bluuebunny/crossref_metadata_2025_split huggingface dataset:
195 Use of Abdominal Ultrasound Scans in Surgical Assessment Unit
Authors: Okoh M , Ikram S , Abraham-Igwe C 
Published: August 2024

Abstract

Aim
Abdominal ultrasound scan is one of the most common scans performed in general surgery. It is relatively cheaper, faster, and safer than most of the other imaging modalities. However, inappropriate use of abdominal ultrasound scans can lead to delay in diagnosis, unnecessary hospital admission and extended length of stay, which could induce stress in patients. This study aims to evaluate the need and usefulness of abdominal ultrasound scans performed for patients complaining of abdominal pain in SAU.

Method
A 1-month snapshot retrospective case note review of patients that presented to SAU with abdominal pain and underwent subsequent abdominal ultrasound scans. Variables included presenting complaint, working diagnosis, ultrasound findings, and outcome data. Scans were categorised into normal and abnormal. Abnormal was further sub-categorised into positive for diagnostic question, and positive for other diagnosis.

Results
Of the 522 patients that presented to SAU with abdominal pain, 87 had abdominal ultrasound scans. Of these 87 patients, lower (52%) and upper abdominal pain (40%) were the most common presenting complaints. The most common working diagnoses were pathologies of the biliary (41%) and gynaecological (40%) systems. There were 16 abnormal scans, of which the 10 were positive for the diagnostic question. Ten patients required subsequent MR or CT scan and 5 patients required hospital admission.

Conclusions
Most scans were performed to rule out acute surgical pathologies and for reassurance purposes. To reduce the number of abdominal ultrasound scans performed, we created a standard operating procedure flowsheet that will help determine patients to be scanned based on clinical presentations.
349 Improving the Rates of Outpatient Follow-Up for Patients on a New Elective Ward Following Elective Orthopaedic Joint Replacement Surgery
Authors: Vemulapalli K , Gadikoppula S , Sinha S 
Published: August 2024

Abstract

Aim
This study was an audit which aimed to assess and improve the follow-up of orthopaedic patients following elective arthroplasty on a new elective ward at a district general hospital.

Method
Theatre lists were accessed through the electronic patient records. Patients who had an elective joint replacement were identified through this. Patient appointments were then accessed to see if they had any follow up appointments in place. Should the patient have an appointment, the type of appointment was checked using the clinic codes to determine whether the correct appointment type was booked. The standard expected was that 100% of patients undergoing elective surgery should have the correct follow-up appointment in place.

Results
100% of patients had an appointment booked with the orthopaedic team, however only 44% of these were booked in the correct outpatient clinic. The remaining patients were either booked into the fracture clinic or into the wrong subspecialist’s elective clinic. The intervention consisted of a new specific email address which enabled the surgeon to directly request a specific appointment with a dedicated elective orthopaedic secretary following each case. A re-audit yielded that there was an improvement with 76% of patients having the correct clinic booking. This was then planned to be presented to the executive team of the hospital to hire a ward clerk to facilitate further improvements.

Conclusions
Implementation of the change has increased the current follow-up rates; however, the long-term goal should be the hiring of a ward clerk to ensure that appropriate follow-up is in place.
393 Towards Sustainable Care Pathways: A Review of Outpatient Appointments for Elderly Patients Under Fast-Track Discharge from Surgical Specialties
Authors: Yiu J , Ernst T 
Published: August 2024

Abstract

Aim
To conduct a multi-cycle QI project to review outpatient appointments and evaluate the effectiveness of a junior doctor discharge checklist for elderly patients under Fast-Track discharge from surgical wards at a tertiary hospital.

Method
A pilot questionnaire survey was sent to consultants and junior doctors, followed by dissimilation of a peer-reviewed FT discharge checklist to junior doctors. A retrospective review of surgical patients under FT discharge between July 22 to April 23 was carried out. Inclusion criteria were discharged with palliative care injectables and not deceased prior to discharge.

