bluuebunny/crossref_metadata_2025_split huggingface dataset:
784 Advanced Nurse Practitioners Benefit Patient Care and Flow in an Elective Surgical Hub During Recovery From the COVID-19 Pandemic
Authors: Jang S , Phillips J , Jones T , Boulton R 
Published: August 2023

Abstract
Advanced nurse practitioners (ANPs) have an independent scope of practice in patient care. ANPs were introduced to an elective surgical hub during the COVID-19 pandemic in a similar capacity to senior house officers. We examined the impact of ANPs on patient care as viewed from healthcare professionals and patients, and in facilitating timely discharge to maintain flow.
We constructed two separate questionnaires, one for healthcare professionals (HCPs) and one for patients. We compared the time to completion of discharge summary, adjusted for patient volume, before and after ANPs were introduced to the ward to determine patient flow.
We received 27 responses from HCPs: 18 doctors, 7 nurses and 2 allied health professionals. Average score for overall impact on patient care was 9.2 out of 10. We received 9 responses from patients, of which 6 responded having never met ANPs during their care. Of the 3 responses, average score for overall impact on patient care was 5 out of 5. After ANPs were introduced, discharge summaries had an average completion time of 12:56, which was 6 minutes later than before their introduction (t-test, p = ns). We found that there were more admissions before the introduction of ANPs (25 before, 58 after), indicating a maintenance of flow despite increased workload.
ANPs in this elective surgical hub form an integral part of the team who can carry out the majority of ward-based tasks independently. Despite more than double patient volume, flow was maintained. Further work is needed to increase their recognition amongst patients.
888 Improving the Documentation of Skin Closure and the Plan for Its Removal for Trauma & Orthopaedic Patients
Authors: Peace C , Crone A , Hegarty P 
Published: August 2023

Abstract

Aim
Surgical patients require closure of wounds with skin clips or sutures. Removal at an appropriate time can prevent complications, namely infection. Our goal is to ensure clear documentation of closure type and plan for removal. The Royal College of Surgeons states that “details of closure technique” and “detailed post-operative care instructions” are required.

Method
Retrospective data collections were undertaken in January and September 2022 for trauma patients in Altnagelvin Hospital. Data was gathered from Operation Notes. The first collection included 30 patients, the second included 24 patients. Two main interventions were implemented. The first of these was presentation of the initial findings at a departmental audit meeting for the purpose of education. The second was to amend operative proformas to include different types of skin closure and its removal at a prescribed time in the post-op plan as “delete as appropriate” options.

Results
Following our interventions, the correct skin closure was documented in 100% of patients. Plan for removal of closure was documented in 84.6% overall between both written and typed notes. Typed operative notes had 100% plan for removal documentation compared with only 66.67% of written notes. In the first collection, only 55% of patients had adequate removal plans documented on typed notes so the amended operative notes being introduced have resulted in a clear improvement.

Conclusions
Accurate documentation is essential for patient safety and simple interventions can result in a drastic improvement in quality. Pre-typed operative notes were superior to written operative notes and should be used where available and appropriate.
908 Factors Affecting Last Minute Cancellation of Elective General Surgical Cases; Preliminary Findings of a QIP
Authors: Clarke E , Prabhakaran J , Suliman H , Singhal T 
Published: August 2023

Abstract

Introduction
Waiting lists for elective general surgeries have been growing steadily over the past few years, with short-notice cancellations affecting both cost and patient safety. There are currently nationwide incentives to cut referral-to-theatre delays and tackle the backlog of over 7 million patients (NHS backlog data analysis - British Medical Association 2022).

Aim
To identify common causes of short-notice cancellation of elective general surgery lists, and identify targets for intervention for minimisation.

Method
This audit was registered with the department. Prospectively collected elective general surgery lists between January and November 2022 were compiled and analysed. We coded the reason for cancellation from patient records.
For the patients found to be unfit on the day to come in (TCI), we reviewed PAC notes to see whether they had been deemed fit at PAC and how this had changed.
Data were coded and analysed on Microsoft Excel on secure Trust computers.

