bluuebunny/crossref_metadata_2025_split huggingface dataset:
152 Evaluating the Incidence and Predictors of Readmission in Patients Awaiting Cholecystectomy for Previously Diagnosed Acute Gallstone Disease
Authors: Noureldin K , Razzaq H , Whelan K L , Najdawi A , Wong L , Dick G , Halai A 
Published: May 2021

Abstract

Introduction
The prevalence of gallstones up to 15%.20-40% will develop symptomatic gallstones and occupy most of the surgical waiting list. The timing of a cholecystectomy remains controversial.

Method
Retrospective data analysis over 2 years, including: diagnosis, commodities, ASA class, investigations, readmissions numbers and causes, time to surgery, operative details, and rate of conversion to open procedures. Chi-square test was used for analysis.

Results
532 cholecystectomies were performed.44% of the patients had commodities. Presentations were; Acute cholecystitis (41.7%), biliary colic (23.1%), acute pancreatitis (15.9), obstructive jaundice (9.2%). USS was performed in 97.3%, CT scan in 17.8% and MRCP in 45.8%. 14% had ERCP. Re admission rate was 56.4%, between 1-6 times, secondary to; cholecystitis (12.5%), biliary colic (26.7), gallstone pancreatitis (8.2%), obstructive jaundice (8.0%), other complications (0.5-1.5%). Emergency cholecystectomy was performed in 14.9% with conversion rate 1.4%.major complication rate was 2.7. The median time on waiting list was 12 (0-123) weeks. This prolonged to 25 (0-400) weeks, when calculated at time of diagnosis. Complicated gallstones disease (p-value 0.0001) was predictors of recurrent symptoms and readmissions.

Conclusions
Management plan is due to optimize the timing of cholecystectomy to decrease the negative impact on readmission and complication rates plus the hospitals’ bed capacity and costs.
163 Audit cycle on the formal introduction of a standardised orthopaedic trauma patients’ admission pro-forma: the first Italian experience
Authors: Pace V , Lanzetti R M , Caraffa A 
Published: May 2021

Abstract
An internationally recognised issue of general district hospitals is the accuracy and completeness of the admission documentation, particularly in a trauma setting. We built and formally introduced a Hospital Trust Wide admission pro-forma for orthopaedic trauma patients.
An Audit looking into the quality and completeness of the admission documentation for orthopaedic trauma patients was carried out at a single Hospital Trust in December 2017. This was followed by a second round Audit with formal implementation of our new clerking pro-forma.
Compliance was 94% overall. The documentation was incomplete in 7% of the cases. Delays of patients’ treatment caused by lack of documentation or written plan/instructions was recorded in only 3% of the cases. Satisfaction questionnaire: excellent 55%, good 42%, fair 7%, poor 1%.
The pro-forma provides all relevant information needed to fully assess orthopaedic trauma patients and plan the appropriate management. His utilisation facilitates completeness of documentation with a standardised approach. This is a unique work on the introduction of a standardised clerking pro-forma for the admission of orthopaedic trauma patients with excellent results in terms of compliance and improvement of patients’ care. Our study seems to be a quality improvement intervention with potentials of becoming a milestone for further improvements.
178 Suspected Cauda Equina Syndrome in a District General Hospital
Authors: Ellerton L , Benjamin-Laing H , Harrison W J 
Published: May 2021

Abstract

Introduction
Cauda Equina Syndrome (CES) is rare but when the diagnosis is delayed patient morbidity is significant. Recently, NICE Clinical Knowledge Summaries have updated their red flags on CES to be more explicit enabling earlier referral and diagnosis. A joint project between Orthopaedics and Radiology departments aimed to assess the current pathway of Cauda Equina Investigation at a District General Hospital.

Method
Data was collected from the local Radiology database for requests between July 2017 and August 2018. This included both direct requests to assess for CES and implied. Raw data revealed a potential of 600 patients, of which we have analysed 332 patients met the eligibility criteria.

Results
Only 58 patients had a documented complete bladder function assessment, of those 33% had incomplete or partial bladder emptying. Time to MRI scan ranged from 50mins – 23 hours & 52 mins. 47% had negative scans with CES or Cord compromise on MRI scan was demonstrated on 9%. 23 patients were transferred urgently to the receiving tertiary centre.

