bluuebunny/crossref_metadata_2025_split huggingface dataset:
417 Improving Peri-Operative Management of the Acute Diabetic Vascular Patient
Authors: Moosa S , Hallett C , McBride R , Rahi M 
Published: August 2024

Abstract

Aim
Vascular patients are a high acuity cohort of patients with a high prevalence of diabetes. It’s well established that poor diabetic control is implicated in higher incidence of wound infections/systemic infection and poor healing amongst other sequalae. Many trusts have established guidelines for the peri-operative care of diabetics undergoing surgery and we sought to investigate our departmental compliance.

Method
Over a prospective 30-day period (18/9/23-19/10/23) patients admitted under the acute vascular take or pre-operative for expedited procedures were included. Patient notes and drug charts were reviewed looking for compliance with peri-operative diabetic guidance as well as blood glucose(BM) control.

Results
All 28 patients were type 2 diabetics, fourteen of which were on insulin regimes. Adherence to guidance was 50%, identified issues included background insulin stopped (N:5,18%), SGLT inhibitor not stopped (N:9,32%), Sliding scale not prescribed where indicated (N:3,11%). BM levels were on average higher in those for whom trust guidance was not followed 11.2mmol/L vs 8.6mmol/L with increased BM lability in the 24hr post-operative particularly in those whose background insulin should’ve been continued or sliding scale been prescribed (10.3mmol/L average difference between lowest and highest reading).

Conclusions
Our results highlight improvements required in adherence to trust guidance especially given the implications of poor BM control as established in the literature. We aim to build upon these findings having sent out a questionnaire to investigate the root causes as well as working on building a decision-based app to enable juniors to make timely correct decisions regarding diabetic peri-operative care.
469 Operation Notes Audit: Excellent Bridge in Continuity of Care
Authors: Binti Jamalludin A N , Mann H , Kot M , Ng A , Alkarooshi S 
Published: August 2024

Abstract

Background
Operation notes are vital as part of patient care in-line with Good Medical Practice to provide excellent continuity of care and for medicolegal purposes. This also to raise awareness on existing guidelines and accuracy of operation note documentation.

Aim
To assess compliance of op-notes documentation against Royal College of Surgeons (England) Good Surgical Practice Guidelines “1.3 Record your work clearly, accurately and legibly” in ENT Department Imperial College NHS.

Method
This is a retrospective 2-cycles audit (n=27) analysing October 2023 theatre list for first cycle and November 2023 theatre list for second cycle. Inclusion and exclusion criteria applied to ensure uniformity of data collected based on type of operations. Data documentation analysed against domains in RCS guidelines.

Results
Results are compared for both cycles, for which the results of first cycle were presented in a regional meeting. Almost all domains achieved 100% compliance of documentation except deep vein thrombosis (DVT) prophylaxis (10%), blood loss (5%), antibiotic prophylaxis (85%) and anaesthetists name (50%). Part of the discussion is that blood loss should be documented even in minor cases with minor bleeding risk. DVT prophylaxis might be overlooked in some cases (e.g., hemithyroidectomy which require only overnight inpatient).

Conclusions
Surgical teams are responsible in documenting clear plans and instructions peri-operatively to provide optimum level of patient care, reduce perioperative complications, improve patient satisfaction and ensuring patient safety.
544 The VIP QIP - Reducing the Rate of Inpatient Phlebitis
Authors: O’Donnell C , Fardanesh A , Bakare O , Spiteri A , Dewan L , Rohatgi A 
Published: August 2024

Abstract

Introduction
The VIP (visual infusion phlebitis) score was introduced to monitor cannulation for early signs of phlebitis. This is an avoidable morbidity of hospital inpatients risking cellulitis and potentially increasing length of stay. Nevertheless, a tool is only as effective as the hand that wields it. This quality improvement project aimed to improve VIP score documentation and reduce the rate of inpatient phlebitis.

Method
Baseline measurements of VIP documentation, subjective VIP score, cannulation dates and non-flushing cannulas were recorded over the 3 surgical wards at a district general hospital. This was followed by 2 Plan-Do-Study-Act (PDSA) cycles. In PDSA 1, baseline measurements were displayed in an eye-catching poster and dispensed evenly amongst the wards. For PDSA 2 face-to-face teaching sessions were delivered to clinical teams highlighting both the importance of the VIP score and its documentation.

