bluuebunny/crossref_metadata_2025_split huggingface dataset:
182 Improving Handovers from A Neurosurgical High Dependency Unit to Ward Teams
Authors: Faderani R , Mohamed A , Stewart P 
Published: October 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.
609 Referral for Temporal Artery Biopsy: A Closed-Loop Audit to Improve Quality of Referrals with A Standardised Proforma
Authors: Balai E , Barraclough J 
Published: October 2021

Abstract

Aim
Temporal artery biopsies are performed by the ENT department within our hospital, with referrals generally coming from the Rheumatology team. The motivation to audit practice came from concerns that patients were perhaps not fully aware when a referral had been made, that they may not have understood the logistical implications of this and that key pieces of information were frequently missing. We aimed to audit current practice to assess overall quality of referrals in line with GMC guidance.

Method
We retrospectively audited all referrals for a temporal artery biopsy procedure between July 2018 – March 2020. Assessed the quality of referrals by presence of information relating 15 data points taken from GMC guidelines, covering patient demographics, investigation results and operative factors. In collaboration with the Rheumatology team, we designed and introduced a standardised referral proforma. We re-audited the quality of referrals between June – November 2020.

Results
In the baseline audit of 34 referrals, 2 of the 15 data points were present in 100% of referrals, 5 were present in 50-90%, and 8 were present in &lt; 50%. Two patients were found to be unaware a referral had been made for a biopsy. Upon re-audit after introduction of the standardised proforma; out of 9 referrals, 14 out of the 15 data points were included in 100% of referrals.

Conclusions
Following introduction of a standardised referral proforma we saw significant improvements in the overall quality of referrals for temporal artery biopsy. We plan to continue to prospectively audit the pathway to ensure these improvements are sustained.
684 The Standard of Emergency Operation Note Documentation at A District General Hospital Compared Against The Royal College of Surgeons of England (RCSEng) Standard
Authors: Zuberi S , Mushtaq Y , Patel K , Joseph J , Gurprashad R 
Published: October 2021

Abstract

Introduction
Meticulous operation note documentation is essential for seamless, safe continuity of care in postoperative surgical patients. This study evaluated the standard of emergency operation note documentation at a district general hospital, when compared to the Royal College of Surgeons of England (RCSEng) guidelines and assessed the impact of a new operation note proforma.

Method
A retrospective review of 50 emergency operation notes was conducted between December 2019 and March 2020 and compared to RCSEng guidelines. Initial findings were presented at a local clinical governance meeting and a new electronic operation note was introduced. A further 50 emergency operation notes using the new proforma were analysed between August 2020 and December 2020.

Results
RCSEng mentions 19 main points that all operation notes must include. A total of 100 operation notes were reviewed and each given a score out of 19. Intervention of the new proforma showed significant improvement to the average score (15.64 vs 17.94; p &lt; 0.0001) when compared to RCSEng guidelines. In particular, there was significant improvement in the documentation of assistants involved in the procedure (58% vs 98%; p &lt; 0.0001), estimated blood loss (2% vs 63%; p &lt; 0.0001) and specific mention whether the operation was emergency or elective (20% vs 86%; p &lt; 0.0001).

Conclusions
Implementation of the new proforma showed significant improvement in operation note documentation when compared to the RCSEng standard. Therefore, this study emphasises the need for surgeons to familiarise themselves with the current guidelines and highlights the importance of tailoring local operation note proformas to match this national standard closely.
699 Does Pre-Operative Imaging Improve Negative Appendicectomy Rate?
Authors: Dirie J , Merali N , Macias A. Maria S 
Published: October 2021

Abstract

Aim
Appendicectomy is one of the most commonly performed emergency operations. There is no set guideline for an acceptable negative appendectomy rate (NAR) in the UK. Based on previous studies, a NAR of 15-30% is typically accepted. We sought to define our local practice NAR in our initial audit, introduced an appendicitis pathway based on this initial data, and then re-audited to assess whether there had been an improvement in the NAR.

Method
All emergency appendicectomies carried out over a 1-year period from April 2018 – April 2019 were initially analysed. The subsequent audit analysed data from August 2020 - November 2020, after the pathway had been introduced. Histological analysis was used to determine positive or negative appendicectomy.

Results
A total of 207 patients had an appendicectomy over the initial 1-year time frame. In our re-audit, 38 patients had an appendicectomy. Demographics were similar in both groups. The NAR increased from 17% to 18%.

