bluuebunny/crossref_metadata_2025_split huggingface dataset:
eP52 Enhancing Acute Pancreatitis Management through a Multidisciplinary Upper Gastrointestinal Team Approach: A Closed Loop Audit
Authors: Papaioannou Christos , Soni Rhea , Sheth Camy , Patwardhan Maneesha , Brewer James , Kamocka Anna 
Published: January 2025

Abstract

Aims
Pancreatitis is a severe, acute inflammatory condition of the pancreas, potentially leading to life-threatening complications. This closed-loop audit assessed the impact of a newly established multidisciplinary Upper GI (UGI) team on the management of acute pancreatitis patients at Chelsea and Westminster Trust.

Methods
This closed-loop audit analysed 131 patients admitted with acute pancreatitis over two 6-month periods in 2023 and 2024. Data were prospectively collected on diagnostic timing, Glasgow score calculations, imaging, and referral practices, comparing these metrics to the first audit cycle. The first cycle occurred concurrently with the introduction of the in-hospital UGI team. Interventions following the initial audit included establishing weekly benign UGI multidisciplinary team (MDT) meetings with gastroenterology and radiology specialists, streamlining the ERCP pathway, creating a "hot" cholecystectomy pathway, and implementing targeted education within the surgical department.

Results
The second audit cycle demonstrated substantial improvements. Glasgow score calculation within 48 hours increased to 50%. Escalation of severe pancreatitis cases to higher care rose from 0% to 60%. Imaging within 24 hours achieved 100% compliance. The median time from admission to ERCP decreased to 5 days. Cholecystectomy rates within 2 weeks improved from 75% to 100%, and the transfer of non-gallstone pancreatitis cases to gastroenterology increased from 33% to 50%.

Conclusion
The audit highlighted significant advancements in acute pancreatitis management, including earlier diagnosis, timely surgical interventions, and enhanced multidisciplinary care, underscoring the positive impact of the implemented measures.
eP54 Intussusception in Adults Audit
Authors: Dean Lydia , Frank Amy , Laurie Alex , Isgin Jordan , Dovell Jack , Gee Andrew 
Published: January 2025

Abstract

Aims
Intussusception in adults is a rare but important presentation on the emergency general surgery ‘take’. In this condition, one part of the intestine slides inside an adjacent part, which can lead to bowel obstruction and ischaemia. Unlike in children, in adults there is normally an underlying causative pathology, most commonly malignancy. Thus, bowel resection is frequently curative. This audit aimed to look at investigations, causes, and management of intussusception in adults in one district general hospital.

Methods
Data was collected for adult patients admitted under the general surgical team with imaging showing intussusception between August 2021 and 2024.

Results
71 patients were admitted during this period with intussusception on imaging. 76% of patients were diagnosed via CT scan, 16% by MRI, 4% by ultrasound, and 4% by ‘other’ types. 76% had related symptoms (such as abdominal pain and vomiting), whereas 24% were ‘incidental’ findings on imaging.
For the asymptomatic group, 41% (7 of 17) had significant pathology (5 patients had colorectal cancer, and 2 had a small bowel lipoma). All 7 patients with significant pathology had surgical resection.
For the symptomatic group, 52% (28 of 54) had significant pathology (68% had bowel cancer). 71% of patients with significant pathology were managed surgically, and 29% conservatively.

Conclusion
A large proportion of adults with intussusception on imaging will have underlying pathology that requires surgical management, and thus it is important for the emergency general surgery team to be aware of appropriately investigating patients with potential intussusception (usually with a CT scan).
eP60 Comparative Efficacy and Safety of Laparoscopic vs. Robotic Pancreatic Necrosectomy: A Systematic Review and Meta-Analysis
Authors: Karagiannidis Georgios , Banham Evie 
Published: January 2025

Abstract

Aims
Pancreatic necrosectomy is a critical intervention in severe acute pancreatitis, with minimally invasive techniques like laparoscopy and robotics becoming increasingly prevalent. This systematic review and meta-analysis compare the efficacy, safety, and outcomes of laparoscopic versus robotic pancreatic necrosectomy.

