bluuebunny/crossref_metadata_2025_split huggingface dataset:
1387 Audit of Pregnancy Status Documentation in Emergency Admissions to A Tertiary Colorectal Surgery Unit
Authors: Anbarasan T 
Published: October 2021

Abstract

Aim
Documenting pregnancy status (PS) is an important component of the medical assessment of all females of reproductive age (FRA), defined as age 16-55 years old when admitted to hospital. This audit aims to determine the rate of documentation of PS amongst FRA admitted to a tertiary colorectal surgical unit via the surgical admissions unit (SAU) or transfer from other departments between 01/10/20 – 13/11/20.

Method
A complete documentation of PS comprises of results of urine or serum (β-hCG) and relevant gynaecological history (i.e., last menstrual period and any contraceptive use) clearly reported in the admission clerk-in. Patients with presenting complaint excluding abdominal pain, current pregnancy, history of hysterectomy or sterilisation procedures were excluded.

Results
During the audit duration, 29 FRA were admitted of which 13 (44.8%) were included for analysis. Of patients included, 4/9 (44.4%) and 1/4 (25.0%) admitted via SAU or transferred from other departments respectively had a past colorectal history. 4 (30.8%) had complete documentation of PS of which, 3 (75.0%) were patients transferred from other departments.

Conclusions
Low rates of documentation of PS especially amongst emergency admissions via SAU, is possibly associated with a narrow differential diagnosis influenced by pre-existing colorectal history. This audit did not look at PS documentation prior to any subsequent surgical intervention. A re-audit following the implementation of a guidance poster in SAU is currently underway.
1394 Operation Notes Performa: The Way to Optimise Hand Trauma Service
Authors: Labib A , Oniska S , Karran L , Moledina J 
Published: October 2021

Abstract

Aim
To assess the effect of the introduction of British Society for Surgery of the Hand (BSSH) guided operation note Performa on the hand trauma service in St. George’s University Hospitals.

Method
First cycle was done in October 2019. This included retrospective evaluation of accuracy of documentation for closed hand fracture audit. Reassessment was done in September 2020 after introduction of surgical Performa guided by the latest BSSH guidelines.

Results
27 patients have been included in the first cycle compared with 81 patients in the second cycle. While 82% of first cycle patients underwent operation, only 40% of second cycle patients were treated surgically. Overall documentation has improved by a mean of 40% in all parameters. This includes documentation of discussion of shared decision making regarding conservative and surgical management, documentation of level of competency of the operating surgeon and mobilisation advice given to patients before their first appointment with a hand therapist. This led to improvement in overall patient outcome including rate of infection falling from 14% to 1% and reoperation rate from 23% to 1%.

Conclusions
Op notes Performa is a useful tool in the armamentarium of hand trauma management. It helps junior trainees to memorise critical information to document especially in the ones usually missed like detailed post-operative advice.
1444 Is FBC Being Investigated Within 32 Hours of Surgery in Neck of Femur Fractures?
Authors: Lammin K , Dhingra M , Mishra P , Narayan P , Tenang L A H 
Published: October 2021

Abstract

Introduction
The UK treats approximately 76,000 neck of femur (NOF) fractures annually (NHFD 2018). These patients are known to be frail and dehydrated upon arrival to the emergency department. Surgery can expose patients to substantial blood loss both preoperatively and postoperatively (Foss et al). Furthermore, studies have shown that postoperative anaemia is detrimental in patients who have had hip surgery (Marval et al 2014). Thus, it is imperative to monitor patients’ haemoglobin (Hb) levels immediately after the operation so that optimum treatment can be assured. The current audit standard in our local trust states that all patients must have their full blood count (FBC) within 32 hours post-surgery. As Covid-19 has brought disruption to the NHS, It is important for us to highlight any issues that arise in the monitoring of Hb in the post-operative phase of these NOF patients.

Method
Using retrospective analysis, this study analysed the number of patients having the FBC within 32 hours post-surgery during the pandemic (n = 60) and was compared to a similar cohort pre-pandemic (n = 139).

