bluuebunny/crossref_metadata_2025 huggingface dataset:
776 “Doses of Human Anatomy”: A Telegram Channel Augmenting Anatomy Education
Authors: Ali A , Awad K
Published: August 2023

Introduction

Telegram has become one of the most popular messaging applications. Its multiple features enable its use for different educational purposes. This study aimed to explore the role of a Telegram’s channel in Anatomical education.

Method

A Telegram channel was created and shared to first year medical students of University of Khartoum. Subscription to the channel was optional. The Thorax module was covered through different types of daily online posts and quizzes which were posted over one month, in line with the formal practical sessions. At the end of the module, an online test shared to both subscribers and non-subscribers, a feedback questionnaire and focus group discussion were used to assess the effects of the channel and students’ reflection on it.

Results

336 students subscribed to the channel by the time of the test. There was a significant association between subscription status and test score (p = 0.01, t = 2.79). Frequency of viewing did not affect test score. Students reported that written posts with images and quizzes were the two most helpful types of posts. Students reported that the channel made it easier for them to understand anatomy (86.4%), aided retention of information (92%) and encouraged engagement (81.6%). Continuation of the channel was recommended by 95.2% of students.

Conclusions

The channel provided concise and structured material that acted as a blueprint for students during studying and exam preparations. It proved itself as a useful complementary tool for students in the anatomy module. We recommend formal integration of Telegram channels in anatomy curricula.
617 External Validation of the IDENTIFY Risk Calculator for Predicting Urinary Tract Cancer in Patients with Haematuria
Authors: Khadhouri S , Orecchia L , Banthia R , Piazza P , Mak D , Pyrgidis N , Narayan P , Abad Lopez P , Nawaz F , Thanh T T , Claps F , Hogan D , Gomez Rivas J , Chibuzo I , Kulkarni M , Anbarasan T , Gallagher K , Kasivisvanathan V
Published: August 2023

Aim

Risk-stratification for patients referred with haematuria is important in diagnosing cancer early and for health resource efficiency. A recent prediction model developed from the IDENTIFY study created a cancer risk calculator that aimed to help clinicians with their decision-making in the investigation of patients with haematuria. We aimed to externally validate this model in a separate cohort from the development population.

Method

Data were collected on patient characteristics used for the risk calculator, and the cancer outcome recorded. Patients with a previous or existing urological malignancy were excluded. Development and validation cohort demographics were compared. The area under the receiver operating characteristic curve (AUC), calibration slope, calibration-in-the-large (CITL), and Brier’s score were used to assess external validation.

Results

There were 3483 patients from 111 hospitals across 27 countries. 12 countries were new countries not used in the development cohort. The development and validation cohorts were well matched. When comparing the observed vs predicted outcomes of the prediction model on the validation cohort, the calibration slope was 0.97 and CITL was 0.33. AUC was 0.79. Brier’s score was 0.15.

Conclusions

External validation of the IDENTIFY risk calculator shows good accuracy and discrimination for predicting urinary tract cancer in patients referred with haematuria. The model underestimates the risk slightly and this can be recalibrated by adjusting the intercept of the regression equation. The recalibrated risk calculator can be introduced into diagnostic haematuria pathways to improve risk stratification and health resource allocation.
598 Video-Assisted Thoracoscopic Surgery Versus Robot-Assisted Thoracoscopic Surgery in Early-Stage Lung Cancer: A Systematic Review and Meta-Analysis
Authors: Shirke M , Soh V , Azmi A , Wee A
Published: August 2023

Aim

Video-assisted thoracic surgery (VATS) remains the main surgical procedure for lung cancer resection. However, it is associated with technical limitations and a steep learning curve. Hence, alternative approaches like robot-assisted thoracic surgery (RATS) have been explored. This review aims to compare the clinical outcomes of VATS versus RATS in early-stage lung cancer patients.

Method

A systematic, electronic search was performed according to PRISMA guidelines to identify relevant articles that compared outcomes of the VATS versus RATS procedures in patients with early-stage lung cancer.

Results

Seventeen studies were identified, enrolling 17,111 patients. The mean tumor size was 12.58±7.21cm in the RATS group and 5±2.5cm in the VATS group, with most patients in the Stage 1 cancer group. The primary outcomes, length of hospital stay (MD 0.37, 95% CI [-0.15, 0.89], and conversion (OR 0.99, 95% CI [0.68, 1.43]), were not statistically significant. Although more lymph nodes were retrieved during the RATS procedure (MD -0.70, 95% CI [-1.18, -0.21]), no significant differences were observed in other secondary outcomes such as operative duration (MD -0.14, 95% CI [-1.00, 0.73]), reintervention (OR 1.47, 95% CI[0.22, 9.79]), infection (OR 0.89, 95% CI [0.52, 1.54]), and bleeding (OR 1.15, 95% CI [0.52, 2.55]).

