bluuebunny/crossref_metadata_2025_split huggingface dataset:
932 Provision of a 7 Day Radiology Service for Emergency Laparotomy Patients: Are We Compliant with Current Standards?
Authors: Mirtorabi N , Ikram S , Aain H , Ali D , Dilworth M 
Published: August 2023

Abstract

Introduction
According to “NHS services, Seven Days a week Forum”, a radiological scan should be reported within 1 hour for “critical” requests and within 12 hours for “urgent “ones. Requests are considered critical when the test will alter patient’s management at the time; and urgent if the test will alter management but not necessarily that day.

Aim
The aim was to audit whether the above standards were met for urgent and critical requests for patients undergoing emergency laparotomy.

Method
A single centre retrospective audit of adults undergoing emergency laparotomy between 01/02/2014 to 30/12/2021 was performed. Data was collected from the National Emergency Laparotomy Audit database. A total of 1748 patient records were analysed out of which 1309 were included. Patients who underwent pre-operative CT scan in the same admission were included. Patients who had CT prior to admission for laparotomy and those who had more than one operative intervention were excluded. CT time was calculated as time taken from CT examination to reporting.

Results
Standards were met for 27.5% of all investigations ordered. 0.16% of Critical, and 53% of urgent scans were reported within required times. There was no difference in standards met between weekends and weekdays.

Conclusions
Limitations include the retrospective nature of data collection and amendment time being recorded instead of original reporting time for some scans. Recommendations include allowing time frames for standards and retaining interim report times.
971 Audit of Consent Documentation for Emergency Hand Surgery in the Ambulatory Procedure Unit
Authors: Egbuji O , Zengin H , Saad M , Sheppard N 
Published: August 2023

Abstract

Aim
To audit the handwritten consent forms for emergency hand surgery in the unit.

Method
The notes and consent forms from a selection of 8 days were analysed (total 25). Our audit standards focused on the consenter and the completion of sections on the consent form. There are no published standards for hand surgery complications, therefore a consensus from the general consultant body was used.

Results
80% of our patients were male with a mean age of 48 (range 20 – 71). 60% were tendon repairs, 20% debridement, 20% digital nerve repairs, 12% nail-bed repairs, 12% excision of lesion, 8% terminalisation, 8% incision and drainage, 8% manipulation under anaesthesia, 4% carpal tunnel decompression and 4% plating of fracture.
68% of the consenting clinicians were Registrars, 16% Senior House Officers and 8% Consultants (8% illegible). 92% of the consenters performed the procedure. All the consenters signed and dated their signature and were trained in consenting. 88% documented their job title.
100% of clinicians used the correct consent form, documented the proposed procedure, site and risks. 92% completed the ‘intended benefits’ section, 96% wrote the procedure name in full and 88% placed a label on every page.
Every clinician documented bleeding and infection as a risk factor. 92% documented complex regional pain syndrome, 68% stiffness, 48% wound dehiscence, 40% delayed healing, 84% scarring, 36% injury to surrounding structures and 56% further procedures.

Conclusions
The quality of hand-written consent forms is user dependent. A pre-filled consent form and discussion in clinical governance is proposed to increase compliance.
987 Audit of Prophylactic Antibiotic Prescriptions in Oral and Maxillofacial Surgery and Adherence of Surgeons to Local Trust Guidelines
Authors: Al-Balah A , Bayoumi S 
Published: August 2023

Abstract

Aim
To investigate the adherence of Oral and Maxillofacial surgeons in a district general hospital to local trust prophylactic antibiotic guidelines. Trust antimicrobial guidelines are available freely on the MicroGuide mobile application - https://tinyurl.com/MAXFACS.

Method
A retrospective audit conducted in a district general hospital. The list of patients attending follow up clinic in November post operation was used for the patient sample in this audit. The important information was collected from the trust’s electronic patient record using a predesigned Pro forma.