Conclusions
We found that nearly 90% of patients were being incompletely assessed and time to scan ranged significantly. We are producing a trust wide suspected CES pathway to improve patient assessment.
187 Improving Awareness of Managing Post-Operative Haemorrhage in Patients Undergoing Thyroid and Parathyroid Surgery: The SCOOP Protocol
Authors: Bhattacharya S , Jegadeeson J , Ramsingh J , Truran P 
Published: May 2021

Abstract

Introduction
Post-operative haemorrhage is a rare but potentially life-threatening complication of thyroid surgery and occurs in 1 in 100 patients. Our aim was to assess current levels of awareness of post-operative haemorrhage in the surgical department and to improve confidence in managing this.

Method
Questionnaires with a combination of clinical questions were distributed amongst nurses, foundation doctors, senior house officers and registrars in the surgical department.

Results
There was a clear gap in awareness in all grades. The British Association of Endocrine and Thyroid surgeons (BAETS) have guidance on the management of these patients and in particular the acronym SCOOP (Steristrips removed, Cut subcuticular sutures, Open skin wound, Open strap muscles, Pack wound). 18/24 of participants had not heard of the SCOOP protocol. Most nurses (6/12) all junior doctors (8/8) showed lack of confidence in managing patients with suspected bleeding.

Conclusions
An informative poster was created for relevant clinical areas as per the BAETS recommendation. These posters outlined the steps in the SCOOP acronymas well as the main clinical signs of haemorrhage. BAETS recommend that all first responders, including nursing staff, junior doctors and the crash team should be aware of the SCOOP protocol. Simulation training sessions are in progress for these members of staff.
193 An Audit of Compliance for NICE Guidance of Management of Displaced Intracapsular Neck of Femur Fractures
Authors: Sheen J , Higgins G 
Published: May 2021

Abstract

Introduction
The 2011 NICE guideline ‘CG124 Hip fracture: management’ covers the management of hip fractures in adults aged over 18. It was updated in 2017 to highlight the role of total hip replacement in intracapsular fracture management – Recommendations 1.6.2 and 1.6.3.
The aim of this audit was to assess, and improve, the compliance of Torbay Hospital’s management of intracapsular neck of femur fractures.

Method
The study was split over the three cycles, using data from the National Hip Fracture Database, followed by a review of patient notes. The first audit of 2017 data assessed the compliance of the department. A first change was then implemented to operation note documentation and 2018 data analysed. A further change was then implemented to operation notes and 2019-2020 data analysed.

Results
The 2017 audit showed a compliance of 67.7% against statement 1 and 41.1% against statement 2. After the initial change, the 2018 re-audit showed a slight improvement to 76.0% and 54.9%. After the second change was made, compliance subsequently rose to 100% and 100%.

Conclusions
The initial compliance with NICE guidance was poor. Following changes to the documentation on the operation note, compliance rose to 100%.
219 Documentation of Scrotal Examination in Male Children with Abdominal Pain
Authors: Da Costa K , Watson S , Perks H , Battersby C 
Published: May 2021

Abstract

Background
Abdominal pain is a common presentation in all age groups with 7-10% of emergency department admissions.

Method
This registered audit looks at male children (aged &lt;16), admitted with abdominal pain during this period. Approximately 2,877 children under the age of sixteen were admitted, 1,582 males. This equates to 55% of children admitted within 3 months. Manual note analysis from ED records identified 53 males &lt;16 years of age with abdominal pain for inspection of documentation.

Results
45% of inspected notes had documented genital and scrotal examination, none of which had a documented consent. In addition, 21% had a documented chaperone for the intimate examination. None of the cases had BOTH consent and presence of chaperone documented.

Conclusions
A common presentation in children lacks significant elements of documentation. This is noted in multiple specialties. Potentially overlooked aspects of examination can lead to missed or delayed identification of time sensitive diagnosis namely testicular torsion, with possible substantial legal, professional, and financial consequences.
To improve the quality of documentation, education at junior doctor level has been carried out, with further analysis to take place and with the view to incorporate the three elements of an intimate examination: consent, chaperone, and findings.
233 Concomitant Surgical Atrial Fibrillation Ablation Follow-Up Against Best-Practice Standards at A Tertiary Cardiac Surgery Centre in Brighton
Authors: Singh S , Hussain A , Kugan G , Lewis Michael 
Published: May 2021

Abstract

Introduction
Best-practice as per JCTVS 2006 meta-analysis recommends following patients who undergo concomitant surgical Atrial Fibrillation (AF) ablation at 3-months, 1, 2 and 3 years to ensure AF resolution. A dedicated nurse-led arrythmia clinic managed these patients at Royal Sussex County Hospital (RSCH), Brighton but was relinquished. Follow-up was incorporated into routine cardiothoracic/cardiology clinics. This audit compares current practice at RSCH against best-practice (JCTVS).

