bluuebunny/crossref_metadata_2025 huggingface dataset:
869 Gender Distribution of Invited Speakers at Major Trauma and Orthopaedic Surgery Conferences: A Retrospective Open Cohort Study
Authors: Gargan A , Georgi M , Patel S , Asif A , Fricker M , Khaliq Raja A , Leung K H C , Gargan K , Lee K , Burton O E , Kamboj R , Thamilmaran A , Abdi Z , Haque S , Tse F , Moore C , Nathan A
Published: August 2023

Aim

Females are disproportionately under-represented in surgery despite the upward trend in women entering the medical profession. Visibility of female surgeons at academic meetings has proven to be an important facet of gender equity. We aim to quantify the proportion of female faculty and prevalence of all-male speaking panels (“manels”) at major T&O surgery meetings.

Method

We retrospectively analysed four major annual T&O meetings between January 2016 and December 2021. Data was collected on invited lecturers, panelists and chairs/moderators. Male and female faculty were academically stratified according to mean publications, citations, and H-index. A “manel” was defined as a session with 2 or more speakers, all of whom are men. Sex was defined by gender titles used in the conference program, online speaker biography, or the Gender Balance Assessment Tool.

Results

A total of 968 sessions with 6582 speakers across 18 conferences were identified. The mean percentage of female faculty (invited lecturers, panellists and chairs) was 4.90% (n = 323). Of 775 panel sessions, 568 (73.3%) were manels. No statistically significant difference in the percentage of manels was observed between online (77.8%) versus in-person conferences (72.8%) (p = 0.3195). No statistically significant difference in the proportion of manels was observed over time (from 76.1% in 2016 versus 76.7% in 2021; p = 0.26). Male invited lecturers had a significantly higher H-index than female invited lecturers (p<0.05).

Conclusions

Manels are highly prevalent in major T&O surgery meetings whilst there is poor representation of female speakers. This study highlights the need for greater gender diversity and female representation in T&O.
380 Sustainable Health Care to Provide Good Quality Care in the Surgical Industry- United Kingdom
Authors: Mubarak F S
Published: August 2023

Aim

The surgical industry has a major contribution towards sustainable health care. The aim is to critically evaluate sustainable healthcare to provide good quality care in the surgical industry in the United Kingdom.

Method

A systemic review was conducted using peer-reviewed studies and articles from the United Kingdom related to surgical and anesthetic fields within the last 5 years. The most relevant journal articles were selected based on their relevance to healthcare system performance sustainability, including risks, and subsequently screened using the PRISMA 2020 model screening approach. The findings of the relevant journal articles were then evaluated critically for each theme.

Results

A total of 79 studies were retrieved. Fifteen of the retrieved studies met the inclusion criteria. Ten of the papers evaluated some existing sustainability practices. Only seven papers discussed significant determinants of good quality health care. Only 86.67% of the papers highlighted the implications of sustainability.

The key predictors of high-quality medical care are effective resource management, moral surgical team acquisitions, professional services, integration, short hospital stays, and low mortality and morbidity rates. Conserving water, optimizing treatment routes and transportation, and creating cultural change were found to be the pillars of high-quality sustainable healthcare.

Conclusions

The concept of sustainability varied across these studies and limitations on sustainability through reduced mortality, morbidity, and business services were observed. The most detrimental effect on the sustainability of the surgical industry remains to be anesthetic gas emission from the theatres. A significant discrepancy was noted between the available data and its implication.
74 Retention of Surgical Trainees in England
Authors: Sooriyamoorthy T , Khalil K
Published: August 2023

Background

Surgical training is a competitive process attracting highly motivated clinicians. The National Health Service is currently facing long waiting lists and a workforce crisis yet there is a paucity of data regarding attrition of surgical trainees in England. This study aims to describe the attrition of surgical trainees from 2016-2021 and explore the relationship between specialty competition ratios and attrition rates.

Method

Data was obtained from Health Education England by freedom of information requests. Binary logistic regression analyses explored differences in attrition between surgical specialties. Spearman’s correlation was used to assess the relationship between competition ratios and attrition rates.

Results

From 2016 to 2021, 481 surgical trainees have left surgical training, with an average yearly attrition rate of 2.68%. This number varied considerably across specialties with Paediatric Surgery having the highest rate at 4.20% and Trauma & Orthopaedic Surgery (T&O) the lowest at 1.52%. Compared to General Surgery, trainees in Neurosurgery, T&O and Plastic Surgery were significantly less likely to leave their respective programmes (OR 95% CI 0.53 (0.33 – 0.85) p = 0.009, 0.44 (0.34 – 0.58) p<0.001, 0.51 (0.33 – 0.78) p = 0.002, respectively). Attrition rates were inversely related to competition ratios, with more competitive specialties experiencing less attrition (ρ = - 0.302 (p = 0.078)).

Conclusions

These data highlight the increasing attrition of surgical trainees over recent years, with some specialties experiencing greater rates of attrition than others. Qualitative research and exit interviews are needed to ascertain the causal factors behind the attrition of surgical trainees to improve training and retention of this highly skilled workforce.
686 Transition From Higher Surgical Trainee to Consultant Practice: A PRISMA Scoping Review of Non-Clinical Deficiencies in Training
Authors: Kamran Siddiqui Z , Jayasuriya R , Lewis C , Tomlinson J
Published: August 2023

Background

Higher surgical training (HST) focuses on delivery of clinical knowledge to pass FRCS exams, technical skills to fulfil CCT requirements, and clinical preparedness in the UK. The lack of good quality evidence to characterise the non-clinical challenges during transition from HST to consultant surgical practice, makes it challenging to develop a well-structured intervention to address this gap.

