bluuebunny/crossref_metadata_2025_split huggingface dataset:
325 The Appropriate Use of Plain Film Abdomen in The Acute Surgical Assessment Unit: The Experience of a Model Three Irish Hospital
Authors: Hefferon T , Khullar N , AL-Zubaidy R , Pretorius F 
Published: May 2021

Abstract

Introduction
A plain film abdomen (PFA) is a useful modality of imaging if used correctly. However, when used inappropriately, it leads to unnecessary cost and increases patients’ exposure to radiation. The aim of this study is to assess the adherence to the Royal College of Radiologists (RCR) guidelines for PFA use in acute surgical patients.

Method
A retrospective study was conducted in the Acute Surgical Assessment Unit (ASAU) of a Model 3 Irish Hospital over a 12-day period in October 2019. Data was obtained using a Patient Census Book and the National Integrated Medical Imaging System (NIMIS). Recorded indications for the PFAs were compared against RCR guidelines.

Results
A total of 207 patients were reviewed, 113 males and 94 females, with a median age of 45. In 67 out of 207 patients (31.4%) a PFA was performed. A total of 31 (46.3%) were valid indications. A significant finding was present in 6 of the PFAs none related to the presenting complaint.

Discussion
Based on RCR guidelines regarding the indications for PFA, &gt;50% of the patients had a PFA for reasons not indicated by their presenting complaint. If implemented properly, adherence to guidelines could save cost and more importantly, safeguard our patients.
340 Pre-operative Screening and Treatment of Iron Deficiency Anaemia in Upper GI Cancer Surgery
Authors: Tan J R , Bird N , Rao R 
Published: May 2021

Abstract

Introduction
NICE guidelines recommend intravenous iron for patients with iron deficiency anaemia (IDA) before major elective surgery to reduce blood transfusion rate. The aim of this audit was to assess pre-operative screening for anaemia and treatment of IDA in patients undergoing Upper GI (UGI) cancer surgery.

Method
A retrospective audit of all patients who underwent UGI cancer surgery in year 2019 at a tertiary centre. Data were collected from electronic records.

Results
Pre-operative haemoglobin level was performed in 110/111 (99.1%) patients. 43 (39.1%) patients were found to be anaemic using the WHO definition and 9/43 (20.9%) were severely anaemic (Hb &lt; 100g/L). All anaemic patients had iron status checked and 26/43 (60.5%) patients were diagnosed with IDA. 17/43 (39.5%) anaemic patients received treatment, including IV iron (n = 8), blood transfusion (n = 3), oral iron (n = 3), and both IV iron and blood transfusion (n = 3). Anaemic patients (n = 17) who received treatment had a significant improvement in anaemia (P = 0.005).

Conclusions
This audit has demonstrated good pre-operative anaemia and IDA screening; however anaemic patients are not adequately treated, and IV iron is not routinely offered. Pre-operative anaemia treatment is effective in improving haemoglobin level. We have implemented a new anaemia treatment pathway and MDT proforma to improve the quality of care.
348 Virtual Patient Assessment for Hand Fracture Management: A Departmental Analysis of Financial and Clinical Implications
Authors: Roberts N , Totty J , Pinder R 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic demanded reduced face-to-face (FTF) contact. Our department integrated virtual assessment into the incoming referral pathway to enable continuation of high-quality care. This study aimed to assess any potential efficiency benefit of this change in service whilst ensuring no compromise to clinical outcomes.

Method
A prospective analysis was undertaken of all hand fractures referred virtually during a seven-week period starting at the initiation of national lockdown. Cost analysis using NHS reference costs, inflated to 2019/20 prices, was performed. Clinical performance was assessed using the British Society for Surgery for the Hand (BSSH) Standards for Open and Closed Hand Fractures.

Results
Seventy-six hand fractures were referred; FTF attendance was avoided in 35 cases, with an estimated per-patient cost saving of £179.16. Of the 33 patients who attended FTF, 13 achieved same day non-operative treatment; 20 underwent operative intervention with 95% compliance to BSSH standards. No complications occurred.