Results
At baseline, 26% cannulas had appropriate VIP score documentation and 6.5% cannulas had VIP score &gt;2 indicating early phlebitis signs. With implementation of PDSA 1, this rose to 43.8% documentation and reduction to 2.3% early phlebitis. After PDSA 2 education sessions, VIP documentation reached 91.5% and early phlebitis rate was 2.1%.

Conclusions
This QIP has successfully reduced early phlebitis rate in this patient population to 2.1%, which is now in-keeping with CDC guidance of &lt;5%. In addition, there was a 65.5% improvement in documentation of VIP score demonstrating increased application of the tool in clinical practice. These results are replicable and necessary to improve patient care in both surgical and medical wards.
551 Ultrasound Scans Versus Computerised Tomography Scans in the Diagnosis of Acute Appendicitis: What Is the Preference?
Authors: Terrieux-Taylor A , Dholoo F , Kurian S , Johnson O 
Published: August 2024

Abstract

Aim
Acute appendicitis (AA) is one of the most common surgical presentations. Timely diagnosis reduces complications but is challenged by presentational variability. Computerised Tomography scans (CT) are the preferred diagnostic investigation, offering higher sensitivity and specificity than Ultrasound scans (US). We reviewed AA investigation practice at St Peter’s Hospital (SPH), analysing the utility of CT and US.

Method
Data for 189 SPH AA patients (16/05/2022-13/01/2023) were collated by age, sex (females: F, males: M), pregnancy testing, urine dip, Clinicians’ judgement, imaging performed, and results. Age parameters were: &lt;18, 18-40, 41-64, 65+.

Results
84 F (&lt;18: 11, 18-40: 37, 41-64: 25, 65+: 11) and 105 M (&lt;18: 26, 18-40: 37, 41-64: 31, 65+: 11) were included. 55 F and 52 M had urine dip. Pregnancy testing was performed in 82.0% of applicable F. Judgement was most accurate in 18-40 (M: 94.9%; F: 97.3%). Commonest imaging was US in &lt;18 (F: 5/9 confirming AA; M: 10/13 confirming AA). US-only accuracy was highest for 18-40 (F) and also commonest (24 performed: 16 confirming AA). For 18-40 (M), CT-only were commonest (15 performed, all confirming AA); 11 US performed (6 confirming AA). All F 65+ (11) had CT (all confirming AA); 2 US performed (all inconclusive). All 65+ M (11) had CT (10 confirming AA); 1 US performed (confirming AA). M &lt;65 were more likely (than F) to have no imaging.

Conclusions
The data indicate a disparity between imaging rates and modality based on sex, age, and accuracy. We will highlight this to SPH for consideration.
606 Faster Diagnosis Standards in 2 Week Wait Haematuria Clinic
Authors: Kulkarni A , Pa Pa Lin Y , Warren K 
Published: August 2024

Abstract

Introduction
The Faster Diagnosis Standard (FDS) has been introduced to ensure that patients have cancer diagnosed or ruled out within a maximum of 28 days from referral, for at least 75% of patients. This audit focuses on assessing and improving the time taken for diagnosis or exclusion of suspected bladder or upper tract cancer in the 2-Week Wait (2WW) Haematuria Clinic.

Method
This quality improvement project involved a retrospective analysis of data collected from the 2WW Haematuria Clinic at our centre from February 2023 to May 2023. We analysed waiting times at key stages of the pathway to evaluate adherence to the FDS and identify areas for improvement. Data was collected in two cycles: before and after implementing the change of introducing a Cancer Clinical Nurse Specialist (CNS) led CT Urogram (CTU) results clinic.

Results
Analysis of the data from 50 patients revealed that the median time taken for diagnosis or exclusion of cancer was 54 days (range: 25 – 113 days) from the time of GP referral. Following the introduction of the CTU results clinic, data collected from another 50 patients showed that the waiting time significantly improved to a median of 27 days (range: 13 – 76 days).

Conclusions
This audit demonstrates significant improvement in the adherence to the FDS in the 2WW Haematuria Clinic, which has resulted in timely diagnosis or reassurance of absence in cases of suspected urothelial cancer.
612 A Quality Improvement Project of Management of Acute Pancreatitis in a District General Hospital; How Well Are We Doing Against NICE Guidelines?
Authors: Scott L , Park J K , Revill V 
Published: August 2024

Abstract

Aim
Pancreatitis is a common condition with significant complications, and mortality in 5% of cases. We aimed to identify compliance to the National Institute for Health and Care Excellence (NICE) guidelines of pancreatitis management in our District General Hospital (DGH) to improve patient safety and outcomes.