Results
Between 01/01/2022 and 06/11/2022, 508 (22%) of the scheduled 2300 cases were cancelled, with 235 (10.2%) within 48 hours of their scheduled start date.
Acute patient illness and patient unavailability were the most common causes of short notice cancellation of a case (n = 41), followed by time constraints (n = 33), patients not being medically optimised (n = 27) or no longer requiring surgery (n = 21, as well as administrative error (n = 14).

Conclusions
Targets for intervention following these preliminary audit results included improved patient literature at pre-assessment, clerical chart review in the lead up to the surgery to ensure all administrative tasks have been performed, and a clinical review immediately prior the TCI date to identify any intercurrent illness.
1004 Assessing Appropriateness of Referrals to the Trauma and Orthopaedic Department
Authors: Taiwo B , Menyah E , Garcia S 
Published: August 2023

Abstract

Background
The Trauma and Orthopaedic (T&O) on-call service receives referrals from the emergency department (ED), general practice (GP), urgent treatment centres (UTCs), and requests for inpatient reviews. The virtual fracture clinic (VFC) pathway allows ED and UTC clinicians to assess, discharge and refer when necessary. For VFC, the on-call Orthopaedic Consultant will review the case the next working day and make an appropriate plan. The VFC pathway consists of a traffic light system, in which clinicians can safely discharge with written advice (green), refer to the VFC (yellow) or refer to the on-call team (red).

Method
The aim was to assess how the VFC pathway was being utilised. All referrals to the T&O on-call team over 3 weeks were assessed retrospectively. The following referrals were excluded - Fractured Femur, Head Injury, Trauma Calls and Back Pain Pathway. The following data was collected - Patient details, diagnosis, referral source, the reason for referral, plan, double booking with VFC and appropriateness.

Results
191 referrals were analysed. Most referrals are from the ED (51%) and UTC (23%). 35% of referrals were deemed to be inappropriate. 38% of inappropriate referrals (25/66) should have been referred to VFC. A significant minority (7%) were referred to the on-call team and VFC.

Conclusions
Education and collaboration are required with ED and UTC to ensure the proper use of the VFC pathway. The recent integration of documentation systems will assist in ensuring all clinicians have access to relevant information. Documentation of trauma meeting outcomes should be standardised.
1006 Hot Biliary Telephone Follow-Up Clinic Patient Satisfaction QIP
Authors: Murugan V , Wong T , Fouad M , Sanyal S 
Published: August 2023

Abstract

Aim
Current evidence notes associations between gallstone disease and increased hepato-pancreato-biliary complications in the general population, signifying the importance to optimise the services provided for patients in this group; for instance, telephone follow-up hot biliary clinics that cater to relatively healthy patients with gallstone disease. This QIP aims to increase patient satisfaction rates in these clinics.

Method
A Likert-scale, 13-item questionnaire ranging from 1-5 (1 = strongly disagree, 5 = strongly agree), was developed to assess patient satisfaction with telephone follow-ups. An average score of 4 across all questionnaire items was fixed as the satisfactory cut-off point. 100 patients who had had telephone follow-ups were then retrospectively identified to fill out the questionnaire. The data was then analysed to identify the overall satisfactory rate, and rates according to sex and age groups.

Results
On overall, 75% of patients were satisfied with telephone follow-ups. Breakdown of data according to sex revealed that 79.4% of females and 67.6% of males were satisfied by telephone follow-ups (p-value: 0.19). As for age groups, 72.2% of patients below the age of 50, 88.9% of patients between the ages of 50-59, 71.4% of patients between the ages of 60-69 and 72% of patients above the age of 70 were satisfied (p-value: 0.52).

Conclusions
Despite positive initial findings, these numbers can be improved by implementing measures like providing clinicians with a model teleconsultation template for use in clinics and providing patients the options of choosing either face-to-face appointments or telephone follow-ups.
1076 Staff Perceptions on Electronic Patient List Management: Introducing the General Surgery Care Teams to Improve Patient Safety
Authors: Hinchcliffe Z , Bruggemann N , Hague O , Low J , Sohrabi C , Kenworthy W , Sengupta N 
Published: August 2023

Abstract

Aim
Electronic patient lists are widely used across NHS England and commonly rely on staff manually updating lists to guide inpatient ward-rounds, creating potential for human errors. Locally, lists are extracted from Electronic Patient Record (EPR), whereby doctors are responsible for ‘coding’ patients under ‘general surgeon’ at admission. Errors in this process lead to “missed” patients, raising concerns for patient safety. This study aimed to assess staff perceptions surrounding this system to help implement the new EPR General Surgery Care Team.