Results
A total of fifty-two patients (patients with penicillin allergy; n = 2, 3.8%) were identified from the outpatient clinic list in November. 100% of patients were given prophylactic antibiotics. Types of operations performed as per the categorisation system on MicroGuide: Dentoalveolar or salivary gland surgery (complex) (n = 10, 19.2%), fractured mandible (n = 10, 19.2%), malignancy (n = 9, 17.3%), osteotomies and bone grafting (n = 6, 11.5%), upper aerodigestive (n = 6, 11.5%), dentoalveolar or salivary gland surgery (uncomplex) (n = 5, 9.6%), fractured maxilla/zygoma (n = 3, 5.8%), intracapsular TMJ joint (n = 3, 5.8%). Dentoalveolar or salivary gland surgery (uncomplex) had the highest compliance to antimicrobial guidelines (100% of patients had no antibiotics prescribed as per guidelines) followed by fractured mandible surgery with 20% compliance. The remaining types of surgery had 0% compliance with trust antimicrobial guidelines.

Conclusions
The first cycle of this audit demonstrated poor compliance with trust antimicrobial guidelines. Increasing awareness of the MicroGuide app as well as presenting the findings to the Oral & Maxillofacial surgery department could help improve adherence in the future.
1009 Improving Accuracy and Extractability of Electronic Operative Documentation Data in a Hand Trauma Unit
Authors: Cook H , Aggarwal A , Kanapathy M , Davison E , Ioannidi L 
Published: August 2023

Abstract

Aim
Accurate and thorough operative documentation is essential for continuity of patient care, audit purposes, and the medicolegal protection of patients and doctors. In a hand trauma department in central London, challenges to this include a fast turnover of junior doctors, busy trauma lists, and complex, multidisciplinary cases.
‘Pathpoint’ is an online system with functionality for operative note templates and pre-filled data. However, it is unclear how much this is utilised in the department.
This project aimed to evaluate operative documentation for hand trauma and the utilisation of templates for data input.

Method
All hand trauma cases performed in a one-month period were requested from Pathpoint. Operation notes were initially screened for directly extractable data in template-form then manually checked for free-text data entry using prior-agreed criteria.

Results
The initial search yielded 51 procedures.
Nerve repairs were best documented (18% data missing), terminalisation procedures were worst documented (38% data missing). Overall, only 18.3% of all data were directly extractable; 0% data were extractable for dressings, post-operative antibiotics, follow-up and movement restrictions.
Best documented topics were hand trauma findings, skin closure, and follow-up. &gt;90% of data in each of these were freetext.
Worst documented topics were CEPOD category, ASA grade, intra-operative antibiotics, and tourniquet details.

Conclusions
Despite overall good documentation, multiple important omissions are noted. Furthermore, the majority of data is not recorded in an extractable format. Templates have been distributed within the department. Re-auditing in subsequent months will assess whether accuracy of documentation and ease of data extraction have improved.
1024 Current Adherence to Local Health Board Guidelines for Venous Thromboembolism Risk Assessment in Orthopaedic Trauma Lists
Authors: Todd-Hems A , Duguid A , Cervenak R 
Published: August 2023

Abstract

Aim
This audit aims to assess the current adherence to the local health board guidelines for Venous Thromboembolism (VTE) risk assessment in Orthopaedic Trauma lists.

Method
Data was collected for all patients who underwent operation on trauma lists between 1st June 2022 and 31st June 2022. Data collected included the operation type, if VTE risk assessment was completed on admission and pre-operatively. Plan post-operatively and on discharge was also noted as well as the length of VTE prophylaxis prescribed.

Results
There were 172 patients in total, 117 lower limb procedures and 55 upper limb procedures. Of these procedures 42 lower limb patients and two upper limb patients had risk assessments on admission. 110 patients with lower limb injuries received VTE prophylaxis on admission compared to eight of the non-day case upper limb. Seven lower limb patients and five upper limb did not have a VTE plan post-operatively. There was variation in length of prophylaxis prescribed post-operatively in relation to procedure and guidelines ranging from nine days to six weeks.