Aim

To identify the gap in current literature, methodologies and analysis of inventions trialled to address the transition from surgical trainee to consultant surgeon.

Method

PRISMA-ScR structured scoping review of literature. Search terms were wider than the specific research question of surgery in the UK. Other medical specialities and overseas healthcare training programmes were included to focus the gap analysis for translatable content and sub analysis to highlight the paucity of literature in surgery.

Results

Databases interrogated: Medline, HMIC, Pubmed, Google Scholar. Papers: identified n = 434, screened n = 276, eligible n = 105, included n = 50. Majority of papers were of poor to moderate quality. The moderate-quality papers included those adopting a mixed methods approach to both characterise the gap in training and utilised this to structure interventional programmes.

Conclusions

This review highlights the need for a mixed methods approach alongside a stakeholder analysis to identify target population for qualitative semi-structured interview (most likely to be newly appointed consultants) for characterising the gap in HST for trainees making the transition to UK NHS consultant practice. The topic guide for interviews would be informed by the deficiencies in training identified in this scoping review.
966 Comparison of Mesh Related Patient Reported Outcomes in Patients Who Have Undergone Abdominal Wall Reconstruction with Synthetic vs Bio-Synthetic Mesh
Authors: Adeboye T , Rajoo J , Kulkarni G , Barnes D , Hammond T
Published: August 2023

Aim

To compare Quality Of Life (QoL) outcomes amongst patients undergoing elective Open abdominal wall reconstruction (AWR) with Synthetic Mesh versus Biosynthetic mesh, using the Carolinas Comfort scale (CCS) questionnaire.

Method

This is a retrospective study with longitudinal prospective questionnaire extension of all patients who have undergone AWR within last four years by the same AWR surgeon and Plastic surgeon team with no recurrence. Four groups of patients were compared based on time from surgery (more or less than eight months) and use of synthetic or biosynthetic mesh. The rationale behind it is based on characteristics of the biosynthetic mesh data showing complete disappearance by eight-months and replacement by a scaffolding tissue as an ingrown matrix and collagen.

Results

There were eight patients in each group (total 32 patients). 16 patients had repair with Bio A mesh and 16 with Dynamesh CICAT. Using two-way ANOVA and post HOC Turkey’s difference test, we found a significantly lower score (p<0.05) in the patients who had a repair with the Bio Synthetic mesh. Maximum score on the CCS is 115 points but except for one outlier of 70 points, none of the remaining 31 patients had a score higher than 50. Patients scored higher on questions related to bending, sitting up and exercise.

Conclusions

This outcome provides a review of current surgical practises and meshes, helping surgeons & patients make better informed decisions. Bio-synthetic meshes have better comfort outcomes for patients with lower CCS scores in the long term.
352 A National Survey of National Emergency Laparotomy Audit (NELA) Leads to Identify Current Nutrition Practices and Pathways in NELA-Eligible Emergency General Surgery Patients
Authors: Ashmore D , Wilson T , Halliday V , Lee M
Published: August 2023

Aim

No nutritional data are collected by the National Emergency Laparotomy Audit (NELA), despite the association of malnutrition with worse outcomes. This study aimed to describe the current practices, pathways and barriers encountered in identifying malnutrition in NELA-eligible patients.

Method

Following piloting and validity assessment, anaesthetic and surgical NELA Leads at hospitals across England and Wales that submitted data to NELA’s 7th report were emailed a survey link. Responses were gathered using Qualtrics. Descriptive analysis and correlation with laparotomy volume and professional subtype was performed in SPSSv26. University of Sheffield ethical approval was obtained.

Results

There were 166/289 NELA Leads and 117/167 hospitals that completed the survey (57.4% and 70.1% response rates, respectively). Respondents reported low rates of nutritional screening (39.2%) and assessment (45.8%) for malnutrition pre-operatively with no awareness of local screening tools (41.6%) despite 68% of units having a Nutrition Support Team. Contrary to guidelines, NELA Leads report albumin levels continue to be used to determine malnutrition risk (73.5%). Post-operative pathways were common (71.7%). Reported barriers to nutritional screening and assessment included a lack of time, training and education, organisational support, and responsibility. NELA Leads indicated nutrition risk is inadequately identified and is an important missing data item from NELA (71.2%). Responses were not correlated with hospital laparotomy volume or professional subtype.

Conclusions

Identifying malnutrition risk in NELA patients requires attention. Barriers are wide reaching and include a lack of time, knowledge, and ownership. Nutrition pathways that encompass the pre-operative phase and incorporation of malnutrition data in NELA may support improvements.
93 Managing paediatric torus fractures at the Royal London Hospital: A Clinical Audit and Cost Analysis
Authors: Papaioannou C , Manoukian D
Published: August 2023

Aim

Torus fractures are extremely common, accounting for up to 25% of all paediatric-related visits to the emergency department (ED). This audit aims to assess the adherence of the Royal London Hospital (RLH) to the NG38 NICE guidelines. These guidelines state that patients should not be given a rigid cast and should be discharged, advising carers a follow-up is not required.