Methods
A comprehensive search was conducted across PubMed, Embase, and Cochrane Library databases for studies comparing laparoscopic and robotic pancreatic necrosectomy. Eligible studies were assessed for methodological quality, and data were extracted for meta-analysis.

Results
Twelve studies involving 897 patients (laparoscopic: n = 486; robotic: n = 411) were included. The meta-analysis showed similar efficacy between the two approaches in terms of necrosectomy completion rate (OR 0.78; 95% CI 0.52–1.16), operative time (MD -4.12; 95% CI -13.64–5.41), and postoperative hospital stay (MD -0.26; 95% CI -1.29–0.76). However, robotic necrosectomy was associated with significantly lower conversion rates to open surgery (OR 0.45; 95% CI 0.28–0.72) and reduced intraoperative blood loss (MD -82.14; 95% CI -122.55–-41.72). Safety outcomes, including postoperative complications and mortality rates, were comparable between the techniques.

Conclusions
Both laparoscopic and robotic pancreatic necrosectomy are effective and safe approaches for managing severe acute pancreatitis. Robotic surgery offers advantages in terms of lower conversion rates and reduced intraoperative blood loss. However, further high-quality studies are necessary to validate these findings and assess long-term outcomes.
eP64 Analysing Discharge Failure Following Subcutaneous Abscess Incision and Drainage - A quality improvement project from a High-Volume Centre in the United Kingdom
Authors: Hassan Tamer Hassan , Gull Sadaf , Abdulsatar Farah , Sellers Alexandra 
Published: January 2025

Abstract

Background
Incision and drainage (I&D) of Subcutaneous abscesses1 is a common procedure, and proper post-procedure care is crucial to prevent complications. Effective patient education and clear dressing instructions are vital for optimal recovery and reduce failure of discharge.

Methods
This quality improvement project aimed to reduce the failure of discharge in patients following incision and drainage (I&D) of Subcutaneous abscesses1 by enhancing the clarity and consistency of post-operative instructions. Data were collected from patient records, operative notes, and discharge notes from two separate periods. In the first period, records of 48 patients who underwent I&D were reviewed. In the second period, following the implementation of recommended changes, records of 37 patients were reviewed. The data collection focused on the presence of clear post-operative instructions and the number of patients who returned.

Results
Comparison of Findings, Clear post-operative instructions increased from 12.5% in the first period to 67% in the second period and discharge notes increased from 33.3% to 67% in addition to decreased Patient return from 14.5 % to 5.4%.

Conclusion
The significant improvements in the clarity of post-operative instructions in both operative and discharge notes have had a positive impact on patient outcomes. The reduction in patient return rates suggests that patients are better informed and better able to manage their recovery, leading to fewer complications and better overall health outcomes.
1. Perianal, pilonidal, axillary, back, abdominal wall.
eP71 Audit of Emergency Laparotomy Workload in a District General Hospital: Are We Compliant with NELA Data Entry?
Authors: Itaman Usifoh , Shahrokhi Nazanin , Anam Fatima , Barghash Mohammed , Dalmia Sanjay 
Published: January 2025

Abstract

Aim
The National Emergency Laparotomy Audit (NELA) requires all emergency laparotomies to be registered on its database after completion of care. This audit aimed to evaluate our compliance with NELA data entry by comparing the hospital's workload with national NELA data.

Method
This retrospective audit was conducted over two cycles, covering a total of 30 months. The first cycle focused on NELA Year 8, a 12-month period, which included 61 patients. The second cycle assessed NELA Years 9 and 10, covering an 18-month period, with 75 and 38 patients, respectively. All emergency laparotomies were included, while elective surgeries and procedures not captured by NELA were excluded. Data were extracted from patient records and compared with the NELA database. Analysis was performed using Microsoft Excel.

Results
In the first cycle (Year 8), 61 procedures were eligible for NELA registration, but only 31 (50%) were entered, with just 4 (13%) meeting the submission deadline. Additionally, 18 (67%) cases were registered more than 6 months after discharge, with an average delay of 206 days. Following the intervention, the second cycle showed marked improvement. In Year 9, 84% of cases were registered, and in Year 10, 95%. The average time to data entry decreased to 100 days, and all cases were submitted before the deadline.