Results
91% of patients overall had their Hb checked within 32 hours. 92% in the pre-covid group had a Hb check within time compared to 81% in the covid group. The risk ratio calculated was 1.5.

Conclusions
Conclusively, patients in the covid group were 1.5 times more likely to have their FBC checked past 32 hours post-surgery. However, this finding was not significant. Overall, the audit standard was not met.
1454 The Challenges of Consent and COVID-19: Analysis of Documentation of Risk of Hospital Acquired COVID-19 Infection in a District General Hospital
Authors: Davis H , Mishra S , Cooke J 
Published: October 2021

Abstract

Background
The COVID-19 pandemic has been a challenging time for society and raised further challenges for medical practice. It poses a new material risk to any hospital admission or procedure, and consenting practice must modify to accommodate this.

Aim
To assess the documentation of the risk of COVID-19 infection and associated morbidity in consenting practice, using the existing consent form as benchmark, for patient’s undergoing general surgical procedures under general anaesthesia.

Method
Retrospective case-note analysis of 41 general surgical inpatient consent forms and operation notes during April 2020. Data were gathered on multiple points mentioned in Royal College of Surgeons (RCS) guidance. This includes documentation of risk of COVID-19 infection, the patient’s diagnosis, other risk documentation, peri-operative lifestyle advice and likelihood of success.

Results
Of 41 cases, 16 (39%) had risk of chest infection documented. Of these 16, 10 (63%) specified COVID-19 in the risk documentation. Further, morbidity related to COVID-19 was documented in 4 out of 41 (10%) cases identified.

Conclusions
A material risk is classified as anything that poses substantial risk to a patient, and it is vital that they are made aware of this prior to undertaking any form of medical intervention. This study demonstrates deviation from RCS guidance, and the results have been discussed and distributed within the general surgical department. Advice has been communicated regarding improvements required in consenting practice from the clinical lead. We aim to re-audit practice in the coming months.
1458 Compliance of Abdominal X-ray Requesting with iRefer Guidelines in CDDFT
Authors: McGurk R , Ross E , Toward M 
Published: October 2021

Abstract

Aim
100% of Abdominal x-ray (AXR) requests in the trust should be compliant with iRefer guidelines. Therefore, with this audit we hope to evaluate the compliance of our hospitals with said guidelines.

Method
This audit was retrospective with AXRs taken between 23 – 29th of November 2020 being analysed for compliance creating our first loop. On the 1st of December we placed our intervention. This came in the form of educational posters in the four areas that request the majority of AXRs. Following this, a further weeks’ worth of AXRs were assessed for compliance between 2nd – 8th of December 2020.

Results
Between 23-29/11/20 there were 67 AXRs requested. Eight of these were excluded according to our exclusion criteria, leaving a total of 59 AXRs to be assessed. After reviewing the request cards for these AXRs, 17 were non-compliant (28.8%). Following the intervention, AXR requests were re-audited. Between 2-8/12/20 there were 69 AXRs requested. Six were excluded leaving a total of 63 AXRs to be assessed. After review, 22 were non-compliant (34.9%)

Conclusions
In both loops of this audit, the standard of 100% compliance with iRefer guidelines was not met. There was a high percentage of non-compliance in both loops with a rate of 28.8% and 34.9% respectively – a decrease in compliance. One possible reason to account for this was due the changeover of Junior Doctors within the trust on 2/12/20. Our interventional posters were placed in only half of the Trusts hospitals which may also account for the decrease in compliance.
1503 Review of Electronic Theatre Coding System & Documentation of Neurosurgical Activity
Authors: Broomes N , Giamouriadis A 
Published: October 2021

Abstract

Introduction
It was noticed that the current electronic theatre coding system was limited in its reflection of departmental theatre activity and discrepancies in discharge letters compared to the actual operations performed. To prevent this from recurring, a standardised neurosurgical operation note was developed, and an audit of the electronic coding system was undertaken to see if the correct operation matched that of the code listed.

Method
A 6-month retrospective analysis from March to September 2020 was completed using the electronic theatre coding system, patients’ electronic records and the patient handover list.