Results
21 responses were received with 95% agreed that OP appointments review was essential and 76% reported that no routine review of OP appointments was carried out. Prior to intervention (checklist), 54% (6/11) of patients from colorectal, orthopaedics and vascular wards have OP appointments including face-to-face (F2F) thrombosis and rheumatology clinics with transport. 3 patients were deceased within 2 months. Post intervention, over two cycles, 3 out of 16 patients had appointments, with fewer F2F follow-up, but increase in telephone-led care.

Conclusions
In light of the Royal College of Surgeons report in Sustainability in Surgery in 2022, this study featuring a short checklist revealed gaps in care pathways for co-morbid FT surgical patients. This could entail unnecessary care burden to patients, inappropriate surgical service distribution and sustainability including carbon emission. Akin to medication rationalisation, there is a need for qualitative studies involving patients and carers and in other centres to raise awareness for more holistic and sustainable post-surgical end of life care.
471 Enhancing Outcomes and Improving Patient Services in Complex Abdominal Wall Reconstruction Through Multidisciplinary Collaboration
Authors: Chong M Y , Baldwin A J , Krzak A M , Murray A 
Published: August 2024

Abstract

Introduction
The management of complex abdominal wall pathologies presents a multifaceted challenge. There remains limited evidence for abdominal wall reconstruction, with variations in surgical technique, prosthetic materials, and patient cohorts. The abdominal wall reconstruction multidisciplinary team (AWRMDT) provides a platform for in-depth discussion of complex abdominal wall problems, drawing on expertise of radiologists, general and plastic surgeons. We aim to outline benefits and challenges in creation of our AWRMDT.

Method
From the creation of the MDT in December 2020, monthly meetings have been conducted to consider patient characteristics, nature of the defect, radiological findings, mesh selection and management. Comprehensive records of discussed cases were maintained, documenting profiles, management, outcomes, and any associated complications.

Results
A total of 105 cases were discussed in the AWRMDT from December 2020 to present. 68 (65%) patients were recommended for surgery, with 20 (19%) undergoing perioperative Botox injections. 26 (25%) patients were not recommended for surgery, while 2 (2%) have opted for treatment in the private sector. 18 (17%) required perioperative optimisation such as reduction in BMI and smoking cessation.

Conclusions
With growing prevalence of abdominal wall surgery, the AWRMDT enhances patient care and optimises the utilisation of limited resources. A collaborative approach to the management of this complex patient group is in line with published recommendations and has allowed our team to provide a more robust and standardised approach to this complex patient cohort. Future plans for our AWRMDT include the routine assessment of functional outcomes and achieving specialist centre status.
533 Use of Clinical Frailty Score in Surgical Patients - a QIP
Authors: Mollier J , Whitehall N , Gray E 
Published: August 2024

Abstract

Aim
Frailty is defined as a state of increased vulnerability to poor recovery after a stressor event. Frailty on admission influences investigations, treatment, appropriate ceilings of care, and helps with anticipating complications, and frailty at discharge determines discharge criteria planning. The clinical frailty score (CFS) is a quick way to assess frailty and has been widely validated as a good indicator of patient outcomes. The aim of this audit is to improve use of CFS on admission and discharge of surgical patients at Southend University Hospital.

Method
59 consecutive general surgery patients admitted between 4th-10th September 2023 were screened for documentation of CFS on their admission clerking and discharge letters. A poster detailing how to determine the CFS was then created and distributed to surgical wards. Admission clerking and discharge letters for 32 patients were screened for documentation of CFS on admission and discharge.

Results
Before intervention, 0% of emergency admissions and 86% of elective admissions had CFS documented on admission. No patients (emergency or elective) had CFS documented on discharge. Post-intervention, 20% of emergency admissions and 100% of elective admissions had clinical frailty score documented on discharge. However, on admission, 100% of elective admissions and 6% of emergency admissions had clinical frailty score documented.