Conclusion
Timely NELA data entry is essential for accurate representation of departmental activity. Significant improvements in compliance were achieved through targeted interventions, demonstrating the effectiveness of focused efforts in meeting national audit requirements.
eP79 Fast Pain Relief Matters: Evaluating Adherence to Chest Trauma Guidelines
Authors: Cujic Oliver , Wall Joshua , Herrod Phillip , Tierney Gillian 
Published: January 2025

Abstract

Aims
Patients with rib fractures represent an increasing proportion of the emergency general surgery take. All blunt chest wall trauma guidelines emphasise the importance of establishing early, adequate analgesia - defined as the ability to deep breathe and cough effectively - to reduce the risk of complications. This audit aims to assess adherence to local guidelines for analgesia in blunt chest wall trauma.

Methods
A retrospective clinical audit was conducted, reviewing patient records on the electronic medical records software (Lorenzo) in a single NHS trust. Data were collected on the time from general surgery admission to the first analgesia prescription, compared against the trust guidelines. The study sample included 18 patients admitted to general surgery with rib fractures over a two-week period (08/07/24 - 21/07/24).

Results
22% (4 out of 18) of patients were prescribed analgesia within 30 minutes of admission to general surgery. 50% (9 out of 18) of patients were prescribed analgesia within 60 minutes. 83% (15 out of 18) of patients were prescribed analgesia within 90 minutes. 94% (17 out of 18) of patients were prescribed analgesia within 150 minutes. 100% of patients were prescribed analgesia within 300 minutes.

Conclusion
This audit demonstrates a 50% lack of adherence to trust guidelines, potentially resulting in significant clinical complications. Delays in analgesia prescription may be multifactorial, including patient comorbidities and resource limitations. Further audits are planned to assess the appropriateness and adequacy of prescribed analgesia and the incidence of analgesia-related complications.
eP80 Transitioning from trauma: Audit on discharge quality for major trauma patients
Authors: Hughes Declan , Hancorn Kate 
Published: January 2025

Abstract

Introduction
Major trauma patients require complex multidisciplinary management with significant physical, medical, psychological, and social community rehabilitation needs. Clear effective communication on discharge is vital to ensure safe transition of care from hospital to community services. This audit aims to assess discharge quality, identify issues, and improve transition of care for major trauma patients.

Methods
Data was collected on major trauma patient discharge summaries before and after the implementation of a standardised discharge proforma, local training and education. Results were audited against the RCP discharge summary toolkit. The standard was that records would be 100% complete.

Results
The initial audit (n=20) revealed that discharges were often incomplete, unclear, and of insufficient quality with an average completion rate of 44.1%. Following proforma introduction, staff education and training this improved to 66.57%. Root cause analysis of issues comparing discharge between patients admitted on specialist major trauma ward (n=20,73.14%) vs outlier wards (n=20,60.00%) revealed significant disparity (t(50)=5.42, p=0.000). Following further reinforcement, a third cycle revealed improvement at 78.92% (trauma ward 81.08% vs outliers 76.76%; t(50)=2.12, p=0.037).

Conclusion
Major trauma patients are a unique cohort requiring comprehensive yet clear discharge to facilitate transition of care into the community. This can involve a multitude of different surgical specialties. Long-term quality improvement and education of rotational trainees on induction is essential for sustained quality. Patients on outlier wards are at higher risk of discharge issues. We present our proforma for multiply injured patients to improve discharge communication and patient care.
eP81 SIGMOID VOLVULUS – Are we Managing it Right?
Authors: Taggarsi Meghana , Chatterjee Sunetra , Senthilkumar Karishmah , Rao Milind 
Published: January 2025

Abstract

Aims
Endoscopic decompression for sigmoid volvulus (SV) has success rate of &gt;80%, recurrences range between 45-71%. There is no consensus for management of SV. This study was performed to outline guidelines for management of SV in our trust.

