bluuebunny/crossref_metadata_2025_split huggingface dataset:
317 Why Are We Cancelling Theatre Cases at Ealing Hospital? What Can Be Done?
Authors: Rokkas S , Sethi B , Kim I 
Published: May 2021

Abstract

Introduction
Following a recent spate of on the day cancellation of elective operations being cancelled on the day of surgery, a need for a wider review was felt. Our aim was to identify the causes behind these cancellations.

Method
Retrospective data collection was performed to categorise patients according to the reason for cancellation. Analysis consisted of case presentations being prepared and presented to the surgical consultants.

Results
A total of 130 operations were cancelled on the day of surgery. 22 patients were cancelled due to the procedure not being required and 10 patients were cancelled due to insufficient pre-operative investigations.
Analysis of the 32 cases demonstrated that the majority of cancelled patients were seen and listed for surgery after clinical review by the registrar without involvement of the consultant.
Some cancellations occurred when the consultant responsible for listing the patient was different of the operating consultant.
Both factors lead to differences in opinion arising on the day of surgery.

Conclusions
Ensuring patients are only listed after discussion with the consultant would reduce cancellations arising from lack of experience and clinical misjudgment of the registrar. It would also ensure that cases added to the pooled operating lists are less subjective in their indication and readiness.
318 Management of Incidental Pancreatic Cysts –Are We Adhering to Guidelines?
Authors: Sharmin A , Ahmed R , Singhal T , Kumar M 
Published: May 2021

Abstract

Background
The majority of pancreatic cysts (PC) are incidentally diagnosed. Most NHS Trusts do not have pathways to manage them. We reviewed the management of incidental PC and adherence to guidelines.

Method
Data was collected across three hospitals in our Trust between January 2018-January 2019 when there were no guidelines. Reaudit was performed between July 2019-February 2020 following the introduction of trust guidelines that recommend all PC be discussed in MDT meetings.

Results
The first audit identified 79 patients and 28 in the second. 53% (42) and 64% (18) patients were referred to HPB/GI MDT during the two periods. There was an 11% increase in MDT referrals, however, 35.71% of patients were still not referred. During the initial audit, 62 % (23/37) of patients in the Non-MDT group had no surveillance scans, potentially missing high-risk patients and 38% of patients (14/37) still underwent surveillance scans from non-GI specialists which could be unnecessary. 44% of patients underwent surveillance following MDT in the second period as compared to 83% prior to guidelines (p = 0.002).

Conclusions
Robust guidelines for incidental PC identify high risk cysts that warrant future surveillance/treatment and avoid unnecessary scans releasing radiology capacity.MDT referral ensures malignant transformations are identified early and reduce morbidity and mortality.
322 Snapshot Re-Audit of Implant Checks in SWLEOC Theatres
Authors: Getachew F , Baryeh K 
Published: May 2021

Abstract

Introduction
Never events represent a huge cost burden to the NHS due to litigation. One such event occurred at a high-volume orthopaedic unit involving the wrong implant being inserted into a patient. An extensive investigation was undertaken which highlighted a combination of human error in the implant checking process and implant storage system. As a result, local guidance was developed to ensure a ‘prosthetic pause’ was performed prior to implant opening.

Method
An audit of implant checking practices was performed. The first cycle involved 14 cases observed over two weeks and the second involved 16 cases over five weeks. The checks were deemed compliant if the operating surgeon read aloud the implant details to the team, the scrub nurse did the same and both happened prior to implants being opened.

Results
The initial audit had 8 of 14 cases complying with local guidance. Following the addition of laminated copies of the guidance to all theatres, the guidance being re-distributed to staff and targeted education of the scrub team this improved to 13 of 16 cases.

Conclusions
Targeted interventions and the introduction of a ‘prosthetic pause’ resulted in an improvement in compliance with implant checks and reduces the risk of further never events.
365 Arrival to Decision: Improving Waiting Times in Surgical Ambulatory Care
Authors: Mahmood F , Patel P , Islam O 
Published: May 2021

Abstract

Introduction
An audit of the newly established Surgical Emergency Ambulatory Care Unit (SEAC) at Furness General Hospital found perceived patient waiting times were high. This Quality Improvement Project assessed the patient flow through the SEAC unit and aimed to improve the average time from arrival in the department to senior review by 10%.