Method

We analysed and retrospectively collected data from a cohort of paediatric patients with torus fractures who presented at the RLH between September 2021 and December 2021. In total 59 patients were included in the audit. Recommendations were later presented at the paediatric orthopaedic meeting of the RLH.

Results

From the cohort, 22% of patients were given inappropriate treatment including rigid casts with or without manipulation, with an average time in cast of 3.8 weeks. 18.6% of all the patients were followed-up in clinic, including 54.5% of the patients who received a rigid cast during discharge from the ED (the rest returned only for cast removal). 63.6% of the patients who returned for follow-up had a repeat X-Ray performed.

Conclusions

Overall, 18 out of 59 (30.5%) cases were not managed according to NICE guidelines (received inappropriate treatment, had a clinic follow-up with a clinician or was referred for >1 X-Ray). This incurred an inappropriate cumulative cost of almost 2000£ only during a 4-month period from one hospital. This audit aims to educate ED staff and update local protocols. A re-audit is going to follow to assess the impact of these recommendations.
143 How Well Are We Managing Acute Pancreatitis?
Authors: Akhtar A , Asarbakhsh M , Schuijtvlot N
Published: August 2023

Aim

To evaluate our practice in comparison with gold standards on the management of acute pancreatitis.

Method

This retrospective audit evaluated the management of patients with acute pancreatitis admitted to our hospital between 01/04/22 and 30/06/22. The gold standards were guidelines published by the World Society of Emergency Surgery (2019) and British Medical Journal (2018). Data collection focused on prognostic scoring, IV fluid resuscitation, nutrition, monitoring of patients, invasive intervention, and performance of cholecystectomy. Data sources included paper notes, imaging and prescribing software.

Results

44 patients presented with acute pancreatitis. A prognostic score was calculated in only 4 patients (9.1%). 40 patients (90.1%) received isotonic IV fluids. However, fluid input and output was poorly documented in 17 patients (38.6%). 14 patients (31.8%) received nutritional support; oral Fortisip supplements in the majority (11 patients, 25%).

Regarding outcomes, 5 patients (13.6%) developed single or multi-organ dysfunction (respiratory and/or renal failure): 2 patients (4.5%) required admission to the High Dependency Unit. 2 patients (4.5%) died.

Regarding intervention, appropriately, no patients underwent endoscopic or percutaneous drainage of pancreatic collections. Where gallstones were the underlying aetiology (12 patients, 27.3%), 10 patients (22.8%) underwent laparoscopic cholecystectomy during, or within 2 weeks of, the index admission.

Conclusions

Our compliance with gold standards was variable, and this could negatively impact patient care. Lack of prognostic scoring and fluid balance documentation may undermine ability to recognise deteriorating patients with severe pancreatitis requiring escalation of care. Departmental teaching for surgical doctors is the proposed intervention.
251 Use of Self-expanding Metal Stents (SEMS) in Emergency Colonic Obstruction (a retrospective study)
Authors: Makhort A , Fouad M
Published: August 2023

Aim

Colorectal cancer is becoming increasingly common in UK, presenting as an emergency in 20% of cases. This carries significantly higher (six-fold) mortality compared with an elective presentation. There is high level evidence that self-expanding metal stents (SEMS) can be successfully used both for palliation (as a definitive procedure) and as a bridge to surgery (BTS) in patients with colorectal cancer. ACPGBI consensus guidelines in emergency general surgery suggest expected success rate of 90% whilst requesting units to audit their figures to evaluate success rates and complications.

Method

We performed a retrospective audit of SEMS placement over nearly 5-year period in our colorectal unit (spanning from July 2016 to May 2021). We accessed local reporting systems and electronic patient notes for pathology, site, results and outcome post attempted stenting.

Results

Total number of SEMS inserted = 30. One patient was excluded due to incomplete data present. Male:female ratio = 1.5:1. Mean age at application = 71.5 (range 37-96). Most common site was sigmoid (48%), followed by descending colon (28%). Success rate was 86%. Majority of SEMS were used as a palliative procedure - 86% vs 10% as BTS. 10% of patients had complications following stent insertion, including blockage and leak, in all cases leading to emergency Hartmann’s procedure.

Conclusions

Data shows significant SEMS use locally particularly for palliation. Success rates are comparable with national and show stenting can be performed by an experienced radiologist. However, complication risks are not insignificant, and patients should be counselled accordingly prior to procedure.
252 Incidental Gall Bladder Cancer in Patients Underwent Cholecystectomy: Do We Need Selective Histological Examination of the Gallbladder Following Cholecystectomy?
Authors: Mena J , Kazemi Esfeh N , Mahmoud R , Moudgil-Joshi J , Selvarajoo V , Tapuria N
Published: August 2023

Background

This study evaluated the incidence of incidental gall bladder cancer in patients undergoing cholecystectomy using the selective histological examination of the gallbladder following cholecystectomy operation (S-GALLOP). In return, the study assessed the value of S-GALLOP in patients undergoing cholecystectomy and the factors that can prompt histological examination.

Method

The present retrospective chart review retrieved the records of 3710 consecutive patients who underwent elective or emergency cholecystectomy due to benign pathologies at through 10-year period.