Methods
This was a retrospective study performed over 3 years. Comorbidities were analysed using Charlson Comorbidity Index (CCI). Outcome measures included successful endoscopic decompression, length of stay, surgical management, mortality and recurrence.

Results
42 patients were included. 73.8% were male. The median age was 77 years and 85.7% were &gt;60 years. Median CCI was 4. 76.2% had moderate and severe CCI. 69.04% were over-investigated with both AXR and CTAP.Data Parameters (N=42)Chronic constipation52.4% (22)Care home inmates9.5% (4)Bed bound19% (8)DiagnosisAXR - 73.8% (31)CTAP - 95.2% (40)Both – 69.04% (29)Deranged Electrolytes64.3% (27)Raised lactate9.5% (4)Recurrent SV33.3% (14)Management of SVSelf resolved4Rigid sigmoidoscopy (RS)18Flexible sigmoidoscopy (FS)12Both RS and FS7Sigmoid colectomy1
1 patient suffered perforation after decompression and was palliated. 4 patients had definitive elective surgery. 1 patient underwent Hartmann’s procedure following failed decompression during the 11th recurrence. Recurrences after endoscopic decompression was 53%, which corroborates with literature.

Conclusion
Endoscopic decompression remains the first line of management. However, early definitive treatment plan is necessary to reduce recurrences. This in turn would reduce readmissions and cost burden. Management of SV requires a holistic approach. This study supports early decision to elective surgery if feasible.
eP82 NELA - has it lost its way?
Authors: Wong Chloe , Hassan Kiran , Mohammed Musab , Saha Arin 
Published: January 2025

Abstract

Aims
NELA reports describe hospital-level mortality, process and outcome measures after emergency laparotomy. However, reports have not described which process measures influence mortality. This study analysed NELA data to determine which factors are common to low-mortality hospitals.

Methods
The Year 8 Annual RAG table was interrogated. Hospitals were grouped into ‘low mortality’ (lower than national average) and ‘high mortality’. Process measures were grouped into Red (&lt;55%) or Amber/Green (&gt;55%). Chi-squared tests assessed which process measures were associated with low mortality hospitals.

Results
There were 21710 cases. National adjusted mortality was 9.03% (range, 2.5%-18.4%). There was wide variability in achieving process measures; for example, the proportion of patients who went to ICU ranged from 36% to 100%.
There were no associations between any process measure and low-mortality hospitals apart from lower rates of unplanned return to theatre (P=0.009). This analysis was repeated for all NELA reports; no process measure had any association with low mortality hospitals. Hospitals with low mortality were associated with lower case ascertainment.

Conclusions
NELA reports do not describe which process measures reduce mortality. The only variable associated with lower mortality is unplanned return to theatre, suggesting that high-quality primary surgery is the only factor which hospitals should focus on. Low mortality hospitals were associated with low case ascertainment which may suggest that some (higher mortality) cases have not been submitted. The NELA data offer an unparalleled opportunity to produce meaningful findings to help improve outcomes and future reports should offer specific management recommendations and algorithms.
eP83 Enhanced Abscess Pathway. Emergency surgical flow through an Ambulatory Care Unit. A Pilot Study
Authors: Hamady Ali , Alsibai Mohamed , Nayak Peramapally , Pandey Vikas 
Published: January 2025

Abstract

Aims
The Enhanced Abscess Pathway (EAP) was introduced to improve patient experience and flow, utilising an outpatient setting -our Ambulatory Care Unit (ACU)- to facilitate throughput of patients. This study analysed the safety and efficacy of the EAP.

Methods
Patients &gt;16 years with a cutaneous abscess drainage by the general surgery team were identified. Eligibility criteria included: a) general surgery abscess location, b) no spreading or extensive cellulitis, c) no IV Drug abuse, d) tachycardia resolving with analgesia, e) NEWS &lt;2.
Abscess management was compared with a period 6-months prior to implementation of the EAP.

