bluuebunny/crossref_metadata_2025_split huggingface dataset:
417 Initial Choice of Imaging Investigation for Patients Presenting with Acute Pancreatitis: Should MRCP Be First Line in Selected Patients?
Authors: Yao L , Briggs C , Labib P 
Published: October 2021

Abstract

Introduction
Current guidelines for acute pancreatitis advocate abdominal ultrasound (AUS) as the first-line imaging investigation to identify if gallstones are the cause of pancreatitis. However, many patients have a history of cholecystectomy or present with known gallstones and deranged liver function tests (LFTs). In these patients, magnetic resonance cholangiopancreatography (MRCP) is indicated due to its higher sensitivity and specificity for detecting choledocholithiasis.

Method
This retrospective audit reviewed all consecutive patients who presented to the surgical assessment unit with acute pancreatitis over one month. Their past surgical history, bloods and imaging were reviewed.

Results
Of the 30 patients, seventeen (57%) had no previous cholecystectomy or known gallstones, nine (30%) had previous cholecystectomy and eight (27%) had known gallstones, seven (88%) of which presented with deranged LFTs. Of the seventeen patients who should have had AUS first (n = 17), thirteen (76%) had AUS first, none had MRCP first and four (24%) had computerised tomography (CT) first. Of the patients in whom MRCP was indicated first-line (n = 13), seven (54%) had AUS first, none had MRCP first, four (31%) had CT first and two (15%) went straight to endoscopic retrograde cholangiopancreatography having had recent outpatient MRCPs. In the seven patients in whom MRCP was indicated but AUS was performed first, six (86%) underwent subsequent MRCP.

Conclusions
MRCP should be considered the first line imaging investigation for patients presenting with acute pancreatitis and a history of cholecystectomy or known gallstones with deranged LFTs, as AUS rarely prevents the need for subsequent MRCP.
431 Electronic Structured Response Tool for Deteriorating Surgical Patients
Authors: El-Koubani O , Barnett-Vanes A 
Published: October 2021

Abstract

Aim
The Scottish Patient Safety Programme created the National Early Warning Score to have early recognition of deteriorating patients. Clear communication and documentation during and after episodes were found to improve outcomes. SIGN guidance recommended 9-component that should be included in structured response, creating a paper-based structured response tool (SRT). We aimed to review medical assessments of deteriorating patients in general surgical wards and compare to a formulated electronic SRT in promoting best practice.

Method
Patients scoring over NEWS 4 were identified at eight 2-week time points over a 18-month period and initial assessments evaluated.

Results
101 patients were identified with a NEWS ≥ 4 between July 2018-Feb 2019. Implementation of electronic SRT occurred in Nov 2018 and Feb 2019. Average NEWS was 5.9 (range 4-12). Comparing collection periods, following electronic SRT implementation, documentation of re-review times rose from 37.5% to 79.5%. Documentation of frequency of observations and management plans increased from 24.5% to 65% and 79% to 97% respectively. There was a statistically significant rise in recording of escalation plans following implementation of electronic SRT from 35% to 94% (p = 0.008).

Conclusions
Usage of electronic SRT promoted documentation of all components recommended by SIGN. There is further scope to extend usage outside of surgical wards for all junior doctors by introducing electronic SRT at medical induction.
466 Surveillance Flexible Cystoscopy in Bladder Cancer Follow-up
Authors: Goodman D , Taggart R , Salmond J , Day E H 
Published: October 2021

Abstract

Aim
This study addresses surveillance cystoscopy in patients diagnosed with bladder and upper tract cancer. Managed Clinical Network (MCN) guidelines have clear recommendations for the timetable of follow-up cystoscopy, and we conducted this audit to study regional compliance.

Method
Using a multisite pathology database of bladder cancer cases from 2016, we collected and analysed data on 100 non-muscle invasive bladder cancers. We took the first 10 cases from each month to ensure cross-regional representation. Each case was stratified according to MCN guidelines. Electronic medical records were examined to assess upper tract follow up. We allowed for +/- 1 month each side of the target timeframe.