Results

80.7% of the patients were chronic cholecystitis,6.3% were acute cholecystitis, 1.9% were gallbladder and 1% were gallbladder cholesterolosis. Six cases had incidental GBC (incidence rate = 0.0016%). All patients were females, except two patients, who underwent elective cholecystectomy. The median age 60.5 (range 55 to 70) . The preoperative ultrasound showed multiple gallbladder stones and thickened gallbladder wall in most of these six patients. Four patients had moderately differentiated adenocarcinoma, one had well-differentiated adenocarcinoma, and one had poorly differentiated adenocarcinoma with metastasis. On the other hand, 23 cases had gallbladder dysplasia (incidence rate = 0.006%). The median age was 61 (35 – 73), and 82.3% of the patients were females. Only three cases underwent an emergency procedure. Only one patient had high-grade dysplasia, aged 71 years old.

Conclusions

Incidence GBC is rare in patients undergoing elective or emergency cholecystectomy. Thus, histological examination for all cases is not recommended and S-GALLOP can represent a cost-effective alternative. S-GALLOP is recommended for any gallbladder specimen that seems abnormal on macroscopic examination, especially in old age and patients with suspicious preoperative imaging findings.
341 Safe and Effective Delivery of Anti-Reflux Surgical Standards at a District General Hospital
Authors: Livingstone J , Nanda A , DiMaggio F , Kyrtsonis G , Rock C , Thomas R , Rothnie A , Malik S
Published: August 2023

Aim

Up to 20% of adults in UK suffer from Gastro-oesophageal Reflux Disease (GORD). Surgery offers better short-to-medium term benefit compared to sole medical management. However, practice varies significantly nationwide.

The volume of cases performed in our district general hospital (DGH) has increased from one in 2015, to 24 in 2022. We aimed to establish feasibility and safety of laparoscopic anti-reflux surgery (LARS) at a DGH, by matching our outcomes with the AUGIS national standards.

Method

Data from patients undergoing LARS between January - December 2022 have been collected prospectively and recorded both locally and on National Hiatal Surgery Register (NHSR). Pre-operative symptoms and investigations, intraoperative findings and post-operative short and medium-term outcomes were analysed. Average follow up was 6 weeks.

Results

24 laparoscopic anti-reflux procedures were performed (21 Nissen and 3 Toupet), including 6 paraoesophageal hernia repairs. All patients underwent primary repair and fundoplication. Average length of hiatus hernia preoperatively was 4.1cm for sliding, and 7.6cm for para oesophageal. 23/24 patients were inpatients, 1 was a day case. Mean length of stay was 4 days. Conversion to open rate was 0%. 22 patients had no complications. One patient experienced a mediastinal collection, another patient had post-operative hypotension, both not requiring intervention (Clavien-Dindo 2). 30-day return to theatre rate was 0%, as was 30-day readmission rate.

Conclusions

At our DGH, we significantly increased the volume of LARS performed whilst achieving AUGIS national standards. Anti-reflux surgery can be offered safely and effectively by experienced laparoscopic Upper GI surgeons in a DGH.
375 Introduction of a Physician Associate (PA) Led Surgical Ambulatory Emergency Clinic (SAEC) in the Highlands of Scotland
Authors: Seehafer F , El-Hakim H , Grant A
Published: August 2023

Aim

The delivery of surgical care in the Highlands has changed. SAEC was developed to alleviate bed pressures, improve patient satisfaction, and avoid unnecessary workload. We aim to identify whether SAEC is alleviating pressures in the surgical inpatient department - is it used appropriately and cost effectively.

Method

Attendance was collected prospectively (1/9/22 to 31/10/22) using a dedicated data audit book and booking diary. Patient’s individual review outcomes were gathered.

Results

Of the 165 patients referred to SAEC, 90% were reviewed by the PA, 10% only by the consultant. On average, 3.7 patients were seen per day. The referral reasons were wide ranging: 64 referrals for abdominal pain in addition to abscesses, constipation, weight loss, vomiting, stoma reviews and more. The age of patients ranged from 20-91. 61% were female. 46% had a scan. 85% received a diagnosis. 93% received definitive management. No patients made an unplanned re-presentation within the week following their review. The average time spent in SAEC per patient was 2 hours 48 minutes. 17% of patients were admitted, preventing 116 admissions. This saved approximately £45,820 through admission prevention. In addition, approximately a further £47492 was saved as this was PA led rather than consultant.

Conclusions

Prior to the employment of a PA, SAEC did not provide a consistent service, brought all patients to its surgical ward, and required employment of a second consultant. SAEC has improved patient flow and increased bed capacity whilst providing safe and high-quality care that is cost-effective.
385 Neurovascular Status Documentation in Fracture Manipulation
Authors: Hashim S , Wilkes I , Sivanadarajah N
Published: August 2023

Aim

To improve standards of documentation of neurovascular status before and following manipulation in keeping with standards set by the British Orthopaedic Association (BOAST guidelines: Peripheral Nerve Injury1).

Method

At a major trauma centre, we retrospectively collected data on thirty orthopaedic patients who underwent fracture manipulation in October 2022. Data included documentation of sensory, motor and vascular neurovascular status, prior and following manipulation. Posters were displayed in the emergency and orthopaedic departments on adequate neurovascular documentation, and an autotext proposed to aid senior house officers with electronic documentation. Prospective data was then collected on the subsequent thirty patients.