Conclusions
On first glance, the NAR does not seem to have improved. On a closer look, all patients over the age of 18 in our re-audit had a pre-operative CT, and there were no negative appendicectomies in these patients. The issue arises with younger patients, in whom justifying the radiation associated with a CT scan may be difficult. Although ultrasound does not carry the same radiation risk, previous audits at our trust have shown both its sensitivity and specificity for appendicitis is below 50%. We may have to explore alternative imaging modalities in the paediatric population or accept the higher NAR.
920 Improving the Management of Post-Operative Hypocalcaemia In Thyroid Surgery
Authors: Collins R , Lafford G , Ferris R , Turner J , Tassone P 
Published: October 2021

Abstract

Aim
Hypocalcaemia is a frequent, and potentially dangerous, complication of total thyroidectomy [1, 2] due to the removal of the parathyroid glands. This quality improvement (QI) project was undertaken in a large Ear, Nose and Throat department in the East of England over a year. The project improved postoperative guideline compliance by optimising the recognition and management of patients at risk of hypocalcaemia. This process focussed on improving parathyroid hormone (PTH) and calcium blood testing, appropriate prescribing and the monitoring and management of hypocalcaemia.

Method
A baseline audit was conducted to determine initial guideline compliance. The QI process subsequently involved the introduction of a new intraoperative PTH pathway and the amendment of trust guidelines. In addition, there was a focus on improving clinician awareness of guidelines, junior doctor education, communication between operating surgeons and junior doctors and the optimisation of patient handover.

Results
The measurement of PTH at four hours improved from 42.5% to 52.2%. The project saw a significant improvement in the monitoring of hypocalcaemia (from 22.2% to 83.3% for patients with an intermediate risk of hypocalcaemia) and in the prescribing of prophylactic calcium supplements from 7.5% to 43.5%.

Conclusions
By optimising postoperative care this QI project improved patient safety as well as impacting on the duration, and overall cost, of inpatient stay.
939 Two Is Not Always Better Than One: A Quality Improvement Project Assessing Efficiency and Financial Implications Associated with Using Two Different Electronic Systems in A Busy Orthopaedic Department
Authors: Kutuzov V , Shah H , Chaudhry R , Tan Y C , Nathwani D 
Published: October 2021

Abstract

Introduction
Ensuring correct documentation and safe handover is key to the running of a successful surgical department. At Imperial College Healthcare Trust, this process has been made easier through various electronic systems available to our Orthopaedic department: our in-house CERNER system and out-of-house system eTrauma, the latter of which is predominantly used. The aim of this project was to assess our efficiency in terms of time management between the two systems, as well as financial implications of saved time.

Method
Multiple members of the Orthopaedic team timed themselves when entering information regarding a referral or an admission into both systems. This allowed us to estimate the financial implications of moving away from eTrauma.

Results
An average referral took 165 seconds (n = 27) to input information onto eTrauma, versus 38 seconds (n = 25) for CERNER. Time taken to document an admission was 127 seconds (n = 33) and 26 seconds (n = 31) respectively. The current hourly wage for our junior members is £22.84 per hour or 38p per minute. Moving away from eTrauma to CERNER will save around £1.50 for every 2 referrals and 2.5 admissions, solely from documentation. This is excluding the other benefits of CERNER, such as quick access to relevant clinical information, pathology results and imaging.

Conclusions
Leaving eTrauma behind will reduce the time spent on documentation by orthopaedic junior doctors. This will result in increased efficiency and will lessen the financial burden on an already overstretched budget. Our formal data will contribute to decision making and future resource allocation in our local Trauma and Orthopaedic Department.
950 A Close Loop Audit to Assess Awareness Among Non-Consultant Hospital Doctors Re Use of Personal Protective Equipment
Authors: Amin K , Fahad Ullah M , Hannon E , Feaney G , Khan J 
Published: October 2021

Abstract

Introduction
Personal protective equipments (PPEs) are like war uniforms in the fight against Corona Pandemic. The limited supply of PPEs warrant their proper use not only to avoid shortage of supplies but also to prevent any infectious spread to healthcare workers. This study aimed at analyzing awareness among non-consultant hospital doctors re proper use of PPEs

Method
A questionnaire was devised using local available guidelines published by university Hospital Limerick. The study was done in 2 phases. In 1st phase 100 questionnaires were distributed to non-consultant hospital doctors(NCHDs). Results were analysed and after 1st phase and emails were sent with results and local guidelines and a zoom educational session was organized. In 2nd phase, questionnaire was redistributed in a week's time and results were re analysed to close the loop.

Results
200 NCHDs participated in the study,100 in each phase. Most common age group in two phases was 21-30 yrs. Awareness about PPEs use for Covid 19 increased significantly in 2nd phase across all domains (what is included in PPEs (100% from 91%), Sequence for putting on PPEs (52% to 88% p &lt; 0.05), steps for FIT test (57% to 74% p = 0.247) and sequence for removing PPEs (47% to 81% p &lt; 0.05).