Results
232 operations performed and only 10.3% of procedures were correctly coded by the current coding system. 11 operations were not on the theatre system although performed in theatres. The current system only coded for 82 procedures and did not show the full range of operations. There was wide variety of operation notes and only 185 operation notes were found on the patients’ electronic record. Frequently the procedure was not clearly identified so juniors relied on the inaccurate electronic code on the theatre list for the patients’ operation hence explaining the problem identified in discharge letters.

Conclusions
A new coding list for the electronic theatre system was created with 228 procedures divided into correct subcategories. A standardised template for operation notes was also developed and implemented so that full neurosurgical departmental activity is reflected, and accurate discharge letters are completed so that complete data collection can be done for audit purposes.
1507 Prospective Audit of Vascular Handover List
Authors: Eves J , Stoner R , Cerneviciute R 
Published: October 2021

Abstract

Introduction
Good handover is paramount for orientating on-call teams coming onto shift and maintaining patient safety. In our tertiary referral centre a pre-prepared list on our shared drive is used to handover vascular patients in the hospital. It was felt that there was insufficient information on the list and that inconsistencies / inaccuracies could compromise patient safety.

Method
We performed a full-cycle prospective audit using GMC/ RCSEng guidance as standards. Our list was audited over a period of 10 days 4/2/20-14/2/20. In addition, a questionnaire was sent around doctors of all grades to highlight areas of improvement and to gather ideas. The second cycle (17/2/20- 27/2/20) was then performed after introduction of a new list, which allowed more comprehensive information to be collected in a shared drive. Junior doctors on the team were briefed, and results collected with a second questionnaire.

Results
The new list showed statistically significant improvements in inclusion of key information as set out in the standards. These included presenting complaint ’92% from 57%,’ Diagnosis ’98% from 89%, clinical history 91% from 35%, significant results 86% from 13% and outstanding tasks 80% from 6.2%. (These were all significant p = 0.001 Mann-Whitney U.) Further information including antibiotics and VTE was included after feedback from department. 85% found the new list easier to navigate and 76% felt it reduced risk to patient safety.

Conclusions
Introduction of a revised handover list in a vascular tertiary referral centre resulted in significant improvements in adherence to RCSEng/ BMA standards and staff perceived benefit to patient safety.
1526 Primary Hip and Knee Arthroplasty Documentation: Do Our Operation Notes Follow New GIRFT/BOA Guidelines? A Closed Loop Audit
Authors: Whitham R , O'Callaghan J , Flintoft-Burt M , Shah V 
Published: October 2021

Abstract

Aim
Operation notes provide essential information about the techniques and implants used in surgery. Accurate documentation is important to improve patient outcomes and reduce rising litigation costs within the NHS. The aim of this audit was to assess compliance to recent guidance for hip and knee arthroplasty documentation, issued by the Getting It Right First Time (GIRFT) programme in 2019.

Method
Data was collected retrospectively from operation notes of all primary total/unicompartmental knee and hip arthroplasties during August 2019 and again in October 2019 at a DGH. Documentation was audited against data items from the GIRFT knee and hip arthroplasty ‘best practice’ guidelines. Interventions between timeframes included clinician education and a discussion of the guidelines between local surgeons.

Results
In audit rounds 1 and 2 twenty-six and 34 patients had THRs and 23 and 28 had knee arthroplasties respectively. 100% compliance was seen in 5/23 THR criteria and 9/27 knee criteria. Average compliance for knee documentation rose from 71% to 74% but no improvement was seen for THR (68% vs 64%). Those with least improvement related to assessment of range of movement and vascular status at the end of surgery.

