bluuebunny/crossref_metadata_2025 huggingface dataset:
162 Utilisation of Dissections vs Prosections in Anatomical Education and Its Relevance in Pursuing Surgical Training: A Comparative Study on Students' Perspectives at a Northern Irish Medical School
Authors: Roy S , Ahluwalia A , Shah M H
Published: August 2023

Aim

This study investigates medical students’ opinions regarding their memorisation, retention and implementation of anatomical learning by comparing prosection and dissection studies offered at the university. Furthermore, we also investigated its significance in students considering the surgical training pathway in the future.

Method

Medical students at QUB were sent a 10-item survey weighing their preference for dissection and prosection in the retention and application of anatomical knowledge along with its relevance in pursuing surgery. The survey was distributed amongst Year 1 - 5 medical students in an online format, with answers recorded over the span of two weeks.

Results

26 QUB medical students across preclinical/clinical years answered the survey, 53.85% of whom preferred dissections for identification, memorisation and employment of information regarding anatomical structures. Students who chose dissection agreed that the process offered more interaction, with deeper knowledge about spatial organ recognition. Meanwhile, prosections were chosen by students who believed focusing on isolated organs helped in mapping their knowledge to relevant learning outcomes.

Moreover, 42.11% of respondents found both learning methods helped visualise anatomical concepts outside a medical environment. However, dissection helped most students draw links between pathology and its anatomical basis. Finally, 84.21% considered dissection to play a major role in viewing surgery as a future career.

Conclusions

While there is an observable difference in respondents' perspectives, the survey indicates an overall preference for dissection in anatomical lab practices. The practice appealed to students better due to its greater interactive experience and tactile approach, with respondents agreeing that dissection mimics true surgical craftsmanship.
641 Impact of Frailty on Patient Outcomes After Cardiac Surgery: An Updated Systematic Review and Meta-Analysis
Authors: Elhadi M , Faraj H , Khaled A , Khaled A , BenGhatnsh A , Msherghi A
Published: August 2023

Aim

To determine the impact of frailty on patient outcomes after undergoing cardiac surgery.

Method

An analysis of frail versus non-frail patients who had undergone cardiac surgery was conducted using data from Pubmed/Medline, EMBASE, Cochrane, Web of Science, Scopus, and grey literature, all searched in April 2022. The primary outcomes of early postoperative mortality and major adverse cardiovascular events (MACE) were examined, as well as secondary outcomes, including long-term mortality and complications. Data were analyzed using R version 4.0.3.

Results

A total of 22 studies, including 102,323 frail and 2,187,814 non-frail patients, were included in the analysis. Frailty was found to be significantly associated with higher early mortality (RR: 2.93; 95% CI, 2.19–3.93; P < 0.01; I2 = 17.2%) and MACE (RR: 2.07; 95% CI, 1.21–3.55; P = 0.03; I2 = 22.9%) compared to non-frail patients. Frailty was also associated with a higher risk of acute kidney injury and renal impairment (RR: 3.67; 95% CI, 2.85–4.73; P = 0.03; I2 = 3.9%). In the long term, a higher mortality rate was observed in frail patients (RR: 2.93; 95% CI, 1.69–5.07; P = 0.02; I2 = 22.4%). However, no significant differences were found in pneumonia, respiratory complications, sepsis, or reoperation rates between frail and non-frail patients.

Conclusions

Frailty is associated with higher mortality and MACE in patients undergoing cardiac surgery and a higher risk of acute kidney injury. Frailty should be considered an important factor in preoperative risk assessment and perioperative care for these patients.
999 The Incidence of Foetal Scoliosis and the Chances of Successful Delivery
Authors: Saha P , Walter S , Barkham B , Ajayi B , Lui D
Published: August 2023

Aim

Foetal scoliosis can be detected on antenatal ultrasound and may be associated with other spinal abnormalities such as hemivertebrae. Little is known regarding its incidence and implications.

Method

The computerised foetal medicine ultrasound database at a tertiary hospital was retrospectively analysed using the search terms “spine” and “scoliosis”, between 1997 and 2021. The reports were manually reviewed, and patients removed that showed no abnormalities. Demographics of the mother, pregnancy and outcome data were collated.

Results

During the 24-year study period, 600,000 antenatal ultrasound scans were available. A duplicate rate was calculated, resulting in a total population of 378,000 foetuses. Initial results yielded 195 scans, and after removal of duplicates and manual checking of reports, there were 123 cases of confirmed spinal deformities, with an incidence of approximately 0.33 per 1000 foetuses (1 in 3000). Of the 123, there were 59 (48%) that reached term and 64 (52%) which did not. Of those that survived to term, 36/59 (61%) had normal development and no other concerns. The remaining patients had other non-fatal abnormalities, including VACTERL association in 5 cases (8.4%). Of those that did not survive, only one patient did not have other significant abnormalities. In most cases, there were multiple significant abnormalities, and the decision was taken for termination of pregnancy (52 cases, 81%).

Conclusions

This study represents the largest database review of antenatal scans for spinal abnormalities. The incidence of foetal spinal deformity is approximately 1 in 3000, and prognosis is generally determined by the presence of other significant abnormalities.
81 Audit of Use of Oakland Score on Patients Presenting with PR Bleeding and Effect on Admissions with Retrospective Application
Authors: Todd J , Wilkin R
Published: August 2023

Aim

To audit use of the validated Oakland Score for safe discharge of patients presenting to ED with PR bleeding and assess the effect of the Score on patient admissions.

