bluuebunny/crossref_metadata_2025_split huggingface dataset:
474 Audit of ENT Department Handover Practice: An Improved Patient Safety Outcome
Authors: Tan D , Ko T K 
Published: August 2023

Abstract

Aim
To analyse the comprehensiveness and reliability of e-handover sheets in a district hospital ENT unit, and to compare the departmental standards in line with Royal College England Guidance on Safe Handover (2007).

Method
Retrospective analysis of e-handover sheets were analysed over two periods (31 days and 16 days). To improve standards, we distributed the Royal College of Surgeons England guidance, junior doctors received regular feedback and emphasise the importance of handover to the ENT doctors during clinical governance and induction sessions.

Results
The reaudit cycle demonstrated data transfer improved from morning handover information were present and complete on 70 per cent of days, present but incomplete 30 per cent of days, and absent on 0 per cent of days; evening handover information were complete 75 per cent of days, present but incomplete 25 per cent of days, and absent on 0 per cent of days.

Conclusions
Following our first and second audit cycle results, the quality and standards of e-handover information showed significant improvement.
477 Documentation of Resuscitation Decisions in Surgical Patients in a District General Hospital
Authors: Koh S W , Dornseifer M , Liyanage T , Koay C G , Koh S H , Guru Naidu S , Abeysekara A 
Published: August 2023

Abstract

Introduction
Every patient admitted into hospital has to have a clear documentation of their resuscitation decisions in their current health charts.1 This enables surgeons to provide the best and sometimes major surgical treatment without delay in the first instance. The aim of this study was to assess the completeness of the resuscitation decisions for surgical patients admitted into our department.

Method
All patients on our surgical handover list between 22nd August and 31st August 2022 who were admitted were included in this study. Patient charts were reviewed, and data collected in relation to the completeness of the resuscitation decisions and treatment escalation plan (TEP).

Results
A total of 50 patients were included. 35 patients (70%) had their resuscitation decisions documented whereas 33 patients (66%) had documented TEP. This is in contrast to guidelines as not all of admitted surgical patients had their resuscitation decisions or TEP documented. Our planned interventions were highlighting its importance in a virtual departmental meeting, educating new incoming junior doctors, sending departmental reminder emails and making the section of the proforma a mandatory field to complete.

Conclusions
Documentation of resuscitation decisions is important in providing quality of care for patients. Our result showed intervention is needed to ensure best practice is adhered to. We plan to achieve a better data completeness in our next audit cycle after intervention.
493 Audit of Antibiotic Prescriptions in Appendicectomies and Adherence of Surgeons to National and Local Trust Guidelines: Preoperative and Postoperative
Authors: Al-Balah A , Iskandar A , Yousof H 
Published: August 2023

Abstract

Aim
To investigate adherence of antibiotic prescriptions to national and local standards in appendicectomies, pre-operative & post operative, in a district general hospital. BMJ Best Practice standards state that all patients should be given prophylactic antibiotics preoperatively, but only complicated cases (perforation and/or abscess and/or acutely unwell) need to be given postoperative antibiotics. Adherence to local prophylactic antibiotic guidelines was also assessed. Trust antimicrobial guidelines are freely available on the MicroGuide mobile application - https://tinyurl.com/gastrosurg.

Method
A retrospective audit conducted in a district general hospital. A 6-month audit of antibiotic prescriptions in appendicectomies to investigate adherence rate to national and local standards. The important information was collected from the trust’s electronic patient record through a predesigned Pro forma.

Results
A total of fifty patients (patients with penicillin allergy; n = 4; 8%) underwent an appendectomy between June 2022 and November 2022 in a district general hospital. 100% of patients were given prophylactic antibiotics. However, only 25% of cases of penicillin allergy and 2.2% of cases with no penicillin allergy were given prophylactic antibiotics that adherent to trust policy. Complicated cases comprised 30% of cases. 100% of complicated cases had postoperative antibiotics while 80% of uncomplicated cases had postoperative antibiotics unnecessarily.