Conclusions
Although compliance was good against the majority of data points there was minimal change following a local education intervention. The development and use of fully compliant departmental operation note templates would provide further clarity about steps performed and surgeon rationale should patient care later be scrutinised. The template would also act as an invaluable educational tool for trainees reflecting on the case.
1539 Flexible Nasoendoscopy – Is It Clean? Can You Prove It?
Authors: Teklay S , Green F , Nix P 
Published: October 2021

Abstract

Aim
Flexible Nasoendoscope (FNE) is an essential device routinely used to assess patients who present acutely to the Ear, Nose and Throat (ENT) department with signs and symptoms of ENT pathologies that may compromise the patient’s airway. It is imperative the scope is decontaminated before and after each use. The “Tristel Trio Wipe” decontamination methodology is employed by most ENT departments in UK and the process utilises an audit logbook to correctly document the sterilisation process as well as allowing accurate patient traceability. The audit aim was to conduct a review of documentation of patient traceability and FNE sterilisation after each use on ENT patients in the acute setting.

Method
Retrospective audit over one-month periods 11/10/2019 –10/11/2019 (Audit 1) and 26/12/2019 – 21/01/2020 (audit 2). Tristel audit logbook and electronic patient note on PPM+ were used for data collection. Data was analysed using Microsoft excel.

Results
100% of FNE decontaminations used correct Tristel Trio Wipes. However, audit one demonstrated 54.5% compliance with correct documentation of FNE sterilisation process and 0% had recorded all traceability information. Following intervention of easier identification of FNE scopes and their storage; as well teaching ENT Senior House Officers and registrar about the correct documentation of decontamination process, compliance improved to 81%, while traceability increased to 39% during the re-audit.

Conclusions
As a department, we have significantly improved our compliance with both correct documentation of FNE sterilisation and patient traceability information following the intervention above. A further 3rd audit cycle is planned.
250 Determining Timing of Surgery in the COVID-19 Pandemic: Experience from an E.N.T Department in A Hospital Admitting Patients With COVID-19
Authors: Lovett A , Jones E , Visvanathan V 
Published: October 2021

Abstract

Introduction
The COVID-19 Pandemic has led to significant impact on elective services, with over 1.1 million patients waiting over the 18-week target for consultant-led care. Resumption of elective procedures has been left to the discretion of individual units depending on COVID-19 infection rate, access to testing and PPE, and the co-ordination of other services. We present an audit to determine timing of surgery and assess post-operative mortality associated with COVID-19 infection.

Method
Prospective data collection was undertaken between 5th October 2020 and 1st November 2020, inclusive. With the exclusion of nasal packing and flexible nasoendscopy, all patients operated on within the E.N.T department were reviewed. Inpatient hospital records were reviewed for the 30-day follow-up period.

Results
A total of 98 patients underwent surgical procedures during the audit period. All patients were operated on in a hospital admitting patients with COVID-19. Ninety-five percent of patients were elective, and all-bar-one had a period of isolation and negative SARS-CoV-2 PCR swab prior to operation in a dedicated non-COVID operating theatre. Twenty-eight patients had a peri-operative admission; one patient was advised to isolate on discharge following confirmed COVID-19 contact. Of the total cohort, only one patient died in the 30-day follow-up period; no updated SARS-CoV-2 PCR swab was recorded.

Conclusions
With increasing numbers of elective procedures required, these results provide otolaryngologists with reassurance. We recommend that those awaiting elective surgery should have a negative SARS-CoV-2 PCR swab and period of isolation prior to operation, combined, and be cared for in a dedicated non-COVID setting.
280 The Use of Telemedicine in Plastics Surgery During COVID-19: A Single-Centre Correlation Study with Patient Reported Outcome Measures
Authors: Rojoa D , Raheman F , Ibrahim A , Patel N 
Published: October 2021

Abstract

Aim
With enforcement of social distancing measures during the COVID-19 pandemic, face-to-face patient contact was shifted to telemedicine consultations. There is limited evidence evaluating patient experience of follow-ups and expectations into quality metrics. Our aim was to perform a service evaluation by prospectively evaluating the management and outcomes of plastic surgery patients.

Method
Patients were consecutively assessed over the COVID-19 lockdown period, from March to May 2020. They ranged from urgent cancer cases to burns and trauma. We used a questionnaire to evaluate initial treatment, wound care, complications, and overall service. A validated health-related quality of life (HRQL) survey was used to assess the impact of injury or wound on lifestyle and we also assessed patient enablement. Correlation analysis determined relationships between outcomes, service evaluations and HRQL variables.