Conclusions

The RATS and VATS procedures have comparable outcomes, thus proving the RATS procedure to be a safe alternative. However, the technical feasibility and cost-effectiveness need to be thoroughly studied. This review calls for robust trials comparing the two techniques to further evaluate the value of the RATS procedure in early-stage lung cancer.
828 Real-Time Artificial Intelligence Instruction in Comparison to Human Expert Instruction in Surgical Technical Skills Teaching – a Randomized Controlled Trial
Authors: Yilmaz R , Bakhaidar M , Alsayegh A , Abou Hamdan N , Fazlollahi A M , Del Maestro R
Published: August 2023

Aim

Surgical simulators equipped with artificial intelligence (AI) systems provide risk-free training on realistically simulated complex patient cases, objective performance assessment, and tailored error avoidance feedback. This study compared the efficacy of real-time AI instruction with human instructor-mediated training in surgical technical skills teaching.

Method

Medical students (n = 98) were randomly allocated into three feedback groups. Everyone repeated a virtual brain tumour resection five times. The first repetition was done without receiving feedback to assess their baseline performance. Students in Group 1 did not receive real-time feedback, and they were shown visual feedback only after each procedure based on expert benchmarks. Students in Group 2 were instructed in real-time by the AI system. After each task, the students were shown their error-video clips generated by this system alongside the expert-level demonstrations relating to each error. Students in Group 3 were instructed by human instructors during the tasks. After each task, instructors summarized the areas of improvement and demonstrated correction techniques. All participant data was scored using a composite-score. Statistical analysis was conducted to compare learning from the first to the last task repetition.

Results

Students in Group 2 and Group 3 significantly improved in the performance score by the third and second repetition, respectively (p<0.01, p = 0.01) compared to their baseline performance. Students in Group 2 achieved significantly higher scores than those in Group 3 in the fifth repetition (p<0.01).

Conclusions

Artificial intelligence systems may provide competency-based curricula in surgical training with efficient surgical technical skills teaching methodologies.
69 Is CT Urogram Screening Necessary in All Patients with Visible Haematuria in Both the Immediate and Short-Term Follow-Up Period?
Authors: Mallalieu K
Published: August 2023

Introduction

A standardised specific investigation protocol for visible haematuria (VH) screening remains a debate. A recent regional audit highlighted our department as an outlier for the high useage of CT urogram (CTU). We sought to determine the incidence of upper tract cancer (UTC) in a VH cohort, exploring the benefit of routine CTU versus the possibility of developing a selective patient-centred approach.

Method

Retrospective case-note review of all 2-week-wait patients referred for VH from May-October 2018. Data was analysed to describe the incidence of bladder transitional cell carcinoma (TCC), upper tract transitional cell carcinoma (UTTCC) and renal cell carcinoma (RCC); the detection rate of CTU and the missed rate of UTC over the following four years.

Results

437 patients (334 men, 103 women; age range 21-95 years, median age 71 years; 35% smokers, 45% non-smokers, 18% smoking status unknown) underwent VH screening with a cancer detection rate comparable to previous literature (18% TCC, 1.4% RCC, 1% UTTCC). 73% (n = 321) underwent CTU, 52% (n = 229) underwent CTU and ultrasound (USS). USS missed one RCC subsequently detected by CTU. 72.7% and 63.6% of those diagnosed with UTC (age range 57- 86, mean age 71 years) were male or smokers, respectively. 43% (n = 189) received further upper tract imaging during the subsequent four years, with one further RCC detected.

Conclusions

The additional detection rate of CTU and subsequent development of UTC was minimal within our cohort suggesting the use of CTU in VH screening could be selective rather than routine.
91 Introduction of a Simple Proforma Improves Documentation of Neuro-Vascular Status in Paediatric Supracondylar Humerus Fractures (Closing Loop Audit)
Authors: El-Gendy M , Hassan A , Soliman E , Deierl K
Published: August 2023

Introduction

Supracondylar fractures of the humerus are the most common fracture around the elbow in children. There is a risk of significant complications including nerve injury, vascular compromise, compartment syndrome and clinical deformity. BOAST (British Orthopaedic Association Standards for Trauma) published guideline 11 in 2014 (updated in Oct 2020) which lists criteria that should be assessed and documented for each child with this injury.

Aim

Assess whether an introduction of a simple proforma will Improve documentation of the neuro-vascular status in paediatric supracondylar humerus fractures.

Method

a closing loop Audit to review the accuracy of documentation of the neuro-vascular status in the admission clerking against the standards published in the updated BOAST guidelines both before and after introduction of a simple documentation proforma.

Results

In the first audit cycle 30 patients were included and detailed documentation of the Neuro-vascular status as per the BOAST guideline was less than 40 %. After the proforma was introduced, the second closing loop cycle included 31 patients and detailed documentation of the Neuro-vascular status as per the BOAST guideline was 70 %.

Conclusions

The introduction of a simple proforma has improved significantly the documentation of the neurovascular status in children presenting to the ED with a supracondylar humerus fracture.
139 “Never Event, Never Again” - a Closed Loop Audit on the Documentation of Nasogastric Tube Position Following X-Ray Confirmation
Authors: Iosif G , Tan C H , McCadden L
Published: August 2023

Aim

Nasogastric feeding is common among ENT patients with dysphagia. CXRs are performed to confirm tube position before feeding. However, communication failure from poor documentation potentially leads to feeding through a misplaced tube into the lungs which is a "Never Event". This audit aims to reduce risk of patient harm by encouraging the use of nasogastric tube documentation sticker on clinical notes in Royal Victoria Hospital ENT ward.

