bluuebunny/crossref_metadata_2025_split huggingface dataset:
100 Assessing the Admission Proforma: A Multi-Cycle Audit Evaluating the Quality of Documentation of The Burnsadmission Proforma At the Regional Mersey Burn Unit
Authors: Noshirwani A , Drewniak K , Parekh V , Patel S , Mandal A , Shokrollahi K 
Published: October 2021

Abstract

Introduction
A thoroughly completed Burns Proforma can provide vital information for the effective management of a burn and enables the sharing of information with other members of the multidisciplinary team.

Aim
We aimed to assess the quality of record-keeping of the new Burns Proforma, compared it with the previous cycle, and identified areas of improvement.

Method
Data on 76 fields on version 4.0 of the Mersey Burns Proforma was collected for 92 patients between January and February 2020. The data was compared to cycle 1of the audit collected in July 2019.

Results
Assessing the 61 comparable fields between audit cycles, 58 fields (95%) improved while 3 (5%) deteriorated. 21 fields achieved a completion rate greater than 80%. Vital information such as history, comorbidities, and drug history achieved 100% completion, up from 94%, 94%, and 95%, respectively. Total body surface area (TBSA) increased to 93% from 83%, the use of the Lund & Browder chart remained the same, treatment plan documentation increased to 95% from 91%, documentation of admission increased from 24% to 51%, consultant confirmation of TBSA increased to 10% from 5%, but this requires further improvement. Comments stated the proforma was clearer and provided a flowchart layout which made documentation easier.

Conclusions
The Burns Admission Proforma has made significant improvements. Working with the nursing staff and consultant body, we aim to improve our completion rates of vital information further. It sets a high standard for data collection and presents itself as a useful tool for other Burns Units across the United Kingdom.
108 Neck of Femur Fractures: Streamlined Approach to Improve Consenting Practices
Authors: Brown O , Gaukroger A , Raza M , Sturley R , Arnander M 
Published: October 2021

Abstract

Aim
Neck of femur fractures (NOFs) are synonymous with frailty, and successful outcomes are achieved with operative fixation. The United Kingdom’s General Medical Council guidance governing consent highlights the importance of thorough pre-operative discussion of risk with the patient. We aimed to audit consenting practices in NOF patients within our unit against the British Orthopaedic Association’s (BOA) criteria, with the addition of delirium as a risk factor.

Method
In cycle one all operatively managed NOFs over a two-month period in October-November 2019 were retrospectively reviewed. Consent forms 1 (CF1) and 4 (CF4) were assessed against BOA-endorsed criteria. Our intervention included a standardised sticker detailing 14 important risks was introduced and a departmental seminar on delirium. A second cycle was undertaken from August-October 2020 to close the audit loop

Results
No consent form documented all BOA-approved risk factors in cycle one (N = 35). Of cycle two’s 35 patients, 70.8% CF1 were completed using the novel sticker. All of these had 100% BOA-approved risk documentation. Consent forms without the sticker in cycle two documented 9/14 risks (mean value). No CF4 had any risks documented in either cycle. Delirium was documented in 51% in total and in 75% patients with CF1. Delirium documentation improved from 2.9% in cycle one to 51.4% in cycle two.

Conclusions
Clear lapses in operative consenting processes were identified, especially regarding delirium and CF4 documentation. The introduction of a novel consent sticker drastically improved compliance with BOA guidance for CF1. Recognition and departmental education regarding delirium significantly reduced incidence between cycles.
163 Morbidity of Presumed Temporary Loop De-Functioning Stomas in Patients with Colorectal Cancer
Authors: Alfred J , Macdonald S , Kalaiselvan R 
Published: October 2021

Abstract

Objectives
The incidence of parastomal hernia (PSH) can be up to 80% of patients who have a stoma following abdominal surgery (1). Surgical intervention is required in 70% of patients due to pain, obstructive symptoms, or stoma appliance issues (2). This study aims to show the morbidity related to a presumed temporary loop stoma.