Results
77 patients were consecutively treated in our unit, of which 46 completed the questionnaire. 42.2% used multimedia as mode of follow-up, including smart phones for messages and videocalls, and trust e-mails. There was a 3-fold increase in number of infections for non-face-to-face consultations, with a correlation significance of 0.043. We found no correlation between age and wound complication rates. 72.7% of patients found overall service very good or excellent. Although overall service satisfaction was similar for multimedia use and face-to-face consultations (p = 0.02), less patients were confident looking after their wound without face-to-face follow-ups.

Conclusions
COVID-19 has brought upon an unprecedented change in practice in our department. Implementing multimedia use and educating patients on wound care can significantly improve efficiency and service provision.
298 Review of Rapid Implementation of Virtual Hand Therapy Clinics During COVID-19
Authors: Timon C , O'Ceallaigh B , Siney E , McInerney N 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic led to the introduction of movement restrictions and the concept of social distancing in Ireland, beginning suddenly on March 12th 2020 (1). Following this, virtual consultation via video-call have been identified and integrated as an alternative to in-person consultation. To follow national recommendations and reduce the risk of patient attendance, video consultations were rapidly integrated by the hand therapy team at University Hospital Galway. This service provides a service to 730,513 people across eight counties (2) and was utilised for a range of upper limb injuries, providing vital care to trauma patients post-operatively and to minor injury cases. We wanted to retrospectively assess the implementation of these virtual clinics and how it affected patients.

Method
Patients were offered virtual hand therapy appointments. Patients were sent a link with their virtual appointment time and date via email. The patient could accept or decline the option of a virtual appointment at this stage. Patient satisfaction was measured via a bespoke survey. Functional outcomes were assessed via the QuickDASH assessment tool (3).

Results
44/74 ( 59.5%) of patients responded to the survey. Subjectively, the vast found the service user-friendly, convenient and beneficial. Objectively, the QuickDash score demonstrated low disability and high upper limb function return post injury.

Conclusions
Implementation of virtual hand therapy was integrated into practise without major issues. Patient satisfaction was very high. Virtual health services have obvious economic and environmental benefits and are essential to providing safe patient care in a social distancing society.
301 Theatre Timing Audit (TTA): HPB and Transplant theatre timing during COVID
Authors: Ghobrial Marios , Crush Jos , Chipurovski Igor , Georgiades Fanourios 
Published: October 2021

Abstract

Introduction
Severe-Acute-Respiratory-Syndrome-Coronavirus-2 is a novel, highly infectious virus that has spread throughout the world causing respiratory disease (COVID-19). COVID-19 was declared a global pandemic by the World Health Organisation in March 2020. The UK has been severely affected with around 70000 deaths recorded by December 2020. Surgical practice during this pandemic has changed, as peri-operative infections carry significant mortality and morbidity burden.

Method
Theatre timing from a large volume hospital specifically for HPB-Transplant dedicated theatres were assessed to evaluate the impact of the national/local COVID-19 protocols on service delivery. “Pre-COVID period” was defined by auditing times from ward-to-theatre, anaesthetic induction-to-start of procedure and end of procedure-to-transfer out of theatre for 2 consecutive weeks in October/November 2019. “COVID period-1” and “COVID period-2” were defined as two consecutive weeks during the UK government-imposed lockdown in April and November 2020, respectively.

Results
Under the care of the HPB-Transplant team pre-COVID 56 individuals were treated in 30 sessions. Only 16 patients (28.6% of capacity) in 12 sessions were treated in COVID period-1 and 48 patients were treated (85.7% of capacity) in 30 sessions in COVID period-2. Similar times were observed in transferring patients to theatre (p-value=0.265) and induction of anaesthesia (p-value=0.698) across the 3 periods. Significant delays were observed in transferring patients out of theatre during COVID period-1, that returned to near normal timing during COVID period-2 (16.6±12.8 Vs 39.4±10.9 Vs 17.6±10.5 min; p-value = &lt;0.00001).

Conclusions
Despite returning to near normal theatre timings in COVID period-2, we treat fewer patients, adversely affecting waiting lists.