Method

An initial study was conducted in June 2022 evaluating the quality of documentation of NGT position following CXR. Subsequently, several interventions were implemented including teaching doctors on utilising the documentation sticker that comes with each NGT pack, placing posters on the ward and reminding the nursing staff to check the documentation before starting feed. Further re-audit was carried out in August 2022 post-intervention.

Results

58 CXRs were performed. Use of the documentation sticker rose from 42.1% to 85%. This led to verification of patient identity increasing from 39.5% to 100% and confirmation that the x-ray was most recent for the patient from 44.7% to 100%. 85% of the x-rays had time and date verified compared to 34.2% previously. Documentation of the position of NGT and instructions for feeding improved from 63.1% to 75% and 65.8% to 75% respectively. Record of the staff who confirmed tube position increased from 60.5% to 75%.

Conclusions

This audit demonstrated an increased use of the documentation sticker resulting in improvements in confirmation and documentation of NGT position. These positive changes reduce risks of significant patient harm thereby improving patient safety.
185 Improving Care and Outcomes with One-Stop Haematuria Clinic
Authors: Klyvyte G , Fernandes M , Nelson A
Published: August 2023

Aim

To compare the outcomes of pre and post implementation of a Faster Diagnostic Standard (FDS) at 28 and 62 days before and after implementation of the One-Stop Haematuria Clinic in James Paget University Hospital.

Method

The data for the retrospective audit was collected from the Somerset cancer registry and Ullyses. All patients referred on 2 week-wait haematuria pathways were included from July 2020-October 2020 (pre-implementation of the one-stop clinic, n = 132) and from September 2021 – January 2022 (post-implementation of the one-stop clinic, n = 269). The data points were 2 week-wait, referral to flexible cystoscopy, imaging, 28-day and 62-day targets. The data was analysed using unpaired T-test.

Results

Following implantation of the one-stop clinic, the mean number of days for referral to flexible cystoscopy reduced from 27 to 19 (p<0.0001) and referral to imaging reduced from 27 to 19 (p<0.0001). The mean number of days to reach 28-day target decreased from 47 to 31 (p<0.0001). Days from referral to TURBT (Transurethral Resection of Bladder Tumour) decreased from 61 to 57 (p = 0.60). The patients meeting the 62-day target of TURBT as FDT increased from 66% to 83% (p = 0.35).

Conclusions

The introduction to one-stop haematuria clinic led to shorter time from referral to flexible cystoscopy, imaging and diagnosis. However, time from referral to TURBT was similar. A greater percentage of patients met the 62-day target of TURBT as FDT. Therefore, one stop haematuria clinics provide a more efficient diagnostic pathway for this group of patients.
237 Delay in Ankle Fracture Fixation Against BOAST Guidelines for Ankle Fractures
Authors: Hassan R , Divekar M
Published: August 2023

Aim

Ankle fractures are common, and the majority are the result of low energy torsional trauma. The aim of treatment is to restore and maintain stability and alignment of the joint, ideally with normal anatomy of the ankle mortise. According to BOAST guidelines for ankle fractures, Early fixation within 24-48 hours is recommended in the majority of patients under 60 years when the ankle mortise is unstable. This study aimed at assessing our practice in managing ankle fractures against BOAST guidelines and infection rate assessment.

Method

Data was collected respectively from electronic patient records for three months period and entered excel. First cycle results were presented in a departmental audit meeting and recommendations to improve practice were acted upon. Second cycle data was collected three months later and for three months period. Final re-audited results were presented in a departmental audit meeting.

Results

First cycle results: only 11% of patients had their ankle fractures fixed within 48 hours and none of them had surgical site infection. 65.2 % of patients had their operations over a week with an Infection rate of 10.6%.

Second cycle results: 19% of patients had their ankle fractures fixed within 48 hours and none had surgical site infection. 47.6 % of patients had their operations over a week with an Infection rate of 4.8%.

Conclusions

Second cycle results showed improvement in operative timing and surgical site infections rate against BOAST guidelines compared to initial first cycle results. Early fixation for ankle fractures is associated with lower infection rates.
331 Improving Equity of Access in a Post-Covid World: A Closed Loop Audit of the Varicose Vein (VV) Referral to Treatment (RTT) Pathway
Authors: Farndon D , Bennett P
Published: August 2023

Aim

Restrictions in clinic, investigations and theatre capacity following COVID-19 led to a change in local CCG VV referral criteria meaning those with advanced venous disease were seen. However, it was noted that many patients attending clinic didn’t meet these new CCG criteria.

Method

Following a change in CCG criteria in April 2021, all VV referrals to vascular surgery between 01/04/21-28/02/22 (AC1) were audited and differences between the consultants’ acceptance practice was reviewed. Results were presented at clinical governance in 09/03/22, with change implemented and referrals between 01/04/22-31/07/22 (AC2) re-audited.

Results

250 VV referrals were made in AC1, 43.5% Male, mean (±SD) age 54.8 (16.9) years, by GPs (82.8%), other HCP (11.6%). 158 (63.2%) failed the criteria and should have been rejected. However, the actual rejection rate was 44.9%, with significant differences (P<0.001) in consultant practice demonstrating inequity for patients’ acceptance to be seen in clinic. 62.9% of ineligible patients attending clinic had subsequent investigations, increasing the waiting list time for all patients.

