bluuebunny/crossref_metadata_2025_split huggingface dataset:
6 Improving Patient Flow in a Multi-Specialty Assessment Area by Introducing Referral Pathways for Orthopaedics and Plastic Surgery during the COVID-19 Pandemic
Authors: Gordon G , Fadulelmola A , Scott S 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic has seen fundamental organisational changes to emergency departments internationally. Specialties throughout the hospital setting have been asked to change their working practice, often with the aim of adapting to new processes in emergency departments. Early in the pandemic, the orthopaedic team at one district general hospital were required to provide 24/7 onsite cover in a multi-specialty area. Confusion over the referral pathways of two specialties (orthopaedics and plastic surgery) led to increase waiting times, constrained patient flow and poor patient and staff satisfaction.

Method
This quality improvement project occurred over three cycles of data collection and intervention over a two-month period. A novel referral pathway was developed and implemented after discussion with consultants in orthopaedics, plastics, and emergency medicine. Interventions included staff teaching, clarifying of roles at morning meetings and the deployment of posters.

Results
In cycle 1, 39% of orthopaedic referrals were inappropriately referred. By cycle 3, 0% of orthopaedic patients were inappropriately referred. Average time in department for patients referred to orthopaedics improved from 124 minutes to 88 minutes. Staff reported increased satisfaction, with appreciation for the clarification on referral criteria.

Conclusions
This QUIP demonstrates how simple interventions during times of crisis can solve complex organisational issues.
56 Antibiotic Prescribing for Open Fractures - A Quality Improvement Project to Enhance BOAST 4 Attainment
Authors: Imsirovic A , Walton T J , Drake P J H , Guryel E 
Published: May 2021

Abstract

Introduction
Open fractures are associated with increased infection rates and the evidence shows timely administration of prophylactic antibiotics within one hour of injury improves the outcomes.

Method
A multi-cycle audit was carried out retrospectively for patients presenting to Brighton and Sussex University Hospitals NHS Trust (BSUH) with an open limb fracture in 2018-2020. Targeted teaching was carried out for orthopaedic trainees, prompt posters created and alterations to the trauma clerking proforma were implemented.

Results
In first cycle, 48 (92.3%) out of total 52 patients were prescribed antibiotics prior to definitive surgical management, with a mean time to administration of 271 minutes. Of these, 41 (78.8%) received prescriptions according to BSUH guidelines. The use of STAT ‘once-only’ prescriptions was found to significantly reduce the mean time to administration for 154 minutes. In second cycle, all of 29 patients (100%) were prescribed antibiotics prior to definitive surgical management, with a reduced mean time to administration (233 minutes). Of these, 26 (89.7%) received prescriptions according to BSUH guidelines, and a significantly greater proportion received initial STAT prescriptions (51.7% vs. 15.4%).

Conclusions
This quality improvement project has demonstrated the successful implementation of targeted changes to improve the attainment of BOAST 4 guidelines.
64 The Impact of Inadequate Pain Control Following Chest Trauma on The Incidence of Hospital Acquired Pneumonia and Hospital Admission Length
Authors: Butterworth W , Ong O T , Magar O , Bird J , Scannell R 
Published: May 2021

Abstract

Introduction
The National Audit Office (2010) report estimated there was 20,000 cases of major trauma per year in England; of which 5,400 died and many others sustaining permanent disability. Blunt chest wall injuries are associated with high levels of morbidity and mortality, and we aimed to investigate the impact of poor pain control in patient outcomes.

Method
Compliance with trust guidelines was assessed via a retrospective audit of all chest trauma patients between October 2019-20.

Results
28 chest trauma patients identified (M:F 15:13) with ages ranging from 47-94 yrs old (average age 73). Chest trauma was associated with high levels of morbidity (32%) and mortality (7%). 39% patients were found to have inadequate pain control. Only 17% patients eligible for regional anaesthetic blocks were performed within 24hrs. 33% patients developed hospital acquired pneumonias (HAP), of which 44% had received inadequate pain control. Average admission length of patients with a HAP was 15 days compared to 5 days without. 85% patients experienced either delayed or no assessment by specialist teams (i.e., physiotherapy, pain team).