Results

Prior to manipulation, sensory neurological status was documented in 40% of patients and motor neurological status in 43.3% in patients. Post-manipulation documentation was 10% and 13.3% respectively. Documentation of vascular status prior to and post-manipulation was 40% and 16.7%. Following our intervention, pre-manipulation documentation of sensory and motor neurological status was 60% and 63.3%; post-manipulation was 20% and 13.3%. Documentation of vascular status prior and post-manipulation was 70% and 20%.

Conclusions

Following our intervention, there was an improvement in documentation of both sensory and motor neurological status prior to manipulation, however there was no change in motor status post-manipulation. The intervention used may not provide a sustainable improvement in documentation. Use of a designed electronic form, which can be accessed easily for electronic documentation, may improve results further.
397 The Effects of a Virtual Specialist Nurse-Led Clinic on Plastics Outpatient Services at a Major Trauma Centre: A Closed Loop Audit
Authors: Lacey H , Bernard K , King I
Published: August 2023

Aim

To reduce the number of plastic surgery clinics working over capacity due to the effects of both increasing caseload and the COVID-19 pandemic by implementing a virtual specialist nurse-led clinic.

Method

Outpatient activity was audited due to the number of patients being overbooked into the plastic surgery outpatient clinics. A virtual specialist nurse-led clinic was implemented to bridge gaps between appointments, maintain early triaging of complications, and reduce clinics working over-capacity. Suitable patients were identified and offered virtual follow-up in place of face-to-face appointments. Outpatient activity was re-audited after implementation, to assess effects on force bookings and number of new/follow-ups seen in consultant clinics.

Results

Following virtual clinic implementation, there was a significant reduction in consultant clinics working over-capacity (95% to 71.8%, p = 0.002) and forced bookings (54 to 10, p = 0.006) in the audited period. The average number of new patients seen in consultant clinics each month increased by 15.3% (p = 0.019).

Conclusions

Introduction of a virtual clinic reduced forced bookings and clinics working over-capacity. This increased capacity for new patients to be seen face-to-face, created a manageable clinic while maintaining early identification of complications, and reduced delays between clinic appointments. Early virtual assessment of wounds and identification of complications enabled patients to be booked into urgent face-to-face plastic appointments, triaging them away from A&E and GP services. The virtual clinic also allowed the team to reassure patients with ongoing concerns between appointments, further reducing A&E and GP burden.
459 Standardised Surgical Admission Proformas: A Quality Improvement Project
Authors: Gaffney M , Chan K Y , Raftery N , Eltigani E , Johnston S , Rayis A , Abdelhafiz T
Published: August 2023

Background

“Documentation burden” in a busy healthcare setting is a commonly cited cause for suboptimal documentation and its associated adverse implications. While electronic patient records have been heralded as a solution, costs associated with necessary infrastructure may be prohibitive. We designed and implemented a standardised surgical admission proforma and evaluated its impact on improving compliance with standards for documentation.

Method

Freehand admission notes for consecutive surgical admissions over a 4-week period were audited against guidelines produced by the Royal College of Surgeons (England). A standardised and structured admission proforma was introduced over a 2-week period to replace freehand documentation, its efficacy subsequently reaudited over a 4-week period.

Results

A total of 67 freehand admission notes were evaluated. Key components such as vital signs, medications and allergies were documented in less than 46%, 43% and 72% respectively. Additionally, smoking and alcohol consumption were documented in less than 40% of admission notes. 51 admission proformas, with a 100% uptake, were evaluated post-intervention. The mean improvement in documentation of vital signs was 60.0% (SD = 0.11). Documentation of existing medications, alcohol consumption, smoking status and laboratory investigations results improved significantly by 46.9%, 43.1%, 40.6% and 17.5% respectively. Additionally, 96.1% of admission notes had identifiable medical council registration numbers. Improvements in legibility and efficiency of documentation were also noted.

Conclusions

Introduction of a standardised admission proforma resulted in significant improvements in quality and completeness of admission documentation. Concise, legible, and accurate documentation is fundamental in maintaining effective clinical governance, allowing for the provision of safe and efficient patient care.
481 An Audit on the Completion of Hand Trauma Proformas – a Tertiary Centre Experience
Authors: Ibrahim A , Khudr J
Published: August 2023

Aim

The Royal College of Surgeons of England in its guidance "Safe Handover" set out minimum data necessary for safe handover. The Hand Pro-forma should be thought as part of hand over as it allows for clear communication of information between members of the team. In addition, the Hand Pro-forma is a medicolegal document.

Our previous audit on the quality of proforma completion highlighted that x-ray documentation was improving as it increased to 71% from 56% of the cases.

Method

We assessed the completion of the x-ray section within our current hand proforma. We reviewed the Hand trauma proforma documentation trauma clinic and ward admissions between 20/8/22 – 20/9/22 and used the British Society for Surgery of the Hand guidelines as a standard to compare.

Results

We reviewed twenty completed proformas. This indicated that an X-ray was obtained in 80% of the cases, which is a drop considering the previous audit highlighted a reporting rate of 95.5%. Only 40% of proformas documented which hospital the X-ray was performed and only 60% documented x-ray findings. This is a significant decrease from a previous 100% completion rate.