Conclusions
There was some improvement in documentation of CFS on admission and discharge, but further work would include improving awareness of CFS with teaching sessions and providing a space for this to be documented on admission clerking proformas.
665 Timely Gentamicin Sampling and Impacts on Administration in Paediatric Surgical Patients
Authors: Johnson R , Attia A , Wade J , Emordi V , Mernenko R , Hannon E 
Published: August 2024

Abstract

Aim
Gentamicin serum level monitoring is mandatory to ensure safe administration. Optimum guidance in children suggests an 18–23-hour sampling window following the 1st dose. We aim to see if this target is met and to improve timely administration of gentamicin in a paediatric surgery department.

Method
A 6-week retrospective review included paediatric surgical patients receiving once daily gentamicin in our hospital. Data collected included times of blood sampling, receipt by laboratory, result reporting and gentamicin administration. Interventions were then implemented to encourage sampling at 18 hours; including posters, educational sessions, department emails and involvement of nursing, pharmacy, and laboratory teams. Data was then collected prospectively in the same format for comparison.

Results
Our population included 27 patients: 17 pre-interventions, 10 post. Ages ranged between 1-18 years. Primary indications for gentamicin included appendicitis and anorectal surgery. Pre-intervention, 8/17 (47%) patients had samples taken within 18-23 hours. 3/17 (18%) patients received infusions on time; defined as &lt;1hr due (mean administration 3hr 56m late). Post-intervention, 10/10 (100%) patients were sampled before 23 hours (mean sampling 18hr 35m post-dose). 8/10 (80%) patients received infusions on time (mean administration 4m early). In addition, delays in serum level reports dropped from 76% (pre-intervention) to 10% (post).

Conclusions
Junior doctor and nursing education led to significant reduction in sampling and administration delays. Setbacks such as laboratory errors or insufficient samples are often accounted for when sampling at 18 hours post-dose. This mindset can be adopted through simple interventions. Of note, no serum levels met the toxicity threshold.
721 Optimising Acute Pancreatitis Management: A Comprehensive Evaluation of Guideline Adherence and Clinical Outcomes in a District General Hospital
Authors: Mushtaq M , Gurprashad R 
Published: August 2024

Abstract

Aim
This study sought to evaluate compliance with NICE guidelines for assessing and managing acute pancreatitis at a district general hospital, following the implementation of a trust protocol designed to align with these guidelines; with a specific emphasis on initial interventions and Glasgow-Imrie scoring.

Method
A retrospective review of 102 patient admissions from January to October 2023 was conducted. Adherence to initial management protocols, as per NICE guidelines, was scored out of 6; covering fluid resuscitation, analgesia, nutritional support, causal investigations, imaging for suspected complications, and correct antibiotic use. Each patient’s Glasgow-Imrie score on admission was also calculated.

Results
Out of the 102 patient admissions analysed, 9.80% had a Glasgow-Imrie score ≥3, indicative of severe pancreatitis. Among these cases, there was on average a 96.67% adherence rate to NICE-recommended treatments, compared to 88.41% for less severe cases. Suboptimal practices were identified in antimicrobial prescriptions, with 23.54% administered incorrectly as prophylaxis. Additionally, 25.49% of patients were made nil-by-mouth without an alternative nutrition plan. Furthermore, deficiencies were noted in components necessary for Glasgow-Imrie scoring, with only 11.76% and 22.55% of patients having a measured PaO2 and LDH, respectively.

Conclusions
While this study demonstrates a commitment to evidence-based management in severe acute pancreatitis, identified variations in guideline application for more moderate cases emphasise the need for targeted educational interventions, particularly in antimicrobial prescribing and providing nutritional support. Ensuring adherence to often-overlooked parameters (LDH, PaO2) in the Glasgow-Imrie scoring system is crucial for a more accurate assessment of severity, thereby facilitating appropriate and effective management for these patients.
864 Optimizing Prescribing Strategies for Neck of Femur Fracture Patients: The Role of Electronic Order Sets
Authors: Pattnaik S , Sidhu G , Kaur H 
Published: August 2024

Abstract

Aim
Neck of femur fractures impose a substantial burden on the National Health Service (NHS) in the UK, with rising incidence rates and escalating costs. The aim of this study is to investigate the impact of implementing an order set on medication prescribing for patients with neck of femur fractures, with a focus on optimizing pain management and enhancing patient outcomes.