Conclusions
Chest trauma patients often receive inadequate pain control and delayed specialist team input resulting in increased frequency of HAPs, admission length and morbidity/mortality.
101 Use of Blood Cultures to Detect Bacteraemia in Surgical Patients: A Prospective, Closed Loop Quality Improvement Project
Authors: Osborne C 
Published: May 2021

Abstract

Introduction
Sepsis is a complex, life-threatening condition, posing a significant burden to both NHS resources and society in general. Bacteraemia is a common presentation in surgical pathology and requires prompt investigation and treatment. Blood cultures remain the gold standard for detecting bacteraemia and providing targeted antibiotic therapy. We aimed to improve the overall use of blood cultures in pyrexial surgical patients.

Method
A three-loop, prospective quality improvement project was performed. Patients identified as being pyrexial were reviewed to determine when it was recorded and whether blood cultures were taken. Following a departmental presentation, two further audit cycles were performed at two months and seven months post-intervention to determine long-term response.

Result
A total of 56 patients were included over the three audit cycles. Blood culture adherence improved from 58.7% at baseline to 65% at 7 months. Most notably, out-of-hours compliance improved from 44.4% to 66.6%. 2-month compliance was 85%, however, this comprised of only 7 patients.

Conclusions
Early recognition and management of sepsis remains a key area of improvement. Whilst overall and out-of-hour blood culture compliance improved, continued education is needed to further increase this.
108 Developing A Non-Biopsy Protocol for The Female Cohort 25-29 Years with Clinically Typical Fibroadenoma Conforming to Maxwell Criteria on Ultrasound – Our Peninsular Experience in Wirral
Authors: Arif T , Vinayagam R 
Published: May 2021

Abstract

Introduction
The aim of this study was to introduce a non –biopsy protocol in our department for benign breast lump referrals confirmed as typical U2/3 fibroadenoma on imaging. Current UK guidance is not to biopsy sonographically typical fibroadenoma in women under 25 years. We have studied our population extending the radiological Maxwell criteria reflecting benign outcomes in 25-29 years cohort.

Method
Retrospectively data was collected of all women between 25-29 years of age undergoing core biopsies for ultrasound confirmed fibroadenoma between 2014 and 2019 over a period of five years. The number of cancers picked up was compared with the number of referrals and the discordance between radiological diagnosis of fibroadenoma and histopathological confirmation of malignancy was recorded.

Results
A total of 1707 referrals were made across five years. n = 175 image guided core biopsies were carried out for U2, U3, U4 lesions appearing as fibroadenoma on ultrasound. Out of these (n = 175), all lesions coded U2/3 (n = 165) based on Maxwell criteria on ultrasound were negative for cancer. U4 lesions on ultrasound were confirmed as cancers mimicking fibroadenoma(n = 10).

Conclusions
This retrospective audit of 1707 patients provides sound evidence for non-biopsy of typical fibroadenoma in 25–29 years cohort sonographic features meet strict criteria.
184 30% Reduction in Time to Admission for Trauma Cases; An Integrated Multidisciplinary Model of Care Pathway in a Major Tertiary Hospital
Authors: Cheung Y , Carmody O , Synnott K 
Published: May 2021

Abstract

Introduction
Blue Book Guidelines recommend admitting hip fracture patients to an orthopaedic ward within 4 hours of presentation. BOAST guidelines advise early multidisciplinary team management. Since 2018, our Institution has utilised an integrated, multidisciplinary model for referrals of trauma patients in the Emergency Department. We hypothesised that this significantly reduces time to admission.

Method
We retrospectively reviewed data on all trauma cases admitted over a two-month period in 2017 and 2019 (before and after development of our Integrated Pathway). Our Integrated Pathway is facilitated by a mobile application which is accessed by all ED and Orthopaedic medical staff, including Consultants, allowing instantaneous communication.

Results
Sixty-six trauma patients were admitted to our Institution between December 2017 and January 2018. Average time taken from triage in ED to admission by the Orthopaedic team was 7hrs 10mins. Sixty-three patients were admitted over the same period in December 2019 and January 2020. Average time taken from triage in ED to admission by the Orthopaedic team was 4hrs 59mins.