Method

Retrospective audit of patients presenting to ED with PR bleeding between 1 Jan 22 - 30 Jun 22. Notes were reviewed and Oakland Score calculated. Threshold discharge scores of 8 and 10 were used to determine the effect on admission numbers. 88 patient notes were reviewed, 75 were included.

Results

0/72 patients had an Oakland Score on initial clerking. Retrospective application of the Oakland Score with a threshold of 8 would have increased admissions by 20/37 (54%). An admission threshold of 10 would have increased admissions by 3/37 (8.1%).

A threshold score of 8 suggests 27/37 patients were inappropriately discharged (73%) and 7/38 (18%) could have been safely discharged rather than admitted. 41/75 (55%) were admitted or discharged correctly.

A threshold score of 10 suggests 18/37 patients (47%) were inappropriately discharged and that 15/38 (39%) could have been safely discharged rather than admitted. 42/75 (56%) were admitted or discharged correctly.

Conclusions

PR bleeding represents a significant number of patients presenting acutely to general surgery. Discharge and admission of patients presenting with PR bleeding is inconsistent and subjective. Introduction of the Oakland Score would provide objective criteria for safe discharge and appropriate admission. An admission threshold of 10 has a 91% confidence in safe discharge and would not result in a large increase in admissions of otherwise healthy patients.
232 Skin Cancer Histopathology Requests Within a Plastic Surgery Service
Authors: Stark D , Hendrickson S
Published: August 2023

Aim

To ascertain whether plastic surgeons include adequate information on skin cancer histopathology request forms to aid accurate and timely histopathological diagnosis.

Method

We completed a prospective closed loop audit on histopathology request documentation at a single centre over two two-week periods. The standards were agreed following multi-disciplinary discussion (dermatology, plastic surgery, and pathology) and based on the Royal College of Pathology dataset. Mandatory information was differentiated from desirable information. A poster intervention was introduced that illustrated the guidance. Inclusion criteria consisted of excision biopsies and wide local excisions performed under local anaesthetic in minor operating rooms.

Results

Pre-intervention data included 45 lesions excised from 33 patients. A description of the lesion was documented in 26%, provisional diagnosis in 91%, lesion progression in 11%, surgical margins at the periphery in 56%, margins at deep in 16% and relevant past medical history (previous chronic lymphocytic leukaemia diagnosis and previous radiotherapy on that site) in 9%.

Post-intervention data included 45 lesions from 40 patients. There was improved compliance with all standards. A description of the lesion was documented in 76%, provisional diagnosis in 98%, lesion progression in 33%, margins at the periphery in 78%, margins at deep in 38% and relevant past medical history in 29%. Site and laterality were documented in all patients in both cohorts.

Conclusions

We observed improved documentation following a simple educational intervention. Further studies should aim to understand the impact this has on laboratory turnaround times, and further improve adherence to agreed guidance by incorporating mandatory fields in the request form.
286 Two-Cycle Audit on Post-Tonsillectomy Analgesia
Authors: Thamer M , Soltan I , Ojha S , Sinclair T , Saunders M , Gaskin J
Published: August 2023

Objective

To assess whether children undergoing tonsillectomy were receiving adequate analgesia postoperatively and comparison made against national standards. Implementation of new ibuprofen dosage guidance, reducing opioid prescribing, and assessment of whether this impacts re-admission rates for post tonsillectomy pain and bleeding.

Method

Retrospective audit of tonsillectomies performed over a 5-month period in 2021 and prospective audit over the same time period in 2022, with new ibuprofen prescribing guidelines (7.5mg/kg QDS compared with 5mg/kg TDS previously) and effect on reduced opioid prescribing.

Results

There were approximately 110 tonsillectomies performed in each cycle. For the first retrospective cycle, 95% were prescribed inadequate ibuprofen, with a mean dose of 5.5mg/kg. All patients who were readmitted with pain/haemorrhage had ibuprofen prescribed at a TDS frequency. There were 6% of cases presenting with bleeding, none returned to theatre. Coblation was used in about 40% of cases (extracapsular and intracapsular). For the second prospective cycle, 55% of patients have been prescribed the correct ibuprofen dosage of 7.5mg/kg QDS, with reduced opioid prescribing. No patients were re-admitted with post-operative pain and only a low number of patients presented with post-tonsillectomy bleeds.

Conclusions

Changing the dosing of ibuprofen to 7.5mg/kg QDS and ensuring departmental consistency has resulted in adequate analgesia dosing with no admissions for poorly controlled pain post-tonsillectomy. We feel a secondary impact is on reduced bleeding rates.
369 Should We Be Group and Save Testing for Laparoscopic General Surgical Procedures? a Retrospective Audit of Transfusion Rates at a District General Hospital
Authors: Atkins W , Ibrahim A , Dighe S
Published: August 2023

Introduction

The risk of bleeding in surgery makes the requirement for transfusion a pertinent consideration for all clinical staff involved in the care of surgical patients. Group and save testing allow for appropriate blood to be dispensed, but each Group and Save sample costs approximately £20 per sample and 116g of CO2 per test.