Method
This was a retrospective cohort study of all left-sided colorectal cancer resections undertaken in a single centre. Electronic healthcare records and Picture Archiving and Communication System (PACS) were used to gather data on patient demographics, operative details and details of de-functioning stoma fashioned. Morbidity related to de-functioning stoma was determined based on hospital admissions and length of inpatient stay related to stoma, complications in relation to the stoma, return to theatre, stoma reversal and fate of stoma site.

Results
147 patients (87 M; 60 F, median age 69 (23-93)) underwent left sided colorectal cancer resections at a single centre. In total, 50 de-functioning loop stomas were fashioned (49 loop ileostomies and 1 loop colostomy.) At a median follow-up of 23 months (8-44), prior to reversal, 12 PSH were identified. 38 of the de-functioning stomas were reversed at a median time of 11 months (1-44), 5 of which were emergency procedures due to obstruction (n = 3) or high output (n = 2). There were 9 stoma related re-admissions identified in 7 patients.

Conclusions
Presumed temporary defunctioning loop ileostomies in Low anterior resections is associated with significant morbidity, but low risk in terms of life-threatening complication.
181 Preoperative Blood Investigations in Surgical Fixation of Distal Radius Fractures (Jan-Apr 2020)
Authors: Mohamed H A S K 
Published: October 2021

Abstract

Background
Venepuncture is not a risk-free procedure; 1 in 125 000 risk of nerve injury and risk of spreading MRSA. Blood biochemistry and haematology testing is expensive; a Group & Save can cost up to £20 (Inc. VAT). Distal Radius fractures are common injuries seen and treated at the Worthing Hospital. ORIF or MUA + K-wires of Distal Radius are highly unlikely to result in the need for intra-operative transfusion.

Aim and Objective
Aim to reduce unnecessary preoperative bloods from wards under T&O “control” during re-audit period to zero.

Results
This audit included 27 patients (4 male, 23 female) (average age 58 years). four patients were ≥ ASA 3, 23 were ASA 1- 2. About 20/27 (74.1%) patients had FBC performed. About 3/4 (75%) patients with ASA ≥ 3 had FBC done and 17/23 (73.9%) patients with ASA 1-2 had FBC. Almost 11/27 (40.7%) patients had Coagulation screen performed, with no previous history of anticoagulation. About 16/27 (59.2%) LFTs performed. About 14/27 (51.8%) G&S performed with 21 samples sent of these figures 7/27 patients had two G&S samples sent and 7/27 patients had only 1 sample sent to pathology lab.

Conclusions
The practice of doctors at Worthing hospital does not meet NICE guideline recommendations in Pre-operative blood investigations for Distal Radius fractures. This can add more cost to the trust, wasting resources and putting extra load on health care professions working in pathology department.
225 The Management of Acute Cholecystitis in a District General setting: An Audit of Practice
Authors: Robinson P , Jones S , Metcalf A , Bond A 
Published: October 2021

Abstract

Aim
The benefits of laparoscopic cholecystectomy during index admission with acute cholecystitis (AC) are multiple. As such, current NICE guidelines dictate that adults with AC undergo laparoscopic cholecystectomy within 1 week of diagnosis. However, significant variation exists with regards to the management of such patients. Here we present the results of an audit of practice at a UK district general hospital and suggest that this standard can be achieved regardless of hospital.

Method
Electronic database search at Salisbury District Hospital over a period of 12 months to identify all patients with a coded diagnosis of AC. Electronic Discharge System (EDS) was consulted to assess whether patients underwent laparoscopic cholecystectomy within 7 days of diagnosis. Notes were reviewed for all patients who failed to meet this target to ascertain reasons why.

Results
Of the 336 patients coded as AC 8 were excluded due to incorrect coding leaving 328. 285 patients (87%) underwent laparoscopic cholecystectomy within 7 days. Of the 43 that did not, 31 (65%) had clinically justified reasons for delay. 285/297 (96%) patients met the NICE standard.

