bluuebunny/crossref_metadata_2025_split huggingface dataset:
385 Neurovascular Status Documentation in Fracture Manipulation
Authors: Hashim S , Wilkes I , Sivanadarajah N 
Published: August 2023

Abstract

Aim
To improve standards of documentation of neurovascular status before and following manipulation in keeping with standards set by the British Orthopaedic Association (BOAST guidelines: Peripheral Nerve Injury1).

Method
At a major trauma centre, we retrospectively collected data on thirty orthopaedic patients who underwent fracture manipulation in October 2022. Data included documentation of sensory, motor and vascular neurovascular status, prior and following manipulation. Posters were displayed in the emergency and orthopaedic departments on adequate neurovascular documentation, and an autotext proposed to aid senior house officers with electronic documentation. Prospective data was then collected on the subsequent thirty patients.

Results
Prior to manipulation, sensory neurological status was documented in 40% of patients and motor neurological status in 43.3% in patients. Post-manipulation documentation was 10% and 13.3% respectively. Documentation of vascular status prior to and post-manipulation was 40% and 16.7%. Following our intervention, pre-manipulation documentation of sensory and motor neurological status was 60% and 63.3%; post-manipulation was 20% and 13.3%. Documentation of vascular status prior and post-manipulation was 70% and 20%.

Conclusions
Following our intervention, there was an improvement in documentation of both sensory and motor neurological status prior to manipulation, however there was no change in motor status post-manipulation. The intervention used may not provide a sustainable improvement in documentation. Use of a designed electronic form, which can be accessed easily for electronic documentation, may improve results further.
397 The Effects of a Virtual Specialist Nurse-Led Clinic on Plastics Outpatient Services at a Major Trauma Centre: A Closed Loop Audit
Authors: Lacey H , Bernard K , King I 
Published: August 2023

Abstract

Aim
To reduce the number of plastic surgery clinics working over capacity due to the effects of both increasing caseload and the COVID-19 pandemic by implementing a virtual specialist nurse-led clinic.

Method
Outpatient activity was audited due to the number of patients being overbooked into the plastic surgery outpatient clinics. A virtual specialist nurse-led clinic was implemented to bridge gaps between appointments, maintain early triaging of complications, and reduce clinics working over-capacity. Suitable patients were identified and offered virtual follow-up in place of face-to-face appointments. Outpatient activity was re-audited after implementation, to assess effects on force bookings and number of new/follow-ups seen in consultant clinics.

Results
Following virtual clinic implementation, there was a significant reduction in consultant clinics working over-capacity (95% to 71.8%, p = 0.002) and forced bookings (54 to 10, p = 0.006) in the audited period. The average number of new patients seen in consultant clinics each month increased by 15.3% (p = 0.019).

Conclusions
Introduction of a virtual clinic reduced forced bookings and clinics working over-capacity. This increased capacity for new patients to be seen face-to-face, created a manageable clinic while maintaining early identification of complications, and reduced delays between clinic appointments. Early virtual assessment of wounds and identification of complications enabled patients to be booked into urgent face-to-face plastic appointments, triaging them away from A&E and GP services. The virtual clinic also allowed the team to reassure patients with ongoing concerns between appointments, further reducing A&E and GP burden.
459 Standardised Surgical Admission Proformas: A Quality Improvement Project
Authors: Gaffney M , Chan K Y , Raftery N , Eltigani E , Johnston S , Rayis A , Abdelhafiz T 
Published: August 2023

Abstract

Background
“Documentation burden” in a busy healthcare setting is a commonly cited cause for suboptimal documentation and its associated adverse implications. While electronic patient records have been heralded as a solution, costs associated with necessary infrastructure may be prohibitive. We designed and implemented a standardised surgical admission proforma and evaluated its impact on improving compliance with standards for documentation.

Method
Freehand admission notes for consecutive surgical admissions over a 4-week period were audited against guidelines produced by the Royal College of Surgeons (England). A standardised and structured admission proforma was introduced over a 2-week period to replace freehand documentation, its efficacy subsequently reaudited over a 4-week period.

