bluuebunny/crossref_metadata_2025_split huggingface dataset:
109 Compliance Rates of the WHO’s Surgical Safety Checklist, Within a District General Hospital’s ENT Department
Authors: Sadera R , Kazemi N , Hettige R 
Published: August 2024

Abstract

Background
The WHO’s Surgical Safety Checklist (SSC) is a required component of surgical procedures. It has been proven to decrease patient mortality. This audit’s objective was to assess the compliance with the timeout segment (specifically, the confirmation of all team members) of the SSC, at a district general hospital’s ENT department in comparison to WHO guidance.

Method
A prospective audit analysing elective and emergency theatres was undertaken over four months (1st cycle: 12/05/23- 21/06/23 and 2nd cycle: 27/07/23-20/08/23) with 19 patients for each cycle. The assessment focused on the completion of the segment’s names section, which included the names of the surgeon, surgical assistants, anaesthetic consultant, and registrar, and team leader for each case.

Results
During the first cycle, the Trust’s compliance rate for filling the sections was 4%. However, following our interventions of email communications and face-to-face staff meetings to theatre personnel on the importance of completing the theatre board with the categories’ names, there was an improvement resulting in a 100% compliance for all sections. To ensure compliance continued, we presented our findings within clinical governance meetings as our secondary intervention.

Conclusions
This audit demonstrated that simple measures could help to ensure compliance to WHO protocols as well as illustrating our Trust’s compliance to WHO guidance. To ensure ongoing compliance, a third cycle with interventions ensuring that new rotating staff are informed about the significance of the WHO SSC is needed. Furthermore, it may be beneficial to conduct analysis across various surgical specialties for comparative studies.
215 Title: An Overview of Adhesional Small Bowel Obstruction Management Across Two High-Volume Tertiary Centres in the North West of England
Authors: Birkenhead P , James E , Emilian-Nita G 
Published: August 2024

Abstract
This study is a retrospective audit conducted in November and December 2022 across two high volume tertiary centres in Liverpool (Royal Liverpool University Hospital and Aintree Major Trauma Centre), aiming to evaluate the local diagnostic and therapeutic approaches to ASBO, benchmarked against the established Bologna ASBO Working Group Guidelines of 2017 and the NASBO recommendations. Our audit encompassed 22 patients, with a slight female predominance (59.1%), and an average age of 63.5 years. The audit revealed several critical insights, including a tendency to over-utilise abdominal X-Ray contrary to current WSES (Bologna) recommendations, suboptimal utilisation of water-soluble contrast agents in conjunction with CT imaging for ASBO diagnosis and management (36.4% adherence), delayed timing to cross-sectional imaging (averaging 11.7 hours from suspicion to imaging) and delayed time to surgical intervention (mean duration of 102.6 hours in emergency, and up to 135 hours in semi-emergency scenarios), inconsistent biochemical monitoring with notably deficient lactate surveillance (16.7%), delayed implementation of parenteral nutrition (36.4%), and a mortality rate of 13.6%, which notably exceeds the Bologna report figures.
These findings have catalysed a comprehensive re-evaluation and restructuring of our local protocols for ASBO treatment and management. Future directives include expedited diagnosis through prompt CT scanning integrated with water-soluble contrast agents at the point of entry, advocacy for both conservative and surgical intervention as clinically indicated, the promotion of a multidisciplinary approach with early involvement of dietitian team and establishment of TPN, and an overarching goal to curtail mortality rates associated with ASBO.
274 Audit of the Written and Oral Assessment of the Dissertation Component of a Laparoscopic Surgical MSc Programme Using Internal and External Benchmarks
Authors: Ajah J , Narayanan Raju R , Patel B 
Published: August 2024

Abstract

Aim
To critically audit the laparoscopic surgery master’s programme dissertation assessment against internal and external Quality Assurance. The main objective was to vet and benchmark the module assessment to the Queen Mary University London(Internal) & University College London(external) benchmarks. Additionally, to pinpoint areas for potential enhancement with a projected re-audit in the 2024/2025 academic session.