Results
We had 64 male and 36 female subjects. In our risk categories, we had 31 low risk, 37 intermediate risk and 32 high risk bladder cancers. 67 were new cases, 33 were recurrent tumours.
10 (43.4%) of low-risk and 19 (79.2%) of intermediate-risk patients underwent surveillance cystoscopy earlier than the recommended 12-month timeframe. 18 (78.3%) of low-risk patients continued to have further surveillance cystoscopies after a 12-month disease-free period.

Conclusions
43.4% of low-risk bladder cancer patients are receiving surveillance cystoscopy earlier than recommended. 78.3% of these patients are then undergoing unnecessary procedures following a 12-month disease-free period against regional guidelines and recommendations. This places an increased burden on clinic/theatre time and contributes to patient anxiety surrounding cancer follow-up. Evidence-based medicine guidelines have shown that less is more when it comes to low-grade bladder cancer surveillance. We now need to assess why we are deviating from our own guidelines.
495 Audit on Blood Ordering Requests in Mastectomies: The Need for a Routine Group and Hold
Authors: Chan K Y , Keogh S , Aucharaz N , Buckley J , Merrigan A , Tormey S 
Published: October 2021

Abstract

Aim
A group and hold (G&H) forms part of the pretransfusion compatibility testing and is commonly requested in anticipation of a possible blood transfusion. Requests made in the context of elective procedures with a low transfusion probability, such as a mastectomy, are associated with added financial burden and increases workload in a healthcare system. This audit aims to analyse the cost-benefit associated with the routine request for a preoperative G&H in patients undergoing mastectomies.

Method
A total of 100 patients undergoing mastectomies from the period of September 2019 to October 2020 were included in the audit. Data regarding blood order requests, units of blood transfused, perioperative haemoglobin and the type of mastectomy (right, left or bilateral) were collected.

Results
All patients had a routine G&H as part of their preoperative assessment. The average age in this cohort was 60.3. Right-sided mastectomy was the commonest procedure in this cohort (N = 52). The average preoperative haemoglobin was 13.0g/dL. 2/100 patients received post-operative blood transfusions. The transfusion probability in this cohort was 2%. Only 15% of the cohort had a post-operative haemoglobin level checked. The average drop in haemoglobin in this cohort was 2.3g/dL.

Conclusions
This audit demonstrates the low prevalence of blood transfusions in patients undergoing mastectomies, consistent with current literature. The projected cost savings associated with selective requests for G&H are significant. However, the implementation of a safe and targeted blood ordering approach in patients with high bleeding risks will require a validated stratification system.
501 Antiplatelet Therapy Following Coronary Artery Bypass Grafting: A Closed Loop Audit in a Tertiary Centre
Authors: Scarborough A , Bleetman D 
Published: October 2021

Abstract

Aim
Guidelines recommend 12 months of dual antiplatelet therapy (DAPT) for patients undergoing percutaneous coronary intervention (PCI) followed by emergency coronary artery bypass grafting (CABG). In patients with stable coronary artery disease (CAD) undergoing CABG, DAPT does not give a survival benefit but may prevent venous graft occlusion. Variation exists in practice between consultants with regards to duration of DAPT after CABG in stable CAD patients.

Method
All patients who underwent CABG in our centre in October and November 2020 were identified. Type and duration of antiplatelet and/or anticoagulant were recorded, as was history of MI and/or PCI. An antiplatelet prescription aid, taking into account surgeon preference, was designed and the effect on prescribing re-audited.

Results
35 patients underwent CABG. All patients except 2 received lifelong aspirin or a DOAC/NOAC. 3 patients had STEMI/NSTEMI in the preceding 12 months; two received DAPT and one received aspirin and a DOAC. Variation exists for DAPT prescribing duration following CABG for stable CAD. Re-audit results shows improvement in consistency of prescribing following implementation of the prescription aid.

Conclusions
Adherence to DAPT guidelines following PCI and CABG is good. However, variation exists in DAPT prescribing in stable CAD patients, between consultants and between patients for the same consultant. Consistency improved with implementation of the prescription aid.
524 Effectiveness of Burns Wound Cleansing by Comparison of Prewash and Post Wash Swab Reports
Authors: Sayed M A , Jabeen S , Soueid A 
Published: October 2021

Abstract

Aim
The main aim and objective were to optimise wound healing through infection prevention. This clinical audit aimed to investigate the effectiveness of burn wound cleansing in decreasing bacterial load by comparing pre-wash and post-wash swab results against local burn wound management and aseptic non touch technique (ANTT) guidelines.

