Dr Ian Jackson Back
Dr Ian Jackson is a distinguished anaesthetist, clinical safety leader, and former consultant anaesthetist with extensive experience in day surgery, anaesthesia, critical care, and healthcare IT implementation. Dr Jackson is a Past President of both the International Association of Ambulatory Surgery and the British Association of Day Surgery.
What has been the biggest change in surgery during your career?
When I started managing my hospitals day surgery unit in the early 1990’s we were mainly a Urology and Gynaecology service. Cholecystectomies were still open surgery and required several days stay in hospital. So, I think that the expansion of laparoscopic surgery into other specialties has been the biggest change I have witnessed and helped bring a large number of procedures into the day surgery arena.
What innovation excites you most?
I think technology that supports the day surgery pathway excites me most. Systems are now available that help support the patient through the entire pathway. If you use the system to start the preoperative assessment process, then it knows which patients are on drugs that need stopping or diabetics who need instruction on what to do on the day. The system can automatically prompt the patient. However, it is the post discharge process that really interests me – the ability for 2-way messaging, completion of post discharge questionnaires and system that highlights to team where there is an issue.
What do other trusts do better than yours / what does yours do best?
I found this the most difficult question to answer as every day unit has strengths and weaknesses and arguably that is a reflection on the surgical leadership for each specialty. I believe that we can become complacent – thinking the job is done. So instead, I would like to suggest that day surgery units should invite an external colleague to spend a day reviewing the unit and their procedures on a 5-yearly cycle. The expert should produce a report that can be used to consider where improvements can be made – a fresh pair of expert eyes can be very enlightening.
What advice would you give someone starting their career?
If a surgeon, then visit the day surgery facility and see for yourself how it works. Speak to those in charge and meet some of the staff before your first list. Then start slowly and don’t try to do too much on your first lists. Use the time on those lists to get to know the staff that you are working with and their abilities. If you are introducing a new procedure work to help the staff understand what is required of them and support their training. Obviously, I would say join BADS but also attend the annual meeting and look for the nuggets you can take back to your own unit.
If an anaesthetist, then I would suggest that you ensure you know all the protocols that your day unit has – many have good ‘recipes’ the how to succeed with the more challenging day surgery procedures. Follow the protocols and if you disagree with one, then work with colleagues to get it changed. Get to know the staff and ask who has the best outcomes for their patients. Look at what they are doing and consider your own practice and what you can do to improve. Again, join BADS and attend the annual meeting, use it to build a network with colleagues and you will learn from each other.
What will day surgery look like in 10 years?
It is inevitable that procedures undertaken as day surgery will continue to expand but we will also lose some procedures to outpatient settings and some procedures will disappear as medical advances remove the need for them e.g. HPV vaccination, GLP-1 medications.
Day surgery for this expanding group of procedures and patients will be supported by technology that includes digital links to the patient at home. Devices will make monitoring of vital signs and patient movement easy and will be coupled with AI to constantly review the data providing the ability to alert clinical team if an issue is detected.