Historically the reported transfusion rate for laparoscopic surgery has been low. This audit aimed to ascertain the overall transfusion rate in laparoscopic surgery at a District General Hospital and use the data to inform practice regarding group and save requirements before surgery.

Method

A retrospective audit was undertaken incorporating all elective and emergency laparoscopic procedures undertaken at one trust between January 2020 and October 2021. Colorectal and Gynaecological procedures were excluded. Analysis was then undertaken with records from clinical coding and the hospital blood bank to determine how many patients received transfusion intra-operatively or within 72 hours of their procedure.

Results

1794 laparoscopic procedures were included in the data set. Procedures included were laparoscopic cholecystectomy, laparoscopic appendicectomy, diagnostic laparoscopy, and laparoscopic hernia repair. Of these procedures 93.8% were performed on adults. Following analysis, 2 patients in the data set were found to have received transfusion within 72 hours of their procedure (0.11%).

Conclusions

The low transfusion rate in this study is comparable to other rates reported in the literature. This resulted in a local change in trust policy for elective and emergency laparoscopic surgery, reducing or eliminating the group and save requirement for most procedures.
414 Has Routine Purulent Peritoneal Fluid Aspirate Culture Results During Appendicectomy Helped in Patients’ Management?
Authors: Kalu U A , Walshaw J , Ravi V , Yassin S , Eltom M , Jayawardane G
Published: August 2023

Background

Intra-operative purulent peritoneal fluid aspirate for microscopy, culture and sensitivity during appendicectomy is routinely practiced aiding post-operative management of patients if the patients get unwell requiring a change of the prescribed pre-operative antibiotics. As at the time of this audit, there was no guideline in the NHS regarding the routine purulent peritoneal aspirate for culture during appendicectomy. This necessitated the need to carry out this audit.

Aim

To evaluate if there is/ are benefit(s) from the routine purulent peritoneal fluid aspirate culture results during appendicectomy.

Method

This was a retrospective review of medical records with operation notes of all the patients who had appendicectomy with purulent peritoneal fluid that were aspirated for microscopy culture and sensitivity in the last 3 years (May 2019 to April 2022). The data were analysed using SPSS version 22.

Results

There were 127 patients that had appendicectomy and 73 (57.5%) patients had purulent peritoneal fluid culture results. Seventy-one (71.2%) of the patients had positive culture result from the purulent peritoneal fluid while there was no growth in the culture result in 28.8% of the remaining patients. Re-operation and ultrasound drainage were avoided in 13 patients out of 17 patients with post-operative intra-abdominal collections due to the change of the pre-operative antibiotics following the routine peritoneal fluid culture results.

Conclusions

The routine purulent peritoneal fluid culture results during appendicectomy was beneficial in 28.8% of the patients that required change of the pre-operative antibiotics due to the culture results.
424 Early Outcomes of the Insides Chyme Reinfuser (ICR) in the Management of High-Output Stoma
Authors: Mohamed R , Htet W , Wilson J , Magee C
Published: August 2023

Aim

High-output stomas present a significant surgical, nursing, nutritional and patient challenge. Patients are at risk of complications ranging from disrupted GI and renal physiology to severe complications from vascular access.

The ICR device allows chyme to be reinfused and may be a promising way to establish early enteral feeding, shorten hospital stays, and reduce complications such as significant GI losses and prolonged parenteral feeding.

We aimed to investigate the early outcome of ICR in our initial cohort of patients.

Method

Prospective analysis of all patients using ICR from 2020-2022. Outcomes included: primary pathology, hospital stay, duration of Parenteral nutrition, albumin level, commencement and tolerance of Chyme reinfusion, and mortality.

Results

Eight patients used ICR. Five became independent in using the device. Four were successfully reversed with one waiting reversal. In all patients, a significant reduction in using parenteral nutrition was noted as five patients were nutritionally autonomous whilst using ICR.

Although an imperfect marker, albumin levels responded to ICR use (an average improvement from 31g/L to 38g/L).

One patient died due to complications from the primary pathology.

Conclusions

The ICR device is safe and effective. It can be used by nursing patients and most patients. Our data suggest a possible reduction in TPN use which will have financial and clinical benefits. The ICR device should be considered in selected patients. There remains considerable mortality in patients with significant co-morbidity who are left with a high-output stoma.
467 Fluid Balance Documentation and Fluid Prescribing in Surgical Patients at a District General Hospital: Are Posters Too Passive for an Effect?
Authors: Mostafa O , Rafiq O , Waraich N
Published: August 2023

Aim

t is estimated that 1-in-5 patients receiving intravenous (IV) fluid therapy suffer from complications following inappropriate fluid prescribing. In March 2022, a spot audit evaluating fluid management in 20 surgical patients highlighted inaccuracies in fluid balance documentation, with up to 70% of sampled patients in an excess fluid balance.

As interventions, educational posters and teaching on IV fluids were delivered to doctors and nurses. A second audit cycle was sought to re-assess the impact of the interventions.

Method

A 30-item proforma was used to audit 100 general surgical patients between May-June 2022. Parameters collected included reasons for IV fluids and renal function. To assess doctors’ satisfaction with the intervention, an online survey was distributed among doctors working in General Surgery. All data were analysed using statistical software (SPSS).