153 VV referrals were made in AC2, 43.1% Male, mean (±SD) age 55.3 (17.7) years, by GPs (86.3%), other HCPs (12.4%). 96 (63.7%) failed the criteria. However, in AC2 there was a 15.5% improvement (p = 0.02) in consultants appropriately rejecting outright and no significant differences in consultant practice (P = 0.46).

Conclusions

There is now less variation between consultants and a greater adherence to CCG criteria in AC2 demonstrating improved equity of access. There are fewer inappropriate clinic attendances, therefore less investigations and treatment booked, decreasing overall wait time and unnecessary downstream costs.
388 “Day Case Laparoscopic Cholecystectomy – Are We Getting It Right?”
Authors: Zeng L , Joglekar S
Published: August 2023

Introduction

About 66,660 cholecystectomies are performed in the UK annually, of which majority are laparoscopic, costing NHS about £ 111 million. As per GIRFT, 80% eligible patients should have cholecystectomy within 8 days of hospital admission. Cholecystectomy quality improvement collaborative was established nationwide to support surgical teams and improve patient outcomes. At our hospital, we have established a twice weekly HOT LAP CHOLE list to manage these patients.

Aim

To analyze outcomes after day case laparoscopic cholecystectomy.

Method

Records of 100 patients over 3 months undergoing elective or emergency cholecystectomy were retrospectively analyzed. Data collection included demographics, diagnosis, length of stay (LOS), complications, conversion rate, and re-admission rate.

Results

Among 100 cases (26 males, 74 females, with an age range of 22 – 89), 80 were elective and 20 were emergency. All emergency cases were operated on within 8 days of hospital admission. 73 were successfully performed as day cases (69 elective, 4 emergency), making the elective day-case rate 86%. LOS ranged from 1 to 34 days, and the reason of stay was mainly post-op pain/vomiting or drain left intraoperatively. 3 cases were converted to open (2 electives, 1 emergency). The re-admission rate was 6% (4 electives, 2 emergencies), mainly because of post-operative pain. 9 patients had complications (3 - bleeding, 5 - bile leak, 1 - wound infection).

Conclusions

The successful day-case rate meets the recommendation by the British Association of Day Case Surgery (> = 60%). And our HOT LAP CHOLE list has effectively improved the management of emergency cholecystectomy. However, post-op pain control should be optimized.
463 Adherence to Extended Venous Thromboembolism Prophylaxis for Post Operative Resection of Colorectal Malignancies
Authors: Yeung T , Ng S , Sidhu R , Ali M
Published: August 2023

Aim

Patients undergoing cancer resection abdominal surgery are at high risk of developing venous thrombo-embolism (VTE) in the post-operative period. To reduce this risk, these patients should be considered for extended pharmacological VTE prophylaxis for 28 days post-surgery as per NICE guidelines (NICE NG89). In our surgical department, we give all colorectal cancer resection patients 5000 units of Deltaparin for 28 days post resection unless it is contraindicated. We aimed to evaluate adherence to this guideline.

Method

This is a single-centre retrospective audit study. We included 100 colorectal cancer resection cases between 1st October 2021 and 28th February 2022 (n = 100). Retrospective data was collected including the type of procedure, histology and whether post-operative Deltaparin was prescribed for 28 days. All consecutive colorectal cancer resections were included in the study. The data was collected from the patient electronic records, electronic prescribing system and the electronic discharge summaries.

Results

The most common operation was anterior resection of the rectum (42%) followed by right hemicolectomy (40%). The Adherence to the NICE guidelines for extended VTE prophylaxis was 87%.

Conclusions

The adherence to the NICE guidelines in our department falls below the national target of 90% adherence. To improve the compliance, we will carry out staff education on appropriate anticoagulation prescribing and also display informative posters in the surgical wards to increase the awareness. We will aim to re-audit the adherence to the guidelines after implementing these measures.
472 An Audit on the Optimal Timing of Imaging in Acute Pancreatitis
Authors: Patel M , Khawaja A , Oki T , Eigbefoh R , De Silva K , More A , Lascelles S , Troller R
Published: August 2023

Aim

Acute pancreatitis (AP) is an inflammatory process of the pancreas with varied aetiology, commonly gallstone disease (50%) and excess alcohol. We aimed to assess the compliance of our trust in diagnosing and imaging against IAP/APA and BSG guidance.

Method

Patients diagnosed with AP between 05/2022 and 12/2022 were retrospectively collected. We investigated factors based on guidelines including correctly diagnosing AP within 48 hours of admission, adherence to optimal timing for ultrasonography (<24 hours of diagnosis) and CT (within 72-96 hours after onset of symptoms or 48 hours of admission).

Results

65 patients were analysed and correct diagnosis within 48 hours was achieved in 90%. The compliance with timing and type of imaging was, unfortunately, extremely low. Only 6.15% of patients had a CT after 48 hours of admission, 29.23% within 72-96 hours after the onset of symptoms and only 17% had ultrasonography within 24 hours of diagnosis. CT was the initial imaging modality for 75% of patients despite it diagnosing pancreatitis secondary to gallstone disease in only 17% of all cases.