Method
Perceptions were analysed using an online anonymous questionnaire, distributed via a messaging group. Questions were categorised into ‘ease of use’, ‘time-efficiency’ and ‘safety’, and assessed using a Likert Scale (1-5). Open questions screened for list-related examples of poor patient care and areas for improvement.

Results
Twelve responses were analysed: 7 (58.3%) Foundation Year 1, 4 (33.4%) Senior House Officers and 1 (8.3%) Registrar. Eleven (91.7%) responses reported the system to be inefficient and 7/12 (58.3%) difficult to use (scoring Likert 4-5). 100% believed the system disturbed patient care (Likert 3-5), describing it as “complicated”, “time-consuming” and “messy to use”. This “compromises patient safety” and “increases junior workload”. Nine (75%) responses identified specific examples where the system directly affected care, including patients “missed” from ward-rounds, delayed management, and adverse outcomes.

Conclusions
The ‘old’ list management system was complex and slow to use, directly compromising patient care. Further qualitative data is required to continue improving the General Surgery Care Team List, implemented using this feedback, to optimise patient safety.
1078 Assessing the Compliance & Adherence to the Emergency General Surgery Admission Proforma via ‘Take 10’ Principles - a Complete Clinical Audit
Authors: Akhtar M A B , Varzgalis M 
Published: August 2023

Abstract

Aim
To assess the adherence and compliance to the emergency general surgery admission proforma, based on the ‘Take 10’ principles which includeObservationsExaminationsImpressionInvestigationsAntibioticsIV FluidsVTE RiskNutritional AssessmentEstimated Length of StayCeiling of Care

Method
Retrospective review of the admission proformas of 20 random patients was done - without prompting the admitting team to strictly comply to the ‘Take 10” principles. Education was provided to the next surgical on-call team, who were encouraged to fill out the proforma and carry out the post-take ward round using ‘Take 10’ principles. A relook retrospective review was carried out on a subsequent 20 random patients after 4 weeks. The results from both weeks were compared.

Results
Percentage adherence Observations:25% in 1st week and 95 % in 2nd week Examinations:100% in 1st week and 100 % in 2nd week Impression:100% in 1st week and 100 % in 2nd week Investigations:95% in 1st week and 100 % in 2nd week Antibiotics:63% in 1st week and 90 % in 2nd week IV Fluids:25% in 1st week and 95 % in 2nd week VTE Risk:45% in 1st week and 100 % in 2nd week Nutritional Assessment:48% in 1st week and 100 % in 2nd week Estimated Length of Stay:10% in 1st week and 85 % in 2nd week Ceiling of Care:12% in 1st week and 78 % in 2nd week

Conclusions
The implementation of the Take 10 checklist during the post take surgical ward round, resulted in improved documentation on the emergency general surgery admission proforma.
1141 Good Medical Practice: Patient's Right to the Information - an Audit of the Patient's Understanding and Satisfaction with the Information Provided to the Patients with Acute Pancreatitis
Authors: Jamal Z , Zafar N , Khawaja Z , Haider I , Adnan N 
Published: August 2023

Abstract

Aim
The aim of this audit was to find out if adequate information regarding acute pancreatitis as per the NICE guidelines was being provided to the patients and their family members and to assess patients’ satisfaction in terms of the provided information.

Method
30 patients were admitted in the department of general surgery with acute pancreatitis were provided with a questionnaire containing 10 questions asking about the information provided to them about their condition by healthcare professionals.

Results
Overall, 60% of the patients were not satisfied with the information provided. None of the patients were provided written information and more than 90% were not explained condition with the help of a diagram. The other areas where the patients were not provided information were investigations done (40%), treatment (60%), provision of verbal information (26%), and alcohol as the potential cause of the condition (27%).