Results
A total of 67 freehand admission notes were evaluated. Key components such as vital signs, medications and allergies were documented in less than 46%, 43% and 72% respectively. Additionally, smoking and alcohol consumption were documented in less than 40% of admission notes. 51 admission proformas, with a 100% uptake, were evaluated post-intervention. The mean improvement in documentation of vital signs was 60.0% (SD = 0.11). Documentation of existing medications, alcohol consumption, smoking status and laboratory investigations results improved significantly by 46.9%, 43.1%, 40.6% and 17.5% respectively. Additionally, 96.1% of admission notes had identifiable medical council registration numbers. Improvements in legibility and efficiency of documentation were also noted.

Conclusions
Introduction of a standardised admission proforma resulted in significant improvements in quality and completeness of admission documentation. Concise, legible, and accurate documentation is fundamental in maintaining effective clinical governance, allowing for the provision of safe and efficient patient care.
481 An Audit on the Completion of Hand Trauma Proformas – a Tertiary Centre Experience
Authors: Ibrahim A , Khudr J 
Published: August 2023

Abstract

Aim
The Royal College of Surgeons of England in its guidance "Safe Handover" set out minimum data necessary for safe handover. The Hand Pro-forma should be thought as part of hand over as it allows for clear communication of information between members of the team. In addition, the Hand Pro-forma is a medicolegal document.
Our previous audit on the quality of proforma completion highlighted that x-ray documentation was improving as it increased to 71% from 56% of the cases.

Method
We assessed the completion of the x-ray section within our current hand proforma. We reviewed the Hand trauma proforma documentation trauma clinic and ward admissions between 20/8/22 – 20/9/22 and used the British Society for Surgery of the Hand guidelines as a standard to compare.

Results
We reviewed twenty completed proformas. This indicated that an X-ray was obtained in 80% of the cases, which is a drop considering the previous audit highlighted a reporting rate of 95.5%. Only 40% of proformas documented which hospital the X-ray was performed and only 60% documented x-ray findings. This is a significant decrease from a previous 100% completion rate.

Conclusions
From this audit we identified that lack of access to external PACS system as a significant barrier to completion of documentation. As part of this audit cycle, we addressed this by providing access to the generic doctors account, to act as a temporary measure while newly rotating doctors sort their accounts. We are aiming to re-audit in 6-months’ time to assess intervention effects.
551 Admissible or Overkill - Get It Right First Time (GIRFT) operative documentation for Laparoscopic Cholecystectomy
Authors: Hennessy J , Potter L , Digne-Malcolm H , Ninkovic-Hall G , Ahmed M , Magee C 
Published: August 2023

Abstract

Aim
Get It Right First Time (GIRFT) Laparoscopic Cholecystectomy (LC) documentation best practice was updated in September 2022. This was a combined incentive by NHS & Royal College of Surgeons with the aim to improve poor operative documentation leading to medico-legal claims and preventing defence of good medical practice. We aim was to assess how we locally adhere to these.

Method
Retrospective 2-cycle, 2-month review of all LC (August 2022 (pre GIRFT) and September 2022 (post GIRFT)). Operation notes were scrutinised and compared to the newly set national standards. 60 operation notes were sampled (33 pre, 27 post), completed by 8 surgeons. We defined the recommendations into 24 essential and 8 non-essential elements.

Results
N = 0 operative notes contained 100% of the required information recommended by GIFRT. Of the pre GIRFT, 33% (n = 11) had ≥75% of the essential criteria (p = 0.162). Post GIRFT, 44% (n = 12) had ≥75% of the essential criteria (p = 0.097). Notable deviation from standards were poor documentation on patient position & skin preparation (23%), intra-abdominal pressure setting (7%) and histology sent (3%). 0% stated the table position (reverse Trendelenburg or right side up).

Conclusions
Although the GIFRT guidelines for documentation in LC are lengthy, without them it is difficult to defend good medical practice when exposed to medico-legal claims. Despite GIFRT release, locally we only had minor improvements in documentation standards. This indicates that a set operation notes proforma and further dissemination of these recommendations may be needed to improve documentation standards.
726 Pre-Operative Glycaemic Control in Diabetic Trauma Patients
Authors: Boothman C 
Published: August 2023

Abstract

Aim
To review the preoperative diabetic management of trauma patients pending theatre

Method
We analysed 2 months of trauma admissions including all patients with diabetes. We reviewed them against standards from our trust guidelines which state a blood glucose (BM), HbA1c, and urine analysis should be performed on admission. We reviewed which patients were commenced on variable rate insulin infusions (VRII) as the guidance states it should be considered when the patients’ BM is &gt;12 or if the patient is to miss 2 or more meals.