Conclusions
As per local health board guidelines all patients that are admitted or undergo operation as part of the Orthopaedic Department should have VTE assessment carried out. This audit concludes that approximately 25% of VTE assessments on admission are clearly documented. Despite the lack of formal assessment most patients receive VTE prophylaxis but questions whether prescription is appropriate. We also conclude that most patients have a well-documented post-operative VTE plan. Re-audit with intervention is due to end 4th January 2023.
1039 Preventing Avoidable Harm with Safe IV Fluid Therapy – a Closed Loop Audit
Authors: Hassan S W U , Alam S N , Shoaib M , Ibrahim M 
Published: August 2023

Abstract

Aim
The National Institute for Health and Care Excellence (NICE) states that one in five people on intravenous (IV) fluids suffer from complications or morbidity due to their inappropriate administration. We aimed to compare our Trust’s current IV fluid prescription practices to standards set out in the NICE CG174 guidelines.

Method
We retrospectively reviewed 50 case notes for patients admitted to the Acute Medical Unit. We evaluated if hydration status was assessed comprehensively, and if resuscitation and maintenance fluids were prescribed appropriately, according to the NICE CG174 guidelines. The findings were presented at a local meeting and interventions were implemented by putting up posters and conducting regular teaching sessions on safe IV fluid prescription. To close the audit loop, data from a further 50 patients was collected post-intervention.

Results
The first audit cycle showed poor overall compliance with the guidelines; however a significant improvement was noted post-intervention. Pre-intervention, only 10% of patients had regular hydration assessments, 32% of patients received fluid resuscitation appropriately, and while 52% of our sample received maintenance fluid when indicated, 0% received the correct composition. Post-intervention, these figures rose to 28%, 66%, 84% and 15% respectively.

Conclusions
Inappropriate fluid administration is a risk to patient safety. This audit highlighted several areas for improvement regarding IV fluid prescription, and although a significant change was noted, further work is needed to increase compliance. We hope to incorporate the topic of IV fluids into the hospital’s regular teaching programmes to sustainably improve IV fluid prescription practices across the Trust.
1041 Audit of Enhanced Recovery After Surgery (ERAS) Protocol in Elective Colorectal Surgery (A Loop Audit)
Authors: Akhtar M A B , Zeeshan S 
Published: August 2023

Abstract

Aim
Audit of current adherence to the ERAS guidelines for all elective colorectal surgical procedures in our hospital.
Comparison was made with first audit which was done in 2018 and subsequently improvement was done in second loop in 2019.

Method
Retrospective review of all elective patient’s admitted for Colorectal surgery between January 1st 2019 – December 31st 2019. Inclusion Criteria: All elective colorectal surgeries including right hemicolectomy, extended right hemicolectomy, left hemicolectomy, anterior resection, and abdominoperineal resections. All colorectal surgeries after either adjuvant or neoadjuvant chemotherapy or radiotherapy 37 patients were identified for the audit. Every component of Enhanced recovery after surgery (ERAS) was carefully noted in patient's records. All the data was collected and collaborated manually in excel sheet. The data was then presented in graphical manner. Exclusion Criteria:Emergency colorectal procedures.

Results
Audit in 2018:Percentage adherence:Pre-admission – 59.2%Pre-operative – 73.9%Intra-operative – 70.1%Post-operative – 52.7%No ERAS Anaesthetic component was includedOverall Adherence to guidelines – 63.9%Mean Length of Stay – 9.8 days
Loop Audit in 2019:Percentage adherence:Pre-admission – 88 %Pre-operative – 80.25%Intra-operative – 76.8%Post-operative – 79.6%All ERAS Anaesthetic components includedOverall Adherence to guidelines – 81.1%Mean Length of Stay –7.1 days

Conclusions
Very Good compliance to ERAS. Improved as compared to previous audit.
1045 A 6-Year Cohort Study Assessing Outcomes Following Calf Fasciotomies at a Single Tertiary Vascular Trauma Centre
Authors: Gnanasundaram A , Laloo R , Bailey M , Scott J 
Published: August 2023

Abstract

Background
Acute compartment syndrome (ACS) is a surgical emergency.Delayed diagnosis and fasciotomy can result in irreversible muscle necrosis causing permanent disability and major amputation.This study compared outcomes following prophylactic (Group1) versus therapeutic calf fasciotomies (Group2), as well as early (within 6 hours) versus delayed fasciotomies (&gt;6 hours) at a single tertiary vascular trauma centre.