Method
The Plan Do Study Act (PDSA) methodology for quality improvement was used, the time from arrival in the unit to senior decision was recorded for each patient seen over one-week data collection periods. Analysis of the data allowed for a patient process map to be created to visualise bottlenecks in patient flow. The findings were discussed with all team members and an agreed intervention was implemented and tested.

Results
Over three PDSA cycles, a significant improvement in the overall time from arrival to decision was achieved, from an average time of 193 minutes to 150 minutes. This was achieved by introducing a referral form, which altered how and when members of the multidisciplinary team communicated with each other.

Conclusions
Clear communication at the appropriate time between all members of the SEAC team significantly improved the average time from arrival to decision.
367 Improving Handover Documentation in Surgical Inpatients Using Weekend Handover Stickers
Authors: Boyle C , Chien S , McCallum A 
Published: May 2021

Abstract

Introduction
Transfer to the care to the oncoming team is the point at which inpatients are most vulnerable. Effective handover is vital to protect patient safety and clinical governance. The Royal College of Surgery (RCS) Safe Handover guidelines highlight relevant information required for comprehensive handover. This QI project aimed to determine if implementation of weekend handover stickers in surgical patients’ notes improved handover documentation.

Method
A retrospective records-based audit of patients admitted under general surgery over a 4-week period was performed. Standards were set using the RCS guidelines to determine if sufficient weekend handover was documented.
We designed weekend handover stickers to be inserted in notes based on guidelines. A re-audit cycle over a 4-week period was performed to determine if the intervention improved handover documentation.

Results
119 patients were in the initial audit. 125 patients were in the re-audit. Documented handover in the notes improved from 43.7% to 89.6% after intervention.
Documentation of the following clinical information also improved: clinical situation (43.7% to 92.0%); co-morbidities (14.3% to 89.6%); current issues (71.4% to 94.4%); weekend blood tests (32.8% to 92.0%); antibiotic therapy (21.8% to 92.0%).

Conclusions
Weekend handover stickers resulted in a significant improvement in handover documentation improving patient safety.
389 General Surgery Operative Cancellations Within Aberdeen Royal Infirmary 2019
Authors: McIntosh S , Jardine R , Ghazanfar M 
Published: May 2021

Abstract

Introduction
Operative cancellation rates can be up to 17.6%, resulting in delays to patient treatment and management. This audit was conducted to assess underlying reasons for operative cancellations with the aim to minimise cancellations in the future.

Method
A retrospective review of General surgery operative cancellations during 2019 at Aberdeen Royal Infirmary was undertaken. Data was obtained from Theatre Management.

Results
28548 operations were performed across all surgical specialities during 2019 with 2664 operations cancelled. Within General Surgery, 447 were cancelled (182 emergency (40.7%), 265 electives (59.3%)). The most common reason was lack of theatre time for elective cases and procedure no longer needed for emergency cases. For cancelled elective surgeries, there was a median time of 29 days before being operated.

Conclusions
We highlight that both elective and emergency operations are susceptible to cancellation. There are clear differences in the reason of cancellation between elective and emergency. Going forward, it is worth discussing booking emergency operations with the on-call consultant to ensure they are necessary. Regarding elective operation cancellations due to lack of theatre time it would be imperative to assess the exact cause of this as to minimise operative cancellations. We plan re-audit once a departmental discussion has been made.
398 Theatre Waste Management and the Impact of COVID-19
Authors: Luney C , Little C 
Published: May 2021

Abstract

Introduction
Audit of waste management in an elective orthopaedic complex was interrupted due Covid-19 pandemic. We investigated the impact of the enforced changes on theatre waste due to Covid-19.

Method
Over a 1week period data on waste bag availability and number of bags of each category of waste per surgical case in an elective theatre complex was collated; this was compared to waste generated during Covid-19 pandemic.