Conclusions
Though PPEs donning and doffing sessions were organized by the hospital officially, Awareness about effective use of PPEs among NCHDs further improved after organizing a Zoom educational session and auditing.
978 Improving Satisfaction in Patients with Learning Disabilities
Authors: McConaghie G , Mistry J , Thakkar K , Wigley D , Lam G 
Published: October 2021

Abstract

Aim
Patients with learning disabilities (LD) are less satisfied because they do not fully understand their surgical management. Poor communication between doctors & LD patients leaves them unhappy & reluctant to seek further help. We aimed to improve satisfaction in 90% of patients.

Method
In one year in a midlands DGH 201 patients with an LD were admitted. Interviews were conducted which highlighted key problems. Multiple ideas were reviewed, and the simple but effective intervention was a brightly coloured prompt sheet with 4 questions placed in the patient notes: Have you explained:
A simple scale tracked the patient & carer satisfaction over 8 weeks as the prompt sheets were introduced to patient notes by the learning disability nurses.

Results
A 90% increase in patient satisfaction was not achieved but considerable positive feedback was. Moreover, the LD nurses witnessed an increased use of hospital passports among doctors as well as improved patient-doctor communication. A small target population restricts the rapid collection of large amounts of data. The patient satisfaction measure was qualitative, and a 10-point scale would have detailed smaller changes. Lack of carer continuity also made it difficult to collect consistent data.

Conclusions
The role of learning disability nurses is key to improving patient understanding and satisfaction, but they can be assisted by channelling and maintaining initiatives to raise awareness of the needs of these patients.
1245 Enhanced Recovery Program in Colorectal Surgery at Basildon And Thurrock University Hospital
Authors: Chetitah Salim , Seraj S , Robinson A , Adetoye S , Haque Samer 
Published: October 2021

Abstract

Introduction
Enhanced recovery program (ERP) is an integrated multidisciplinary approach that requires participation and commitment from different member of staff, and the patient. This is an evidence-based protocol designed to standardize medical care, improve outcomes, and lower care costs. The aim of this study is to observe how ERP protocol is followed in our institution, and to monitor different outcomes. Data was compared to NICE guideline.

Method
We reviewed all patients who underwent elective colorectal resection for cancer between June 2018 and May 2019. data was collected retrospectively from patient electronic case notes. We monitored compliance with ERP protocol (NICE), as well as outcomes

Results
114 patients were included in our study. We noted that just 35% of patients had intraoperative nasogastric tube. Antibiotics: 74.56%, Catheter 98.24%, PCA 79.82%, Spinal anaesthesia 52.63%, Drain 38.59%. In the post op period, patients were mobilized at 1.89 day (1.27) [mean (SD)], NGT removal: 1.81 day (2.31) Refeeding: 1.36 day (1.01). It has been proven that patients with inadequate perioperative analgesia are more prone to develop ileus, to have a prolonged hospital stay, and have an overall higher mortality (p0.001)

Conclusions
It seems that there is a room for improvement especially in analgesia and prophylactic antibiotics. Following ERP protocols improves overall outcomes.
1602 A Quality Improvement Project on The Management of Patients with Traumatic Head Injury Presenting to A District General Hospital
Authors: Muthusami A , Techaboonanake S , Desai N , Malik N , Reynolds M , Ahn K , De Carvalho L , Gawley M , Waraich N 
Published: October 2021

Abstract

Introduction
Traumatic Brain Injury (TBI) is associated with morbidity and mortality. All District General Hospitals (DGH) in West Midlands liaise with Neurosurgery centres for management of these patients through a referral system (NORSe). The aim of this study was to assess outcomes in TBI following the implementation of vital interventions.

Method
A retrospective data was collected between 1/1/2019 and 1/12/2020. We included all patients admitted with traumatic brain injury over the age of 16. We accessed the data from the hospital database, clinical notes, and NORSe. A re-audit was performed following implementations of recommendations (proforma and care of elderly input). Further data were collected prospectively.

Results
Our cohort included n1=61 patients (first cycle) and n2= 29 (second cycle). The demographic age and gender were comparable in both cycles. The median time for Neurosurgery advice was 229 minutes (IQR 60-690) in the first cycle as compared to 80 minutes (IQR 40-120, P &lt; 0.05) and the main cause for delay was inadequate information transfer. The mortality rate was 24% (5 were attributed to sepsis), as compared to 14% in the second cycle. The median length of stay (LOS) was 4 days (IQR 3-13.5) in the first cycle, which translates to a cost of £26,815 per quarter. In comparison, LOS was 3 days (IQR 2-4), which translates to the cost of bed occupancy of £12,771 and saving of £14,043 per quarter, in the second cycle.

Conclusions
The introduction of simple interventions in a DGH can help to significantly improve patient outcomes in those admitted with Traumatic brain injury.
1651 Improving Surgical Admission Clerking in A Major Trauma Centre – The Role of a Standardised Clerking Proforma
Authors: Arnaouti M , Foxall-Smith M , Mittapalli D 
Published: October 2021

Abstract

Introduction
High quality medical records are integral to Good Medical Practice in the UK, for provision of good patient care. This study assesses the effectiveness of a structured Surgical Assessment Proforma in improving documentation, within the Surgical Assessment Unit (SAU) of a major trauma centre.