Method
All patients undergoing calf fasciotomies between 1st January 2017 and 31st November 2022 were identified from a prospectively collected vascular departmental database.The primary outcomes included foot drop, amputation and mortality while infection, wound debridement,neuropathic pain and negative-pressure dressing were secondary outcomes.Statistical analysis with SPSS was performed using Fisher’s exact test.

Results
88 patients (65 men, 23 women) of median age (IQR) 67 (56-74) underwent calf fasciotomies.Of these, 43 (48.9%) were therapeutic (Median age = 62) and 45 (51.1%) were prophylactic (Median age = 67).Ischaemia was more prevalent among Group1 while trauma among Group2.There were no significant differences among outcomes between both groups apart from higher 30-day mortality rate (26.7% vs. 7.0%, p = 0.014)and incidence of neuropathic pain (22.2% vs. 4.7%, p = 0.027)in Group1 versus Group2.Most patients (79.5%) underwent early calf fasciotomy with no significant differences in primary and secondary outcomes between early and delayed fasciotomy groups.The delay was attributed to theatre unavailability (n = 6) and on-going resuscitation (n = 5) .

Conclusions
Higher rates of neuropathic pain and 30-day mortality in group1 may be attributed to co-existing lower limb ischaemia.Further work is required to establish the impact of neuropathic pain.Pathways should be developed to ensure rapid access to theatres for patients with suspected ACS.
1054 The Use of Tranexamic Acid in the Wythenshawe Plastic Surgery Department
Authors: Reid G , Bedford J 
Published: August 2023

Abstract

Aim
This audit aimed to benchmark current practice of the use of tranexamic acid (TXA) in the Wythenshawe plastic surgery department against the recent recommendations from the Joint Royal Colleges Tranexamic Acid in Surgery Implementation Group. The new guidance recommends that one gram of TXA should be given intravenously at the start and end of all inpatient surgery. TXA is routinely given in the plastic surgery department and is protocol for all the breast reconstructive surgeries however current practice is to administer this only at the start of the operation.

Method
30 general anaesthetic operations were reviewed retrospectively. The inclusion criteria were as follows: age &gt;18 years old and must be admitted to hospital (at least 1 overnight stay).

Results
The first cycle demonstrated a 0% compliance. Following the intervention of all consultants being made aware of the new recommendations the second audit cycle demonstrated that a 13% compliance was achieved. It was noted that all breast reconstructions received the new recommended dosage regime however uptake amongst the other subspecialties was variable.

Conclusions
Simple education had a significant impact on increasing compliance. Further education amongst all junior doctors has been given to try and further increase uptake of this new guidance.
1094 Pre-Operative Prescribing Practices for Patients Undergoing Emergency General Surgical Operations
Authors: Nair K , Gill M , Sri-Pathmanathan C , Balasubramaniam D 
Published: August 2023

Abstract

Aim
To identify if pre-operative prescribing has improved over time within the general surgery department as identified within the NCEPOD 2002 report on pre-operative drug treatment. This multi-cycle audit aims to achieve 100% compliance when administering essential drugs and omitting certain drug classes.

Method
Data for the current cycle of this audit was collected retrospectively. The drug charts of 131 patients who had an emergency general surgical operation in CEPOD theatre between August and October 2022 were analysed. The drug classes to be collected were based on the NCEPOD 2002 report, local trust and European anaesthesiology/cardiology guidelines. The data was compared to previous cycles collected over multiple years.

Results
For a total of 236 essential drug classes prescribed, 181 were given pre-operatively (76.7%). Compared with previous cycles, results have improved (67% in 2021, 68% in 2018 and 56% in 2015). A frequent reason charted for holding essential medications was “nil by mouth”. Of the 9 medications that should have been withheld on the day of surgery, 7 were held appropriately (77.8%), which was similar to previous results (78% in 2021, 50% in 2018, 75% in 2015).