Results

Half of the sampled patients were on IV fluids. Only 50% had an indication documented, and 56% had IV fluids in their management plan. 37% were in fluid excess. Accurate urine and stool measurements were recorded in 68% and 75% of patients, respectively. Drains and stomas were higher (relative to the first cycle). All doctors felt the posters were beneficial; only 36% of doctors felt comfortable with fluid prescribing before the posters, which increased to 93% after the posters were distributed.

Conclusions

Fluid management remains a cornerstone of surgical care. Fluid status should be incorporated into the daily patient assessment. Visual tools, such as posters, need objective assessment over longer durations to evaluate their benefit for healthcare professionals and patients.
531 Virtual Fracture Clinic Management During the COVID-19 Pandemic at Glasgow Royal Infirmary: The MAVCOV Study
Authors: Loh C , Baig S , Russell A , Pravinkuma R , Cemm N , Drury C
Published: August 2023

Aim

To evaluate the efficacy of the Virtual Fracture Clinic (VFC) in terms of patient satisfaction and clinical outcome, pre and during COVID at Glasgow Royal Infirmary (GRI). The impact of the pandemic on the quality of patient management was assessed by comparing two sets of patients who (1) presented to the clinic when British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) COVID-19 guidelines were first introduced (Pre-Lockdown Cohort) and (2) presented after practitioners were familiar with these guidelines (Lockdown Cohort).

Method

This was a retrospective review of VFC patients. Data extracted included demographic information, management plans and three-month follow-up outcomes. Patients discharged without further follow-up underwent a telephone questionnaire to assess patient satisfaction.

Results

286 patients were included in this study. 96.7% of patients in the pre-lockdown cohort presented to the VFC within 3 days of presentation as opposed to 93.3% of the lockdown cohort. 54.1% of the pre-lockdown cohort were referred to face-face/specialty clinics as opposed to 44.8% of the lockdown cohort. 6.9% of a subset of the lockdown cohort had an unplanned re-attendance to hospital for associated pain as opposed to 1.12% of a subset of the pre-lockdown cohort. 72% of the pre-lockdown cohort reported they were ‘very satisfied’ as opposed to 40% of the lockdown cohort.

Conclusions

The data reflects that there was a net shift from face-face consultations to discharge with nurse call between the pre-lockdown cohort and lockdown cohort however, this came with a substantial drop in patient satisfaction and an increased re-attendance rate.
587 An Audit to Establish the Need for Ear, Nose and Throat Antibiotic Guidelines at a Teaching Hospital in the UK
Authors: Le Blevec L , Shahsavari S , Walker D
Published: August 2023

Aim

Correct antimicrobial prescribing is paramount in providing and improving the safety and quality of patient care. The aim of the audit was to assess how confident doctors who treat patients with ear, nose and throat (ENT) conditions at a teaching hospital were at prescribing the correct antimicrobial therapy, as well as how confident they were in finding the relevant guideline.

Method

A survey was sent via email to emergency department, ENT and surgical clinicians in this hospital ranging from foundation year one doctors to consultants. They were asked a series of questions using a five-point likert scale.

Results

Thirty-one responses were collected, mostly from emergency department clinicians (64.5%) and ENT (29%), of which 41.9% were consultants, 19.4% non-training grade SHOs and 12.9% foundation year one doctors. Nearly half (48.4%) were only ‘somewhat’ to ‘not at all confident’ in prescribing the correct antibiotics for ENT patients. 58.1% were ‘somewhat’ to ‘not at all confident’ in finding antibiotic guidelines for ENT conditions in this specific hospital. 96.4% suggested an ENT section on ‘MicroGuide’ (a mobile platform to distribute antimicrobial guidelines) would be useful plus or minus a poster.

Conclusions

This study showed there was a significant need for secondary care ENT guidelines at this local hospital. Due to limitations of physical guidelines such as posters becoming outdated, we planned to collaborate with the microbiology team to create online ENT antibiotic guidelines on MicroGuide.
612 Consultant Review in the Emergency General Surgical Take: A Single-Centre Audit for Compliance to Royal College of Surgeon’s Guidelines
Authors: Salih M , Dyer C , Salih S , McRobb J , Sheth H
Published: August 2023

Aim

To assess if patients are reviewed within the timeframe suggested by the Royal College of Surgeons England (RCSE) and the association of guideline adherence with clinical outcomes in the emergency surgical take.

Method

We conducted a single-centre closed loop audit to assess the time taken for consultant review of the acute surgical patient. Clinical notes and electronic records were used to collect data on the acuity of the presenting complaint, time of review and plan by the consultant surgeon. Data was collected over an 8-week period before and after implementing changes in the form of educational sessions and email reminders regarding documentation. Post-implementation showed an improvement in record taking and, subsequently, increased compliance to RCSE guidelines.

Results

In the first and second cycle of this audit, 211 and 230 patients were seen, respectively. Before our intervention, of the 211 patients admitted to general surgery, 70% were reviewed within the recommended time, 10% had missing documentation and the remaining 20% were seen 1-2 hours outside the recommended window of time. Following intervention, 80% of the total surgical patients were reviewed within the recommended time and 5% had missing documentation. No worse outcomes were noted between any group of patients, outside the timeframe or otherwise.