Method
Patients who underwent surgical AF ablation between 2016-2017 at RSCH notes were interrogated for demographic, clinical and outcome data. Survival, freedom from AF at 3-years and post-operative anticoagulation/rate-control medications at follow-up data were extracted.

Results
Sixty-two patients underwent surgical AF ablation; 21 were followed up locally at RSCH and included in the final analysis. 53% had post-surgical AF resolution. At 3-years, 48% were free from AF; all patients survived. Only 38% patients had 4 follow-up appointments as per best-practice standards. 62% and 66% continued anticoagulation and rate-control medications, respectively.

Conclusions
Best-practice standards were poorly met. Patients inappropriately followed-up could incur severe AF-related complications including longer hospital stay, treatment and poorer quality of life. A nurse-led arrhythmia clinic can prevent AF-related hospital admissions and sequalae by ensuring cost-effective review, optimal anticoagulation, and rate/rhythm control.
236 Novel Guidelines to Avoid Routine Blood Tests After Robotic Assisted Radical Prostatectomy (RARP)
Authors: Nathan A , Hanna N , Rashid A , Patel S , Phuah Y , Flora K , Sharma A , Cleaveland P , Kasivisvanatha V , William N , Mia S , Collin J , Sridha A , Kelka A , Sha N , Kell J , Briggs T , Shaw G , Sooriakumaran P , Rajan P , Lamb B , Nathan S 
Published: May 2021

Abstract

Introduction
Patients undergoing RARP commonly require routine post-operative blood tests. This practice dates from an era of open surgery, with increased blood loss and complications. We aim to improve specificity of blood test requests with novel guidelines.

Method
1039 consecutive RARP patients at two tertiary urology centres in the UK were audited. Novel guidelines constructed based on risk stratified evidence from the initial audit were used to prospectively audit 133 patients.

Results
16% had clinical concerns post-operatively. 1% and 4% had an intra- and post-operative complication. Intra- or post-operative clinical judgement flagged post-operative complications in 99.9%. 80% had routine blood tests with no clinical concerns. 6% had delayed discharge due to delayed processing of blood tests. 0.9% received a peri-operative transfusion.
Re-Audit Novel guidelines reduced the number of blood tests requested from 100% to 36%. Specificity in diagnosing a complication improved from 0% to 67%. Discharge delays reduced from 6% to 0% and no post-operative complications were missed (sensitivity 100%).

Conclusions
Routine blood tests, without an indication, did not flag any additional post-operative complications. Blood transfusion is rare for RARP. Novel guidelines to request post-operative blood tests will reduce costs and discharge delays whilst maintaining appropriate patient safety and care.
261 Using Technology to Improve Inpatient Surgical Lists
Authors: Gowda A , Chia Z , Fonseka T , Smith K , Williams S 
Published: May 2021

Abstract

Introduction
Every day in our surgical department; prior to our quality improvement project, Junior Doctors spent on average 3.26 clinical hours maintaining 5 surgical inpatient lists of different specialities with accessibility of lists rated as “neutral” based on a 5-point scale from difficult to easy. Our hospital previously had lists stored locally on designated computers causing recurrent difficulties in accessing and editing these lists.

Method
We used surveys sent to clinicians to collect data.
Cycle 1: Surgical Assessment Units list on Microsoft Teams
Cycle 2: Addition of surgical specialities and wards lists onto Microsoft Teams.
Cycle 3 (current): expand the use of Microsoft Teams to other specialities.

Results
Utilising technology led to a 25% reduction in time spent on maintaining inpatient lists, to 2.46 hours a day, and an improvement in the accessibility of lists to “easy”. Across a year, this saves over 220 hours clinician hours which can be used towards patient care and training. Furthermore, use of Microsoft Teams has improved communication and patient care, in the form of virtual regional Multi-Disciplinary Team meetings and research projects.