Method
Two separate analyses were carried out for the written dissertation and its oral presentation. The criteria assessed include the 50% rule, blind double marking, resolving differences between markers, marking trails, guidance specific to the dissertation and moderation. (internal). External benchmark criteria assessed include parity meeting, Independent i.e., double marking, reconciliation of marks, documentation of marking, guidance specific to the dissertation and moderation. The anonymous results of a total of 18 students were assessed.

Results
For the internal benchmark of the dissertation component, assessment practice surpassed the 50% rule and double blinding requirements by 200%(9 vs 18), parity marking was done after marking (external), and differences in marks were agreed upon by discussion between examiners only(both internal and external), marking trails were left electronically(internal/external), only double-blind marking was done, and moderation was not needed(both). The viva component was essentially the same except differences in marks were agreed upon by splitting the difference between examiners.

Conclusions
An area of improvement is having electronic viva marking sheets in the next academic session. This audit shows an example of good practice in academic surgical education that other similar programmes within the UK and globally can adopt.
275 Pre-Treatment Diagnosis in Lung Cancer Resections
Authors: Omran A 
Published: August 2024

Abstract

Aim
Measure compliance with Lung Cancer Quality Performance Indicator 15, which states that patients should have a cytological or histological diagnosis prior to definitive treatment, i.e., surgical resection. Standards: 75 %

Method
In a retrospective audit, data was collected from existing databases and case notes between November 2022 and January 2023 at Golden Jubilee University National Hospital. The data was input into and analysed using Microsoft Excel.

Results
108 patients underwent lung cancer resection between November 2022 and January 2023; 79 patients (73%) had a pre-treatment histological diagnosis. Diagnosis was obtained by means of CT-guided biopsy in 53 patients (67%), frozen sections in 14 patients (17.7%), bronchoscopy and endobronchial biopsy in 9 patients (11.3%), EBUS-TBNA in 2 patients (2.5%), and previous blind resection in 1 patient (1.2%).

Conclusions
The 75% target for preoperative histological diagnosis was not achieved. 27% of patients didn’t have pre-treatment diagnosis due toTechnical difficultiesfailed or inconclusive biopsyRadiological findings were accepted for treatment.

Impact
The project has contributed to the introduction of a new service to the hospital, namely a regional service for CT-guided lung biopsy, which was granted clinical governance approval on November 1, 2023.
310 Documentation and Consent Audit in HPB Patients
Authors: Aggarwal N 
Published: August 2024

Abstract

Aim
Investigating documented information relating to the care of the hepatobiliary patients to ensure record-keeping standards are being met and written consent for procedures are recorded in accordance to trust and national guidance.

Method
17 patient files, selected at random, were included in this audit. Microsoft Forms application was utilised to complete the data collection. The files were audited against trust guidelines regarding documentation and consent.

Results
Although all entries were legible and signed oftentimes GMC number and designation was omitted (81%). Allergy status and drug history had also been omitted from most records (62 and 63% respectively). Regarding consent, all forms were present in the notes, and all properly described the name/ benefits/ risks of the procedure. In 77% of consent forms, it was not documented whether an information leaflet has been provided to the patient. Only the minority of patients received a carbon copy of their consent form (23%). When the carbon copy remained in the patient’s file, the consenter had failed to circle “no” indicating patient did not accept the copy in every case. Abbreviations were used in over half of the consent forms audited (54%).

Conclusions
Key areas for improvement in documentation and consent were underlined by this audit. Proper and clear highlighting of patient’s allergies and drug histories is an important area for improvement regarding documentation. Consenters should make more efforts to offer patient information leaflets and carbon copies of consent forms to patients and to document this appropriately.
329 An Audit into the Prescription of Maintenance IV Fluids for General Surgery Patients
Authors: Ravendran K 
Published: August 2024

Abstract

Introduction
Intravenous (IV) fluids are vital for maintaining surgical patients in a "nil by mouth" (NBM) state. They prevent dehydration, maintain electrolyte balance, support perfusion, provide nutrition, administer medications, stabilize blood pressure, monitor fluid balance, and address emergencies. The central objective of this audit is to assess the level of adherence to NICE guidelines in the surgical department concerning the prescription of IV fluids.