Conclusions

From this audit we identified that lack of access to external PACS system as a significant barrier to completion of documentation. As part of this audit cycle, we addressed this by providing access to the generic doctors account, to act as a temporary measure while newly rotating doctors sort their accounts. We are aiming to re-audit in 6-months’ time to assess intervention effects.
551 Admissible or Overkill - Get It Right First Time (GIRFT) operative documentation for Laparoscopic Cholecystectomy
Authors: Hennessy J , Potter L , Digne-Malcolm H , Ninkovic-Hall G , Ahmed M , Magee C
Published: August 2023

Aim

Get It Right First Time (GIRFT) Laparoscopic Cholecystectomy (LC) documentation best practice was updated in September 2022. This was a combined incentive by NHS & Royal College of Surgeons with the aim to improve poor operative documentation leading to medico-legal claims and preventing defence of good medical practice. We aim was to assess how we locally adhere to these.

Method

Retrospective 2-cycle, 2-month review of all LC (August 2022 (pre GIRFT) and September 2022 (post GIRFT)). Operation notes were scrutinised and compared to the newly set national standards. 60 operation notes were sampled (33 pre, 27 post), completed by 8 surgeons. We defined the recommendations into 24 essential and 8 non-essential elements.

Results

N = 0 operative notes contained 100% of the required information recommended by GIFRT. Of the pre GIRFT, 33% (n = 11) had ≥75% of the essential criteria (p = 0.162). Post GIRFT, 44% (n = 12) had ≥75% of the essential criteria (p = 0.097). Notable deviation from standards were poor documentation on patient position & skin preparation (23%), intra-abdominal pressure setting (7%) and histology sent (3%). 0% stated the table position (reverse Trendelenburg or right side up).

Conclusions

Although the GIFRT guidelines for documentation in LC are lengthy, without them it is difficult to defend good medical practice when exposed to medico-legal claims. Despite GIFRT release, locally we only had minor improvements in documentation standards. This indicates that a set operation notes proforma and further dissemination of these recommendations may be needed to improve documentation standards.
726 Pre-Operative Glycaemic Control in Diabetic Trauma Patients
Authors: Boothman C
Published: August 2023

Aim

To review the preoperative diabetic management of trauma patients pending theatre

Method

We analysed 2 months of trauma admissions including all patients with diabetes. We reviewed them against standards from our trust guidelines which state a blood glucose (BM), HbA1c, and urine analysis should be performed on admission. We reviewed which patients were commenced on variable rate insulin infusions (VRII) as the guidance states it should be considered when the patients’ BM is >12 or if the patient is to miss 2 or more meals.

Results

In our study population, 30% did not have a blood glucose on admission; and 80% did not have an HbA1c. Of those patients whose admission BM was over 12; 100% were started on a variable rate of insulin. The variation came with our tablet-controlled group as 33% were started on VRII and 77% were not. Of those not on VRII when it came to the day of surgery 18% had a BM of over 12. The average duration patients were kept nil by mouth was 14 hours

Conclusions

Polytrauma patients with diabetes are at higher risk of mortality; they are at increased risk of surgical site infections, poor wound healing, and non-union. This audit highlighted that the team recognise the importance of starting a VRII on those with hyperglycemia. However, going forward we need to ensure all patients have a BM on admission and this will direct our appropriate use of VRII and thus hopefully improve our trauma patients' outcomes.
752 How Do We Manage Open Fractures in Emergency Department? – a Closed Loop Audit
Authors: Li C H , Banks J , Zhu M , Tucker H
Published: August 2023

Aim

Patient with an open fracture is resuscitated mainly by the emergency physician prior to being referred to the relevant surgical specialties. Yet, there is lack of uniform guidance in managing open fractures. This audit aimed to evaluate the existing guidelines at the emergency department.

Method

A retrospective search was performed at the Tertiary trauma center. Four main parameters were evaluated 1.) the photo documentation. 2.) Antibiotic administration rate 3.) Tetanus prophylaxis utilisation. 4.) Systematic evaluation of neurovascular status pre and post splint.

Results

41 patients (M: F, 63%:37%) were analysed. The most common open-fracture were lower-limb long bone (39%) and phalanx (39%) , followed by upper-limb long bone fracture (9.8%), head (7.3%), facial (2.4%) and pelvis (2.4%). Multiple fractures were seen in 20.9%. Multiple open fractures were only seen in 1 case. The average transfer time by ambulance to the hospital was 116 mins. 97.5% of open fractures received antibiotics: 13.3%, 60%, and 100% of patients received antibiotics respectively within 1hr, 3hr, and 6hr from the time of injury. 48.8% received tetanus prophylaxis, and only 4.87% have documented tetanus assessment. 100% has a neurovascular examination. 72% of open fractures required surgical intervention. The average time to the theatre was 16.7 hours.

Conclusions

Antibiotic administration within the first hour from the timing of the injury is not practical in real-life situations. Future work should focus on creating a universe open fracture grading system, beyond lower-limb fracture, to better inform clinicians of the prognosis of open fracture and help with risk stratification.
831 Improving Documentation of Post-Operative Day 1 Checks After a Hip Hemiarthroplasty or Total Hip Replacement
Authors: Rasquinha M , Oakley B , Bhangoo N
Published: August 2023

Background

Post-operative day 1 checks (X-ray, bloods, dressing check and neurovascular status) are essential after hemi-arthroplasty (hemi) or total hip replacements (THR) to look for peri-prosthetic fracture, dislocation, anaemia, acute kidney injury, wound site bleeding and neurovascular impairment. Senior clinicians in the T&O department at the trust have raised concerns regarding documentation of post-operative day 1 checks in hemi/THR patients. Thus, offering no certainty to doctors reviewing patients at a later date that day 1 checks were carried out. Ultimately, raising the issue of patient safety.