Results
Prior to Covid-19 only clinical waste bins were available in many non-dominant clinical areas providing evidence of inappropriate routine disposal of domestic/recyclable waste. Pre-Covid-19 a mean of 6waste bags were used per surgical case (3.7yellow clinical bags, 1.3black domestic bags, 0.4clear recycling bags), with Covid-19 changes to waste management practice the mean number of waste bags used per case increased to 11 (9 orange contaminated bags, 0.5black, 0.3clear bags).

Conclusions
Clinical waste management has a significant economic and environmental impact. Covid-19 has led to nearly all waste being deemed to be contaminated and so requiring incineration, with increased volumes of waste generated per case through widespread adoption of PPE. This has increased cost and reduced the ability to recycle non-contaminated waste.
399 A Re-Audit of Secondary Prevention Medications Following Coronary Artery Bypass Grafting: Are We Still Compliant with The Updated Guidelines?
Authors: Dey A , Sastry P 
Published: May 2021

Abstract

Introduction
In the years following myocardial revascularisation with bypass grafts, patients remain at risk for subsequent ischemia as a result of native coronary artery disease progression or development of graft occlusion. Therefore, secondary measures, primarily medical therapy, play an indispensable role in post-operative care. An audit conducted in 2014 identified reduced compliance to prescription of secondary prevention medications. This audit aims to re- evaluate the level of compliance to updated guidelines.

Method
A retrospective case-note review of 100 patients, who underwent CABG (Coronary Artery Bypass-Grafts), was conducted primarily focusing on prescription of secondary prevention drugs at discharge, indications, and contraindications.

Results
99% patients were discharged on anti-platelet agents. However, 12%, discharged on dual anti-platelet agents, did not have any indications for them. 97 % patients were discharged on beta-blocker. Of the 3 defaulters, one had contraindication to beta blockade. 96% patients were discharged on one or more lipid lowering agents and 74% were discharged on ACEi/ARBs. Of the 26% patients discharged without RAAS (Renin Angiotensin Aldosterone System) inhibitor, 9% had no clear indication for it whereas for 7%, it was contraindicated at discharge.

Conclusions
A generalised improvement in compliance rate is noted for secondary prevention medications prescription according to updated guidelines from the previous audit.
420 Accuracy of Documenting Complications When Consenting Patients for Laparoscopic Appendectomy
Authors: Karki B B 
Published: May 2021

Abstract

Background
Appropriately performed informed consent acts as a shield against false complaints or claims of malpractice against the doctors. Laparoscopic Appendectomy accounts for a significant portion of general surgical workload hence shows a difference in the patient consenting.

Method
A proforma was devised which included recognised complications of Laparoscopic Appendectomy and grade of the consenting medical professional. The proforma containing 10 standard complications was then cross-referenced with the consent forms of 38 patients and the documented risks in each form was noted.

Result
The result showed a wide variation in the documentation of complications based on the grades of the medical professional. Out of 38 consent forms, 32/38 ( 84.21 %) were completed by Junior Grade Doctors out of which 15/32 by FY2 and 17/32 by Core Surgical Trainees (CST) and 6/38 (15.78 %) by Specialist Registrars (SpR). Of the set standard 10 complications, FY2 documented an average of 4.2, CST documented 6.2 and SpR documented 8.16 complications.

Conclusions
The study showed a need of improvement in the documentation of complications especially among Junior Doctors. Procedure specific complication stickers was developed for a standardised list of complications which will act as a source of information for the patient and prompt doctors to discuss the risks.
422 Improving Theatre Capacity for Orthopaedic Trauma Cases
Authors: Karbowiak M , Kohls J 
Published: May 2021

Abstract

Introduction
Delay to surgery in orthopaedic trauma is associated with higher morbidity and mortality, as well as prolonged hospital stay. In this study we have looked at how replacing half-day sessions with all-day trauma lists at the Royal Surrey NHS Foundation Trust has affected theatre efficiency and waiting times for surgery.

Method
Details for all trauma cases (with patient demographics, injury, and surgery details) operated on in April 2019 and April 2020 were collected using hospital records.