Conclusions
This audit cycle showed poor adherence to national and local antimicrobial standards. Action plan includes presenting results in the monthly surgical audit meeting, increase awareness of the MicroGuide app and BMJ Best Practice standards and reaudit to enhance adherence to antimicrobial guidelines.
494 The Safe Use of Intraoperative Tourniquets
Authors: Elmenawy Z , Hassan T 
Published: August 2023

Abstract

Aim
This quality improvement project has been conducted aiming to review the adherence to standards of practice as per the guidelines set out by ''British Orthopedic Association'' for the safe use of tourniquets. Additionally, aiming to generate data for future quality improvement projects relating to the field of surgery.

Method
In a retrospective review of the month of July 2022, a total of 146 cases (collected through electronic patient records - Chameleon+E-Trauma) were found to have orthopedic-related surgical procedures. Following the application of our inclusion and exclusion criteria, 54 cases had surgery that relevantly involves the application of an intraoperative tourniquet. These patients were thoroughly reviewed for compliance rates against the following set standards of practice relating to Tourniquet Time, Pressure, and Method of Exsanguination.

Results
Tourniquet time and pressure documentation compliance rates were both less than 50%. In almost cases where TQ pressures were documented, many surgeons use “standard” set pressures without considering the patient’s systolic blood pressure. In 2 cases of tourniquet time exceeding 120 minutes, there was no reason stated in the surgical documentation. Very low compliance rates on the method of exsanguination In all cases.

Conclusions
Tourniquet use is highly prevalent in several surgical procedures; therefore their safe use needs to be implemented in order to decrease related long-term complications. There is a significant lack of compliance rates regarding the use of intraoperative tourniquets and for that reason, it is quite imperative that education and awareness strategies relating to their use need to be proposed to improve reported results.
527 BSSH Standards of Care in Hand Trauma: The Impact of COVID-19 on Timing to Treatment
Authors: Elzagh A , Shah S , Amin K , Bedford J 
Published: August 2023

Abstract

Aim
To evaluate the compliance of our regional unit against the British Society for the Surgery of the Hand (BSSH) standards of care in hand trauma (BSSH, 2020) following an increase in our WALANT practice post-pandemic.

Method
A retrospective audit of two parallel 6-month periods was undertaken in our unit in Greater Manchester. Group 1 (pre-pandemic) comprised of cases managed at our main site from September 2019 – February 2020. Group 2 (post-pandemic) consisted of patients managed under the newly devised regional and national WALANT guidance at our sister site between September 2020 – February 2021. Data collection involved cross-referencing multiple databases. Exclusion criteria included delayed presentation, no injury identified at time of surgery, re-rupture and re-operation.

Results
Number of cases across the 2 study periods were almost identical (group 1 = 451, group 2 = 449). There was an improvement in compliance post-pandemic (78.86%) versus pre-pandemic (75.4%); this was not statistically significant (p = 0.283). We observed a significant improvement in compliance for patients undergoing extensor tendon repair (pre-pandemic = 68.97%, post-pandemic = 85.94%, p = 0.42). This was not the case for the other sub-groups (table 1). Crucially, we observed a &gt;50% reduction in GA cases post-pandemic (14.92%) compared to pre-pandemic (66.08%).

Conclusions
Despite a significant reduction in anaesthetic team input, we have achieved similar levels of compliance as pre-pandemic across multiple domains whilst observing improved compliance for extensor tendons.
542 Prolonged VTE Prophylaxis Post Abdominal Cancer Surgery: Is It Necessary?
Authors: O'Malley E J , Lima de Mendonca Y , Smith A , Kirby K , Bethune R 
Published: August 2023

Abstract

Aim
NICE guidance currently recommends extending venous thromboembolism (VTE) prophylaxis to 28 days for patients who have undergone major cancer surgery in the abdomen. Literature highlights controversy around the efficacy of prolonged treatment preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) and potential areas for improvement.

Method
Retrospective study of urology and colorectal cancer patients undergoing surgery between October 2020 and September 2022. Electronic patient notes were used to determine adherence to guideline and prevalence of PE and/or DVT in post-operative patients. Comparison was made between both cohorts.