Method
A retrospective analysis of first-time presentations of acute pancreatitis over a 12-month period, assessing the five domains addressed in NICE-NG104: identifying cause, antibiotic stewardship, nutrition, severity and complications, and lifestyle advice. Our data was compared to that of the PANC study, a UK-national cohort study.

Results
A total of 33 cases fit criteria –17 male and 16 female. Cause was identified in 55%, of which 86% were within 48 hours. 51% were prescribed antibiotics on admission, of which 23% had an indication recorded. 91% of patients were nil-by-mouth, only 20% of those cases had a reason recorded. Only 6% had severity documented. Four patients were discussed with a tertiary centre. Lifestyle advice was offered to 33% of patients on discharge.
In comparison with the PANC Study, there were domains with significant differences. For example, the study reported that 56.4% of cases were offered oral nutrition vs 9% in our DGH, and antibiotics were prescribed in 34% vs 51% locally.

Conclusions
The audit highlighted need for improvement in NICE guideline compliance of acute pancreatitis management in our DGH. This is being tackled by cycles of quality improvement, including introduction of a ‘Pancreatitis Management Bundle’ and local clinical guidelines, increased staff awareness and patient education.
656 Is Routine Group and Save Required for Laparoscopic Cholecystectomy? An Audit of a High Volume NHS Centre
Authors: Akharaekpanya T , Nair A , Ward K , Nevins E J 
Published: August 2024

Abstract

Aim
Bleeding is a recognised complication of laparoscopic cholecystectomy (LC). Yet very few patients require blood transfusion in the perioperative phase. However, it is routine practice for patients undergoing LC to have a group and save (G&S) prior to surgery. This audit aims to assess number of LC patients at Northumbria Healthcare NHS Foundation Trust who required transfusions, and the number who had “valid” group and save (G&S) samples obtained within 72 hours pre-operatively.

Method
Records of patients who had either elective or emergency LC at Northumbria Healthcare NHS Trust between 1st January 2021 to 31st December 2022 were reviewed retrospectively using theatre and transfusion records.

Results
A total of 836 patients were included (557 female and 279 male, age ranges 19 to 90 years old). Out of 571 elective LC, none required transfusion. 383 had a “valid” G&S, despite 360 having at least one historical sample. Of 265 emergency LC, 245 patients had a “valid” G&S, despite 207 having at least one historical sample. No patients needed intra-operative transfusion. 2 emergency LC patients required non-urgent post-operative transfusion where G&S sampling could have been taken once transfusion decision was made. One patient had cirrhosis and anaemia secondary to liver metastases, and the other developed a post-operative liver haematoma.

Conclusions
This audit suggested that no patients required intra-operative transfusion, and very few patients required peri-operative transfusion for LC. Eradication of routine G&S sampling is likely to provide financial and environmental benefits without increasing the risk profile of this procedure.
760 Intravenous Maintenance Fluid Prescribing in Nil-by-Mouth Patients in General Surgery: A Closed-Loop Audit
Authors: Ismail R 
Published: August 2024

Abstract

Aim
Inappropriate intravenous fluid prescribing in peri-operative nil-by-mouth patients increases the risk of electrolyte, metabolic imbalances, and starvation ketosis.(1) NICE guidelines offer recommendations for intravenous maintenance fluid prescribing in nil by mouth' patients. (2) This audit assessed the prescribing of maintenance intravenous fluids in nil-by-mouth patients in our General Surgery department.

Method
We retrospectively audited our practice over two randomized 14-day periods pre and post-intervention to check compliance with guidelines. Inclusion criteria included non-diabetic patients, no pre-existing electrolyte imbalances and nil-by-mouth for ≥24hrs. Interventions: We delivered teaching sessions to FY1/2 on General surgery highlighting NICE guidelines on correct IV fluids prescribing. Posters summarizing this were displayed around the surgical wards.

Results
Cycle 1 showed significant lack in the prescribing of potassium and glucose in our department. Cycle 2 revealed that 82% of patients met their daily water requirements, while 94% and 96% met their sodium and chloride requirements, respectively. This translates to 40%, 10% and 11% increase in adherence to recommended water, sodium, and chloride intake, respectively. Although a small percentage of patients met their glucose (24%) and potassium (16%) requirements, the department witnessed a 55% and 54% increase in prescribing of glucose-containing and supplemental potassium-containing bags, respectively.