Conclusions

We demonstrated that our trust is proficient at timely diagnosis of AP, however, has poor compliance with both the timing and type of imaging. BSG recommends ultrasonography as initial imaging in suspected AP over CT due to ultrasonography’s low cost, accuracy and sensitivity. Additionally, early CT’s underestimates final disease severity and do not improve outcomes. Improvements to our service can be made by educating staff regarding the current guidelines and working with the trust to increase ultrasonography availability.
474 Audit of ENT Department Handover Practice: An Improved Patient Safety Outcome
Authors: Tan D , Ko T K
Published: August 2023

Aim

To analyse the comprehensiveness and reliability of e-handover sheets in a district hospital ENT unit, and to compare the departmental standards in line with Royal College England Guidance on Safe Handover (2007).

Method

Retrospective analysis of e-handover sheets were analysed over two periods (31 days and 16 days). To improve standards, we distributed the Royal College of Surgeons England guidance, junior doctors received regular feedback and emphasise the importance of handover to the ENT doctors during clinical governance and induction sessions.

Results

The reaudit cycle demonstrated data transfer improved from morning handover information were present and complete on 70 per cent of days, present but incomplete 30 per cent of days, and absent on 0 per cent of days; evening handover information were complete 75 per cent of days, present but incomplete 25 per cent of days, and absent on 0 per cent of days.

Conclusions

Following our first and second audit cycle results, the quality and standards of e-handover information showed significant improvement.
477 Documentation of Resuscitation Decisions in Surgical Patients in a District General Hospital
Authors: Koh S W , Dornseifer M , Liyanage T , Koay C G , Koh S H , Guru Naidu S , Abeysekara A
Published: August 2023

Introduction

Every patient admitted into hospital has to have a clear documentation of their resuscitation decisions in their current health charts.1 This enables surgeons to provide the best and sometimes major surgical treatment without delay in the first instance. The aim of this study was to assess the completeness of the resuscitation decisions for surgical patients admitted into our department.

Method

All patients on our surgical handover list between 22nd August and 31st August 2022 who were admitted were included in this study. Patient charts were reviewed, and data collected in relation to the completeness of the resuscitation decisions and treatment escalation plan (TEP).

Results

A total of 50 patients were included. 35 patients (70%) had their resuscitation decisions documented whereas 33 patients (66%) had documented TEP. This is in contrast to guidelines as not all of admitted surgical patients had their resuscitation decisions or TEP documented. Our planned interventions were highlighting its importance in a virtual departmental meeting, educating new incoming junior doctors, sending departmental reminder emails and making the section of the proforma a mandatory field to complete.

Conclusions

Documentation of resuscitation decisions is important in providing quality of care for patients. Our result showed intervention is needed to ensure best practice is adhered to. We plan to achieve a better data completeness in our next audit cycle after intervention.
493 Audit of Antibiotic Prescriptions in Appendicectomies and Adherence of Surgeons to National and Local Trust Guidelines: Preoperative and Postoperative
Authors: Al-Balah A , Iskandar A , Yousof H
Published: August 2023

Aim

To investigate adherence of antibiotic prescriptions to national and local standards in appendicectomies, pre-operative & post operative, in a district general hospital. BMJ Best Practice standards state that all patients should be given prophylactic antibiotics preoperatively, but only complicated cases (perforation and/or abscess and/or acutely unwell) need to be given postoperative antibiotics. Adherence to local prophylactic antibiotic guidelines was also assessed. Trust antimicrobial guidelines are freely available on the MicroGuide mobile application - https://tinyurl.com/gastrosurg.

Method

A retrospective audit conducted in a district general hospital. A 6-month audit of antibiotic prescriptions in appendicectomies to investigate adherence rate to national and local standards. The important information was collected from the trust’s electronic patient record through a predesigned Pro forma.

Results

A total of fifty patients (patients with penicillin allergy; n = 4; 8%) underwent an appendectomy between June 2022 and November 2022 in a district general hospital. 100% of patients were given prophylactic antibiotics. However, only 25% of cases of penicillin allergy and 2.2% of cases with no penicillin allergy were given prophylactic antibiotics that adherent to trust policy. Complicated cases comprised 30% of cases. 100% of complicated cases had postoperative antibiotics while 80% of uncomplicated cases had postoperative antibiotics unnecessarily.

Conclusions

This audit cycle showed poor adherence to national and local antimicrobial standards. Action plan includes presenting results in the monthly surgical audit meeting, increase awareness of the MicroGuide app and BMJ Best Practice standards and reaudit to enhance adherence to antimicrobial guidelines.
494 The Safe Use of Intraoperative Tourniquets
Authors: Elmenawy Z , Hassan T
Published: August 2023

Aim

This quality improvement project has been conducted aiming to review the adherence to standards of practice as per the guidelines set out by ''British Orthopedic Association'' for the safe use of tourniquets. Additionally, aiming to generate data for future quality improvement projects relating to the field of surgery.

Method

In a retrospective review of the month of July 2022, a total of 146 cases (collected through electronic patient records - Chameleon+E-Trauma) were found to have orthopedic-related surgical procedures. Following the application of our inclusion and exclusion criteria, 54 cases had surgery that relevantly involves the application of an intraoperative tourniquet. These patients were thoroughly reviewed for compliance rates against the following set standards of practice relating to Tourniquet Time, Pressure, and Method of Exsanguination.