Method
A four-phase prospective study was undertaken – using PDSA methodology. This included: initial clinician survey and proforma development, audit, re-audit post-implementation, and final user survey. Evaluation and proforma design utilised standards from the RCS(Eng) and the PRSB. Notes of all patients admitted to the SAU, over two separate one-week periods, were assessed for completeness of documentation. Statistical analysis employed T-Test, with a P value of &lt; 0.05 considered significant. The study was considered service evaluation, and therefore exempt from ethical approval.

Results

Pre-Proforma Survey
100% of respondents felt a proforma would be beneficial. 77% believed key elements of clerking were missed within the previous system.

Cycle 1 (n = 62)
Of note, assessment categories lacking information were: Responsible Consultant, Medication History, Allergy Status and Differential Diagnosis.

Cycle 2 (n = 119)
Of 45 assessment criteria: 38 improved (23 significantly (P &lt; 0.05)), 2 showed no change, 5 were reduced (2 significantly (P &lt; 0.05)). Documentation rates in nine categories improved by over 50%.

Post-Proforma Survey
73% of doctors and 86% of allied health professionals (AHPs) agreed documentation improved with proforma use. 66% of clinicians agreed proformas reduced omission of essential information and provided safe clerking guidance for doctors. 100% of AHPs agreed the proforma improved handover.

Conclusions
In a major trauma centre SAU, standardised proforma use improves completeness of clerking.
1367 Five Years of Robotic Surgery in Colorectal Service: James Cook University Hospital Experience
Authors: France K , Aradaib M , Jha M 
Published: October 2021

Abstract

Aim
This paper gives an account of our institutional experience with safe adoption of robotic surgery in colorectal service.

Method
Analysis of our prospectively maintained database of all patients who underwent robotic colorectal surgery in our institute between February 2015 and February 2020. Overall surgical and oncological outcomes were interrogated.

Results
A total of 255 patients underwent robotic surgery between 2015 and 2020. 148 were males, and 107 were females. Median age was 68 years (range: 35–89). 198 patients had bowel cancer and 57 had benign conditions. Operative procedures performed were anterior resection (n = 125), right colectomy (n = 77), abdominoperineal resection (n = 40), subtotal colectomy (n = 5), completion proctocolectomy (n = 2) and reversal of Hartmann’s procedure (n = 6). Mean operative time was 164 (SD ± 47.5) for right colectomy and 267 (SD ± 77.8) for anterior resection. Median length of hospital stay was 6 days (IQR: 4 – 9). There was no 30 days mortality or intraoperative complications. Conversion to open or laparoscopy surgery rate was 5.1% (n = 13). Anastomotic leakage occurred in 3 patients (1.2%). Median lymph nodes harvested were 21 (range 4 – 79) and the R0 resection rate was 96.5%.

Conclusions
Our results demonstrate that colorectal robotic surgery is feasible and can be adopted safely for both benign and neoplastic conditions without undermining clinical or oncological outcomes.
1420 ViRtual prOficiency Based prOgression for Robotic Training (VROBOT): A Prospective Cohort Study Protocol
Authors: Nathan A , Patel S , Georgi M , Hang K , Mullins W , Asif A , Fricker M , Ng A , Sridhar A , Collins J 
Published: October 2021

Abstract

Introduction
Robotic surgery is an evolving field that requires specialist training. Historically, robotic surgery training has lacked standardisation. Recently, training centres have introduced proficiency-based modules and curriculums to certify and progress the skills of novice robotic surgeons. However, training tends to be self-directed and non-interactive. Limited interactive teaching does exist but can be inaccessible and expensive. We aim to validate the effectiveness of the current Fundamentals of Robotic Surgery (FRS) training curriculum with the addition of interactive virtual classroom teaching.

Method
16 novice surgical trainees will be assigned to two training groups. The interventions will be implemented following a one-week robotic skills induction. Both groups will receive access to the FRS curriculum for one week. The intervention group will additionally receive virtual classroom robotic skills training. The primary outcome will be the objective performance scores after training using a synthetic model based on task errors, time taken and contact pressure. In week 3, each group will receive the alternate intervention and objective performance scores will be measured to determine the trajectory of scores.

Results
Significant objective performance improvement following the intervention will be indicative of intervention quality.

Conclusions
This will be the first feasibility study evaluating the efficacy of interactive virtual robotic surgery training. It will determine the effect size of virtual classroom training on the development of basic robotic surgical skills in addition to the proficiency-based FRS curriculum. The findings will assist the development and implementation of further resource-efficient virtual robotic surgical skills training programs.