Results
In our study population, 30% did not have a blood glucose on admission; and 80% did not have an HbA1c. Of those patients whose admission BM was over 12; 100% were started on a variable rate of insulin. The variation came with our tablet-controlled group as 33% were started on VRII and 77% were not. Of those not on VRII when it came to the day of surgery 18% had a BM of over 12. The average duration patients were kept nil by mouth was 14 hours

Conclusions
Polytrauma patients with diabetes are at higher risk of mortality; they are at increased risk of surgical site infections, poor wound healing, and non-union. This audit highlighted that the team recognise the importance of starting a VRII on those with hyperglycemia. However, going forward we need to ensure all patients have a BM on admission and this will direct our appropriate use of VRII and thus hopefully improve our trauma patients' outcomes.
752 How Do We Manage Open Fractures in Emergency Department? – a Closed Loop Audit
Authors: Li C H , Banks J , Zhu M , Tucker H 
Published: August 2023

Abstract

Aim
Patient with an open fracture is resuscitated mainly by the emergency physician prior to being referred to the relevant surgical specialties. Yet, there is lack of uniform guidance in managing open fractures. This audit aimed to evaluate the existing guidelines at the emergency department.

Method
A retrospective search was performed at the Tertiary trauma center. Four main parameters were evaluated 1.) the photo documentation. 2.) Antibiotic administration rate 3.) Tetanus prophylaxis utilisation. 4.) Systematic evaluation of neurovascular status pre and post splint.

Results
41 patients (M: F, 63%:37%) were analysed. The most common open-fracture were lower-limb long bone (39%) and phalanx (39%) , followed by upper-limb long bone fracture (9.8%), head (7.3%), facial (2.4%) and pelvis (2.4%). Multiple fractures were seen in 20.9%. Multiple open fractures were only seen in 1 case. The average transfer time by ambulance to the hospital was 116 mins. 97.5% of open fractures received antibiotics: 13.3%, 60%, and 100% of patients received antibiotics respectively within 1hr, 3hr, and 6hr from the time of injury. 48.8% received tetanus prophylaxis, and only 4.87% have documented tetanus assessment. 100% has a neurovascular examination. 72% of open fractures required surgical intervention. The average time to the theatre was 16.7 hours.

Conclusions
Antibiotic administration within the first hour from the timing of the injury is not practical in real-life situations. Future work should focus on creating a universe open fracture grading system, beyond lower-limb fracture, to better inform clinicians of the prognosis of open fracture and help with risk stratification.
831 Improving Documentation of Post-Operative Day 1 Checks After a Hip Hemiarthroplasty or Total Hip Replacement
Authors: Rasquinha M , Oakley B , Bhangoo N 
Published: August 2023

Abstract

Background
Post-operative day 1 checks (X-ray, bloods, dressing check and neurovascular status) are essential after hemi-arthroplasty (hemi) or total hip replacements (THR) to look for peri-prosthetic fracture, dislocation, anaemia, acute kidney injury, wound site bleeding and neurovascular impairment. Senior clinicians in the T&O department at the trust have raised concerns regarding documentation of post-operative day 1 checks in hemi/THR patients. Thus, offering no certainty to doctors reviewing patients at a later date that day 1 checks were carried out. Ultimately, raising the issue of patient safety.

Aim
The aim of this audit was to improve documentation of post-operative Day 1 checks in hemi/THR patients.

Method
Medical notes of those who underwent either a hemi/THR were reviewed. They were appraised on day 1 post-operative documentation of review of xray, acknowledgment of bloods results, dressing and NV status checks. Two PDSA cycles were carried out between September – November 2022. Interventions included: a) raising awareness on the junior doctor WhatsApp group; b) educating junior doctors via teaching sessions.