Results

Tourniquet time and pressure documentation compliance rates were both less than 50%. In almost cases where TQ pressures were documented, many surgeons use “standard” set pressures without considering the patient’s systolic blood pressure. In 2 cases of tourniquet time exceeding 120 minutes, there was no reason stated in the surgical documentation. Very low compliance rates on the method of exsanguination In all cases.

Conclusions

Tourniquet use is highly prevalent in several surgical procedures; therefore their safe use needs to be implemented in order to decrease related long-term complications. There is a significant lack of compliance rates regarding the use of intraoperative tourniquets and for that reason, it is quite imperative that education and awareness strategies relating to their use need to be proposed to improve reported results.
527 BSSH Standards of Care in Hand Trauma: The Impact of COVID-19 on Timing to Treatment
Authors: Elzagh A , Shah S , Amin K , Bedford J
Published: August 2023

Aim

To evaluate the compliance of our regional unit against the British Society for the Surgery of the Hand (BSSH) standards of care in hand trauma (BSSH, 2020) following an increase in our WALANT practice post-pandemic.

Method

A retrospective audit of two parallel 6-month periods was undertaken in our unit in Greater Manchester. Group 1 (pre-pandemic) comprised of cases managed at our main site from September 2019 – February 2020. Group 2 (post-pandemic) consisted of patients managed under the newly devised regional and national WALANT guidance at our sister site between September 2020 – February 2021. Data collection involved cross-referencing multiple databases. Exclusion criteria included delayed presentation, no injury identified at time of surgery, re-rupture and re-operation.

Results

Number of cases across the 2 study periods were almost identical (group 1 = 451, group 2 = 449). There was an improvement in compliance post-pandemic (78.86%) versus pre-pandemic (75.4%); this was not statistically significant (p = 0.283). We observed a significant improvement in compliance for patients undergoing extensor tendon repair (pre-pandemic = 68.97%, post-pandemic = 85.94%, p = 0.42). This was not the case for the other sub-groups (table 1). Crucially, we observed a >50% reduction in GA cases post-pandemic (14.92%) compared to pre-pandemic (66.08%).

Conclusions

Despite a significant reduction in anaesthetic team input, we have achieved similar levels of compliance as pre-pandemic across multiple domains whilst observing improved compliance for extensor tendons.
542 Prolonged VTE Prophylaxis Post Abdominal Cancer Surgery: Is It Necessary?
Authors: O'Malley E J , Lima de Mendonca Y , Smith A , Kirby K , Bethune R
Published: August 2023

Aim

NICE guidance currently recommends extending venous thromboembolism (VTE) prophylaxis to 28 days for patients who have undergone major cancer surgery in the abdomen. Literature highlights controversy around the efficacy of prolonged treatment preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) and potential areas for improvement.

Method

Retrospective study of urology and colorectal cancer patients undergoing surgery between October 2020 and September 2022. Electronic patient notes were used to determine adherence to guideline and prevalence of PE and/or DVT in post-operative patients. Comparison was made between both cohorts.

Results

Patient cohort n = 802, colorectal n = 345 and urology n = 457. Average age 66.6±10.4. M:F ratio = 543:258. Colorectal cohort 20.9%(n = 71) received extended prophylaxis, 79.1%(n = 269) did not, of which 19.7%(n = 53) prophylaxis was contraindicated. 5 excluded as died or an inpatient. Urology cohort 53.4%(n = 244) received extended prophylaxis, 46.6%(n = 213) did not, of which 28.2%(n = 60) prophylaxis was contraindicated. Overall, 39.5%(n = 315) received extended prophylaxis vs 60.5%(n = 482) did not. n = 4 developed PE/DVT. Of which, n = 1 on extended prophylaxis and n = 3 not, Chi-squared 0.35, P value = 0.55.

Conclusions

Very few patients developed symptomatic PE and/or DVT despite a significant proportion of patients not receiving extended prophylaxis. No significant difference in symptomatic PE or DVT in patients with extended prophylaxis vs patients without. Prolonged administration of low molecular weight heparin as anticoagulation has repercussions such as cost and patients’ ability to self-administer which may subsequently require community support or a longer hospital stay. Therefore, a more targeted approach to extended VTE should be explored.
579 Audit to Measure if >5% Reduction in Weight Occurred, as Recommended by the National Institute of Health and Clinical Excellence (NICE), for Patients Suffering from Osteoarthritis Before Their Scheduled Total Joint Replacements, at Darwen Health Link Surgery
Authors: Sarma A , Mustafa S
Published: August 2023

Aim

Osteoarthritis causes damage to synovial joints, manifesting as pain, loss of function, and disability. A high BMI is correlated with an increased incidence of osteoarthritis, for which NICE recommends a >5% (ideally >10%) decrease in baseline weight to improve pain and functionality. This audit aims to measure Darwen Health Link’s adherence to NICE guidelines 226 “Osteoarthritis in over 16s: diagnosis and management” for the management of osteoarthritis patients regarding weight-loss.

Method

This audit analysed 15 osteoarthritis patients with a BMI>30 who underwent total joint replacements from November 2021 to November 2022. Patient records were analysed for their weight management from 3-12 months prior to surgery, up till their surgery period to assess: if weight-loss advice was provided, and if >5% weight-loss took place. Standards were designated per clinician recommendations and NICE guidelines.