Conclusions

Most patients reviewed on the general surgical take were seen within the recommended time. Below-standard documentation appeared to be the biggest cause of not meeting guidelines. Consistency regarding types of documentation, as well as teaching to highlight the standard of documentation required, may help rectify this.
627 The Use of Gastrograffin in Adhesive Small Bowel Obstruction (ASBO)
Authors: Tabassum T , Rehman S , Ibrahim M
Published: August 2023

Background

SBO constitutes 12–16% of emergency surgical admissions and 20% of emergency surgical procedures. As per Bologna guidelines, partial adhesive small bowel obstruction (ASBO) can be managed safely with non-operative management with WSCM and tube decompression. The radiologic appearance of WSCM in colon within 24hrs from administration predicts resolution. According to NASBO recommendations, WSCM should be embedded into prognostic and therapeutic management of ASBO. We investigated the use of gastrografin amongst patients who had ASBO and audited the practice in our hospital.

Method

We collected and analysed retrospective data of patients who received gastrografin from February 2022 to September 2022. CTscan-identified ASBO cases were included. We excluded cases of gastrografin use for other bowel obstruction aetiologies e.g. hernias, extrinsic compression, post-operative ileus, or when CT scan did not explicitly report adhesive aetiology.

Results

In 54 patients who received gastrografin, 27 were identified to be for ASBO by CT scan (50%). Of these, 24 (89%) received gastrografin within 24 hours of NG tube insertion. 21 (78%) successfully resolved with gastrografin administration alone with 6 (22%) going on to have surgery. The mean duration of conservative management in gastrografin-resolved ASBO was 2 days.

Conclusions

We demonstrate that non-operative management should initially be attempted in patients with uncomplicated partial ASBO, with gastrografin use showing therapeutic benefit. Lack of resolution after 24hrs of administration should be considered for surgical adhesiolysis. CT reporting of specific SBO aetiology should be encouraged to better guide whether gastrografin is indicated.
634 Analgesia Use in Acute Renal Colic Patients- Complete Audit Cycle
Authors: Husain S , Otite U
Published: August 2023

Aim

Prevalence of renal colic is up to 20% worldwide, with recurrence rates approaching 50% within 10 years- making it a common acute presentation. NICE guidance (NG118) states NSAIDs are first-line analgesia for renal colic, followed by intravenous paracetamol and opiates. Our aim was to assess compliance with NG118 within one acute NHS teaching Trust.

Method

All patients with renal colic as the primary differential diagnosis during March and April 2022 (1st cycle) and September and October 2022 (2nd cycle) were included. Data was extracted retrospectively from electronic patient records into a pre-designed proforma. Findings from the 1st cycle were presented within local departmental meetings. Posters were also installed reminding clinicians of the analgesic pathway within the relevant clinical areas. Subsequently, a re-audit was performed.

Results

90 patients were included (60- 1st cycle, 30- 2nd cycle). There was a significant improvement in compliance between the 1st and 2nd audit cycles (60% versus 83%, p = 0.0193). However in cases of non-compliance, documentation was poor (>70% did not state a reason) during both cycles. Imaging confirmed renal colic in 82% of patients in the 1st cycle and 93% of patients in the 2nd cycle. PR Diclofenac was the most common NSAID prescribed.

Conclusions

Low-cost, easily reproducible interventions resulted in significant prescribing practice changes. Findings from the latest national renal colic audit (2012-13) showed analgesia compliance in only 69% of cases nationally- similar to our 1st audit cycle results. Disseminating our findings to other hospitals regionally and nationally will hopefully result in better outcomes for renal colic patients.
683 Closed Loop Regional Audits on Quality Predictive Indicators for Renal Cell Carcinoma Management in Northern Ireland
Authors: Simon N , Curry D , Devine A
Published: August 2023

Aim

To conduct a full cycle Regional Audit in Northern Ireland to assess the ten Quality Predictive Indicators (QPI) in the management of Renal Cell Carcinoma (RCC) as per National Cancer Quality Steering Group (NCQSG) of NHS Scotland. Each cycle lasted for 6 months.

Method

QPIs were assessed in four major domains such as radiological, histological, surgical and pre-treatment performance indicators in the management of RCC. Using the Northern Ireland Electronic Care record, data were collected, recorded in MS Excel and analysed and arrived at conclusions. The results were compared with NHS Scotland RCC audit reports published in August 2019 and October 2022.

Results

In audit cycle 1, NCGSQ targets of quality prediction was achieved in 3 QPIs (Nephron Sparing Surgery, Trifecta rate and 30/90 mortality rate) among the 10 QPIs. In Audit Cycle 2, additional 4 NCGSQ targets were achieved namely- pre-treatment CT/MRI, Histodiagnosis in cryotherapy, histodiagnosis in chemotherapy and MDT discussion.

Conclusions

There has been significant improvement in all QPIs in the management of RCC in Northern Ireland during the audited period. We have achieved NCGSQ quality performance indicator targets in 7 among the 10 QPIs that were audited. Further interventions may be required to achieve targets in QPIs such as Leibovich scoring, pre-treatment TNM staging and prognostic scoring in metastatic RCC.
699 Audit of Post-Splenectomy Patients in Primary Care
Authors: Allen L , Kerley D
Published: August 2023

Aim

To describe the demographics of a large general practices post-splenectomy patient population (including sex, age, and indication for splenectomy), and audit of cohort's care against national immunisation and antibiotic prophylaxis guidelines.