Aim

The aim of this audit was to improve documentation of post-operative Day 1 checks in hemi/THR patients.

Method

Medical notes of those who underwent either a hemi/THR were reviewed. They were appraised on day 1 post-operative documentation of review of xray, acknowledgment of bloods results, dressing and NV status checks. Two PDSA cycles were carried out between September – November 2022. Interventions included: a) raising awareness on the junior doctor WhatsApp group; b) educating junior doctors via teaching sessions.

Results

40 medical notes were reviewed during each cycle. Results showed a clear improvement in quality of documentation. Pre-intervention (cycle 1): X-ray (37.5%), bloods (25%), dressing (52.5%), NV status (47.5%). Post-intervention (cycle 2): X-ray (71.5%), bloods (75%), dressing (72.5%), NV status (77.5%).

Conclusions

The relatively simple interventions have been found to have an improvement in documentation of post-operative day 1 checks in hemi/THR patients. Further recommendations include: raising awareness during induction and posters on the ward to prompt junior doctors to complete these checks.
916 Introducing a New Guideline for the Fifth Metatarsal Fracture (5th MTF)
Authors: Yahia Z
Published: August 2023

Background

The 5th MTF is a common injury occurring in the long bone joining the ankle to the toes. This injury can be categorised into two main sub-sections, namely green zone fractures (GZF) and red zone fractures (RZF) which are treated differently. Moreover, patients suffering from uncomplicated GZF are to be discharged directly from emergency department (ED), whereas the complex cases require a review from orthopaedic doctors. Due to time-restraint in ED, some fractures might be misdiagnosed/referred directly to fracture clinics unnecessarily.

Aim

Increase ED-led management and discharge of patients suffering from GZF

Method

A QI was introduced to implement a new guideline and update the patient information leaflet in the emergency department at ELHT. For each set of baseline data, an intervention was suggested to achieve the goal of this project and ensure a safe discharge of patients from ED.

Results

During a four-week study period, 20 patients presented to ED with an uncomplicated green zone fracture, 40% of which were discharged directly from ED. This demonstrates an improvement of 12.7% from a baseline of 27.3%. In addition, 80% of these patients were managed with a walker boot, as mentioned in the new guideline. In total, only three fracture clinic appointments were booked, due to complications, as opposed to twenty appointments. This resulted in a saving of £1.835,4.

Conclusions

The new guideline has led to an improvement of 50% in patient care. The new management plan benefits patients and improves the efficacy of the ED as well as fracture clinics.
1033 Renal Colic Emergency Management - an Audit Cycle
Authors: Mercer R , Jose M
Published: August 2023

Aim

This audit aims to assess whether the management of renal colic diagnosed in an emergency department setting is adhering to the current recommendations by the British Association of Urological Surgeons and National Institute for Health and Care Excellence.

Method

Two audit cycles were completed. Patients were retrospectively identified using the online clerking system in use by the emergency department. Patients were excluded if returning to hospital in the last 3 months, if the patient had a complex urological history, or if the CT scan was negative. Outcomes assessed were CT imaging within 14 hours of assessment, inpatient referral criteria being met, and NSAIDs being prescribed. Interventions included updated NSAID dosing and an updated renal colic pathway for the health board.

Results

The first cycle conducted identified 15 patients post exclusion, 9 were excluded. 87% of patients had NSAIDs prescribed, 93% of patients had a CT within 14 hours of assessment, 100% of patients meeting referral criteria were referred, 67% of patients meeting no referral criteria were referred.

The second cycle identified 6 patients post exclusion, 10 were excluded. 50% of patients had NSAIDs prescribed, 100% of patients had a CT within 14 hours of assessment, 50% of patients meeting no referral criteria were referred.

Conclusions

This audit despite the low patient numbers highlighted a need to update the renal colic pathway for emergency clinicians in keeping with national guidance. In addition, for future audits it has shown a better identifier for renal colic would be all patients receiving CT kidneys, ureters, and bladder.
1162 Management of Acute Gallstone Disease at an Urban Acute Trust During the Pandemic – Closed-Loop Audit
Authors: Sharif M , Osilli D , Mukherjee D , Buhain R
Published: August 2023

Aim

Acute gallstone disease is a surgical emergency with emphasis on early surgery (Laparoscopic Cholecystectomy (LC)) to improve outcomes.

Method

Patients presenting with acute cholecystitis, biliary colic, and gallstone pancreatitis between September and December 2021 were retrospectively audited. We measured re-admission rates, emergency and elective cholecystectomies performed, and interval between operation and initial admission. This revealed a need for improvement in the service provided at this trust.

An intervention was implemented with the Hot Cholecystectomy list being available for other surgeons as well as encouraging acute LC on the Emergency theatre list.

A follow-up retrospective audit was carried out between July and September 2022 using the same criteria as per the initial data collection.

Results

240 patients were admitted with acute gallstone disease during the initial audit period. At the end of audit period, 49 patients underwent LC, of which only 20% were performed acutely. However, 70% of acute operations were performed during re-admissions.