Results
Patient cohort n = 802, colorectal n = 345 and urology n = 457. Average age 66.6±10.4. M:F ratio = 543:258. Colorectal cohort 20.9%(n = 71) received extended prophylaxis, 79.1%(n = 269) did not, of which 19.7%(n = 53) prophylaxis was contraindicated. 5 excluded as died or an inpatient. Urology cohort 53.4%(n = 244) received extended prophylaxis, 46.6%(n = 213) did not, of which 28.2%(n = 60) prophylaxis was contraindicated. Overall, 39.5%(n = 315) received extended prophylaxis vs 60.5%(n = 482) did not. n = 4 developed PE/DVT. Of which, n = 1 on extended prophylaxis and n = 3 not, Chi-squared 0.35, P value = 0.55.

Conclusions
Very few patients developed symptomatic PE and/or DVT despite a significant proportion of patients not receiving extended prophylaxis. No significant difference in symptomatic PE or DVT in patients with extended prophylaxis vs patients without. Prolonged administration of low molecular weight heparin as anticoagulation has repercussions such as cost and patients’ ability to self-administer which may subsequently require community support or a longer hospital stay. Therefore, a more targeted approach to extended VTE should be explored.
579 Audit to Measure if &gt;5% Reduction in Weight Occurred, as Recommended by the National Institute of Health and Clinical Excellence (NICE), for Patients Suffering from Osteoarthritis Before Their Scheduled Total Joint Replacements, at Darwen Health Link Surgery
Authors: Sarma A , Mustafa S 
Published: August 2023

Abstract

Aim
Osteoarthritis causes damage to synovial joints, manifesting as pain, loss of function, and disability. A high BMI is correlated with an increased incidence of osteoarthritis, for which NICE recommends a &gt;5% (ideally &gt;10%) decrease in baseline weight to improve pain and functionality. This audit aims to measure Darwen Health Link’s adherence to NICE guidelines 226 “Osteoarthritis in over 16s: diagnosis and management” for the management of osteoarthritis patients regarding weight-loss.

Method
This audit analysed 15 osteoarthritis patients with a BMI&gt;30 who underwent total joint replacements from November 2021 to November 2022. Patient records were analysed for their weight management from 3-12 months prior to surgery, up till their surgery period to assess: if weight-loss advice was provided, and if &gt;5% weight-loss took place. Standards were designated per clinician recommendations and NICE guidelines.

Results
All osteoarthritic patients (n = 15) were given weight-loss advice at presentations before surgery. However, only 20% (n = 3) of patients lost &gt;5% of their baseline weight before their joint replacements, against the 50% standard. Therefore, interventions to improve weight-loss in patients and clinician guidance were implemented. These include a targeted poster, detailed weight-loss advice packs for patients, and clinician education about weight-loss programmes available locally.

Conclusions
The first part of the audit indicates suboptimal performance by Darwen Health Link. Their performance will be re-audited in 3 months post-interventional implementation. Reducing osteoarthritis’s burden on patients in primary care can significantly reduce pain and the need for surgery.
596 A Local Audit Assessing Completeness of Morbidity and Mortality Records in Vascular Surgery in a Tertiary Centre in the UK
Authors: Le Blevec L , Tsui T C , Makar R 
Published: August 2023

Abstract

Aim
Good Surgical Practice recommends surgeons’ regular participation in morbidity and mortality meetings (M&M) as this hold strong educational value, but most importantly maintain and improve patient care. The Royal College of Surgeons advises that formal records of discussions be kept, however as these vary in quality, their effectiveness and lessons learnt do too. The aim of this audit was to assess and review the completion of the current M&M records used for vascular surgery in a UK tertiary centre.

Method
Data was collected retrospectively from five M&M meetings which took place in 2022, identifying thirty-four PowerPoint presentations to review (each corresponding to one case presentation). We noted presence of patient hospital number, as well as documentation of any information in each of the five sections (‘discussion’, ‘action’, ‘who’, ‘when’ and ‘attending consultants’) on the ‘discussion’ slide using a binary scale (0 = no information, 1 = any information).

Results
None of the records included patient hospital number. Only 20.6% had five out of five sections complete with the least section filled being ‘when’ or time scale for action plan (29.4%) followed by ‘attending consultants’ (41.2%). 29.4% had no record of any discussion being carried out. 35.2% showed no record of an action plan and 47.0% had no responsible person to action the aforementioned plan.