Conclusions
This audit identified an area of miseducation in our department and created a positive impact in the correct prescribing of maintenance fluids, particularly in the prescribing of potassium and glucose in nil-by-mouth patients.
767 A Retrospective Analysis of Unplanned Admissions in Inguinal Hernia Repairs, Laparoscopic Cholecystectomies and Para-Umbilical Hernia Repairs (Day Surgery) Against the GIRFT Guidelines
Authors: Ponnuswamy K , Burke J , Dalip A , Bugren S , Natarajan M , Khan A 
Published: August 2024

Abstract

Aim
Getting It Right First Time (GIRFT) is a national initiative to homogenise and improve the treatment pathways amongst various NHS trusts. Unplanned admission after day case surgery results in unexpected cost and burden to the NHS. In this study, we investigated the causes for unplanned admission of patients undergoing laparoscopic cholecystectomy, paraumbilical and inguinal repair.

Method
A retrospective analysis of day cases over a period of one-year (January 2022 – January 2023) was undertaken. All patients’ pathways were compared against the GIRFT pathway.

Result
A total of following cases were included: 51/232 (22%) laparoscopic cholecystectomy, 7/48 (14.5%) paraumbilical hernia, and 18/152 (12%) inguinal hernia cases had unplanned admissions. The main causes for unplanned admissions for laparoscopic cholecystectomy were high-risk patients booked as day case (5 cases), complex intra-operative procedures (11 cases), and post-op complications/social reasons (4 cases); for paraumbilical hernia, the causes included social concerns, obstructive sleep apnea, extended post-op recovery; for inguinal hernia the main causes were urinary retention (5 cases) and high-risk patients booked as day case (11 cases).

Conclusions
For majority of cases, the GIRFT pathway was followed. Most of the unplanned admissions had predictable and preventable causes.
802 Assessing the Below Knee Amputation Service in a London Major Trauma Centre: An Audit
Authors: Chan K , Singh P , Iliadis A , Pafitanis G 
Published: August 2024

Abstract

Aim
For certain complex orthoplastic patients, a below knee amputation (BKA) is the best form of reconstruction. An audit was carried out to assess whether orthoplastic patients undergoing BKAs at a major trauma centre in London were being managed according to best practice guidance set out by NICE and the Vascular Society.

Method
A retrospective review was carried out to analyse all BKAs that were performed on orthoplastic patients at the Royal London Hospital between 2020-2022. Patients were found by manually searching through the plastic surgery departmental inpatient database, and their electronic medical notes were reviewed for information specifically related to the recommendations set out by NICE guidelines for complex fractures and the Vascular Society’s guidance for major amputations.

Results
19 cases were identified. The average age of patients was 45.8 years. 11 amputations were emergencies, 8 were planned. The average time to surgery once a decision was made to amputate was 1.75 days. Compliance was 100% with having an MDT discussion pre-operatively, recording the decision to amputate in the patient’s notes, and making a formal referral to the amputee rehabilitation team for prosthetics. Areas of lower compliance included giving written counselling to families, naming a discharge co-ordinator pre-operatively, and review by the pain team within 24 hours post operation.

Conclusions
This audit has identified specific areas for improvement and will help to develop a written pathway for lower limb amputations in the trust, ensuring that patients undergoing BKAs receive the best care possible.
841 The Management of Post-Operative Haemorrhage in Thyroid and Parathyroid Surgery: An Educational Quality Improvement Project in ENT
Authors: El-Hassan M , Kumaresan K , England R 
Published: August 2024

Abstract

Aim
To improve understanding of the protocol and critical urgency of post-operative haemorrhage and actions needed to secure a safe airway in patients’ post-thyroid and parathyroid surgery, in the ENT department of Castle Hill Hospital.

Method
Employing the guidelines established by The British Association of Endocrine & Thyroid Surgeons (BAETS), we devised identical questionnaires to be completed before and after the intervention on google forms. The intervention was a delivered as a video on acute haemorrhage management and one-to-one teaching. In November 2023, the survey was circulated to all ward and theatre staff responsible for the care of these patients. The pre- and post-intervention questionnaire included qualitative and quantitative questions, measuring competence in identifying and managing post-operative haemorrhage. Statistical analysis involved a paired t-test to evaluate differences in pre- and post-intervention data.