Method
The audit was conducted retrospectively on children admitted to Burns Unit during August 2019, excluding resuscitation burn patients. Pre- and post-wash swabs taken on admission were included and the results obtained from Chameleon database. Data were collected on excel spread sheets including demographic variables such as age, sex, type of injury, percentage total body surface area (TBSA) and mechanism of injury. Data were analysed and results compiled.

Results
Fifty patients were admitted over a month period; amongst those 60% were male and 40% female of ages ranging from 5 months to 14 years. Scald (50%) was found to be the most common mode of injury followed by contact burn (36%) involving 0.30 to 9% TBSA. Among 50 patients, 30 (60%) showed no growth in pre-wash and 36 (72%) in post-wash swabs. However, 6% post-wash swabs that were initially negative later showed bacillus cereus, staph aureus, Enterobacter, and Acinetobacter. Similarly, another 4% post-wash swabs developed new microorganisms as compared to pre-wash swabs.

Conclusions
The most common bacteria colonising both pre- and post-wash swabs was staph aureus. Overall, cleansing had reduced the bacterial load significantly around 82% very effective. It is imperative to stick to local guidelines to reduce morbidity and mortality in burn patients.
530 An Audit of Appropriate Documentation Following Urethral Catheterisation
Authors: Dokubo I , Armitage J 
Published: October 2021

Abstract

Introduction
Urethral catheterisation is a procedure frequently done in the hospital by medical personnel. Appropriate documentation is necessary to ensure safe clinical care and to reduce the risk of litigation.

Method
We randomly reviewed electronic notes of patients seen by the on-call urology team who had a urethral catheter inserted in September 2020. Reviewing the trust’s guidelines, we considered that appropriate documentation should include reference to the following 10 items; indication, chaperone present, consent obtained, groin examination, catheter size, catheter type, insertion process, urine colour, water in balloon and residual volume were reviewed.

Results
A total of 50 patients were included. 72%(36/50) were inserted by a member of the urology team. Only 28%(14/50) had all 10 items documented. Indication for catheterisation was best documented at 94%(47/50) while presence of a chaperone and groin examination (i.e. presence of a foreskin and its replacement post-catheterisation) were the lowest at 44%(22/50).

Conclusions
This study shows there is low compliance to adequate documentation of urethral catheterisation. A ‘smart phrase’ has been developed for use with our Trusts electronic medical records system to assist clinicians with appropriate documentation. Clinicians that use the phrase ‘.icat’ are prompted to document all 10 requisite items. This uses the mnemonic i-CATHETAR [indication, Chaperone and consent, groin Assessment, Tube (catheter size and type), insertion process (Hard/Easy), urine Tint, Aqua in balloon, Residual volume]. A second audit cycle is currently being done to review the effectiveness of this intervention.
552 A Single Centre Retrospective Study of Outcomes in Open Liver Surgery
Authors: Shrestha D , Gungadin P , Sonanis S , Sultana A , Subar D 
Published: October 2021

Abstract

Aim
Despite advances in laparoscopic surgery for liver resections, an open approach remains the most frequent approach for complex liver resections for benign and malignant conditions. The aim of this study was to evaluate the clinical outcomes of patients undergoing open liver resections at a single tertiary HPB centre.

Method
All patients undergoing open liver resections between March 2018-July 2020 were included. Clinical and pathological data was reviewed for all patients and data collected including demographics, indication for surgery, complications, length of hospital stay and 30- and 90-day mortality.

Results
A total of 51 patients underwent open liver resection with median age of 65 (IQR 60.5-70.5). Indication for surgery included CRC metastasis (45%), HCC (27%), Intrahepatic cholangiocarcinoma (8%), Cholangiocarcinoma (8%), other metastasis (8%). The median hospital stay was 8 days (IQR 6-15). Complications were noted in 17 patients (Clavien-Dindo Classification III (8%) and IV (12 %). 6 patients had post op bile leaks, 4 with grade B and 2 with grade C bile leaks. 8 patients had post hepatectomy liver failure (5 Grade A, 2 Grade B, 3 Grade C). No mortality was noted at 30 and 90-day time-points.