Results
40 medical notes were reviewed during each cycle. Results showed a clear improvement in quality of documentation. Pre-intervention (cycle 1): X-ray (37.5%), bloods (25%), dressing (52.5%), NV status (47.5%). Post-intervention (cycle 2): X-ray (71.5%), bloods (75%), dressing (72.5%), NV status (77.5%).

Conclusions
The relatively simple interventions have been found to have an improvement in documentation of post-operative day 1 checks in hemi/THR patients. Further recommendations include: raising awareness during induction and posters on the ward to prompt junior doctors to complete these checks.
916 Introducing a New Guideline for the Fifth Metatarsal Fracture (5th MTF)
Authors: Yahia Z 
Published: August 2023

Abstract

Background
The 5th MTF is a common injury occurring in the long bone joining the ankle to the toes. This injury can be categorised into two main sub-sections, namely green zone fractures (GZF) and red zone fractures (RZF) which are treated differently. Moreover, patients suffering from uncomplicated GZF are to be discharged directly from emergency department (ED), whereas the complex cases require a review from orthopaedic doctors. Due to time-restraint in ED, some fractures might be misdiagnosed/referred directly to fracture clinics unnecessarily.

Aim
Increase ED-led management and discharge of patients suffering from GZF

Method
A QI was introduced to implement a new guideline and update the patient information leaflet in the emergency department at ELHT. For each set of baseline data, an intervention was suggested to achieve the goal of this project and ensure a safe discharge of patients from ED.

Results
During a four-week study period, 20 patients presented to ED with an uncomplicated green zone fracture, 40% of which were discharged directly from ED. This demonstrates an improvement of 12.7% from a baseline of 27.3%. In addition, 80% of these patients were managed with a walker boot, as mentioned in the new guideline. In total, only three fracture clinic appointments were booked, due to complications, as opposed to twenty appointments. This resulted in a saving of £1.835,4.

Conclusions
The new guideline has led to an improvement of 50% in patient care. The new management plan benefits patients and improves the efficacy of the ED as well as fracture clinics.
1033 Renal Colic Emergency Management - an Audit Cycle
Authors: Mercer R , Jose M 
Published: August 2023

Abstract

Aim
This audit aims to assess whether the management of renal colic diagnosed in an emergency department setting is adhering to the current recommendations by the British Association of Urological Surgeons and National Institute for Health and Care Excellence.

Method
Two audit cycles were completed. Patients were retrospectively identified using the online clerking system in use by the emergency department. Patients were excluded if returning to hospital in the last 3 months, if the patient had a complex urological history, or if the CT scan was negative. Outcomes assessed were CT imaging within 14 hours of assessment, inpatient referral criteria being met, and NSAIDs being prescribed. Interventions included updated NSAID dosing and an updated renal colic pathway for the health board.

Results
The first cycle conducted identified 15 patients post exclusion, 9 were excluded. 87% of patients had NSAIDs prescribed, 93% of patients had a CT within 14 hours of assessment, 100% of patients meeting referral criteria were referred, 67% of patients meeting no referral criteria were referred.
The second cycle identified 6 patients post exclusion, 10 were excluded. 50% of patients had NSAIDs prescribed, 100% of patients had a CT within 14 hours of assessment, 50% of patients meeting no referral criteria were referred.

Conclusions
This audit despite the low patient numbers highlighted a need to update the renal colic pathway for emergency clinicians in keeping with national guidance. In addition, for future audits it has shown a better identifier for renal colic would be all patients receiving CT kidneys, ureters, and bladder.
1162 Management of Acute Gallstone Disease at an Urban Acute Trust During the Pandemic – Closed-Loop Audit
Authors: Sharif M , Osilli D , Mukherjee D , Buhain R 
Published: August 2023

Abstract

Aim
Acute gallstone disease is a surgical emergency with emphasis on early surgery (Laparoscopic Cholecystectomy (LC)) to improve outcomes.

Method
Patients presenting with acute cholecystitis, biliary colic, and gallstone pancreatitis between September and December 2021 were retrospectively audited. We measured re-admission rates, emergency and elective cholecystectomies performed, and interval between operation and initial admission. This revealed a need for improvement in the service provided at this trust.
An intervention was implemented with the Hot Cholecystectomy list being available for other surgeons as well as encouraging acute LC on the Emergency theatre list.
A follow-up retrospective audit was carried out between July and September 2022 using the same criteria as per the initial data collection.