Method
A retrospective analysis was conducted to evaluate medication prescribing practices in patients diagnosed with neck of femur fractures. The study was carried out at Queens Hospital, Burton, a level III trauma unit in the UK, utilizing the Meditech electronic patient records. The prescribing patterns of medications, including paracetamol, opiates, antiemetics, laxatives, intravenous (IV) fluids, oxygen, and preoperative drinks, were assessed before and after the introduction of an order set. The study population consisted of 63 patients, with data collected over a two-month period for each phase of the study.

Results
Prior to implementing the order set, prescribing rates for certain medications were suboptimal. Following the introduction of the order set, there was a significant improvement in medication prescribing for all patients with neck of femur fractures. Prescription rates for paracetamol and opiates remained at 100%, while there were substantial increases in the prescribing of antiemetics (68%), nutritional shakes (81%), and oxygen (87%). IV fluid prescriptions increased by 10%, and laxative prescriptions increased by 32%.

Conclusions
Implementing order sets in the management of patients with neck of femur fractures has shown to be effective in optimizing preoperative prescribing practices and improving patient outcomes.
869 A Comprehensive Evaluation of Patient Satisfaction and Safety in Elective Hip and Knee Replacement Surgeries During the COVID-19 Pandemic
Authors: Sidhu G , Pattnaik S , Kaur H 
Published: August 2024

Abstract

Aim
During the initial phase of the COVID-19 pandemic, elective orthopaedic services were significantly delayed, raising concerns about the delivery of orthopaedic care. This study aims to evaluate patient safety, satisfaction, and service delivery in the context of elective hip and knee joint replacement procedures during the COVID-19 pandemic.

Method
A prospective, single-centre study was conducted at Queen Hospital Burton (QHB) involving 100 patients who underwent elective orthopaedic procedures between mid-June 2020 and August 24, 2020. Patient characteristics, including demographics, COVID-19 risk stratification, procedure types, length of stay, complications, and outcomes, were recorded. Data collection involved standardized assessments and surveys to evaluate patient safety and satisfaction.

Results
The study sample had a mean age of 69.1 years, with females representing 59% of the participants. Most patients received spinal anaesthesia (85%), and the majority of procedures performed were total hip replacement (50%) and total knee replacement (41%). The average blood loss was 350.41 ml, with a low transfusion rate. Postoperative events were observed in 20% of patients, mainly related to acute kidney injury, urine retention, and electrolyte imbalances. There were no cases of COVID-19 contraction during hospitalization or after discharge. Only a small percentage of patients required transfer to the main site, and readmission rates were low.

Conclusions
The implementation of a COVID-free pathway for elective orthopaedic patients at QHB resulted in a safe patient environment, the absence of COVID-19 transmission, efficient transfer to the main site, enhanced patient experience, and a reduction in the waiting list.
942 Improving Communication of Driving Advice to Patients Undergoing Day-Case General Surgery
Authors: Crawford A , Nelson A 
Published: August 2024

Abstract

Aim
Day-case emergency surgery often involves short stays in a hectic environment, with limited patient-professional interaction. However, driving after general anaesthesia, sedation, opioid use, or post-op pain poses risks. Additionally, many insurers don't cover post-surgery driving. This project aimed to improve documentation and appropriateness of driving advice for day-case surgical patients, aligning with DVLA and relevant medical guidelines.

Method
All non-elective general surgical admissions to Bristol Royal Infirmary were identified over 4 weeks. Patients discharged within 48 hours of admission, who underwent a procedure requiring general anaesthesia, local anaesthesia or sedation were included. A search of inpatient notes and discharge documents evaluated whether driving advice was communicated, and the appropriateness of the advice given. Following the initial audit, educational sessions were held for on-call surgical teams and posters erected by surgical workstations to guide appropriate documentation of driving advice. A re-audit took place after two months to identify improvements and barriers.