During the re-audit, 109 patients were admitted with acute gallstone disease. Within the three months, 21% of patients underwent LC, out of which 52% were acute operations. 50% of the emergency operations were in re-admission patients. Patients from the initial audit were followed up which revealed average waiting time of 118.5 days from admission to LC

Conclusions

There was almost a 3-fold increase in the rate of Emergency LC post intervention. While there is an increase, provision of emergency cholecystectomies does not comply with national guidelines. Resources need to be allocated nationwide for timely treatment of acute gallstone disease.
370 Biochemical Monitoring and Micronutrient Replacement Following Bariatric Surgery
Authors: Akharaekpanya T , Nevins E , Brown J
Published: August 2023

Aim

This project investigates whether patients received appropriate post-operative biochemical monitoring and micronutrient replacement after bariatric surgery, as per British Obesity & Metabolic Surgery Society (BOMSS) guidelines.

Method

A total of 27 Patients underwent either gastric bypass or sleeve gastrectomy between 1st August 2020 to 31st July 2021 at Northumbria Healthcare NHS Foundation Trust. Data was collected retrospectively.

Results

Most patients received appropriate micronutrient replacement, with 82% for A-Z multivitamin, 84% for calcium supplement, 72% for vitamin D supplement, 96% for vitamin B12 supplement, and 91% for ferrous sulphate for menstruating women.

Similar results found with post-operative blood tests at 6 months, 81% for FBC/LFT/U&E, 74% for ferritin and folate, 74% for calcium and vitamin D, and 70% for vitamin B12. Similar findings at 12 months, 74% for FBC/LFT/U&E, 74% for ferritin and folate, 78% for calcium and vitamin D, 70% for vitamin B12, 67% for zinc, 70% for copper, and 67% for selenium.

However, compliance with blood tests at 3 months was inferior, 48% for FBC/LFT/U&E, 37% for ferritin and folate, 37% for calcium and vitamin D, and 44% for vitamin B12.

Conclusions

Most patients received appropriate biochemical monitoring and micronutrient supplements. Unfortunately, less than half of the patients received monitoring blood tests at 3 months, which is a time where post-operative complications such as malnutrition can be identified and corrected. Several factors may have contributed to this, such as delay in communication between secondary and primary care or lack of facilitation to phlebotomy services.
257 Postoperative Pain, Analgesic Choices, and Ileus: A Snapshot From a Teaching Hospital in a Developing Country
Authors: Al-Jasim A , Aldujaili A A , Al-Abbasi G , Al-Abbasi H , Al-Sahee S
Published: August 2023

Aim

In this study, we looked at the severity of postoperative pain, the type of analgesics used to control the pain, and the incidence of POI at Baghdad Teaching Hospital. We hypothesized that we would find an association between the type of analgesia used and POI.

Method

This observational study was conducted among 100 patients who were residents at the general surgery wards of Baghdad Teaching Hospital. A structured questionnaire was employed focusing on types of analgesics, degree of pain control, and the presence of ileus.

Results

Sixty-nine percent of patients received a combination of opioids and non-opioids. Moderate-to-severe pain was the most commonly reported category on pain scales. More than half of the patients (57%) were found to have POI during their hospital stay and there was a statistically significant association between the type of analgesia and POI development ( p = 0.001).

Conclusions

A mix of analgesics (opioids and non-opioids) was the most common regimen at our centre. The majority of the surgical inpatients reported having moderate-to-severe pain on both pain scales used in this study. Ileus incidence following abdominal surgeries (61%) was significantly higher than the reported incidence worldwide (10-30%). Postoperative ileus has multifactorial causes, one of which is the use of opioids for pain control. Considering the high incidence of ileus in our center and the association we found between the use of opioids and ileus, further studies should look at the doses of opioids used and whether alternative analgesic methods might result in less ileus.
90 Breast Abscess Management: What Is Best for Breast?
Authors: Tam C , Lane R , Sinnatamby R
Published: August 2023

Aim

To assess the speed of resolution of breast abscesses presenting to the unit.

There is significant variation in the management of breast abscesses between units at a national level. Whilst the MAMMA study results are awaited, we wished to understand our unit’s outcomes in order to improve the patient journey.

Method

A single centre retrospective service evaluation of acute breast abscesses. The project was approved on the hospitals online QSIS system. The data was collected by interrogating the health records database using the following criteria: female, minimum age 16, presenting between 01/01/2017 - 31/12/2021. ICD codes for; breast abscess and/or breast infection were analysed with Excel (v16.40).

Results

298 notes were reviewed as a representative sample of outcomes (n = 700). 73 patients (24.5%) were correctly coded to have a breast abscess. The median age was 41 years (IQR 50-29.5). All received an USS scan within 24 hours. The cohort was stratified along smokers (32%) and lactational (23%) risk factors. Smokers were most likely to require I&D (39%) and had the longest duration of antibiotics (24 days). The median time for resolution was similar between those treated with serial aspirations (40 days) and those who needed I&D (42 days).

Conclusions

The study demonstrated prompt access to USS and aspirations. Each abscess presentation took approximately 1 month to resolve and needed 4 visits to the unit. This aspect of care is an area for improvement so that we can streamline the process and take pressure off valuable clinic slots.