formalise POCUS training in the Fellowship of the College of Anaesthetists (FCA) curriculum and make US training more accessible. [ABSTRACT FROM AUTHOR]

For more than 70 years the default therapy for anaemia and blood loss was mostly transfusion. Accumulating evidence demonstrates a significant dose-dependent relationship between transfusion and adverse outcomes. This and other transfusion-related challenges led the way to a new paradigm. Patient blood management (PBM) is the application of evidence-based practices to optimise patient outcomes by managing and preserving the patient's own blood. 'Real-world' studies have shown that PBM improves patient outcomes and saves money. The prevalence of anaemia in adult South Africans is 31% in females and 17% in males. Improving the management of anaemia will firstly improve public health, secondly relieve the pressure on the blood supply, and thirdly improve the productivity of the nation's workforce. While high-income countries are increasingly implementing PBM, many middle- and low-income countries are still trying to upscale their transfusion services. The implementation of PBM will improve South Africa's health status while saving costs.