Conclusions
At Salisbury District Hospital 87% patients presenting with AC underwent laparoscopic cholecystectomy within 7 days. Common reasons for failure included: Awaiting further investigation (i.e., ERCP / MRCP), unfit for operative management, patient choice. Excluding justifiable reasons 96% of patients met NICE standards. Poor documentation was the most common cause for failure. Subsequent education and re-audit showed significant improvement. This audit exemplifies that NICE standards for the management of AC can be achieved in a district general setting.
230 Acute Bowel Obstruction - Are We in The Loop?
Authors: Tan J R , Mann K 
Published: October 2021

Abstract

Aim
Acute bowel obstruction (ABO) is a common surgical emergency associated with high mortality and morbidity. The aim of this audit is to compare the quality of local management of ABO against recommendations set by the NCEPOD.

Method
A prospective audit of all patients presented with ABO over 8 weeks from February 2020 at a tertiary centre. Data was collected from electronic records.

Results
34 patients were reviewed with a mean age of 69.8 years. 24 presented with small bowel obstruction and 10 with large bowel obstruction. 25 (73.5%) patients had a CT with IV contrast with a median time to scan of 5 hours. 25 (73.5%) patients were reviewed by consultants within 14 hours and 5/7 high-risk cases were discussed within an hour. Adequate pain control was achieved in 26 (76.5%) cases. All patients had BMI recorded and 29 (85.3%) had MUST score documented. 16/25 (64.0%) patients aged above 64 had their frailty score assessed and 11/25 (44.0%) received geriatrician input. 32 (94.1%) patients had their treatment plan discussed with them and family was informed in 19 (55.9%) cases. 19 (55.9%) patients underwent emergency operation and there was a delay in access to surgery in 7/19 (36.8%) cases. Morbidity and mortality risk was calculated in 3/19 (15.8%) cases.

Conclusions
This audit has highlighted numerous positive management measures but also the need for improved radiological resources, better emergency capacity planning and risk assessment. There needs to be a focus on predicting outcomes, especially in the elderly and setting limitations and expectations before surgery.
263 Improving the Timing of Operative Management of Closed Hand Fractures – A Closed-Loop Audit of Compliance with BSSH Guidelines in One of The Largest Teaching Hospitals in Europe
Authors: Prokopenko M , Verma Y 
Published: October 2021

Abstract

Introduction
Hand fractures are a common injury resulting in significant morbidity if managed incorrectly. The final outcome is determined by the initial injury but is also affected by timely and appropriate intervention. The British Society for Surgery of the Hand (BSSH) national guidelines recommend that when operative fixation is first choice, surgery should occur within 7-days of injury or within 72-hours when conservative management fails.

Method
We assessed compliance with BSSH closed hand fracture guidelines retrospectively using electronic patient records. Interventions involved department-wide education of national BSSH guidelines alongside suggestion of a dedicated closed hand fracture list. A sporadic WALANT list staffed by hand fellows was provided. The efficacy of the interventions was re-audited five months later.

Results
The first and second cycles included 100 and 56 cases respectively. Compliance improved between the two cycles from 59% to 75% when operative management was first choice. Average number of days until operative management was carried out, when operative fixation was first choice, improved from 7.47 to 5.44 between the two cycles. 23/156 (15%) cases underwent operative management on the additional list, where overall compliance was 78%.

Conclusions
Departmental education and the additional operating list improved compliance to BSSH guidelines. Education of staff involved in the management of closed hand fractures should continue regularly, especially considering the frequent rotation of trainee doctors. Patients should be provided with information leaflets to promote early presentation. The key intervention to improve compliance with national guidelines however remains the provision of a weekly closed hand fracture theatre list.
267 An Audit of The Management of Acute Cholecystitis At ELHT
Authors: Ahmed A E 
Published: October 2021

Abstract

Aim
Acute cholecystitis is a common condition on the surgical take. The evidence shows that the optimal approach is with early laparoscopic cholecystectomy in patients suitable for surgery (Cao, 2015). The aim of this audit was to assess the adherence of the surgical department at ELHT to NICE guidance CG 188 in the management of patients with gallstone disease (NICE, 2014): Offer early laparoscopic cholecystectomy (within 1 week of diagnosis) for acute cholecystitis.