Method
During the pre-intervention phase, a two-week audit was conducted across three surgical wards where patients were in a nil by mouth (NBM) state. Each day, the audit involved a comprehensive review of patient records and drug charts. Additionally, inquiries were made with the respective nurses in charge to gather information on the IV fluids administered to the patients. The Intervention phase was also two weeks, across the same surgical wards. Intervention included a proforma and teaching to foundation doctors on the ward, to comply with NICE guidelines.

Results
The first cycle showed that no patients were given IV fluids according to NICE guidelines. The NICE guidelines state the following: According to the NICE guidelines, the recommended daily maintenance fluid requirements consist of:25-30 ml/kg/day of water,Approximately 1 mmol/kg/day of potassium, sodium, and chloride, andApproximately 50-100 g/day of glucose, primarily to prevent starvation ketosis (although it's important to note that this alone does not address the patient's nutritional needs).
Second cycle is currently in progress, but early signs show a positive improvement

Conclusions
IV fluids are vital for maintaining "nil by mouth" patients.
377 Nutritional Management in Acute Pancreatitis Patients and Its Effect on Recovery in a Single Institution in the UK
Authors: Cai W , Probert S , Khorshid K , Sultan B , Alkistawi F , Karamanakos S 
Published: August 2024

Abstract

Aim
This study aims to evaluate nutritional management of patients admitted with acute pancreatitis in a single institution in a 12-month period. This involves looking at the route of nutritional administration and nil-by-mouth status on admission.

Method
Patients admitted with acute pancreatitis from January to December 2022 at Basildon Hospital were identified using the hospital’s electronic patient records portal. Data on patient demographic, cause of pancreatitis, route of administration of nutrition were collated and analysed in Excel®.

Results
A total of 161 patients were included in this study and 84 (52.2%) were male. The commonest causes of acute pancreatitis in this cohort of patients are gallstones (34.0%) and alcohol (27.8%). Forty-one patients (25.4%) were made nil-by-mouth on admission. The median number of days a patient remained nil-by-mouth is 1 day with an interquartile range of 2 days. Out of the 120 patients who were not nil-by-mouth on admission, one was on nasogastric feeding and the rest had enteral nutrition by mouth. Of those who were nil-by-mouth on admission, 29 patients resumed enteral nutrition by mouth at a later date, 7 had nasogastric feeding, 2 had nasojejunal feeding and 3 had parenteral nutrition. Patients who were NBM on admission had significantly longer mean length of stay when compared to those who were not (p&lt;0.05).

Conclusions
This study has shown most patients with acute pancreatitis started on oral feeding early in the course of the disease in this institution. This is in accordance with international guidelines.
591 Septal Button Service Evaluation
Authors: Mohamed J , Richards E , Jervis S 
Published: August 2024

Abstract

Aim
Nasal septal perforation is a defect extending through the bony or cartilaginous septum and its overlaying mucosal covering, which can impair the structural and functional properties of the nasal septum leading to patient discomfort and symptoms. Septal button is an alternative to surgical repair of the defect and the audit was aimed at reviewing outcomes of septal button insertion done in the department.

Method
It was a retrospective study involving the patients who underwent the procedure during the period between 2017 to 2023. The patients were identified from the theatre logbook and the data collected included demographics, presenting symptoms, complications and further management if required. The data was collected from the theatre documentation and clinic letter, and Microsoft excel was used to analyse the data.

Results
45 patients underwent the procedure during the above time period and a total of 59 septal buttons were inserted. 87% of the buttons inserted were Custom while the others were off shelf. 26 patients kept the first septal button while others had issues after the procedures which required further intervention. Out of the 45 patients, 35 patients had one button in the audited period while 8 patients had 2 buttons and the remaining 2 had 3 buttons.

Conclusions
Septal button is an effective way of treating patients with symptomatic nasal septal perforation. The results of our patients revealed a success rate of 62% which was comparable to the previous studies done for the same procedure (Taylor et al Prosthetics for Nasoseptal Perforations: A Systematic Review and Meta-analysis).
637 Standardising Flexor Sheath Treatment and Hand Therapy in a Regional Hand Surgery Unit
Authors: Ho R , Slade R , Thornsby J , Dickson J 
Published: August 2024

Abstract

Aim
This project aims to compare management of flexor sheath infections in a regional hand surgery unit against guidelines set by British Society for Surgery of the Hand (BSSH).