Method

All adult patients registered with the practice who had undergone surgical splenectomy were included. Included patients’ medical records were reviewed and data including sex; age; date and indication of splenectomy; immunisation history; and drug history were collected.

Results

Fifteen of approximately 13,000 registered patients were coded for having previously undergone surgical splenectomy. The main indications included trauma; haematological disease; major intra-abdominal resection. Patient cohort were of an older patient population (mean age 69) having undergone splenectomy several years previously (mean 39 years ago). Three patients had outstanding pneumococcal vaccine in the past five years, however there was 100% compliance with annual influenza vaccine. All patients had received a minimum of two COVID vaccinations. Variation in prescribed phenoxymethylpenicillin dose, with two patients on incorrect antibiotic prophylaxis, and four patients without antibiotic prophylaxis.

Conclusions

Despite our small patient cohort, this audit highlighted variation and deficiencies in patient care, and has led to a recall of patients with outstanding pneumococcal vaccination and review of antibiotic prophylaxis offered to patients. Additionally, there is no national recommendation that post-splenectomy patients should be offered an annual COVID booster. We recommend that this is reviewed urgently by public health officials due to an increased risk of secondary pneumococcal infection with COVID infection, which may be life-threatening.
876 Are Patients Presenting Acutely with Renal Tract Calculi Routinely Given Dietary Advice?
Authors: Jeffery H , Sharma V , Hosny M
Published: August 2023

Aim

The risk of formation of renal calculi can be reduced by making changes to diet and fluid intake. NICE recommend that dietary advice is given to all patients presenting with renal tract calculi either at presentation or prior to discharge. The purpose of this study was to assess patients’ current knowledge and whether provision of the BAUS leaflet can improve this.

Method

At a district general hospital, patients who have had acute presentations with ureteric calculi who are conservatively managed are followed up in telephone ‘hot clinic’. Over a 3-month period, prior to clinic attendance, patients were invited to complete a questionnaire. Inclusion criteria: adults with an isolated presentation who are not high-risk stone formers.

Results

Of the 59 patients who attended seven clinics, 44 completed the questionnaire (70% male, mean age 46 (22, 83)). Only 10 (23%) of the patients recalled being given dietary advice at initial presentation, two of whom were given written advice. Thirty patients were aware that diet can impact on stone formation, however only 13 (30%) and 21 (48%) were aware that dietary protein and salt respectively can impact on stone formation. Knowledge of recommended fluid intake was good, with 31 (70%) correctly identifying 2-3 litres as adequate and only 2 (5%) stating that <1 litre is adequate.

Conclusions

With the exception of fluid intake, patient knowledge of dietary advice for stone formers is poor, due to lack of education provided at initial presentation. Educative measures and signposting to BAUS-approved resources may reduce risk of future stone formation.
958 A Study on Electronic Treatment Escalation Plan (TEP) Forms Completion and Compliance
Authors: Pattnaik S , Zarifian A , Punwar S , Sidhu G A
Published: August 2023

Aim

Establishing a Treatment Escalation Plan (TEP) allows doctors to discuss and record patient preferences in advance, in addition to cardiopulmonary resuscitation (DNA-CPR), but also for various aspects of emergency care and treatment.This study examines the overall rates of TEP form completion, as well as completion within 48 hours of the patient's hospitalization, as observed in routine practise at a DGH.

Method

This study was conducted utilising PDSA (Plan-Do-Study-Act) cycles and a cross-sectional methodology, auditing all adult in-patients admitted to the hospital for Orthopaedic surgery.The first cycle occurred in March 2022, followed by interventions in the form of an institutional algorithm, and the second cycle followed in November 2022.

Results

In the first cycle, 69.5% of patients had a completed TEP form, with 47.8% filling one within 48 hours of admission.It took an average of 4.4 days to complete, with 3.2 overrides. Following intervention and discussion in departmental meetings, 88.2% of tasks were completed, with 35.2% ended within 48 hours. Average days rose to 3.7 days, and overrides fell to 1.3 times. A questionnaire developed for the juniors to ask them about their reasons for noncompliance, and it was realised that the majority of them were concerned about the legal ramifications, correspondence with the patient and family, and a small percentage were due to a lack of time.

Conclusions

When juniors are fully informed of the technique to complete TEP forms, completion rates increase significantly. The process would be maintained under control by regular audits and training for rotating juniors.
998 Distal Radius Fractures – Assessing Time to Surgery
Authors: Taiwo B , Menyah E , Garcia S
Published: August 2023

Background

The British Orthopaedic Association Standards for Trauma (BOAST guidelines) recommend that intra-articular distal radius fractures should be operated within 3 days and extra-articular fractures within 7 days of a decision to operate (1).

Aim

The objectives of this audit were to assess compliance with BOAST guidelines for operative management of distal radius fractures within a local trauma unit.

Method

Three audit cycles were completed between 2018 and 2021 over 3 -4-month periods. The second and third cycles were completed after elective orthopaedic cases were moved to an elective orthopaedic centre, and commencement of a weekly half day dedicated hand trauma list. All skeletally mature patients with acute distal radius fractures were included.