Conclusions
Poor record-keeping during M&M is apparent. Following presentation at the local governance meeting, we will collaborate with the team to create a more effective way of recording discussion, ultimately to maximise learning outcomes.
639 An Audit to Evaluate the Prevalence and Efficiency of the ‘Acute Abdomen Pathway’ Proforma Used in a Large District General Hospital
Authors: Ross M , Gul A , Kalaiselvan R , Yasin U 
Published: August 2023

Abstract

Aim
The ‘acute abdomen pathway’ was introduced with the aim of early identification of patients with an acute abdomen and once identified to increase the efficiency of imaging, senior review and if required surgical intervention. We audited how this pathway was being used by clerking doctors and its benefits to patient care.

Method
Data collection occurred over 4 weeks (11/09/22-9/10/22) giving a cohort of 390 patients. Patients who met the criteria for 'acute abdomen' were included in the study (e.g. high clinical suspicion of acute abdomen, NEWS2 score &gt;4, recent abdominal surgery, pain score &gt;5/10, history of abdominal trauma, signs of sepsis). We reported time from triage to: surgical review, CT, diagnosis and management.

Results
112 patients met the criterion for the acute abdomen pathway. 4 were correctly recognised and diagnoses included appendicitis, perforated diverticulitis, obstructive cholangitis and complication post-laparotomy. 108 patients were not started on the pathway, their diagnoses included appendicitis (19), pancreatitis (7), small bowel obstruction (5) and others. Waiting times reduced whilst using the proforma. Time from CT request to report fell to 5 hours (from 14). Similarly, triage to diagnosis fell to 5 hours (from 12) and to management 5 hours (from 13).

Conclusions
The acute abdomen pathway is not being used as intended by clerking doctors. The criteria highlighted 112 patients, of which, 65 (58%) received a diagnosis under the umbrella of an ‘acute abdomen’. Our plan is to re-audit once more awareness has been raised to reassess compliance and hopefully show reduction in time from diagnosis to intervention.
647 VTE Prophylaxis Protocol Compliance Post Elective Lower Limb Arthroplasty
Authors: Loh C , Chen B L , Semple A , Grant S 
Published: August 2023

Abstract

Aim
Venous thromboembolism (VTE) is a common post-operative complication, and it is essential for surgical departments to ensure adequate prophylaxis is provided. A single centre DGH introduced a new proforma to be filled out at the time of operation. This audit aims to evaluate compliance with the proforma and its correlation to prophylactic prescription and postoperative VTE rates.

Method
A retrospective study was conducted for 524 patients undergoing elective lower limb arthroplasty between August 2020 and August 2022. Clinical notes were reviewed for of a) presence and completeness of proforma and b) clear documentation of prophylaxis. 30-day post-operative re-admission rates, associated complications, incidence of VTE, and deaths within 90 days of surgery were also reviewed.

Results
335 patients underwent an elective lower limb arthroplasty after the proforma was implemented in August 2021 of which 321 (95.8%) had the proforma in their clinical care forms. Of these, 56/321 (17.4%) forms were filled. All patients had documented VTE prophylaxis prescriptions and 438/524 (83.6%) were clearly described/'complete'. Of those incomplete, 74/86 (86%) were recorded after August 2021. There was 1 confirmed incidence of VTE within 30 days which occurred after proforma implementation. 9/18 surgeons (50%) practiced completing the proforma but 0/18 used it consistently.

Conclusions
There was poor compliance with the proforma but low incidence of VTE rates. Overall, the proforma did not affect VTE rates. In fact, there is the impression that reliance on the proforma worsened quality of documentation of VTE prescription required in operation notes. This suggests implementation of this proforma was negative.
656 Improving Practice in Acute Pancreatitis Management at a District General Hospital
Authors: Mittal S , Slater G 
Published: August 2023

Abstract

Aim
Appropriate management of acute pancreatitis is essential, as this condition is associated with a high mortality rate. This clinical audit aimed to improve the initial management of acute pancreatitis in patients presenting to University Hospital Wishaw in line with current guidelines between June 2021 and August 2022.

Method
A retrospective cohort analysis was performed for acute pancreatitis patients discharged between 01/06/21 and 01/12/21. Management was compared against NICE, British Society of Gastroenterology and Royal College of Surgeon’s audit standards which encompass risk stratification, investigation, and management. To improve and standardise care amongst staff, departmental teaching and a management pro-forma were implemented in April 2022. Repeat prospective data collection was performed from May to August 2022.