Conclusions
This audit emphasized the need of a proper explanation of acute pancreatitis to the patients and their family members. It was also found that no leaflets were available for the patients. Results were shared in the surgical team group and a leaflet has been designed and distributed to every patient with acute pancreatitis.

Second Cycle
After the introduction of the leaflet, improvement has been seen in almost all the areas of the information provided to the patients. Overall, satisfaction has improved from 60% to 92% in the patients admitted with acute pancreatitis.
1160 Improving Operative Notes and Consent Forms in a Urology Department Working Across Four Hospitals; a Quality Improvement Project
Authors: Vaidya A , Bourdoumis A 
Published: August 2023

Abstract

Aim
Consenting patients appropriately and well-written operative notes are essential for patient care. Anecdotal evidence highlighted that both of these areas could be improved in a urology directorate working across four hospitals. This QIP aimed to assess if consent forms included the risks stated by the British Association of Urological Surgeons (BAUS) leaflet for each operation and compliance with Royal College of Surgeons (RCS) guidelines for operative notes.

Method
A QIP using PSDA methodology. Cycle one: a retrospective assessment of one week’s operations assessing compliance of consent forms and operation notes. Cycle two: creating electronic templates for common operative notes which meet all RCS standards and consent forms as per the BAUS leaflets, followed by assessing their implementation for one week’s operating.

Results
Cycle one: 7% of consent forms were filled out appropriately. 0% of operative notes met all the RCS guidelines; 6 sections had 0% compliance. Cycle two: 33% of patients were consented using the templates; 13% of patients underwent an operation for which no template existed. 29% of operations were filled out using the templates and met all RCS criteria. Qualitative assessment found that surgeons did not use the template as they did not know they existed or how to use them; surgeons using the templates reported they saved time.

Conclusions
Premade templates save time and improve the quality of documentation when employed appropriately. However, their uptake requires buy-in from colleagues and teaching to ensure people know how to use them. Additional cycles are required to improve standards further.
1246 High Output Stoma Management Audit
Authors: Mollier J , Jenkinson M , Serisier A , Gurung P , Jacob M 
Published: August 2023

Abstract

Aim
High output stomas lead to a myriad of complications for patients including dehydration, electrolyte imbalances, poor skin integrity & altered bowel function. However, this issue is not well recognised amongst junior doctors. This audit’s aim was to improve awareness of high output stomas including their implications and management according to the Association of Stoma Care Nurses’ (ASCN) national guidelines amongst junior doctors.

Method
An electronic survey was distributed to 20 junior doctors working in General Surgery at Southend University Hospital, assessing their knowledge on recognition and management of high output stomas. A checklist summarising the ASCN guidelines was then created. A post-intervention survey was then distributed to assess for improvement in knowledge and application of ASCN guidelines as well as use of the checklist.

Results
Overall, 51% answers were correct in the first survey compared to 72% answers correct in the post-intervention survey, and 83% of participants used the checklist. There was improvement in use of IV fluids (50% to 100%), monitoring fluid balance (80% to 91%), fibre restriction (37% to 70%), fluid restriction (50% to 70%), checking & replacing Mg (65% to 87%) & use of regular codeine (70% to 77%), as well as moderate improvement in appropriate doses of loperamide being given (5% to 30%).

Conclusions
The above audit resulted in an improvement of knowledge and application of evidence-based guidance provided by ASCN, with ultimate intent to improve patient outcomes. Further work includes distribution of the checklists throughout the hospital and to other hospitals.
1251 A Project Aimed at Improving the Completeness and Quality of Admission Clerking in the ENT Department
Authors: Nowinka Z , Benjamin E 
Published: August 2023

Abstract

Aim
Admissions notes are essential in communicating information regarding patients. The project aimed to improve the proportion of completed admission clerking and the quality of the recorded data for the ENT patients admitted to the ward.

Method
We have included emergency presentations and elective admissions for moderate and major head and neck surgery. Patients were identified from handover lists. Baseline data were collected across a period of six weeks, and 103 admission notes were included. Following the intervention, the data collection lasted another six weeks, and 93 documents were identified. Documents were compared against The Royal College of Surgeons of England Guidelines for Clinicians on Medical Records and Notes. Interventions to improve the standard of admission clerking included: a short departmental presentation, educational posters, and an introduction of the electronic clerking proforma.