Method
A retrospective audit of management of flexor sheath infections compared with BSSH standards between March - August 2023. Data was collected retrospectively from electronic patient records and analysed in Microsoft Excel. Data collected included pre-operative splinting, early IV antibiotics, time to theatre, return to theatre, microbiology results, tendon rupture and access to hand therapy.

Results
13 patients filled the audit criteria within the 6-month timeframe.100% of patients had appropriate early antibiotics. 92% of patients had washouts within 24 hours, with 46% of patients requiring return to theatre. Most microbiological cultures showed no growth, of those with positive swabs 21% were gram positive cocci. No tendons ruptures were observed. No patients had pre-operative splinting. Early referral to hand therapy was inconsistent, only 46% of patients had evidence of hand therapy (variable between day 5-14 post op). Hand therapy was documented in post op instructions for 1 patient.

Conclusions
Patients received good operative care with prompt antibiotics and washout. However, we were not meeting access to hand therapy targets. To standardise post operative care, we created an electronic operation note template on flexor sheath infections with specific post operative instructions as per the BSSH guidelines. A patient information leaflet with exercises is provided immediately post operatively to guide early mobilisation. A further audit cycle is underway to see the effects of intervention.
766 Audit of Stratified Treatment Escalation Plan Completion and DNACPR in Patients with Femoral Fractures – 4th Cycle
Authors: Masala I , Rashinkar S , Bairstow D , Manjunath P 
Published: August 2024

Abstract

Aim
Assess how many patients admitted on the fragility fractures ward (including hip, shaft, distal, periprosthetic fractures) had escalation (STEP) forms completed. We audited whether this was done in a timely fashion, which specialties and grades filled in the forms, if was there a weekend effect in form completion, and if the decisions were communicated with patients or relatives.

Method
In this 4th cycle of the audit, notes of patients admitted on the fragility fracture ward in the period 14/09/23 - 25/10/23 were examined prospectively. Paper and electronic notes were assessed for presence of escalation and DNACPR forms completion, and for evidence of discussion. Standards were set as internally as 100% for all measures: evidence of STEP form completion, completion done within 24 hours, and evidence of escalation plan discussion.

Results
30 patients were audited. STEP form completion was 100% however 13% contained minor errors, needing correction; STEP completed within 24 hours of admission to the ward = 77%; documentation of discussion if for less than full escalation 58% (cognitively intact) and 64% (cognitively impaired).

Conclusions
All patients audited had a STEP form completed. STEP form completion within 24 hours improved from cycle 3. Documentation of discussions did not meet the standard for cognitively intact and cognitively impaired patients for less than full escalation. To improve future care, posters will be displayed, audit mentioned in junior doctors' inductions, and email reminders sent to all grades. Further cycles are being planned, and e-documentation system utilisation for improvement is under consideration.
893 Addressing the Potential Harms in Vascular Surgery Inpatients with Diabetes: A Double Audit and Intervention Project on HbA1c Monitoring and Diabetes Management
Authors: Ekkunagul T , Francis J , Drever S , MacLeod C , Renwick B 
Published: August 2024

Abstract

Aim
Diabetes mellitus confers crucial prognostic consequences in vascular surgery patients. Derangements in long- and short-term glycaemic control predispose to increased risks of post-revascularisation amputation and overall cardiovascular morbidity and mortality. This project aims to address these potential risks by improving departmental HbA1c monitoring practice and diabetes management knowledge at a tertiary centre through a comprehensive educational intervention.

Method
A retrospective audit of HbA1c monitoring practice in vascular surgery admissions from August-September 2023 for peripheral arterial disease or diabetic foot infections was performed against a locally agreed guidance-based 3-monthly monitoring frequency. An educational audit on clinical staff’s knowledge of relevant practical and theoretical aspects to diabetes management was performed through a multiple-choice assessment. An educational teaching programme was subsequently designed and delivered. Post-intervention HbA1c monitoring was prospectively reassessed between October-November 2023, and a post-intervention knowledge assessment was performed.