Results
19 responses were collected, yielding an 83% follow up rate. On a Likert-scale of 1-10, the confidence of managing a post-operative haemorrhage increased from 5.05 to 6.63, showing a significant increase (p&gt;0.0015). Similarly, the overall score of the questionnaire increased from 6.68 to 8.68, showing a significant increase (p&lt;0.0001). Qualitative feedback indicated the need for formal departmental teaching in the management of a post-operative haemorrhage.

Conclusions
Staff interacting with patients following thyroid surgery should be trained to recognise and manage a haemorrhage. There is no formal inclusion of acute haemorrhage management in the departmental induction for staff, which should be added in subsequent rotation inductions. Simulation exercises will be trialled to improve retention in subsequent cycles of this quality improvement project.
929 An Audit of the Perioperative Clinical Assessment and Documentation of Delirium in Older Patients Following Vascular Surgery
Authors: Chand C P , McCarthy T , Anthony R 
Published: August 2024

Abstract

Aim
Guidelines established by the Centre for Perioperative Care recommend daily screening for delirium using a validated tool such as the 4-AT and proactively documenting delirium in patients aged 65 years and over. This audit evaluated the assessment and documentation of delirium in older patients following vascular surgery.

Method
Patients aged ≥ 65 years who had undergone vascular surgery in August 2023 were identified. Data was collected retrospectively with access to the Trust electronic patient record system on a bespoke Microsoft Excel spreadsheet and analysis was carried out using SPSS®.

Results
Of the 51 patients identified, delirium was screened using the 4-AT tool in only 39.2% (n=20) of patients and on average 90 hours post-operatively. The highest documented score was 7 (n=1), with 7.8% (n=4) of patients scoring 1, 2 or 3 and the majority scoring 0 (n=15). The 4-AT was never documented in a consultant-led surgical post-operative review (100%, n=51). Additionally, there were concerns of delirium documented in 7 instances in the post-operative period, with the 4-AT documented in 5 of those instances.

Conclusions
This audit demonstrates poor compliance with perioperative care standards on screening for delirium using the 4-AT and documenting delirium, highlighting the need to increase awareness and improve the perioperative clinical pathway for older people undergoing vascular surgery. Our recommendations include discussion with stakeholders to identify barriers to assessment and documentation of delirium, (2) use of the mantra: 'Post-op bloods and 4AT' during post-operative reviews, and (3) education of various healthcare professionals in completing the 4-AT proforma on the ward.
940 Mobility in Acute Care Surgery Patients - Are We Neglecting the Basics?
Authors: Tannirandorn P , Zeidaabadi B , Zhou S , Zhang H , Zuzarte J , Jose A , Frith D 
Published: August 2024

Abstract

Introduction
Immobility is a harmful yet preventable issue in healthcare. Complications such as DVTs and pressure ulcers require intervention, leading to a prolonged hospital stay. NICE guidelines on trauma rehabilitation suggest tailored exercise rehabilitation programmes as soon as possible after traumatic injuries. However, these guidelines are rarely quantified. Our aim was to assess mobility of surgical patients admitted under the General Surgery (GS) and Major Trauma (MT) teams at a London Teaching Hospital and Major Trauma Centre.

Method
We conducted separate cross-sectional studies on each respective ward. Patients were observed for 3 weeks at 2-hourly intervals commencing at 0800 until 1800 for GS and 1000 to 1600 for MT. They were classified under the following: Bed, Chair, Absent, Mobile. Individuals unable to mobilise were identified through review of notes and excluded. Data-points are a bed surveyed at each time point.

Results
Datasets were combined, and 1309 data-points analysed. Results showed severe lack of mobilisation, with only 4.8% MT and 0.9% GS patients mobilising. Statistical analysis indicated no significant difference between both groups at all time points. Although suitable to mobilise, 98 patients remained in bed over a cumulative 221 days. There was increased tendency to mobilise during lunchtime and visiting hours.

Conclusions
Immobility is prevalent and preventable in acute-care surgical patients. Our study demonstrates that despite guidelines recommending early mobilisation, these are patient-specific and not adhered to. Potential causes include lack of healthcare and physiotherapy staff to assist patients. Patient-specific goals are required to avoid physical, social, and financial costs of acute surgical immobility.