Conclusions
Although the results have shown improvement over time, there is still a significant proportion of patients who are not receiving essential medications pre-operatively. There also remains ongoing misconceptions about what “nil by mouth” means and how this impacts medication administration. More education is required for both doctors and nursing teams with information on which drug classes should still be given pre-operatively and which should be omitted.
1120 Time to Revascularisation for Chronic Limb Threatening Ischaemia – Audit of a Major UK Vascular Service
Authors: Shea J , Ko I , Onida S , Boyce R , Mohamed A , Shalhoub J 
Published: August 2023

Abstract

Aim
Chronic Limb Threatening Ischaemia (CLTI) is severe peripheral arterial disease where arterial supply is sufficiently compromised to threaten tissue viability. CLTI has a prevalence of 1-2% and carries significant morbidity and mortality. Early revascularisation is essential for tissue preservation. Recent guidance from CQUIN 2022/23 set national targets for time to revascularisation based on VSGBI guidelines. This audit assessed one major vascular centre’s compliance.

Method
Audit standards were taken from VSGBI Peripheral Arterial Disease Quality Improvement Framework (PAD-QIF 2019). Data from Imperial College Healthcare NHS Trust was collected from February-April 2022 for inpatients and outpatients presenting with new CLTI. The primary outcome was time to revascularisation from referral. Secondary inpatient outcomes included time to referral, specialist reviews, imaging and discussion at MDT.

Results
59 inpatients and 33 outpatients were included. 54% of inpatients and 83% of outpatients who were candidates for revascularisation breached targets: 5 days and 14 days respectively. Of those breaching most inpatients were re-vascularised within 6-10 days; whilst for outpatients the majority were re-vascularised within 46-75 days. At the time of data collection 7 outpatients were awaiting revascularisation, all &gt;5 months since CLTI onset.

Conclusions
A significant portion of patients are breaching revascularisation targets, increasing risk of poor outcomes. In both pathways delays are multi-factorial. Contributing factors for inpatients include delays in pre-surgery optimisation and bed/theatre slot pressures. For outpatients’ pre-assessment, surgical optimisation, MDT discussion and/or investigations all contribute to delays. Implementation of early anaesthetic optimisation or outpatient one-stop clinics could be considered.
1121 Evaluating the Practice and Post-Procedural Outcomes of Endoscopic Retrograde Cholangiopancreatography in United Lincolnshire Hospitals Trust in 2019
Authors: Marei O , Shenbagaraj L , Sivanesan N , Vojtekova K , Keralia S , Kanade C , Pervaiz F , Morra M , Andrew D , Perry M , Babu S 
Published: August 2023

Abstract

Aim
To evaluate the performance of ERCPs within our trust through exploring the rates of post-procedural complications and outcomes.

Method
Data was collected from multiple databases including EndoWeb, which had all the reports of ERCPs performed, including indications, diagnosis and whether there were any complications during the procedure. We used WebV to look at post-procedural blood results and any tests from readmission that could be consistent with a complication. We also used CarePortal to look at clinic and discharge letters post-ERCP to identify whether readmission was necessary. The data collected was entered in an Excel Spreadsheet and analysis was performed in Microsoft Excel.

Results
We collected data for 248 ERCP procedures and there were 37 patients with repeat ERCPs in the same year. The most common indications were gallstones (34%) and jaundice with dilated ducts (36%). 81% ERCPs were successful, diagnostically and therapeutically and the complication rate was 6% with acute pancreatitis and bleeding being the most common complications. Finally, we noted a 30-day mortality rate of 2.8% but none of the deaths were related to ERCPs and were mostly due to co-morbidities.

Conclusions
The British Society of Gastroenterologists published a standards framework in 2014 concluding that the UK requires a national system to check ERCP practice similar to that of the US, the ERCP Quality Framework. Our post-ERCP pancreatitis rate is within the standards set by the BSG. This audit is a step in developing a national standardising system, however, there is a requirement of 100% engagement from all centres within the UK.