Results

All osteoarthritic patients (n = 15) were given weight-loss advice at presentations before surgery. However, only 20% (n = 3) of patients lost >5% of their baseline weight before their joint replacements, against the 50% standard. Therefore, interventions to improve weight-loss in patients and clinician guidance were implemented. These include a targeted poster, detailed weight-loss advice packs for patients, and clinician education about weight-loss programmes available locally.

Conclusions

The first part of the audit indicates suboptimal performance by Darwen Health Link. Their performance will be re-audited in 3 months post-interventional implementation. Reducing osteoarthritis’s burden on patients in primary care can significantly reduce pain and the need for surgery.
596 A Local Audit Assessing Completeness of Morbidity and Mortality Records in Vascular Surgery in a Tertiary Centre in the UK
Authors: Le Blevec L , Tsui T C , Makar R
Published: August 2023

Aim

Good Surgical Practice recommends surgeons’ regular participation in morbidity and mortality meetings (M&M) as this hold strong educational value, but most importantly maintain and improve patient care. The Royal College of Surgeons advises that formal records of discussions be kept, however as these vary in quality, their effectiveness and lessons learnt do too. The aim of this audit was to assess and review the completion of the current M&M records used for vascular surgery in a UK tertiary centre.

Method

Data was collected retrospectively from five M&M meetings which took place in 2022, identifying thirty-four PowerPoint presentations to review (each corresponding to one case presentation). We noted presence of patient hospital number, as well as documentation of any information in each of the five sections (‘discussion’, ‘action’, ‘who’, ‘when’ and ‘attending consultants’) on the ‘discussion’ slide using a binary scale (0 = no information, 1 = any information).

Results

None of the records included patient hospital number. Only 20.6% had five out of five sections complete with the least section filled being ‘when’ or time scale for action plan (29.4%) followed by ‘attending consultants’ (41.2%). 29.4% had no record of any discussion being carried out. 35.2% showed no record of an action plan and 47.0% had no responsible person to action the aforementioned plan.

Conclusions

Poor record-keeping during M&M is apparent. Following presentation at the local governance meeting, we will collaborate with the team to create a more effective way of recording discussion, ultimately to maximise learning outcomes.
639 An Audit to Evaluate the Prevalence and Efficiency of the ‘Acute Abdomen Pathway’ Proforma Used in a Large District General Hospital
Authors: Ross M , Gul A , Kalaiselvan R , Yasin U
Published: August 2023

Aim

The ‘acute abdomen pathway’ was introduced with the aim of early identification of patients with an acute abdomen and once identified to increase the efficiency of imaging, senior review and if required surgical intervention. We audited how this pathway was being used by clerking doctors and its benefits to patient care.

Method

Data collection occurred over 4 weeks (11/09/22-9/10/22) giving a cohort of 390 patients. Patients who met the criteria for 'acute abdomen' were included in the study (e.g. high clinical suspicion of acute abdomen, NEWS2 score >4, recent abdominal surgery, pain score >5/10, history of abdominal trauma, signs of sepsis). We reported time from triage to: surgical review, CT, diagnosis and management.

Results

112 patients met the criterion for the acute abdomen pathway. 4 were correctly recognised and diagnoses included appendicitis, perforated diverticulitis, obstructive cholangitis and complication post-laparotomy. 108 patients were not started on the pathway, their diagnoses included appendicitis (19), pancreatitis (7), small bowel obstruction (5) and others. Waiting times reduced whilst using the proforma. Time from CT request to report fell to 5 hours (from 14). Similarly, triage to diagnosis fell to 5 hours (from 12) and to management 5 hours (from 13).

Conclusions

The acute abdomen pathway is not being used as intended by clerking doctors. The criteria highlighted 112 patients, of which, 65 (58%) received a diagnosis under the umbrella of an ‘acute abdomen’. Our plan is to re-audit once more awareness has been raised to reassess compliance and hopefully show reduction in time from diagnosis to intervention.
647 VTE Prophylaxis Protocol Compliance Post Elective Lower Limb Arthroplasty
Authors: Loh C , Chen B L , Semple A , Grant S
Published: August 2023

Aim

Venous thromboembolism (VTE) is a common post-operative complication, and it is essential for surgical departments to ensure adequate prophylaxis is provided. A single centre DGH introduced a new proforma to be filled out at the time of operation. This audit aims to evaluate compliance with the proforma and its correlation to prophylactic prescription and postoperative VTE rates.

Method

A retrospective study was conducted for 524 patients undergoing elective lower limb arthroplasty between August 2020 and August 2022. Clinical notes were reviewed for of a) presence and completeness of proforma and b) clear documentation of prophylaxis. 30-day post-operative re-admission rates, associated complications, incidence of VTE, and deaths within 90 days of surgery were also reviewed.

Results

335 patients underwent an elective lower limb arthroplasty after the proforma was implemented in August 2021 of which 321 (95.8%) had the proforma in their clinical care forms. Of these, 56/321 (17.4%) forms were filled. All patients had documented VTE prophylaxis prescriptions and 438/524 (83.6%) were clearly described/'complete'. Of those incomplete, 74/86 (86%) were recorded after August 2021. There was 1 confirmed incidence of VTE within 30 days which occurred after proforma implementation. 9/18 surgeons (50%) practiced completing the proforma but 0/18 used it consistently.