Conclusions
Our outcomes in terms of morbidity, mortality and hospital length of stay are similar to that in published literature.
633 Improving the Quality of AKI Management Within a District General Surgery Department
Authors: Dougal J , Crawford J , Kourounis G , Whalen H 
Published: October 2021

Abstract

Introduction
Acute kidney injuries (AKI) affect 1/5 patients requiring acute hospital admission. The NCEPOD report (2009) described only 50% of AKI care as “good”. Swift identification and appropriate management of AKI is vital. We aimed to assess and improve our adherence to NICE guidance(QS76, NG48) on managing AKI.

Method
Retrospective review of paper notes was conducted in patients admitted under general surgery at Royal Alexandra Hospital found to have a &gt; 50% increase in the serum creatinine. We assessed the completion of a urinalysis and withholding of nephrotoxic medications within 24 hours of AKI identification, and duration of AKI. First cycle was conducted in August 2020. An AKI alert card was introduced outlining the identification of an AKI and initial management. This provided an effective method of recording interventions in patient notes and accessible education on current guidelines to foundation doctors. The second cycle commenced mid-December and is ongoing.

Results
First cycle included 30 patients; median age was 77(IQR:67-85). Adherence to urinalysis and nephrotoxic guidance was completed in 9/30(30%) and 13/30(43%) respectively. Median duration of AKI was 7(IQR:5-12) days. Second cycle has identified 17 patients so far; median age is 75(IQR:68-91). Adherence to urine dip and nephrotoxic guidance improved to 11/17(65%)(p &lt; 0.05) and 16/17(94%)(p &lt; 0.05) respectively. Median duration of AKI also improved to 3(IQR:2-7) days (p &lt; 0.05).

Conclusions
Our interim results show a positive effect to the management of AKI following the introduction of our AKI Alert Cards. Reduction in overall duration of AKI highlights patient benefit.
642 A Closed Loop Audit Looking at The Use of a Checklist in Surgical Ward Rounds to Improve Documentation. Can We Improve Patient Safety?
Authors: Liao Christopher , Sheaff Emma , Wilkins Harry 
Published: October 2021

Abstract

Introduction
Ward rounds are essential in assessing and planning patient care, but they are often subject to variable quality and structure. A ward round checklist could improve documentation and patient safety.

Method
We performed a closed-loop audit with a different novel ward round checklist in each audit, the second made from improving the first, based on feedback. We looked at checklist utilisation, and the quality of documentation in notes. We compared the quality of documentation in notes with the checklist, to notes without the checklist. The data was then collated and analysed. Standards from the Royal College of Physicians’ “Ward Rounds in Medicine”.

Results
In the first audit, our sample was 68, in the second, it was 64. With the use of a checklist (M = 67%, SD = 22%) documentation was significantly better than without (M = 26%, SD = 10%), t(64)=8.85, p&lt;.00001. Ward documentation was especially improved regarding fluid balance, analgesia, and assessing physiotherapy needs. The second version of the checklist (M = 56%, SD = 28%) was used significantly more than the first checklist (M = 13%, SD = 22%), t(75)=7.59, p&lt;.00001.

Conclusions
With the growing role of clinical notes as a legal document, a tool for handover, and a pillar of care planning, improving the quality of the documentation is imperative. This study shows that a systematic checklist significantly improves ward round documentation, which has already established in an improvement in clinical care. We hope to follow-up this study with a third audit, focusing on patient satisfaction and determining reduction in harm caused to patients with a ward round checklist.
648 The Use of Antibiotics in Acute Pancreatitis - A Re-Audit of Current Practice
Authors: Rai A , Kudchadkar S , Munasinghe A 
Published: October 2021

Abstract

Introduction
The NICE guidelines do not advocate the use of prophylactic antibiotics in the management of acute pancreatitis. In severe pancreatitis with necrosis, local antimicrobial guidelines state that it ‘maybe reasonable to use antibiotics with good spectrum anaerobic cover’ and suggest the use of Amoxycillin, Metronidazole and Gentamicin as first line, and Meropenem as second line if needed. Previous audit showed 74% of patients receiving antibiotics without clear indication.