Conclusions
Our pilot model demonstrates potentially significant cost savings of £6270 over a relatively short period, as well as clinical non-inferiority. This supports sustained integration of virtual patient assessment in the ‘new normal’. Further work across all disciplines is needed to define acceptable limits of telemedicine and new avenues for potential benefit.
349 Improving Assessment of Patients with Suspected Cauda Equina Syndrome Using A Standardised Proforma
Authors: Ramasubbu R , Ahlo R , Liao Q , Periasamy K 
Published: May 2021

Abstract

Introduction
Cauda Equina Syndrome (CES) has a devastating impact on the life of affected individuals. Most patients are reviewed by doctors who do not have specialist spinal expertise. NHS Lanarkshire guidelines for CES are based on ‘Standards of Care in Cauda Equina Syndrome’ (Todd and Dickson) 2016.

Method
Documented assessment of a sample of patients with suspected CES in our hospital was audited against standards set in regional guidelines. A tick-box proforma was introduced to standardise assessment, with re-audit thereafter. Chi-squared was used for statistical analysis.

Results
Cycle 1 (2018): Documented assessment of findings in 30 patients - bilateral radiculopathy (80%), urinary incontinence (93%), faecal incontinence (73%), anal tone (93%), saddle anaesthesia (83%), bladder volumes (90%) and ASIA chart (20%).
Cycle 2 (2019): Documented assessment of above findings was 100% in patients where a proforma was used. Proforma was used in 81% of patients.

Conclusions
Use of a standardised proforma improved assessment of CES. There was a statistically significant improvement in use of an ASIA chart (P &lt; 0.01) and assessment of faecal incontinence (P = 0.039). Compliance with use of this proforma could be improved further, to enhance patient care. Following the success of the proforma, it is being reviewed for implementation on a regional level.
357 Improving Surgical Consent – A Quality Improvement Project to Enhance the Consenting Process
Authors: Shrivastava M , Brown J , Sun L , Rajagopal R 
Published: May 2021

Abstract

Introduction
RCS guidelines on consent, recently updated, encourage a dialogue where all risks material to that patient are discussed and are clear. An audit was performed to assess whether practice at Oxford Hospitals is compliant with these guidelines – that all patients for elective surgery are consented prior to admission.

Method
Thirty-two undergoing elective Functional Endoscopic Sinus Surgery (FESS), Tonsillectomy and Septoplasty were interviewed in May-June 2019. Baseline data were presented at a local educational meeting, along with education on the recent changes to the RCS guidelines. Repeat audit took place in August-September 2020.

Results
All 32 patients were consented as per RCS guidelines and understood the reason for their surgery, but only 31% could explain the risks, and 56% could explain alternative options. Twenty (63%) consent forms were easily legible on randomised heuristic assessment. After education and change in department practice, understanding of the operation was much improved (80-100%). One outcome was to create pre-filled consent forms for common ENT operations.

Conclusions
Whilst RCS policy on completing consent prior to admission is being achieved, patient interviews suggest a lack of understanding of the operation. Standardised consent forms have the potential to enhance this understanding, as well as saving time.
408 Hand Trauma Consent
Authors: Masterton G , Aly R , Siddiqui A , Talwar C , Talwar C 
Published: May 2021

Abstract

Background
Consenting patients for procedures is a regular process for a trainee surgeon. The process of consent has come under scrutiny in recent years due to inadequacies highlighted by legal cases. With over 1.36 million patients attending A&E per year with hand trauma, this is the most common acute referral to Plastic surgeons.

Aim
To review current local practice by auditing risks and complications from hand trauma consent forms.
To develop and implement a standardised pre-printed label including relevant risks and complications for hand trauma.

Method
Sample of hand trauma related consent forms audited assessing and comparing the risks and complications sections to a standardised set agreed locally by Consultant Plastic surgeons, cross referenced with literature.
Standardised label including relevant risks and complications put into practice then re-audit their use.

Results
Use of the new standardised label demonstrated an elimination of omissions and increased adherence to 100% for all the relevant risks and complications.

Conclusions
Significant improvements in the process of consent were achieved through the development and implementation of a standardised risk and complications label. This ensures standards from the GMC and RCS guidelines are satisfied; positively impacting on service provision by improving the quality of the consent process.
461 Surgical Telemedicine Clinic - Patient reported Outcome
Authors: Ekowo O , Khan A , Elgabry A , Gouveia N 
Published: May 2021

Abstract

Introduction
To evaluate the patient reported effectiveness (PROM) of surgical telemedicine clinic (STMC) introduced during the Covid-19 pandemic.