Method
Retrospective study of all patients with image confirmed diagnosis of acute cholecystitis between 25th January to 1st October 2018. Any unsuitable candidates for surgery were not counted.

Results
The case notes of 153 patients were reviewed. 109 were included in this study, as the other patients were not likely to be offered surgery due to their comorbidities. Of these 109 patients, 51 (47%) had a laparoscopic cholecystectomy within a week of diagnosis.

Conclusions
ELHT is not meeting the target of management within 7 days for over half of patients. The modifiable reasons for not meeting the targeted treatment time are a lack of capacity in theatre and Consultants’ decisions to delay treatment. The addition of a dedicated hot gallbladder theatre list can increase the numbers treated within the target time.
285 Improving the Identification of Symptomatic or Ruptured AAA in The Emergency Department
Authors: Al-Khazaali B 
Published: October 2021

Abstract

Background
rAAA is a life-threatening emergency. Without early treatment, it can be fatal. Patient &gt; 50 presented with abdominal/back pain &hypotension or collapse a diagnosis of rAAA should be considered. Aortic ultrasound is recommended as it is the standard technique used in clinical practice and the screening program.

Objective
The project aimed to determine the number of patients who were screened for rAAA according to Royal College of Emergency Medicine (RCEM) guidelines and increase the adherence in clinical practice in the emergency department.

Method
Retrospective baseline data were obtained for 40 patients &gt;50 with abdominal/back pain, hypotension and collapse between 1st of November to 31st of December 2019. Re-auditing was conducted after the first intervention (phase one), which included informing colleagues about RCEM guidance via emails and paper forms to record the scans’ results. In August 2020, a final cycle (phase two) was performed after educational posters were put up in the department.

Results
Baseline showed that out of the 40 patients only 10% of them received the U/S scan. After phase one, the audit demonstrated an increase in screening to 42%, and in the final cycle, the percentage improved to 53%.

Conclusions
Routine screening of rAAA were minimal in the emergency department. As a result of the project, more patients received the U/S screening and adherence to RCEM guidelines improved.
317 Audit of The Management of Ankle Fractures in The Emergency Department of Leighton Hospital
Authors: Ugwu K , Lowsby R 
Published: October 2021

Abstract

Background
Ankle fractures are common presentations in the emergency department. The aim of treatment is to provide stability and restore alignment of the joint to as close as possible to the pre – injury state. The British Orthopaedic Association Audits Standards for Trauma (BOAST) guidelines provide clear recommendations for effective management of ankle fractures. Specific aspects of this guidelines that could be objectively assessed were selected for this audit to check if practices in the emergency department were meeting the national recommendations.

Method
Data was collected retrospectively. All patients with closed ankle fractures seen in the emergency department between 01/08/2020 and 31/08/2020 were included. Patients’ emergency department notes as well as electronic radiographic records were reviewed and analysed.

Results
There was 100% compliance rate for 3 of the domains assessed which include: clear documentations of mechanism of injury and clinical findings; documentation of co-morbidities of patients that can influence treatment and urgent performance of radiographs in clinically deformed ankles before manipulation.There was 75% compliance in performing and documentation of radiographs before transfer from the emergency. The worst domain was the re-assessment and documentation of neurovascular status post manipulation with only one reviewer out of five assessed documenting clearly after the process was completed.

Conclusions
Posters circulated in the department highlighting the findings of the audit. Furthermore, the LocSSIPs for reduction of ankle fractures was edited to include re-assessment of neurovascular status post manipulation.
347 Read the First Page: An Audit on Medicine Reconciliation in General Surgery Inpatients at London District General Hospital
Authors: Vutipongsatorn K , Patel P , Prakash A , Musawi J. Al 
Published: October 2021

Abstract

Aim
Medication-related incidents occur more frequently when medicine reconciliation happens more than 24 hours after admission. The National Institute for Health and Care Excellence recommends a complete reconciliation within 24 hours of admission. General Surgery is a busy specialty with a high patient turnover rate. Hence, this audit was conducted to assess the extent of a problem and mitigate it.