Results

Despite the addition of a dedicated hand trauma list and elective services moving to a dedicated site, compliance with BOAST guidelines remained almost unchanged. Compliance was at 100% for extra-articular fractures. However, for intra-articular fractures, compliance only slightly improved from 50 % to 53.3%. The average time to surgery improved from 4.25 days to 3.66 days for intra-articular fractures. Average time to surgery for extra-articular fractures was 3 days. Proposed reasons for delay included lack of trauma theatre time, prioritisation of other urgent cases such as femur fractures and lack of appropriate surgeon.

Conclusions

No distinction was being made to prioritise intra-articular distal radius fractures over extra-articular fractures for surgery. Trauma and Orthopaedic (T&O) staff have been educated and changes made to the T&O department’s trauma database to resolve this.
1002 Outcomes and Documentation of Minor Skin Surgery at a General Practice
Authors: Dawidziuk A , Turner D , Lakasing E
Published: August 2023

Aim

This audit aimed to evaluate outcomes and documentation of minor skin surgery at a general practice. The basis of the audit was the National Health Service Directed Enhanced Service Specification for Minor Surgery 2021-22 (Minor Surgery DES SLA 2021/22). 

Method

The scope included all minor surgery procedures coded as incisions and excisions on the EMIS electronic patient records system carried out at the practice between 25th January 2021 and 25th January 2022. All included records were evaluated for documentation of written consent, comprehensive surgery note, complications, all excised material sent for history, histology results recorded, malignancy reported on histology, and accordance of clinical and pathological diagnoses. The audit standard was set at 80% by consensus of senior clinicians.

Results

The initial search yielded 104 patient records. Following deduplication, 100 cases were included in the audit (8 incisions, 92 excisions). 86% had signed written consent and comprehensive note uploaded to the electronic patient records system (86/100). Complications, including infection, were recorded in 10% of cases (10/100). 92% of cases had all excised material sent for histology and results recorded on the electronic system (85/92) with some material sent in 100% of excisions (92/92). No malignancy has been reported on histology results. The accordance of clinical and pathological diagnoses was confirmed in 79% of excisions (73/92).  

Conclusions

Minor skin procedures completed in the evaluated period met the audit standards. Minor surgery documentation could be further improved by introducing a dedicated electronic note template.
1019 Timing of Laparoscopic Cholecystectomy in Patients with Acute Cholecystitis at a District General Hospital
Authors: Kronberga M , Cartner E , Suresan S , Saha A , Peter M , Khawgali M , Bonner C , Matias M
Published: August 2023

Aim

Early laparoscopic cholecystectomy (LC) is recommended in the treatment of acute cholecystitis (AC) as a balance between reducing gallstone-related complications and surgery-related complications. NICE guidelines recommend LC within a week of diagnosis for adults with AC or to be delayed once acute episode has subsided at least 4 weeks after diagnosis. This audit aimed to assess our Trust's compliance to these recommendations.

Method

A retrospective analysis was conducted on all patients who received cholecystectomy following a diagnosis of acute cholecystitis between June 2021 - July 2021. After implementation, a re-audit was conducted from May 2022 - July 2022.

Results

A 100% compliance rate was achieved in the first cycle of the audit. Out of the 35 patient sample of newly diagnosed AC, only 16 patients underwent surgery in 2021. Out of these 16 patients, 81.3% had LC within a week and 18.7% had the procedure performed after 4 weeks. The re-audit, with a sample size of 52 patients, had an overall compliance of 96.8%. Out of the 31 patients who had surgery, 71% had surgery within a week of diagnosis and 25.8% had surgery after 4 weeks of diagnosis. Only 1 patient (3.2%) had surgery outside of the recommended timeframe as the surgery took place 9 days from diagnosis.

Conclusions

This audit demonstrated that our Trust has very good compliance with the guidelines where >95% of patients received their surgery within the recommended time frame. Our Trust demonstrated high rates of LC during acute admission, which aims to improve long waiting lists for elective LC.
1021 Documentation in Laparoscopic Appendicectomy: Are We Getting It “Write” First Time?
Authors: Monaghan E , Coles H , Sivasothy N , Bath M , Thin N
Published: August 2023

Aim

The Get It Right First Time (GIRFT) initiative was introduced to improve unwarranted variations in practice and improve patient care. GIRFT have published a series of recommendations for surgeons nationwide, which includes operative documentation. We aimed to assess completeness of documentation for laparoscopic appendicectomies in a district general hospital and identify methods of improvements, based on the GIRFT recommendations.

Method

We retrospectively searched prospectively maintained theatre lists for all “Laparoscopic Appendicectomy” performed from July to November 2022, then confirmed operations against the hospital’s electronic coding. All patients of any age were included; patients with an operation note not available online were excluded. Operation note documentation was analysed against the 34 GIRFT guideline recommendations.

Results

A total of 49 patients were included in the study. 38% of operation notes concorded with the recommendations outlined by GIRFT guidelines on laparoscopic appendicectomy documentation. 43% of the operation notes did not document in accordance with the 34 points and 8% documented incompletely. The 34 GIRFT recommendations were broken down into pre-operative, intra-operative and post-operative documentation sections. Highest levels of concordance were seen within intra-operative documentation, with 46% correctly including all necessary GIRFT recommendations. Pre-operative documentation had the poorest results – 56% not documenting in accordance with GIRFT.