Method
The study was registered as a quality improvement project and approved by the information governance team. This study was conducted at Darent Valley Hospital during the period between March – August 2020. Patients who were called as part of the STMC during covid-19 pandemic were contacted to provide a feedback about their experience. The study is ongoing. Herein we present our initial results.

Results
The target sample of 300 patients has been set. A total of 102 patients completed the questionnaire. Overall, 50% of the respondents felt the clinic performance was excellent, 28% rated this performance very good or good whilst 20% rated the clinic poor or very poor. About 80% felt reassured about their condition during the STMC. Despite the satisfactory report about the STMC, 75% reported to prefer face-to-face consultation in future.

Conclusions
Patients rating of the STMC was generally well received, a great majority would prefer face-to-face consultation if given an option to choose.
487 Reducing Intraoperative Fluoroscopic Radiation Exposure in Orthopaedic Theatres at A Trauma Centre
Authors: Hayter E , Rashid M , Johnson F , Erotocritou M , Thomas P 
Published: May 2021

Abstract

Introduction
Intraoperative fluoroscopic imaging in orthopaedic trauma surgery subject’s theatre staff and patients to increasing radiation exposure and its detrimental health effects. This audit cycle uses a target maximum for total number of intraoperative fluoroscopic images taken, as defined by recently published reference values, to reduce intraoperative radiation exposure.

Method
This is a two-phase audit cycle retrospectively reviewing all trauma operations over a 12-month period (456 cases) and a 10-month period (256 cases) after disseminating the target standards through posters and focused training. Audit standards describe target maximum total intraoperative images taken for 5 commonly performed procedures, applicable to 33% of total cases. Operative notes, total intraoperative image count and radiation dose report were reviewed through ORMIS and PACS.

Results
Audit standard compliance improved/remained at 100% in 4/5 of the investigated ‘common procedures’: from 2/5 procedures &lt;80% compliance and 1/5 procedures =100% compliance initially, to 0/5 procedures &lt;80% compliance and 2/5 procedures =100% compliance target upon re-audit. This translated to an improvement in mean radiation risk (DAP Gy.cm^2) in 3/4 common procedures (one exclusion due to dissimilar cohort characteristics).

Conclusions
This study demonstrates employing a target maximum total image count limit reduced radiation exposure in trauma theatres.
514 Audit to Assess Negative Appendicectomy Rate (NAR) in Adult Patients in The Leicester Royal Infirmary (LRI)
Authors: Baguley M , Palser T 
Published: May 2021

Abstract

Aim:
Determine the NAR rate in Leicester Royal Infirmary (LRI) and compare to the national average (20%)
Additional objectives:

Method
This was a retrospective audit which considered all patients admitted over a three-month period to the LRI with suspected appendicitis. Data was collected on patients proceeding to surgery, and then whether their histology was pathological.

Results
318 patients were included, of which 80 proceeded to surgery.
Objective 1
- NAR of 5% (4/80)
Secondary objective 1
Secondary objective 2
- Appendix visualised in 29.3% (48/164) of Ultrasounds

Conclusions
This audit has demonstrated that both USS and CT have a very low false-positive rate in assessment of appendicitis; however, USS visualises the appendix in less than 30% of cases.
I believe the pathway should be altered to remove USS scanning for obese patients where the appendix is difficult to visualise; or in older patients, where there is less concern in using the CT modality.
569 Improving the Urology Post Take Ward Round with Best Clinical Practice and A Governance Checklist. Quality Improvement Project Within Belfast Health and Social Care Trust 2020
Authors: McLoughlin P , McAdam A 
Published: May 2021

Abstract

Introduction
The post take ward round (PTWR) is a vital element to ensure patient safety. Although well established as a necessity, often documentation is poor and does not accurately reflect a clinical assessment or generated management plan. This quality improvement project aimed to assess the pitfalls of the PTWR and improve these were possible in-line with best clinical practice.

Method
Audit standards were established using national guidelines, including those by the Royal College of Physicians, Royal College of Surgeons, GAIN guidelines and NICE. An initial audit was carried out against these guidelines. Following this, three distinct interventions were implemented namely, Junior Doctor Education Sessions, a Urology Consultant Email Circular, and the development of a Urology PTWR Checklist. After each intervention, a re-audit was carried out.