Method
Every adult General Surgery inpatient who were admitted for over 24 hours were included. Patients on intensive care or high dependency unit were excluded. Drug charts were reviewed every Thursday for nine weeks between October and December 2020. Data from the first three weeks were used to establish baseline. Three interventions were introduced, each lasting two weeks. Any significant harm to patients due to incomplete reconciliation was recorded.

Results
At baseline (n = 100), 38.0% of patients had incomplete reconciliation. This significantly reduced to 23.4% (n = 64, p-value=0.037) between Weeks 4 and 5 after baseline data was presented at a team meeting and posters were put up. Allowing pharmacists to flag up missing medications on a daily job’s list did not significantly reduce the incompletion rate (23.0%, n = 74, p-value&gt;0.999). Finally, performing a medicine reconciliation ward round on Weeks 8 and 9 further reduced the incompletion rate to 2.8% (n = 74, p-value=0.001). One significant harm was noted on Week 1.

Conclusions
Medicine reconciliation is a vital aspect of patient safety. Raising awareness of the issue significantly reduced the incompletion rate. However, the most effective intervention is conducting a medicine reconciliation ward round.
359 Incidental Fatty Liver Disease; Are We Adhering to Guidelines?
Authors: O'Sullivan N l , Tyrrell J , McIntyre T , Burke E , Schmidt K 
Published: October 2021

Abstract

Aim
Hepatic steatosis is an increasingly prevalent condition, with estimates of up to 30% amongst western populations. Fatty liver is a common incidental finding on abdominal imaging. Current British Society of Gastroenterology guidelines suggest the use of scoring systems, such as FIB-4 or NFS, to stratify these patients into risk categories for the development of non-alcoholic steatohepatitis, and subsequent liver failure or hepatocellular carcinoma. We carried out an audit of our own practice, to see if these guidelines were being followed.

Method
We interrogated the national imaging management system to identify all scans performed in Wexford general hospital from 16th April to 16th October 2020 which identified “hepatic steatosis” or “fatty liver”. Data extracted included: patient demographics, imaging modality & finding. We correlated this data with the patient’s LFTs to calculate their FIB-4/NFS score and investigated whether suitable patients had been referred to gastroenterology.

Results
Of the 145 patients identified as having hepatic steatosis on imaging, 65 (44.8%) had ALT derangement, 42 (29%) had ALP derangement, 81 (56%) had GGT derangement and 23 (16%) had an elevated total bilirubin. Only 26 (17.9%) of these patients had evidence of subsequent liver serology studies, and only 11 (7.6%) had been referred to gastroenterology. None of the patient cohort had either a FIB-4 or NFS score calculated.

Conclusions
There is clear evidence that guidelines are not being followed in the management of patients who are incidentally found to have hepatic steatosis.
402 Assessed and Discharged - An Audit of Discharge Summaries Completion During On-Calls
Authors: Ma J , Oyewole B 
Published: October 2021

Abstract

Aim
Effective health care provision is heavily dependent on timely, reliable transfer of patient information. Failure of this communication between professionals could result in redundancy of tests, delay in treatment, which may in turn endanger patient safety. The NHS Standard Contract requirements state discharge summaries should be completed within 24 hours of hospital assessment and discharge. Discharge summaries for patients who were reviewed but not admitted have been observed to be poorly completed and this audit aims to clarify this.

Method
On-Call Patient Lists between 1 December to 14 December 2020 were studied retrospectively. Patients who were assessed by the on-call surgical team but not admitted were included in the audit. Patients referred to other specialties were excluded. Hospital electronic system was reviewed for electronic records frim the encounter including clinical note or discharge summary.

Results
In total, 47 patients were identified during the 2 week- period. 40/47 patients were referred from AE and 9 of these patients were discharged from AE directly. 3 of the patients had a clinical note or discharge summary completed on the hospital electronic system. Overall, 18 of the 47 (38.3%) patients had a clinical note or discharge summary on the electronic system, with 6 (12.8%) of them being recorded as discharge summaries.

Conclusions
The overall completion of discharge summaries for this group of patients was poor. Awareness of this failing and the importance of professional communication should be highlighted with the juniors during surgical meeting to improve compliance before re-audit.