Conclusions

Surgeons had varying levels of concordance with the GIRFT guidelines when recording laparoscopic appendicectomy notes. We have introduced a standardised proforma, based on the GIFT guidelines, to our practice and plan to re-assess compliance to ensure optimal documentation.
1056 Are Post-Operative Instructions Clearly Explained in Operation Notes? - Developing the Abscess Pathway
Authors: Hinchcliffe Z , Khalid S , Soares L
Published: August 2023

Aim

“Good Surgical Practice” guidance states that operation notes must include “detailed postoperative care instructions” to facilitate continuity of care by clinicians, alongside the patient themselves. This is especially important for abscess incision and drainage (I&D); a common day-case procedure where patients are left with complex, inaccessible wounds requiring frequent dressings. This study aimed to investigate and improve the compliance of post-operative documentation for I&D procedures.

Method

Retrospective analysis of 100 consecutive abscess I&D procedures performed at a district general hospital between August–November 2022. The operation note for each procedure was screened for post-operative guidance on antibiotics, analgesia, dressing management, showering, returning to daily activities and follow-up.

Results

On average, 55-62 I&Ds were documented each month. 38 operation-notes did not clarify antibiotic choice/duration; 12 were in penicillin allergic patients. Guidance on analgesia was missing from 27 operation-notes; 8 patients reported analgesia-related constipation without laxatives prescribed. Showering and dressing management was excluded from 53% and 19% notes respectively. 62% failed to provide advice on the first dressing change, and Aquacell was not prescribed in 68 cases for community management. Information on returning to daily activities was only included in 6 notes. Follow-up was not mentioned in 67% cases.

Conclusions

Documentation of post-operative instruction for abscess I&D is inconsistent, increasing risks of patient anxiety, pain, infection, and re-presentation to hospital. Data collected will be used to create the ‘Abscess Pathway’ to standardise information provided to patients in the pre-/post-operative period in the form of leaflets and personalised proformas.
1083 Evaluating Adherence to Best Practice for Tissue Sampling in Diabetic Foot Surgery: A Quality-Improvement Study
Authors: Proctor D , Shea J , Lewis S , Howard T , Ahmad M , Obuh O , Shalhoub J
Published: August 2023

Aim

To evaluate adherence to national guidelines (National Institute for Health and Care Excellence – NICE) in tissue sampling during diabetic foot surgery, and to assess the clinical course of minor diabetic foot amputations in relation to bone microbiology and antibiotic therapy.

Method

Between 2020 and 2022, three separate cycles of a plan-do-study-act (PSDA) audit were completed to evaluate the efficacy of a teaching programme and an online operation note proforma. Data were collected retrospectively with the primary outcome measures being the proportion of clinically clean bone samples sent and subsequent impact on changes to targeted antibiotic therapy. Secondary outcomes included the rates of re-infection and re-intervention.

Results

A total of 106 patients were sampled (PDSA 1, n = 52; PDSA 2, n = 27; PDSA 3, n = 27). Following the implementation of a departmental teaching programme the proportion of clinically clean bone samples increased from 68% (PDSA 1, n = 40) to 75% (PDSA 2, n = 12) with a further increase to 89% (PDSA 3, n = 24) after implementation of the online proforma (p = 0.140). Microbiology results prompted necessary changes to targeted antibiotic therapy in 58% of patients (PDSA 1, n = 33) increasing to 95% throughout the study (PDSA 3, n = 19). Targeted antibiotic therapy was associated with comparable rates of re-infection compared to non-targeted therapy (PDSA 3, 5% / 12.5%, respectively) but overall lower rates of re-intervention (PDSA 3, 63% / 47%, respectively).

Conclusions

Both interventions were associated with increased rates of clinically clean intra-operative bone sampling. Lower rates of re-intervention were observed in patients who subsequently received targeted antibiotic therapy.
1097 Assessing the Compliance with RCS Operative Note Content Guidance in the General Surgical Department at a DGH With a Hybrid Note System
Authors: James S , Arbis A , Harshen R
Published: August 2023

Aim

To assess the compliance with the RCS operation note content guidance at Conquest Hospital, Hastings. Ensuring the accuracy of operation notes cannot be overstated, allowing adequate information to be obtained by team members and for medico-legal purposes. Previously, operative notes were completed on paper, with sub-headings for prompts. A few years ago, this process moved online with a blank template.

Method

Using theatreman, we retrospectively collected data beginning 13/9/22 for 100 consecutive elective or emergency operations performed by any general surgeon at Conquest Hospital. Each operation note was observed for compliance with each of the 19 points of the RCS guidelines with data compiled using an excel spreadsheet with simple statistical analysis.

Results

Overall compliance with the 19 points of the RCS guidance was 65.3%. No single operative note contained all the required 19 points. No operative note recorded estimated blood loss.

Conclusions

Compliance with the prescribed guidelines varied greatly. No single operative note contained all the required information. Moving forward, we plan to work alongside the IT team to produce a prepopulated template for the writing of operative notes. Unfortunately, due to complex nature of IT systems, this will likely take some time. In the meantime, we plan to use a template operative note adjacent to each computer screen in theatres where the notes are completed to act as a guide for surgeons when completing their documentation. Following the implementation of each of these changes, we will complete a further audit to assess for compliance.