Conclusions
Microsoft Teams is currently free to all NHS organisations in England so there is potential for these efficiency savings to be replicated nationwide.
262 Analysis of the Factors Contributing to Unplanned Admissions of Surgical Day Cases
Authors: Al-Zubaidy R , Greaney C , Malik H , Awan F 
Published: May 2021

Abstract

Introduction
Day surgery has many benefits including a reduction in waiting lists, cancellations, hospital acquired infections and need for inpatient beds. It is also highly cost effective. The aim of this study is to identify which factors lead to the unanticipated admission of day cases, in order to adjust future patient selection, and retain efficiency

Method
A list of day cases that took place in 2017 was obtained from the HIPE department in St. Luke’s General Hospital. Day case patients who required admission were retrospectively analysed with the use of patient charts. Patient factors such as age, gender and co morbidities were recorded. The root cause of admission was identified, and the data collated.

Results
457-day cases took place during 2017. 35/457 patients were admitted postoperatively (admission rate of 7.8%). The majority of patients were admitted post cholecystectomy (22) and incisional hernia repair (8). Surgical factors were responsible for almost all admissions.

Conclusions
Surgical factors/complications are not always predictable, but a thorough review of a patient’s background history and imaging can lead to the identification of patients, who should be directed away from day surgery, minimising the need for unexpected admissions, and maximising the efficiency of the unit.
275 Feasibility and Patient Satisfaction of Intra-Detrusor Botulinum Toxin (Botox) Injections Under Local Anaesthetic (LA) In the Outpatient Setting
Authors: Tan Y C , Tien T , Ow N L , Chowdhury S l 
Published: May 2021

Abstract

Introduction
Intra-detrusor Botox injections for overactive bladder has shifted to being performed under local anaesthetic rather than general anaesthetic to improve cost and efficiency. However, it may cause the patient pain and discomfort. We aim to assess the feasibility of LA Botox injections in the outpatient setting and to evaluate patient satisfaction.

Method
Our first cycle assessed whether patients would consider intra-detrusor Botox injections under local anaesthetic in the outpatient setting. Our services were then restructured to run LA Botox clinics. Our second cycle then assessed the patient satisfaction of these clinics using the client satisfaction questionnaire (CSQ-8) template.

Results
The first cycle showed that 70% (14/20) of patients would consider having outpatient Botox injections under LA. A potential annual saving of £88,434 was estimated.
The second cycle showed a high patient satisfaction rate with an average CSQ-8 score of 30/32 in 16 patients who had Botox injections in the outpatient setting. 9 patients reported being “very satisfied” with our service and the remainder reported being “mostly satisfied”

Conclusions
LA Botox injections in the clinic setting has a high patient satisfaction rate and can provide considerable cost savings. Suitable patients should have LA intra-detrusor Botox injections in the outpatient setting where possible.
281 Evaluating a Diagnostic Algorithm for Adult Appendicitis – A Quality Improvement Project
Authors: Zucker B E , Loro F , Tyer A , Shabbir J , Finch-Jones M , Blencowe N 
Published: May 2021

Abstract

Introduction
Diagnosing appendicitis remains challenging, despite being the most common surgical emergency. We conducted a single-centre mixed method quality improvement project to assess the validity of a diagnostic algorithm for appendicitis and the diagnostic impact of increasing cross-sectional imaging during the Covid-19 pandemic.

Method
Adult histology reports and preoperative imaging data were retrospectively retrieved for patients operated on between 1/7/19-31/12/19 (‘baseline data’) and an appendicitis diagnostic algorithm was developed.
Imaging and risk stratification data were prospectively collected, as part of a national audit, between 20/03/30-23/6/20 for all adult appendicitis patients. This data was used to evaluate the efficacy of the proposed diagnostic algorithm.
Use of imaging and histological diagnoses was compared between datasets.

Results
194 patients were included across both time periods. The rate of cross-sectional imaging increased from 36.6% to 76% and the normal appendicectomy rate (NAR) decreased from 5.22% to 2.4%. Thirty-six percent of patients in the latter time period were not managed in accordance with the proposed algorithm. The proposed diagnostic algorithm may have prevented up to 87.5% of normal appendicectomies across both time periods.