Results
Compliance with guidelines improved across all standards set. Overall compliance improved from 19.0% to 70.4% after our three interventions were implemented.

Conclusions
The results of the initial audit outlined that PTWR documentation is often very poor or severely lacking. Fortunately, this QIP demonstrates how the urology PTWR can be significantly improved with relatively simple measures.
658 An Audit of Frequency of Cancer Genetics Referral in Patients with a Family History of Colorectal Cancer
Authors: Abbakar M , James T , Boxall P , Lim M 
Published: May 2021

Abstract

Introduction
Guidelines on the management of hereditary colorectal cancers were updated in 2019. In this study, data from patients within the colonoscopy surveillance programme for hereditary cancer at York Teaching Hospitals Trust were analysed to assess category of risk and appropriateness of referrals to regional geneticists.

Method
After examination of electronic records and clinical notes, patients were assigned a risk category of average, moderate or high according to the Amsterdam criteria and latest BSG/ACPGBI/UKCGG guidelines. Patients were then assessed to see if a concurrent referral had been made to the regional cancer genetic services.

Results
There were 228 patients. 72(31.6%) patients were in the average, 81(35.5%) in the moderate and 41(18%) were in the high-risk category. 34 (14.9%) patients with insufficient data and/or assessments were in the indeterminate category.
18 of 72 (25%) patients with average risk were unnecessarily referred to the regional genetics team, while 5/41(12%) of high-risk patients were not. A large proportion of patients with insufficient data (19/34, 55.8%) were rightly or wrongly, referred to the regional genetics team.

Conclusions
Assessment of hereditary cancer risk is difficult in the absence of good quality information. Risk assessment may be improved with use of a dedicated family history questionnaire/template - this facilitates identification of high-risk patients that benefit most from referral to geneticists.
670 Assessing Patient Satisfaction of the Fast-track Pathway to Pancreatic Resection
Authors: Lambe T , Roberts K , Powell-Brett S , Pustula M 
Published: May 2021

Abstract

Introduction
The ‘fast-track’ pathway to pancreatic resection is a straight to surgery approach that avoids potentially harmful preoperative biliary drainage. A possible criticism is that the shortened time span from diagnosis to surgery makes it more difficult for patients to adjust to their new diagnosis and mentally prepare for surgery. The emotional impact that ‘fast-track’ surgery has on patients has never been assessed. This study evaluated patient satisfaction of the ‘fast-track’ pathway compared to standard care.

Method
23 consecutive patients undergoing pancreatic resection between December 2019 and March 2020 at the QEHB were included. Patient were assigned to ‘fast-track’ (N = 12) or standard care (N = 11) pathways and satisfaction was assessed via a standardised, clinician supervised questionnaire using Likert scales to grade satisfaction.

Results
There was no significant difference in patient satisfaction between patients on the ‘fast-track’ pathway and patients undergoing standard care (p &gt; 0.05). Satisfaction levels were high for both cohorts, with 91.97% of responses rated as ‘Good’ or ‘Outstanding’.

Conclusions
The ‘fast-track’ pathway does not have a negative effect on patient satisfaction and therefore, emotional impact should not be a barrier to implementing this pathway nationally.
715 A Re-Audit of Compliance with Documentation Standards in General Surgery Operation Notes at A District General Hospital
Authors: Ogundeji O , Hornby S , Dwerryhouse S 
Published: May 2021

Abstract

Introduction
The operation note is an important document in patient care. It is an essential part of a patient’s medical record. Apart from helping to ease the continuity of care, it is also a crucial medico-legal document.
The aim of this audit was to re-assess the compliance of current operation note documentation in the department with the guidelines set out by the Royal College of Surgeons (RCS) of England.

Method
We carried out the re-audit 4 months after presenting the initial findings. 40 operation notes, randomly selected, were used for this audit over 6 weeks. Only operations conducted by General Surgery consultants (24) or registrars (16) were audited. Both Emergency and Elective procedures were audited (13 Emergency; 27 Elective).

