Peter Young is a consultant in Anaesthesia and Critical Care at the Queen Elizabeth Hospital, King’s Lynn. He has a strong interest in innovation and is involved in the development of a number of new technologies to help improve patient safety, including the PneuX™ (LoTrach) endotracheal and tracheostomy tube and cuff pressure controller, and SAFIRA® for regional anaesthesia, both of which are being used across the globe. Peter was selected as a fellow on the NHS Innovation Accelerator programme to understand the barriers to implementation of VAP prevention strategies.
JAP: As a specialist in anaesthesia and critical care, could you tell us more about your experience and training background in this field?
PY: I trained at Edinburgh Medical School from 1985-1990 and subsequently worked in Edinburgh, Leeds, Norwich, Cambridge and Christchurch, New Zealand. I undertook a post-graduate degree at the University of East Anglia, completed in 1999. I have been on the Queen Elizabeth Hospital staff as a specialist since 2000.
My research interests include the development and implementation of medical safety innovations to prevent serious adverse and never events. I have filed 15 patents for innovations over 25 years, which are under development through the NHS, Industry, Medtech Accelerators and start up companies and of which eight are on the market. I represent innovation, safety and industry for the Association of Anaesthetists, am an Alumni Fellow of NHS Innovation Accelerator Programme and a mentor for the NHS Clinical Entrepreneur Programme.
JAP: What drove you to choose anaesthesia as a career?
PY: I have always enjoyed the immediacy and excitement of correcting acute physiological derangements, thereby providing unambiguous and timely benefits to vulnerable patients.
JAP: This year, it is clear that the healthcare industry has been greatly impacted by the pandemic, what has been the greatest impact within the anaesthesia industry?
PY: 2020-21 was the most challenging year of my career and certainly carried a personal toll. Working on the frontline was stressful for all of us facing personal risks and overseeing terrible tragedies. This was perhaps most overwhelming for the trainees and the nursing staff especially those reallocated to critical care.
I was honoured to be able to contribute nationally, both through my work with the NHS Clinical Entrepreneur Programme with the “COVID-19 ventilator challenge” and with the Association of Anaesthetists COVID response group offering advice, guidelines, governmental lobbying and welfare for our 10,000 members.
JAP: What’s the best part of your job?
PY: Providing benefit to my patients and providing education and support to my trainees and nursing colleagues. I also get a kick out of designing safety onto medical equipment, because when this becomes used widely, it feels like you are making a small improvement to safety for many, many patients around the world.
JAP: … and the worst?
PY: The imprecision of difficult decision-making in anaesthesia and critical care is particularly challenging when weighing up benefits and burdens with patients and families to help determine the best course of treatment for them.
JAP: What has been the highlight of your career so far?
PY: I have multiple highlights, each time one of my engineered safety innovations is marketed and used widely to protect patients
JAP: Tell us more about your invention to promote safety in regional anaesthesia and the development pathway for the product?
PY: One of my most recent inventions was done as a collaboration with three co-inventor colleagues at my hospital. We spotted the problem of injection pressure related nerve injury which had not been satisfactorily addressed and created patient harm and medicolegal claims against individuals and hospitals. We created a clinical simulation study to show that it was impossible for anaesthetists and assistants to judge injection pressures and showed that they commonly injected at vastly excessive pressures. We presented this at ASRA (American Society of Regional Anesthesia and Pain Medicine) and we saw an opportunity to fix the problem.
It was important to achieve a perfect trinity of patient benefit, clinician benefit and benefit to the healthcare institutions. After a number of prototypes we settled on the best and drew up and filed patents for the novel aspects of the system. This enabled us to engage with industry, through an NHS start up company, Medovate, and with the help of Medtech Accelerator grants we produced proof of concept prototypes which ultimately evolved into an FDA approved and CE Marked device.
JAP: How can this create improved patient outcomes and a better clinical outcome?
PY: The device was named SAFIRA®: SAFer Injection for Regional Anaesthesia. It is a technology that makes regional anaesthesia a single person procedure and returns the control of the infiltration timing and speed to the operator thereby offering an ergonomic improvement. SAFIRA® includes a built-in safety mechanism which automatically prevents injection above 20psi, reducing the risk of nerve injury. Patients, anaesthetists and healthcare providers can be reassured when SAFIRA® is used. This technology has had very rapid uptake and is being used across the globe to help improve patient safety and care.
JAP: Do you have any more innovations in the pipeline?
PY: Yes – there are a number, from my first innovation, the PneuX Pneumonia Prevention System which prevents pulmonary aspiration and Ventilator- associated pneumonia, to most recently the WireSafe device which facilitates the clinician placing a Seldinger-wired catheter but crucially makes it impossible to leave the guidewire in the patient which is a ‘never event’. Previously, clinicians were blamed for what human factors science tells us is an inevitable error – now there is a system solution which can be implemented to protect both the patient and the clinician at the sharp end. Two other devices are the ‘GlucoSave’ and the ‘Humidicare’ which help prevent two other ‘never events’ in critical care.
JAP: If you weren’t an anaesthetist what would you be?
PY: If I was restarting now, I would be a mathematician and empower medicine with machine learning. I see AI as the next revolution in what we do within and outside of medicine over the next 20+ years.
JAP: What would you tell your 21-year-old self?
PY: Buy Bitcoin then sell in 2021. More seriously, I think developing an early understanding of business and the levers that are needed to allow timely development and implementation. It has taken me 35 years to get a feel for this.
JAP: If you were Health Minister for the day what changes would you implement?
PY: I would work towards a return to true strong clinical leadership in NHS hospitals. I would also improve the recognition of the contribution of political decisions, funding and organisational responsibilities relating to safety and errors. Currently, for predictable errors which are incompletely mitigated against, blame is all too often devolved to clinicians at the sharp end.
JAP: Away from the clinic and operating theatre – what do you do to relax?
PY: I have a young family so relaxation is at quite a premium. I enjoy technology, DIY and a G&T in the garden on a summer’s day.
JAP: How do you think the future looks in the field of anaesthetics and patient experience and what are your predictions for the decade ahead?
PY: Anaesthesia will continue to become safer through culture, education, training and vigilance. But crucially we will learn from the high reliability industries who produced the hierarchy of interventional effectiveness. This tells us that for rare but serious events, errors will need to be prevented through engineering and implementing design improvements and/or AI assistance.