Results
Mean pre-admission HbA1c values in the pre- and post-intervention admission cohorts were 78.6±18.4 mmol/mol (n=21) and 73.6±35.7 mmol/mol (n=12) respectively. Repeat HbA1cs were required in 38% of pre-intervention and 50% of post-intervention admissions. Appropriate HbA1c re-checks on indicated admissions increased from 25% to 86% post-intervention. Mean knowledge assessment performance increased from 56% to 77% with improved mean scores in all knowledge domains.

Conclusions
Gaps in departmental understanding of practical diabetes management and monitoring relevant to vascular surgery patients with diabetes were effectively addressed through the educational intervention. Referral practice for multidisciplinary diabetes optimisation and harm reduction should be a further area of focus given the patient cohort's highly elevated HbA1c measurements.
1039 Improving Escalation Pathways and Appropriate Use of E-Whiteboard Out-of-Hours Task Generation in Trauma & Orthopaedics
Authors: Ogunmwonyi I , Weight G , Farah N , Chadwick C 
Published: August 2024

Abstract

Aim
E-whiteboard is an electronic record system utilised across Sheffield Teaching Hospital NHS Trust. It is used to record and update patient information including observations. There is a task function which allows clinical personnel to write tasks relating to specific patients, however this should only be used outside of normal working hours. Previous inappropriate use has resulted in delays in care, especially for time critical jobs. We aimed to assess and improve the use of the E-whiteboard task system, an in-hours escalation by nursing staff.

Method
We retrospectively looked at e-whiteboard task data from 01/06/22- 31.07/22. The number of tasks, location of task generation and task content were reviewed, and tasks were further reviewed for content, urgency, and time to completion.
Following several changes in the department, includingThe introduction of the Consultant of the Week (COW) model of careWard based Junior doctorsNursing staff educationA poster on the bleep and task escalation pathway.
A subsequent reaudit from 03/03/23-10/05/23 was performed.

Results
There was a reduction in the number of inappropriate tasks generated and a decrease in the proportion of urgent tasks (from 84.6% to 29.4%) as well as tasks with patient safety implications (from 70.6% to 61.6%). Additionally, mean time to completion of tasks decreased from 5.24 to 3.61 hours

Conclusions
This improvement project has demonstrated some improvement in the use of E-whiteboard tasks, which may be due to several factors including staff education and consultant led decision making.
1110 Thoracic Theatres: Audit of Theatre Efficiency
Authors: Wong N Z J , Abah U 
Published: August 2024

Abstract

Aim
Turnover time is the cumulative time of processes between procedure finish (final dressing applied) and next procedure start (knife to skin). This audit aims to establish current turnover times and identify individual process times within patient turnover to improve theatre efficiency.

Method
This audit spanned between 22/5/2023-22/6/2023. Patient turnovers (N=41) from all elective thoracic procedures (N=61), across 19 operating days were examined. Operating days (N=2) with single cases were excluded from analysis. A process map was used to visualise the processes involved in patient turnover. Individual process times were extracted from Bluspier and data analysis performed using Microsoft Excel. All descriptive statistics are reported as mean±standard deviation with 95% confidence intervals.

Results
Mean procedure and turnover time were 93±16 and 94±14 minutes respectively. The audit revealed 2 main processes contributing to current turnover times, handover from theatre to recovery bay (23±8 minutes) and subsequent patient sign-in and transfer to anaesthetic room (36±6 minutes). Both processes make up 54±13 minutes of current turnover times. Recovery bay availability was influenced by ward/ ITU availability, with patients ready for discharge spent an extra 48±13 minutes in recovery pending ward transfer. This causes time blocks for the anaesthetic team who are unable to complete handover to recovery resulting in delays for subsequent patient sign-in.

Conclusions
Ideal solutions to improve turnover times would involve parallel processing with concurrent handover and patient sign-in and workforce expansion to improve ward availability. However, with limited resources, a cost-neutral solution would be difficult to achieve.