Results
88 cases were identified in April 2019 - the average time from presentation to hospital to the operation was 3.82 days. In April 2020, there were 79 cases with average time to surgery of 1.26 days. There was a reduction in the number of ambulatory trauma, however, more femoral trauma was recorded in April 2020. The reduction in waiting time for surgery following the introduction of all-day lists was statistically significant with p value &lt;0.05 across all subcategories except upper limb trauma.

Conclusions
The introduction of all-day trauma lists led to a statistically significant reduction in the time from patients presenting to hospital to surgery. In view of these findings, the department has now permanently introduced all-day lists on selected weekdays running alongside the elective sessions.
450 Retrospective Analysis of Surgical Clerk-Ins Within the Acute Receiving Unit: A Quality Improvement Project
Authors: Lee L , MacLeod A , Bradley A 
Published: May 2021

Abstract

Introduction
Accurate patient documentation at the ARU is vital to patient safety and ensuring smooth handovers to secondary care services. Because the nature of surgical treatment requires frequent patient handovers, and this increases the risk of miscommunication, we aimed to assess the quality of surgical clerk-ins and identify areas for improvement.

Method
Emergency admissions at the Dumfries Galloway Royal Infirmary were audited, looking at documentation quality under various clerk-in sections. Data was analysed before presentation to clinical governance.

Results
When 46 patient clerk-ins were examined, venous thromboembolism (VTE) prophylaxis plans were performed in only 24% of admissions - less than 1 in 4 patients.
Comparing out-of-hours and in-hours patient documentation, much higher omission rates were identified in the out-of-hours documentation: in systemic enquiry (42 vs 100%) and family history (31% vs 66%).

Conclusions
These results brought to attention the effect of hospital admission timing on patient documentation quality, and the lack of VTE prophylaxis planning. In surgery, these plans are key to minimising risk of avoidable thromboembolic complications.
A departmental meeting was convened to stress the importance of accurate and comprehensive clerk-ins to ARU doctors. Future audits could explore the factors influencing documentation quality for out-of-hours admissions, and ways to address these issues.
459 Implication of Changes in Management of Acute Pancreatitis During COVID-19 Pandemic
Authors: Ayoub N , Aboelkhair A , Mlotshwa M 
Published: May 2021

Abstract

Introduction
when COVID-19 pandemic stroked the country, the Royal College of Surgeons recommended cholecystectomy for gall stone pancreatitis could be delayed up to 12 weeks during Covid-19 pandemic. This may have exposed patients to recurrent gall stone morbidity and serious complications.

Method
Patients admitted with gall stone pancreatitis during Covid-19 period 12th March 2020 till 15th June 2020 to Western Sussex hospitals were analysed retrospectively for a period of 3 months post index submission. The endpoints were readmission rates and complication relating to gall stones.

Results

Conclusions
Delaying cholecystectomy for gallstone pancreatitis to 3 months is associated with significant readmission rates and serious complications. Cholecystectomy for gallstone pancreatitis should be categorised as 1B or 2 during Covid-19 period.
467 Impact of the Coronavirus Pandemic on Acute Surgical Patients’ Discharge Summaries
Authors: Ooi R , Stimson I B , Williams G 
Published: May 2021

Abstract

Background
The emergence of the Coronavirus pandemic has placed increased demands on the NHS workforce, especially in medical and intensive care units. The subsequent redistribution of surgical house officers to accommodate this in a single centre has possibly negatively impacted on the effective discharge notification of acute surgical patients.

Methods:
Discharge summaries of all patients discharged from a Surgical Assessment Unit were collected and analysed, to identify the date of completion and grade of responsible clinician. Data collection was carried out over three weeks before the initiation of lockdown measures and continued for a further three weeks during the peak of the Coronavirus pandemic with a three-week interventional period in between.

Results
In the initial audit, 36.2% of the 246 patients had delayed discharge summaries with an average of 7 days to complete. On re-evaluation, 45.3% of the 223 patients had delayed discharge summaries, with an average of 12 days to complete. A survey conducted post-re-audit identified that the most common reason for this was due to time constraints.