Conclusions
Our Integrated Multidisciplinary mobile application system resulted in a 30.5% decrease in time to admission, which is a significant improvement. We would recommend the introduction of similar systems in other hospitals as part of their Model of Care Pathway.
238 Colorectal Cancer Surveillance In IBD: An Audit of a Large NHS Healthcare Trust
Authors: Claxton H , Johnson C 
Published: May 2021

Abstract
Aim: To investigate compliance with endoscopic screening guidelines for patients with Inflammatory bowel disease (IBD) in a large English Foundation Trust.

Method
A database of pathology specimens coded with a diagnosis of IBD since 2012, was cross-referenced with trust-wide colorectal cancer database.
NICE guidelines (2011) provided audit standard: Low risk require 5 yearly, moderate risk 3 yearly, and high-risk yearly colonoscopies. A randomised sample of IBD patients (n = 50) and all patients with both IBD and colorectal cancer (n = 4) were compared to this standard.

Results
Compliance to the audit standard within the population (n = 54) was only 50%, and only 25% within sub-group with both IBD and Colorectal cancer (n = 4).

Conclusions
Only 4 cases of colorectal cancer within our IBD population were on record since 2012, suggesting incomplete patient identification, perhaps due to unreliable coding.
The importance of optimising cancer screening programmes has only increased following the burden of the COVID-19 pandemic. Compliance within the audit population (n = 54) was only 50%, these findings promote a review of the screening process within the trust and advocate further complementary audits of additional NHS healthcare trusts.
248 Improving Handovers from A Neurosurgical High Dependency Unit to Ward Teams
Authors: Faderani R , Mohamed A , Stewart P 
Published: May 2021

Abstract

Introduction
A good handover is fundamental in providing continuity of care within a multidisciplinary team, allowing for safe and effective management of patients.

Method
Handovers between the neurosurgical high dependency unit and the ward team were prospectively evaluated as patients were stepped down over a 6-week period. The handover rate and consequences of poor handovers (missed investigations, referrals, or delayed discharges) were documented. After 6-weeks, handover proforma was introduced and the rates were recalculated.

Results
In the initial 6-week period, 36 patients were transferred, with only 2(5.6%) appropriately handed-over. Consequently, 9(26%) patients had delayed scans, 5(15%) missed referrals, and 24(71%) delayed discharges. In the 6-week period following the introduction of the proforma, a total of 28 patients were transferred, with 19(67.8%) documented handovers. Consequently, 1(3.5%) patient had a scan delay, 0 missed referrals and only 2(7%) patients had delayed discharges.

Conclusions
By raising awareness of handovers and introducing a proforma, we improved documented handovers by 62.3% whilst reducing the rate of missed investigations, referrals, and delayed discharges by over 90%. This project highlights how small, simple, and easy to enforce changes can lead to significant improvements in the quality of care provided to patients.
256 Antimicrobial Stewardship in Skin Cancer Surgery. Assessing Best Practice in Reducing Significant Post-Operative Complications
Authors: Walker K , Keward A , Botha E , Knepil G 
Published: May 2021

Abstract

Introduction
Antibiotic prescription is variable and with the growing frequency of antibiotic resistance, responsible use of antibiotics is necessary in keeping with Public Health England (PHE) Antimicrobial Stewardship guidelines. An audit was conducted to assess current practice of prophylactic antibiotics prescription in Skin Cancer Surgery in the department of Oral & Maxillofacial surgery.

Method
A retrospective case note review of patients who had undergone reconstructive surgery following skin cancer excision, recorded use of systemic and topical antibiotics and infective outcomes. Inclusion criteria were patients that had undergone surgical excision and reconstruction of skin cancer, followed by a wound assessment in an outpatient’s clinic with the outcome measure of infection defined by PHE Surgical Site Infection guidelines. A standard of 5% infection rate which is recognised by the British Association of Dermatologists was used.

Results
There was a 2% significant post op infection rate in patients with topical antibiotics used and 4.5% where neither systemic nor topical antibiotics were used. Immunocompromised patients had no increased incidence in significant post op infections occurring in either group.