Results
240 patients were admitted with acute gallstone disease during the initial audit period. At the end of audit period, 49 patients underwent LC, of which only 20% were performed acutely. However, 70% of acute operations were performed during re-admissions.
During the re-audit, 109 patients were admitted with acute gallstone disease. Within the three months, 21% of patients underwent LC, out of which 52% were acute operations. 50% of the emergency operations were in re-admission patients. Patients from the initial audit were followed up which revealed average waiting time of 118.5 days from admission to LC

Conclusions
There was almost a 3-fold increase in the rate of Emergency LC post intervention. While there is an increase, provision of emergency cholecystectomies does not comply with national guidelines. Resources need to be allocated nationwide for timely treatment of acute gallstone disease.
370 Biochemical Monitoring and Micronutrient Replacement Following Bariatric Surgery
Authors: Akharaekpanya T , Nevins E , Brown J 
Published: August 2023

Abstract

Aim
This project investigates whether patients received appropriate post-operative biochemical monitoring and micronutrient replacement after bariatric surgery, as per British Obesity & Metabolic Surgery Society (BOMSS) guidelines.

Method
A total of 27 Patients underwent either gastric bypass or sleeve gastrectomy between 1st August 2020 to 31st July 2021 at Northumbria Healthcare NHS Foundation Trust. Data was collected retrospectively.

Results
Most patients received appropriate micronutrient replacement, with 82% for A-Z multivitamin, 84% for calcium supplement, 72% for vitamin D supplement, 96% for vitamin B12 supplement, and 91% for ferrous sulphate for menstruating women.
Similar results found with post-operative blood tests at 6 months, 81% for FBC/LFT/U&E, 74% for ferritin and folate, 74% for calcium and vitamin D, and 70% for vitamin B12. Similar findings at 12 months, 74% for FBC/LFT/U&E, 74% for ferritin and folate, 78% for calcium and vitamin D, 70% for vitamin B12, 67% for zinc, 70% for copper, and 67% for selenium.
However, compliance with blood tests at 3 months was inferior, 48% for FBC/LFT/U&E, 37% for ferritin and folate, 37% for calcium and vitamin D, and 44% for vitamin B12.

Conclusions
Most patients received appropriate biochemical monitoring and micronutrient supplements. Unfortunately, less than half of the patients received monitoring blood tests at 3 months, which is a time where post-operative complications such as malnutrition can be identified and corrected. Several factors may have contributed to this, such as delay in communication between secondary and primary care or lack of facilitation to phlebotomy services.
257 Postoperative Pain, Analgesic Choices, and Ileus: A Snapshot From a Teaching Hospital in a Developing Country
Authors: Al-Jasim A , Aldujaili A A , Al-Abbasi G , Al-Abbasi H , Al-Sahee S 
Published: August 2023

Abstract

Aim
In this study, we looked at the severity of postoperative pain, the type of analgesics used to control the pain, and the incidence of POI at Baghdad Teaching Hospital. We hypothesized that we would find an association between the type of analgesia used and POI.

Method
This observational study was conducted among 100 patients who were residents at the general surgery wards of Baghdad Teaching Hospital. A structured questionnaire was employed focusing on types of analgesics, degree of pain control, and the presence of ileus.

Results
Sixty-nine percent of patients received a combination of opioids and non-opioids. Moderate-to-severe pain was the most commonly reported category on pain scales. More than half of the patients (57%) were found to have POI during their hospital stay and there was a statistically significant association between the type of analgesia and POI development ( p = 0.001).

Conclusions
A mix of analgesics (opioids and non-opioids) was the most common regimen at our centre. The majority of the surgical inpatients reported having moderate-to-severe pain on both pain scales used in this study. Ileus incidence following abdominal surgeries (61%) was significantly higher than the reported incidence worldwide (10-30%). Postoperative ileus has multifactorial causes, one of which is the use of opioids for pain control. Considering the high incidence of ileus in our center and the association we found between the use of opioids and ileus, further studies should look at the doses of opioids used and whether alternative analgesic methods might result in less ileus.