Conclusions
Increasing cross-sectional imaging was associated with a decrease in the NAR. The use of the proposed diagnostic algorithm may have reduced the NAR further.
291 Pre-Operative Venepuncture: An Audit of The Trauma and Orthopaedic Department at The Royal Sussex County Hospital, Brighton
Authors: Harris H , Antonio T , Hagiga A , Crone D 
Published: May 2021

Abstract

Background
NICE recommends that patients undergoing intermediate or minor elective surgery do not need routine coagulation or transfusion blood testing unless they are ASA 3+ or taking anticoagulation mediation, where testing may be considered. Currently there is no guidance for trauma patients.

Method
We identified all patients that underwent intermediate or minor trauma and orthopaedic surgery within a three-month period from December 2019- February 2020 at the RSCH. We excluded major trauma patients, patients taking anticoagulants and patients with complex admission or past medical history. Computer records were used to identify pre-operative investigations and admission history.

Results
843 patients met our inclusion criteria. In total, 92 clotting studies and 200 transfusion samples were taken preoperatively. The majority of tests were for patients undergoing ankle 130/292 (45%) or Tibia/Fibula 54/292 (18%) procedures. This equates to approximately 1168 blood tests per year. Based on the lab cost of £15.97 for a transfusion sample and £18 for a coagulation sample, this is a cost of approximately £19,616 each year on blood testing that is not indicated.

Discussion
We hope that by presenting these results we will help reduce the unnecessary time and financial burden of routine venipuncture in departments undertaking intermediate and minor surgery.
299 Implementing A Formal Surgical Handover Tool for Junior Doctors – A QI Approach
Authors: Gill E , Quested S , Lim J , Mohsin M 
Published: May 2021

Abstract

Introduction
An informative medical handover facilitates safe patient care. It was recognized that insufficient clinical information at handover resulted in unsafe communication in the general surgical department at Pinderfields General Hospital (PGH). We aim to utilise the Royal College of Surgeons’ (RCS) and British Medical Association’s (BMA) guidelines to improve the existing handover system, facilitate an efficient and relevant handover, and furthermore improve patient safety.

Method
General surgical foundation doctors (FDs) (n = 15) at PGH were surveyed to establish their perspectives of existing handover documentation. Subsequently a handover tool was iteratively designed, using tests of change, combining RCS and BMA guidelines with FDs’ suggestions of patient information required for safe handover. At two time points, FDs in the department were re-surveyed to measure improvement.

Results
Prior to implementation of a formal document, only 20% of FDs reported sufficient patient identifiers of the handover. This improved to 67% post intervention. Pre-intervention, 0% perceived the handover as ‘Excellent’, 20% as ‘good’. Post-intervention, these improved to 34% and 60% respectively.

Conclusions
Over six months, we improved the FD’s handover document, resulting in positive feedback of perceived safety of surgical patient handovers. However, recognised time constraints have highlighted the need for more efficient handover documentation.
307 Improving Compliance with Standard of Care Guidelines for Suspected Cauda Equina Syndrome Across A District General Hospital Network
Authors: Richardson D , Greenway F , Mostofi A , Pereira E 
Published: May 2021

Abstract

Introduction
Cauda equina syndrome (CES) is a spinal emergency that cannot be reliably detected through clinical examination alone and as a result requires prompt MR imaging to provide a diagnosis. This audit examined compliance to standard of care following service improvements in line with the updated SBNS/BASS national guidelines for CES.

Method
A retrospective analysis of 200 patients referred to neurosurgery for suspected CES: 100 pre- and 100 post-service improvement SBNS guideline implementation.
The online neurosurgical database was reviewed, cases assessed for completeness of referral information (including appropriate exam and pre-referral MRI) with patient demographics, referring hospital and outcome also recorded.

Results
Prior to the SBNS guidelines only 19 patients received MRI prior to referral, 70% of all referrals were incomplete or contained erroneous clinical information. Post-service improvements there was a 68% increase of pre-referral MRI (32 cases), and an improvement in quality of clinical information with only 19% of referrals providing insufficient or unreliable information.

Conclusions
Through relatively simple changes to local policy, patient care flow and education of emergency department clinicians we have significantly improved pre-referral MRI rates as well as overall referral quality across the whole DGH network.