Conclusions

There was poor compliance with the proforma but low incidence of VTE rates. Overall, the proforma did not affect VTE rates. In fact, there is the impression that reliance on the proforma worsened quality of documentation of VTE prescription required in operation notes. This suggests implementation of this proforma was negative.
656 Improving Practice in Acute Pancreatitis Management at a District General Hospital
Authors: Mittal S , Slater G
Published: August 2023

Aim

Appropriate management of acute pancreatitis is essential, as this condition is associated with a high mortality rate. This clinical audit aimed to improve the initial management of acute pancreatitis in patients presenting to University Hospital Wishaw in line with current guidelines between June 2021 and August 2022.

Method

A retrospective cohort analysis was performed for acute pancreatitis patients discharged between 01/06/21 and 01/12/21. Management was compared against NICE, British Society of Gastroenterology and Royal College of Surgeon’s audit standards which encompass risk stratification, investigation, and management. To improve and standardise care amongst staff, departmental teaching and a management pro-forma were implemented in April 2022. Repeat prospective data collection was performed from May to August 2022.

Results

There were a total of 73 patients included in Cycle 1, and 44 patients in Cycle 2. There was an improvement in all ten audit standards measured. Appropriate investigation into pancreatitis aetiology improved from 25% to 50%, with an 83% reduction in clinicians assuming alcohol-induced pancreatitis without suitable investigation of alternate causes. Initial risk stratification of patients improved from 36% to 52% and severity assessment increased from 4% to 36%. The provision of nutritional support to appropriate patients improved by 35%. Comparison of sub-cohorts revealed that adherence with the pro-forma showed measurably better compliance with standards.

Conclusions

The implementation of teaching and a management pro-forma demonstrated an improvement in standardisation of care. Specifically, use of a visual aid has been shown to better standards. Future cycles could focus on improvement of the pro-forma, and increased compliance.
690 Quality Improvement Project: Improving Engagement with Smoking Cessation Services Among Emergency Surgical Admissions
Authors: Ngo V , Hutching J , Fyles F , Rodrigues P , Jones G
Published: August 2023

Aim

Smoking status has a significant impact on surgical patient outcomes, with significantly increased rates of intra- and post-operative complications. Within Liverpool University Hospitals NHS Foundation Trust (LUHFT), the CURE team is a dedicated smoking cessation service that uses an electronic proforma to identify smokers and offer support. We assessed smoking cessation efforts among emergency surgical admissions pre- and post-teaching intervention.

Method

Two rounds of audit were completed: a baseline audit of emergency surgical admissions from 01/01/21 to 31/01/21(n = 202); and a reaudit of emergency surgical admissions from 01/11/22 to 30/11/22 (n = 163), following a structured teaching session on smoking cessation, delivered to incoming doctors in August 2022. We assessed documentation of smoking status within patient notes, completion of the smoking status proforma, prescription of nicotine replacement therapy (NRT), and assessment/follow up from CURE.

Results

Following intervention, smoking status documentation improved from 83% (n = 166) to 96% (n = 157), and proforma completion from 55% (n = 112) to 91% (n = 148). Among documented smokers (cycle 1 n = 49; cycle 2 n = 47), NRT prescription improved from 29% to 40%, and CURE involvement increased from 31% to 64%. Overall, following intervention, 21% of smokers accepted ongoing support from CURE during and post-admission, compared to 10% at baseline.

Conclusions

Use of electronic smoking status proforma and a dedicated inpatient smoking cessation team has high rates of engagement among emergency surgical inpatients. The use of structured teaching sessions to highlight the importance of smoking cessation among these patients has led to improved rates of smoking cessation support, benefiting surgical outcomes.
691 Gallbladder Polyp Surveillance Audit
Authors: Tabassum T , Khrais M
Published: August 2023

Background

Gallbladder polyps pose a clinical dilemma in surveillance owing to being a very common US findings yet gallbladder malignancy being a infrequent diagnosis. The joint guidelines of ESGAR, EASES, EFISDS and ESGE 6, 12 and 24 monthly follow up scans for 6-9 mm sized polyps or <5 mm polyps with risk factors for malignancy. Cholecystectomy is recommended in polyps >10mm. UK hospitals follow local guidelines, which for our trust is 12 and 24 monthly follow up scans. We investigated the surveillance and management of Gallbladder polyps and audited the practice in our DGH.

Method

We collected and analysed retrospective data of US-diagnosed GB polyp cases from May2010 to September2022. US-diagnosed GB Polyp patients above the age of 18 were included. We excluded cases of CT or MRI diagnosed and/or followed up cases.

Results

A total of 212 patietns were selected. Polyp sizewise, 118(52%) were<5mm, 12(5.3%) were>9mm. 82(36.6%) 6-9 mm polyps, 62(75%) were followed up. Mean time and median time to obtain a second scan was 472days 556 days. Of these, 14 had an increase in size of polyps, whilst 3 with increase>2mm. 17 patients with GB polyp had Cholecystectomy, 1(one) had a diagnosis of malignancy.

Conclusions

We demonstrated that the correct modality of scan was chosen for follow up. However, the timing of the follow up was not within the recommended guidelines. Further teaching and evaluation of practice is recommended. A case can be made into a unified UK guideline.