Conclusions
The standard was met illustrating the low infection rate following reconstruction of Skin Cancer defects with or without prophylactic antibiotics and support a more discerning approach to antimicrobial prescribing.
321 Role of Antibiotics in Acute uncomplicated diverticulitis, A Systematic Review and Meta-Analysis
Authors: Tahir A A , Ali K M , Khan A U , Kamal S , Hussain A , Khan A U 
Published: May 2021

Abstract

Introduction
Diverticular disease is a common health problem with a wide clinical spectrum. About 75% of the patients would have uncomplicated diverticulitis. Cornerstones of treatment are antibiotics, analgesia, and dietary advice. Recent evidence has shown that its treatment is controversial, questioning the use of antibiotics. Aim is to assess the role of antibiotics in the treatment of acute uncomplicated diverticulitis.

Method
This is a systematic review and Meta-analysis. Literature review of the available studies was conducted using search engines like Pubmed, Medline, Embase, Google Scholar, and Cochrane databases. Statistical analysis was conducted using RevMan5.4.

Results
Out of 1754 records 1324 were duplicates, 430 studies were screened. 395 were further excluded.35 full text articles were assessed and in the final review 10 studies were included. PRISMA guidelines were used. Pooled OR for recurrence = 0.92 (95% CI = 0.74 to 1.13). Pooled OR for Hospital stay= -0.66 (95% CI= -1.12 to -0.21). Pooled OR for complications = 1.06 (95% CI = 0.69 to 1.64). Pooled OR for treatment failure= 1.24 (95% CI = 0.90-1.69).

Conclusions
We conclude that from the available evidence antibiotics have no role in reducing recurrence, complications, treatment failure, and duration of hospital stay in acute uncomplicated diverticulitis.
342 Rib Fracture Scoring at The Royal Sussex County Hospital, A Major Trauma Centre
Authors: Harris H , Mitha Z , White D , Davies W 
Published: May 2021

Abstract

Introduction
In April 2017, The Royal Sussex County Hospital introduced rib fracture scoring to help guide the management of rib fractures.
Rib fracture score = (number of fractures x number of sides) + age score1
In this study, we audit our adherence to the scoring system and compare our management of chest trauma before and after its implementation.

Method
All admissions with rib fractures between 1/10/2016- 28/02/2017 (N = 35) and 1/10/2019- 31/01/2020 (N = 41) were recorded. Electronic and written notes were used to retrospectively record multidisciplinary care involvement, analgesics, chest infection and death.

Results
The pre-intervention cohort had an average age of 55.1 years and rib score of 8.8. The post intervention cohort had an average age of 67.2 years and score of 11.3. Following implementation, 45% of patients had a rib score recorded. Post-intervention, anaesthetic involvement increased by 34.5% and 15.4% more patients received a regional block. Inpatient nights fell from 11.2 to 10.1, mortality rate from 7% to 4% but the incidence of chest infection remained similar.

Conclusions
The implementation of a rib fracture scoring system has led to greater multidisciplinary care and higher levels of pain management. A larger study is required to assess patient outcome given the change in sample population over time.
356 Reducing Long Term Opioid Prescribing Post Thoracic Surgery
Authors: Allen N , Gregg A , McGuigan J 
Published: May 2021

Abstract

Introduction
Patients are routinely started on strong opioid analgesia after surgery with most receiving a prescription for these to continue discharge. We examine the analgesia prescribed in our unit, comparing to ERAS principles from EACTS. We aimed to reduce the total equivalent dose of morphine prescribed on discharge by implementing ERAS principles.

Method
We undertook a retrospective analysis of the analgesia prescribing for patients post open and VATS procedure noting the total dose opioids (using the equivalent dose of morphine). We examined how many patients were still being prescribed opioids analgesia long term, defined as 6 weeks post procedure. We implemented ERAS principles, changing to morphine rather than oxycodone, using short-acting preparations and increasing use of opioid sparing analgesia including NSAIDs.

Results
20% of patients started on strong opioids post procedure were still being prescribed these 6 weeks later. We used ERAS principles to reduce the equivalent dose of morphine dispensed on discharge by a third.