Results
Initial analysis of 24 patients showed one (4.2%) had advice documented on the discharge summary and one who had advice documented on the operation note. Neither were in line with current guidance. Post-intervention, 4 of 15 (26.6%) had advice documented on discharge summary, all consistent with current guidance. Results were discussed at a surgical governance meeting and barriers identified as rotating staff, busy on-call shifts and difficulty accessing specific guidance.

Conclusions
Although increasing awareness made small improvements, it was agreed to implement a standardised driving advice statement, available as a tick box on a mandatory section of the electronic discharge summary.
638 Abscesses. to Pack or Not to Pack?
Authors: Hussain R , Darling M Finch , Dior A , Singh S , Iqbal N , Singh S , Ramcharan S 
Published: August 2024

Abstract

Aim
Recent studies have suggested packing post incision and drainage (I&D) of abscess results in increased pain with minimal impact on recurrence or fistula formation. The aim of this study is to assess the management of abscesses post I&D and determine short-term outcomes.

Method
Cases undergoing I&D between January 2022 and August 2023 from a single district general hospital in the UK were included. Information regarding patient demographics, type of abscess, wound management and patient outcomes including pain in the acute setting, recurrence, fistula formation, return to daily activities and readmission rate was obtained.

Results
A total of 78 cases were identified (mean age 44 years, s.d 17, males = 38, females = 40). These included perianal (30%), pilonidal (24%), axillary (9%), groin (11.4%), back (11.4%), abdominal (3%), buttock (3.6%), chest (1.3%), chest wall (2.5%), gluteal (2.5%) and infected cyst (1.3%).
83% of patients underwent packing, which was associated with higher rate of readmission overall (3.1% vs. 0%).
For perianal abscesses, packing was associated with a lower recurrence rate (17.6% vs 57.1%) but higher fistula formation (37.5% vs 25%).
Packing did not result in increased post operative pain scores compared to non-packing, however, was associated with more time to return to daily activities within 1 week (25% vs. 38%).

Conclusions
Majority of abscesses were packed (83% vs 17%), leading to a higher rate of readmission and patient morbidity. Emphasising patient experiences of packing and the lack of clinical benefit can ensure that daily practice aligns closer with recent research findings.
66 Escape Room as an Educational Strategy for Foundation Doctors Basic Surgical Skills Induction
Authors: Sohail A , Tay T , Abid Sohail Z , Kaur N 
Published: August 2024

Abstract

Aim
Simulation-based surgical education in the form of an Escape room is a well-published method of teaching surgical content and skills. However, little has been published on the use of Kirkpatrick model in the design of basic surgical skills as part of foundation doctors’ induction. We wanted to evaluate the use of an educational escape room for teaching surgical skills as part of foundation doctors’ induction.

Method
We designed and implemented an escape room for the Induction programme of Foundation Year One doctors in the United Kingdom at our local district general hospital. In groups, the doctors had to work through several tasks including gowning and gloving, knot tying and suturing in order to "escape the room". Pre- and post-session feedback were collected as surveys using Likert scale and semi-structured free-text questions were thematically analysed. Kirkpatrick model was used as a method of designing and evaluating the study.

Results
In total, 11/24 participants completed the feedback forms. On a scale of 1-5 where 1 is strongly agree and 5 is strongly disagree, 9/11 agreed they found escape rooms as a useful method for learning, and 10/11 understood how to scrub in, placing interrupted sutures; all felt confident in putting a hand-tie. Participants highly recommended this for future training. We were unable to evaluate longer term wider impact of this project within the wider surgical team.

Conclusions
Our pilot study indicates that the Kirkpatrick model is useful in the design and evaluation of in the use of Escape room in teaching basic surgical skills induction.