Method
A retrospective re-audit of the use of antibiotics in patients admitted with a clinical or radiological diagnosis of acute pancreatitis was undertaken in a single-centre University Hospital between July and October 2020.

Results
78 patients were admitted during this period, with a mean age of 52years (range 6-89 years), and male preponderance. All patients were conservatively managed with intravenous fluids, analgesics and antiemetics. 31(40%) received intravenous antibiotics, of whom, 14 (45%) had no clearly documented indication for their use. The remaining 17 had pancreatic necrosis (4), cholangitis/cholecystitis (4), infected pseudocyst (2), UTI (2), fever spike (1), positive blood cultures (1) and pancreaticoduodenal fistula (1). Metronidazole was the most commonly used antibiotic (58%), followed by Amoxicillin (38.7%), Co-amoxiclav (35.4%), Gentamicin (22.5%) and Meropenem (22.5%).

Conclusions
In line with the recommendations made from previous audit and improved awareness, there was a significant improvement in the number of patients receiving antibiotics without indications from 74% to 45%. We hereby stress the importance of the use of appropriate clinical judgement in decision-making and avoiding the unwarranted use of antibiotics in acute pancreatitis.
670 Documentation and Communication of National Emergency Laparotomy Audit (NELA) Mortality and Morbidity Scoring with Patients Prior To Consenting: Are We Following the Best Practice?
Authors: Barghash M , Rehman J , Salimi F , Mansour M 
Published: October 2021

Abstract

Aim
Patients presenting as an emergency have a greater risk of dying than those admitted electively. The ability to stratify risk and calculate a percentage chance of death, not only gives the clinical team a common language to be able to formulate a management plan but also enables them to communicate this with patients and their families. This includes a full explanation of potential risks, benefits, a ceiling of care and management alternatives. In this project, we assessed if the NELA score has been properly calculated, documented prior to surgery for every emergency laparotomy patient and whether such patients were aware of NELA risk predictions prior to consenting.

Method
This was a retrospective audit based on the NELA guidelines of pre-operative risk stratification and the fifth report NELA recommendations. We assessed 50 case notes of patients who had laparotomies from January 2019 to April 2020 in a busy district general hospital in the UK.

Results
We noted that NELA risk prediction score was not utilised/documented in most of the patients with compliance of only 26%. We also found that, in the majority of notes, no NELA score discussion with the patient/family was documented, even with patients who had their NELA score calculated preoperatively. Compliance was only 14% in relation to this category.

Conclusions
A formal assessment of the risk of mortality and morbidity should be made explicit to each patient and should be recorded clearly in the consent form and medical record.
680 Excelling in Adversity - Maximising Training Opportunities by Reducing Cancelled Operations
Authors: Holden C , Warrell D , Addams-Williams J 
Published: October 2021

Abstract

Aim
Viral swabs for Covid-19 are an essential part of a patient’s pre-operative checklist. Patients require negative swabs before proceeding to theatre. Delay in this process may lead to a cancelled operation with physical and mental health implications for the patient. There is a knock-on effect on surgical training, with fewer procedures and operations for teaching.

Method
Previous guidance required 2 staggered swabs prior to admission. This was simplified on 19th August 2020 to a single pre-operative swab. A retrospective audit was established within the Otolaryngology department at the Royal Gwent Hospital to assess whether the simplification of guidance reduced the rate of cancellations and the number of same-day swabs needed to maintain operating.

Results
In a 4-week period prior to the simplification in guidance there were 34 listed procedures, 3 of which were cancelled due to swab related issues. 1 patient required a same-day swab to facilitate surgery. In a 4-week period after the simplification in guidance there were 48 listed operations and no cancellations due to swab issues. 6 patients required same-day swabs to facilitate surgery.

Conclusions
Whilst the simplification of swab guidance has improved the rate of operations cancelled, the reliance on same-day swabs to maintain operating has increased. This could reflect better availability of same-day swabs. It is in the interest of trainees to ensure that patients are fully prepared for operations pre-operatively to minimise unplanned cancellations, associated patient harm and loss of training opportunities.