Conclusions
We identified a significant issue with long term opioid prescribing and initiated measures which have resulted in positive change. Our next cycle will measure the outcome of our changes on long-term prescribing implement a multi-disciplinary approach to try reducing the burden of long-term opioid prescribing further.
372 Short- And Long-Term Outcome of Pneumonectomy for Lung Cancer: 20 Years’ Experience of a Single Centre
Authors: Amran R , Hussain A , Din A C , Cowen M , Chaudhry M , Loubani M , Tentzeris V , Qadri S S 
Published: May 2021

Abstract

Introduction
Surgery is the most important therapeutic modality for the treatment of primary lung cancer. Studies normally reported as 30-days or 90-days post-operative mortality or 5-years survival. However, survival for ≥10-years is rarely mentioned.

Method
Retrospective data collection from a tertiary centre database was implemented which include patients who underwent pneumonectomy from January 1998 until November 2019. The data was analysed for short and long-term outcomes including their respective Thoracoscore.

Results
268 patients who had pneumonectomy were selected, in majority for lung cancer. 79.1% were male with mean age is 63. Overall operative mortality in this cohort was 4.9% while reported national mortality for pneumonectomy for lung cancer is 7%. No 30-days post-operative mortality in the last 5 years. The 5,10- and 15-years survival rate for patients are 36.9%, 23.9% and 20.3% respectively. This showed significant increase in the survival rate for 5- and 10-years post-pneumonectomy in comparison to previous study. Long-term survival was better in female with age &lt;70 years. The overall survival rate &gt;15 years is 0.4%.

Conclusions
This study shows that our operative mortality for pneumonectomy is significantly lower (30% less) than national mortality. This confirms that pneumonectomy is still an effective modality in the treatment of lung cancer.
397 Impact of COVID-19 on Theatre Utility
Authors: Luney C , Little C 
Published: May 2021

Abstract

Introduction
Covid-19 has significantly impacted the environment in which surgeons operate. Level-2 PPE is worn in our orthopaedic theatres, with increased time taken for simple tasks due to claustrophobia, excessive heat, and difficulties in communication due to masks, including donning and doffing. We sought to determine the impact of Covid-19 on theatre utility.

Method
8week period during Covid-19 was reviewed for semi-elective orthopaedic surgery. Pre-Covid-19 case controls for age, procedure and ASA were identified. Electronic database was used to determine total time in theatre complex, time taken for anaesthesia, total procedure time, and time taken for patient to leave the theatre.

Results
27patients undergoing semi-elective surgery during Covid-19 pandemic and 27-matched controls from before pandemic were identified. No statistically significant difference in procedural or anaesthetic time. Significant difference in time interval between cases (14minutes pre-Covid-19 v 58minutes during Covid-19; p &lt; 0.05). Mean theatre start times are 51minutes later during Covid-19.

Conclusions
Procedural times of surgery have not significantly increased, however the time between cases has increased; resulting in a decrease in overall theatre complex utility and direct impact on future costing.
474 Increasing the Availability of Operation Notes at Hand Surgery Follow-Up Through the Use of Electronic Operation Notes
Authors: Macneal P , Brar S , Dassanayake S , Jones K , Ghareib A , Moledina J 
Published: May 2021

Abstract

Introduction
The availability of operation notes is crucial to provide high-quality post-operative care. This clinical audit evaluates the availability of operation notes at post-operative follow-up, in a Tertiary Hand Unit, before and after implementation of electronic operation notes.

Method
This was a prospective audit analysing the availability of operation notes at the first post-operative hand surgery appointment. The initial data collection was over a 6-week period (July – August 2019). Following this, a standardised electronic operation note template was created in line with BSSH Hand Trauma Guidelines and RCS Good Surgical Practice. Six months later, a re-audit was conducted over a 4-week period (March 2020).

Results
The initial audit included 104 adult patients, with operation notes available for 64% (n = 67) of patients, and 94% (n = 63) of those were in paper format. Following implementation of electronic operation notes, the re-audit included 53 adult patients. For these patients, 96% (n = 51) of their operation notes were available, and 96% (n = 49) of the operation notes were electronic.

Conclusions
These findings demonstrate that electronic operation notes greatly increased the availability of operation notes at follow-up This innovation has significant implications for upholding well-coordinated continuity of care for patients undergoing surgery.