Results
Following the intervention, the proportion of completed admission clerking has increased and the quality of recorded data has improved.The proportion of completed admission clerking increased from 95.4% to 100% for emergency presentations, and from 2.6% to 68.2%for elective admissions. Data completeness has improved across all documentation domains. For emergency presentations, the most notable improvement was recorded for the medication history (76.9% vs 93.0%) and allergy status (73.9% vs 87.3%). For elective admissions, the greatest improvement was noted for past medical history (2.6% vs 65.6%) and social history (0% vs. 56.5%).

Conclusions
In conclusion, the use of clerking proforma alongside educational presentation and posters increased the completeness and quality of admission clerking, for both emergency and elective presentations in the ENT department.
757 Indocyanine Green Colonic Perfusion Demonstration Following Robotic Da Vinci X Inferior Mesenteric Artery Ligation for the Treatment of Type II Endoleak
Authors: Lambert J , Al Majid S , Salaman R , Gavan D , Sheikh A , Gill M 
Published: August 2023

Abstract

Background
We describe the technical operative details of the robotic repair of a type II endoleak (T2E) following endovascular abdominal aortic aneurysm repair (EVAR). We demonstrate that indocyanine green (ICG) can be used intra-operatively to demonstrate perfusion of the colon following ligation of the inferior mesenteric artery (IMA) vessel feeding the aneurysm sac.

Method
A 74-year old male underwent EVAR for a 5.8 cm infra-renal abdominal aortic aneurysm using an E-Tegra, Jotec Device (JOTEC Gmb, Lotzenäcker 23,D-72379 Hechingen). Surveillance contrast CT (CTA) over the ensuing 30 months confirmed progressive sac expansion.

Results
ICG confirmed colonic perfusion via the marginals after IMA ligation. Total operative time 56 min &lt; 50 mls blood loss and 1-day hospital stay. 3-month follow-up: CTA and ultrasound demonstrated complete resolution of T2E and adequately perfused colon.

Conclusions
A total robotic approach can be performed safely with intra-operative ICG used to demonstrate colonic perfusion as an added safety measure.
890 Surgical Multidisciplinary Team Meetings Are Enhanced by Collaboration in the Metaverse
Authors: Ghaderi R , Edwards T , Cobb J , Logishetty K 
Published: August 2023

Abstract

Aim
Multidisciplinary team meetings (MDT-Ms) are utilised as a clinical decision-making tool. Currently, these are in-person or remote, using screen-sharing of patient health records including clinical findings, numerical data, and imaging (2D/3D). Immersive Virtual Reality (IVR) is an emerging technology allowing multiple care-providers to remotely interact with patient data in the metaverse. Our aim was to develop an IVR metaverse for MDT-M and test its feasibility and efficacy in the orthopaedic trauma setting.

Method
Interviews of users attending existing orthopaedic trauma MDT-Ms at a regional major trauma centre identified strengths, weaknesses, opportunities, and threats (SWOT analysis) for a novel platform. Iterative testing allowed feature development and curation of twenty-four simulated cases from previous admissions. User experience in pilot MDT-Ms was measured using the NASA Task Load Index (NASA-TLX) and System Usability Scale (SUS).

Results
An IVR metaverse platform was developed and four MDT-Ms were successfully conducted with healthcare professionals (n = 13). Participants found ‘data visualisation’ and ‘clinical decision-making’ effective in IVR: median 5 (IQR 4-5); and 5 (IQR 4-5) respectively. Ratings on ‘ease of communication’ in the metaverse were varied with a median of 3 (IQR 2-4.5). Qualitative analysis highlighted the strength of IVR for collaborative interrogation of 3D anatomy and injury patterns. The NASA-TLX domain ‘task performance’ was rated consistently highly.

Conclusions
Healthcare professionals can conduct MDT-Ms using a novel platform on commercially available IVR headsets. Participants were able to collaboratively interrogate clinical data, facilitating enhanced discussion, decision-making, and perceived task performance. Future iterations will focus on role designation to improve communication in MDT-Ms.