Results
Time was still inconsistently documented in operation notes although there was a slight improvement (37%; 47.5%). Operative diagnosis was present in 82.5% of notes, compared with 78% in the first audit. 100% of notes had the signature of operating or assisting surgeon. Detailed post-operative plans were present in 95%, an improvement of 17% from the previous audit.

Conclusions
The quality and compliance with standards of the operation notes improved generally but there is still room for further improvement.
765 Reducing ‘At Risk’ Skin in Neck of Femur Fracture (NOF) Patients – A Quality Improvement Project Standardising Catheterisation and Peri-Operative Care
Authors: Sambhwani S , Kandiah A , Rayan F , Wazir A , Sheikh N 
Published: May 2021

Abstract

Introduction
A service evaluation audit highlighted significant variation in our practice as regards catheterisation in NOF patients. A pilot protocol was developed with real time data monitoring to see if we could improve our patients’ pathway.

Method
The protocol focussed on early catheterisation, monitoring the condition of patients’ skin, documentation around catheter care and removal instructions and surveillance for urinary tract infection rates (UTI)

Results
150 patients were included in the pilot. There was a reduction by more than 50% of patients assessed as having at risk or broken skin. 94.5% of patients were catheterised out of theatres (previously only 4%) saving an average of 14 minutes of theatre time per case. Delays in catheter removal after documented request reduced by 2 days and our UTI rates were relatively unchanged (3.3% compared to 2.7%). Documentation significantly improved. We also noted that overall length of stay was reduced by 2 days.

Conclusions
Standardising our care pathway has improved our patient care and documentation. It has benefitted theatre efficiency and also nursing of fragile skin in 'at risk' patients. Prompting early removal and compliance may have also had a positive impact on overall length of stay. This has been a successful quality improvement project in our department.
774 Primary vs Deferred Ureteroscopies In Stone Management-Quality and Cost Evaluation
Authors: Wani M , Hassan W 
Published: May 2021

Abstract

Introduction
To investigate quality and cost benefits of primary ureteroscopies (URS) compared to deferred URS after initial ureteric stenting in patients presenting with urolithiasis.

Method
This was one-year, retrospective study, carried out to evaluate quality and cost benefits of primary URS in comparison to deferred URS after initial stenting. 85 patients underwent emergency stenting while as 148 patients underwent elective URS (Including both primary as well as deferred URS). The quality assessment was based on patient factors -including number of procedures, days spent at hospital, days off work and expertise of person operating. Cost analysis included hospital stay expenses and income loss due to off work.

Results
Study revealed the average stay of patients who had a stent inserted on index admission was 2.54 days compared to 1.35 in patients who underwent primary URS during index admission. Overall, additional expenditure in patients who did not undergo primary URS was in the range of £ 1800 for hospital alone, excluding loss of work for patients, who needed to return for multiple procedures.

Conclusions
We conclude approach of primary URS and management of stone in index admission in stone management is very effective in both improving quality of patients as well as bringing down cost.
785 Ankle Fractures Management in Stoke Mandeville Hospital
Authors: Gkorila A , Wehbe J , Neal-Smith G , Augustine R , Duncan J , Aktselis I 
Published: May 2021

Abstract

Introduction
Ankle fractures treatment aims to restore joint stability and alignment to achieve full functional recovery. Current quality of care in Stoke Mandeville Hospital was compared to the gold-standard management approach as described in BOAST-12 guidelines.

Method
This closed loop audit looked at closed malleolar and syndesmotic ankle injuries in skeletally mature patients under Trauma and Orthopaedics. In the first audit cycle, 16 patients were included over a one-month period and 53 cases, with similar management, were identified over a three-month period for the second audit cycle.

Results
The initial audit cycle revealed that the main aspects of management that required improvement were the timing of reduction and splinting, as well as the documentation of neurovascular status post-reduction.
We discussed our findings at the clinical governance meeting and interventional posters were distributed around the hospital.
Documentation of the timing of reduction and splinting significantly increased from 6% to 85% post-interventions, and neurovascular examination post-reduction improved from 17% to 43%. All other quality assessment criteria recorded more than 90% documentation rates after implementation of changes.

Conclusions
Quality of care significantly improved post-interventions, which indicates that BOAST-12 gold-standard is achievable. The introduction of a proforma was suggested to further facilitate appropriate documentation.