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Aims/Background Heart failure affects approximately 1 million people in the UK, adversely affecting quality of life, functional capacity and cognitive health. Iron deficiency complicates heart failure in approximately 50% of patients. Giving intravenous ferric carboxymaltose has been shown to improve quality of life in patients with heart failure (New York Heart Association class and Kansas City Cardiomyopathy Questionnaire). Methods A quality improvement project was designed to assess the feasibility, safety and cost implications of establishing an intravenous iron service in the authors' centre. Results Between July and December 2019 61 patients who were screened met the inclusion criteria and were administered intravenous ferric carboxymaltose. There were statistically significant improvements in ferritin levels (83.3 ug/litre to 433 ug/litre; PConclusions Intravenous iron replacement with ferric carboxymaltose is safe and cost effective, and should be considered in eligible iron-deficient patients with symptomatic heart failure. Integration with another day case intravenous service represented the most logistically simple and economically viable method of service delivery.

Introduction Heart failure (HF) affects approximately 1 million people in the UK, adversely affecting quality of life, functional capacity and cognitive health. This results in frequent hospitalisation and significant healthcare costs1, 2. Iron deficiency complicates heart failure in approximately 50% of patients3, and is increasingly recognised as a significant contributor to morbidity in this group. Intravenous ferric carboxymaltose (FCM) has been shown to improve quality of life (New York Heart Association [NYHA] class and Kansas City Cardiomyopathy Questionnaire [KCCQ]), performance in 6-minute walk test (6MWT), reduce hospitalisations, and is reflected in international guidelines4-7. We aimed to assess the feasibility, safety and cost implications of establishing an IV iron service for patients with HF in a large tertiary cardiology centre. Method Over a 6-month period (July-December 2019), outpatients with symptomatic heart failure (NYHA class ≥2) and severe left ventricular systolic dysfunction (LVEF ≤40%) were screened, and serum iron studies performed. Patients with iron deficiency (ferritin Results Fifty-two patients underwent IV iron replacement (69% male, mean age 66 years) with no significant adverse events or hospital admissions. The financial impact to the trust was a net income of £55 per patient (FCM treatment £290, remuneration £345). Ferritin increased significantly 83.3ug/L to 433ug/L (p Conclusion Utilisation of the existing iron infusion service facilitated the delivery of IV iron replacement for patients with heart failure with little need for additional training and resources. Delivery of the service did not incur additional cost to the trust and in fact there was a small net gain. In-keeping with published data we demonstrated comparable improvements in serum iron parameters and a trend towards improvement in NYHA class. IV iron replacement with FCM is safe and affordable and should be considered in all iron deficient patients with symptomatic heart failure. Conflict of Interest Yes - recieved honorarium from Vifor

The number of potentially preventable medical errors that occur has been steadily increasing. These are a significant cause of patient morbidity, can lead to life-threatening complications and may result in a significant financial burden on health care. Effective communication and team working reduce errors and serious incidents. In particular the implementation of the World Health Organisation (WHO) Safe Surgery Checklist has been shown to reduce in-hospital mortality, postoperative complications and the incidence of surgical site infection. However an increasing number of complex medical procedures and interventions are being performed outside of the theatre environment. The lessons learnt from the surgical setting are relevant to other procedures performed in other areas. For the echocardiographer, transoesophageal echocardiography (TOE) is one such procedure in which there is the potential for medical errors that may result in patient harm. This risk is increased if patient sedation is being administered. The British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists have developed a procedure specific checklist to facilitate the use of checklists into routine practice. In this article we discuss the evolution of the WHO safety checklist and explore its relevance to TOE.

Background Cardiac surgery is increasingly performed on patients aged 80 years and over. Previous studies have shown an associated longer length of hospital stay and higher morbidity and mortality. Our aim was to establish whether an increased mortality was demonstrated in patients aged over 80 undergoing surgery in our centre, and the impact of age upon critical care and hospital stay, and 30-day and 6-month survival. Methods Over a 12-month period, 2042 critical care episodes were examined collectively and divided into those undergoing thoracic and cardiac surgery. Propensity matching of 216 patients who underwent cardiac surgery was performed for parameters including Acute Physiology And Chronic Health Evaluation (APACHE) II and Intensive Care National Audit and Research Centre score. Results Of the admissions studied, 1784 were of patients under 80 years of age, and 258 over 80. Thirty-day mortality of those aged over 80 was significantly higher (8.9% vs. 3.8%, p Conclusions As previously demonstrated, we found an increased mortality in the older patient group. Following propensity matching, there was no significant difference in 30-day or 6-month mortality. Older patients must be fitter than their younger peers to compensate for the effects of age on APACHE II score. Even when this is taken into consideration, cardiothoracic operations appear to be safe in patients aged over 80.

Necrotizing fasciitis is a rapidly progressive, life-threatening soft tissue infection which is rapidly fatal unless diagnosed promptly and treated with immediate debridement of necrotic tissue. As early clinical suspicion is paramount to improved survival, this review aims to increase awareness of the condition.

Modified early warning scoring (MEWS) uses abnormalities in routine observations to identify patients at risk of critical illness. Nurses recorded scores at or above the medical response score of 3 on a hospital clinical information system during the first year of introducing MEWS to 10 wards in a university hospital. A total of 619 triggers were recorded in 365 patients. Fifty-nine required intensive care unit (ICU)/high dependency unit (HDU) care; 71 died. Survival was significantly worse for initial scores >4 (35/104 patients died) than for scores 3-4 (P