Results
EAP eligibility in both cycles of the audit was 76.3% (55/72) vs 80.6% (75/93). The EAP increased the rate of same-day discharges pre- (27.5%, p=0.0012) and post-operatively (25.7%, p=0.0031). The median bed day in the 1st Cycle was 1-day (IQR: 2), decreasing to 0-days (IQR:1) after the EAP. In the re-analysis, 49.3% (37/75) of eligible patients went through the pathway. 94.6% (35/37) were discharged the same day post-operatively vs 44.7% of non-EAP (17/38). There were no acute events in the discharge period during either cycle. No significant difference in prolonged admission &gt;2 days – 5.5% (3/55) vs 6.7% (5/75) after EAP. Low risk of re-admission within 1-month in both cycles: 0% vs 4% after EAP. Readmission after the EAP was 2.7% (1/37) in the EAP group vs 5.3% (4/38) in the non-EAP group.

Conclusions
This study demonstrates that the EAP utilising the ACU environment is safe and improves patient flow for minor surgical emergencies.
eP86 Improving NELA Risk Documentation with EPIC Electronic Medical Records
Authors: Choo Li Ling , Brar Jasdeep , Wilson Iain 
Published: January 2025

Abstract

Aims
Identifying and extracting data from medical records can be difficult and time consuming. This can serve as a barrier to clinicians calculating a risk assessment score for patients undergoing emergency laparotomy.
The EPIC electronic patient records system enables clinicians to develop ‘Smartphrases’ to identify and extract specific data from a patient’s medical record. We developed a Smartphrase to identify the data required to calculate a NELA Parsimonious Risk Score in order to make risk calculation easier and more efficient.

Methods
A closed loop audit was conducted. Documentation of risk scores in patient notes or consent forms was observed between November 2022 to February 2023. The NELA Smartphrase was developed and publicised. Documentation of risk scoring was subsequently observed between September 2023 to September 2024. Data was analysed using a one-tailed test.

Results
42 NELA cases were retrospectively identified in the first cycle. 18/42 (42.9%) patients had a documented NELA score. 175 NELA cases were prospectively identified in the second cycle. Following introduction of the Smartphrase, 148/175 (84.6%) patients had a documented score. Introduction of the NELA Smartphrase significantly increased risk score documentation (p&lt;0.0001).

Conclusions
This closed-loop audit demonstrates that EPIC electronic patient records can aid clinicians in calculating and documenting risk assessments for NELA patients. This tool improves efficiency and can help trusts achieve best practice tariff. This tool can be shared beyond our trust.
eP87 To pack or not to pack (abscesses) - that is the question. An audit evaluating local practice and its estimated environmental impact
Authors: Bramer Solange , Atkins William , Ingleton Rose , Sengupta Neel 
Published: January 2025

Abstract

Introduction
Consensus guidelines in general surgery recommend intra-operative packing for haemostasis following incision and drainage (I&D) of perianal abscesses, but suggest there is insufficient evidence for regular post-operative packing. This audit evaluated current practice in a general surgery department regarding packing of perianal and cutaneous abscesses after I&D, and estimated associated carbon emissions.

Methods
Operation notes of I&D of abscesses were reviewed in two cycles over a 6 month period. After the first cycle, results were disseminated and discussed with the department, with a recommendation for regular packing after discharge only when considered necessary. Estimated carbon savings were calculated using published emissions factors.

Results
In cycle one, 100% of the 56 patients had intra-operative packing, and 89% were recommended regular packing changes after discharge. In the second cycle of 50 patients, there was a 10% reduction in intra-operative packing and 43% decrease in post-operative packing. Carbon emissions were estimated to be 16% lower for patients without regular post-operative packing (57 kgCO2e vs 68 kgCO2e), when calculating emissions for the entire patient pathway (including travel to healthcare facility, A&E attendance, surgery, and wound care consumables).

Conclusion
This ongoing QI project has demonstrated that there is a carbon saving associated with reducing regular post-operative packing after abscess I&D. There are likely to be other benefits, such as financial savings and improved patient experience, which could be assessed through future study. We continue to work on optimising the abscess pathway and disseminating best practice guidelines locally.