Conclusions
The reallocation of surgical staff has affected communication between primary and secondary care. Given the potential repercussions of these delays, healthcare systems should be made aware of this consequence, especially in preparation for any future resurgences.
473 Post-Tonsillectomy Advice: What Are UK Patients Being Told?
Authors: Gabrawi M , Haymes A , Davis J 
Published: May 2021

Abstract

Background
Tonsillectomy is one of the commonest surgical procedures performed in the UK, with just over 45,000 recorded in England in 2018-2019(1). Despite this there is wide variation in, and a lack of evidence for, the post-operative advice given to patients.

Method
Post-tonsillectomy patient advice sheets were obtained from 110 UK NHS Trusts and equivalent organisations. Their contents were analysed and compared with published literature on post-tonsillectomy management to determine whether the advice is evidence-based or not.

Results
Post-tonsillectomy dietary and fluid intake advice varied between hospitals; whilst many recommend eating and drinking a normal diet (88%), many recommended eating a ‘hard’ (26%) or ‘soft’ (8%) food diet. Literature written for adults was more likely to encourage adequate fluid intake than that for children (75% versus 25%). Non-evidence-based advice including avoiding fizzy drinks (21%), fruit juices (9%), and using chewing gum (51%), was frequently given. Reported post-operative risks and safety-netting also varied, with 71% advising urgent hospital attendance if any bleeding was experienced whilst 12% suggested that bleeding up to a spoonful was to be expected and should not necessarily be acted upon.

Conclusions
Much of the advice given appeared to be anecdotal and not based on, or contrary to, published evidence.
482 New Zealand Rural Hospital Junior Doctor General Surgery Guidelines for Emergency Department (ED): every little helps
Authors: Keren B , Voll J , Herewini A , Paranawidana R , Prasad J , Collins D 
Published: May 2021

Abstract

Introduction
Clinical guidelines are associated with improved patient outcomes. This is especially true for junior staff members with little clinical experience. We created Pocket Guidelines for the management of surgical patients in ED, aimed at house officers.

Method
Seventeen common surgical conditions were selected for guidelines. Information was collated on presentation, exam findings, differential diagnosis, laboratory tests, imaging, indications for referral, and timing. Evidence based guidelines were approved by General Surgical consultants in the department. The utility of our guidelines was assessed by surveying 20 junior doctors.

Results
16 out of 20 house officers responded to the survey, ranging from post graduate year (PGY) 1 to 4, majority of them (37.5%) being PGY1. 69% were female and 31% were male.
A 5- point Likert scale was utilised for answers. No house officers ‘strongly agreed’ with being confident in managing surgical conditions in ED. Over 80% strongly agreed with the need to have ED clinical guidelines for surgical patients. Over 90% of house officers, having studied the pocket guidelines, found these useful.

Conclusions
We implemented pocket guidelines for general surgery in a rural hospital ED to streamline surgical admissions. Guidelines were found to be beneficial by the majority of junior doctors.
494 Streamlining the Minor Operations Process - The Effect of Better Documentation
Authors: Schrire T , Estela C 
Published: May 2021

Abstract

Introduction
Plastic Surgery Minor Operations is a fast paced, rapid turnover operative environment. It is reliant on effective communication, accurate surgery, and time efficiency. It was noticed in our department that there was confusion regarding booking and operative intentions leading to delays in surgery and over-running lists. This was worsening patient experience and leading to delays in patient care.

Method
In response to the delays and confusion in booking, a new booking form was created, so all patients have a standardised booking containing the necessary information. This form was disseminated across all the booking clinics and formed a vital part of the pre-operative check in process.

Results
The audit was carried out at the time of introduction, and then re-audited a year later to see if the form has improved care for patients. Results showed that with the new booking form, people were not having to cancel or rearrange patients. Patient booking forms were sufficient, and a copy of the clinic letter no longer required for the operation to proceed or for clarity. It was noted that more senior advice was sought.

Conclusions
The new form has improved patient flow and quality of patient care, whilst streamlining the booking process.