Results
There were a total of 73 patients included in Cycle 1, and 44 patients in Cycle 2. There was an improvement in all ten audit standards measured. Appropriate investigation into pancreatitis aetiology improved from 25% to 50%, with an 83% reduction in clinicians assuming alcohol-induced pancreatitis without suitable investigation of alternate causes. Initial risk stratification of patients improved from 36% to 52% and severity assessment increased from 4% to 36%. The provision of nutritional support to appropriate patients improved by 35%. Comparison of sub-cohorts revealed that adherence with the pro-forma showed measurably better compliance with standards.

Conclusions
The implementation of teaching and a management pro-forma demonstrated an improvement in standardisation of care. Specifically, use of a visual aid has been shown to better standards. Future cycles could focus on improvement of the pro-forma, and increased compliance.
690 Quality Improvement Project: Improving Engagement with Smoking Cessation Services Among Emergency Surgical Admissions
Authors: Ngo V , Hutching J , Fyles F , Rodrigues P , Jones G 
Published: August 2023

Abstract

Aim
Smoking status has a significant impact on surgical patient outcomes, with significantly increased rates of intra- and post-operative complications. Within Liverpool University Hospitals NHS Foundation Trust (LUHFT), the CURE team is a dedicated smoking cessation service that uses an electronic proforma to identify smokers and offer support. We assessed smoking cessation efforts among emergency surgical admissions pre- and post-teaching intervention.

Method
Two rounds of audit were completed: a baseline audit of emergency surgical admissions from 01/01/21 to 31/01/21(n = 202); and a reaudit of emergency surgical admissions from 01/11/22 to 30/11/22 (n = 163), following a structured teaching session on smoking cessation, delivered to incoming doctors in August 2022. We assessed documentation of smoking status within patient notes, completion of the smoking status proforma, prescription of nicotine replacement therapy (NRT), and assessment/follow up from CURE.

Results
Following intervention, smoking status documentation improved from 83% (n = 166) to 96% (n = 157), and proforma completion from 55% (n = 112) to 91% (n = 148). Among documented smokers (cycle 1 n = 49; cycle 2 n = 47), NRT prescription improved from 29% to 40%, and CURE involvement increased from 31% to 64%. Overall, following intervention, 21% of smokers accepted ongoing support from CURE during and post-admission, compared to 10% at baseline.

Conclusions
Use of electronic smoking status proforma and a dedicated inpatient smoking cessation team has high rates of engagement among emergency surgical inpatients. The use of structured teaching sessions to highlight the importance of smoking cessation among these patients has led to improved rates of smoking cessation support, benefiting surgical outcomes.
691 Gallbladder Polyp Surveillance Audit
Authors: Tabassum T , Khrais M 
Published: August 2023

Abstract

Background
Gallbladder polyps pose a clinical dilemma in surveillance owing to being a very common US findings yet gallbladder malignancy being a infrequent diagnosis. The joint guidelines of ESGAR, EASES, EFISDS and ESGE 6, 12 and 24 monthly follow up scans for 6-9 mm sized polyps or &lt;5 mm polyps with risk factors for malignancy. Cholecystectomy is recommended in polyps &gt;10mm. UK hospitals follow local guidelines, which for our trust is 12 and 24 monthly follow up scans. We investigated the surveillance and management of Gallbladder polyps and audited the practice in our DGH.

Method
We collected and analysed retrospective data of US-diagnosed GB polyp cases from May2010 to September2022. US-diagnosed GB Polyp patients above the age of 18 were included. We excluded cases of CT or MRI diagnosed and/or followed up cases.

Results
A total of 212 patietns were selected. Polyp sizewise, 118(52%) were&lt;5mm, 12(5.3%) were&gt;9mm. 82(36.6%) 6-9 mm polyps, 62(75%) were followed up. Mean time and median time to obtain a second scan was 472days 556 days. Of these, 14 had an increase in size of polyps, whilst 3 with increase&gt;2mm. 17 patients with GB polyp had Cholecystectomy, 1(one) had a diagnosis of malignancy.

Conclusions
We demonstrated that the correct modality of scan was chosen for follow up. However, the timing of the follow up was not within the recommended guidelines. Further teaching and evaluation of practice is recommended. A case can be made into a unified UK guideline.