bluuebunny/crossref_metadata_2025_split huggingface dataset:
377 A Quality Improvement Project to Improve the Documentation of Post-Operative Complications on Discharge Documentation of Patients Undergoing Elective Colorectal Surgery at a Tertiary Centre
Authors: Baker D 
Published: August 2023

Abstract

Aim
To improve the documentation of post-operative complications on discharge letters following elective colorectal surgery.

Method
Notes were retrieved for patients undergoing elective colorectal surgery and who were discharged in the month of August 2021. Notes were retrospectively analysed and complications occurring in the post-operative course were documented and cross-checked with discharge documentation. Summary statistics were used to summarise and compare inpatient complications vs discharge documentation of complications. A proforma was created to aid juniors in summarising inpatient complications and to be utilised as a reference for completing discharge documentation. A one-month period of using the proforma was trialled and data was re-collected to assess for improvement in discharge documentation.

Results
A total of 17 patients were discharged in August 2021 and suffered a total of 72 complications. Complications ranged from minor electrolyte disturbances to requiring operative intervention for anastomotic leak. Of the 72 complications only 28/72 (38.9%) were included (range 0-100%). The proforma for documentation was trialled for one-month and included a total of 18 patients suffering from 46 complications. Of these 46 complications a total of 31 (67.4%, range 50-100%) were documented on discharge letters. No major complications were missed when utilising the proforma.

Conclusions
Utilisation of a proforma to aid in documentation of complications on discharge has markedly improved the accuracy of discharge documentation. Further work is required to assess barriers to completion and to further improve the accuracy of discharge documentation.
405 Improving Confidence in Managing Acute Urology: A Quality Improvement Project
Authors: Bradley C , Iqbal R , Shivakumar N , Ibrahim I 
Published: August 2023

Abstract

Introduction
A lack of confidence in the management of acute urology presentations amongst junior trainees was identified. Out of hours cover is provided by middle-grade doctors (FY2 to ST2), from general surgery and orthopaedics.  Ward cover is provided by FY1s. There are no dedicated urology juniors, therefore exposure to urology presentations/teaching is limited. A teaching course was designed to address this and improve confidence in managing common acute urological presentations.

Method
The ‘Emergency Urology Course’ was delivered at a district general hospital over four weeks, comprising of four sessions (stones, penoscrotal, catheters/retention, oncology/miscellaneous topics). Teaching sessions were undertaken by trainees with experience of urology at registrar level. The course was advertised via email, posters and word of mouth. Teaching topics were based on common presentations. All sessions were well attended by juniors with no prior urology experience. 20 completed the pre and post course evaluations.

Results
Course evaluations showed an increase in reported confidence amongst junior doctors across all topics/sessions. The juniors rated their confidence out of 10 with regards to management of emergencies. The average score prior to the course was 4.6/10. Following course devliery, the average confidence had increased to 7.9/10.

Conclusions
Overall, we demonstrated an increase in junior doctors' confidence in the management of emergency urology presentations, following delivery of a focused course. This will aim to support the juniors and reduce registrar involvement, especially out of hours. Future plans include converting the course into an online format to be more flexible, and reach a wider audience.
469 Improving the Quality of Trauma Meeting Documentation
Authors: Yip C R , Nadar N , Warrington D , Kassir A , Peach C 
Published: August 2023

Abstract

Aim
Trauma meeting allows discussion of new referrals, formulate treatment plan and coordinate the trauma threatre list. Modern electronic patient record platform has facilitated the feasibility of real-time documentation. The purpose of this audit is to evaluate the current practice of trauma meeting documentation, subsequently implementing a proforma which provides structured and effective documentation using an electronic smart-phrase function, aiming to improve the overall quality and consistency of trauma meeting documentation.

Method
Three retrospective Plan, Do, Study, Act (PDSA) studies of ten days duration each, were performed for all patients discussed in three occasions: pre-implementation, post-implementation, and one-month post-implementation of the smart-phrase. Appropriate adjustments were made based on data analysed and multi-disciplinary feedback. Eight standards were measured which include documentation of consultant on-call, consultants present, imaging discussed, concerns from the multi-disciplinary team, diagnosis, laterality, clear plan and weight-bearing status.

Results
A total of 296 cases were discussed in three study periods, 90 cases in PDSA 1, 98 cases in PDSA 2 and 108 in PDSA 3. Only 64% of the cases discussed in PDSA 1 had documentation. Following introduction of the smart-phrase, 94% and 88% of cases discussed were documented in PDSA 2 and 3 respectively. An overall improvement was noted in all eight standards measured following implementation of the smart phrase in PDSA 2 and 3. Lack of time to complete documentation was highlighted.

Conclusions
The smart phrase has provided a structured and effective mean of documentation. However, orthopaedic consultants need to allocate more time to ensure completion of documentation for each cases discussed.
471 Accuracy of Preoperative MRI for Rectal Cancer: A Retrospective Study at a District General Hospital
Authors: Wani I , Husain N , Thomas P , Alam A , Narayanasamy S 
Published: August 2023

Abstract

Aim
To investigate the accuracy of preoperative MRI for rectal cancer in the form of sensitivity, specificity, positive predictive value and negative predictive value.

Method
The retrospective study included a cohort of 47 patients of rectal cancer from April 2017 to March 2022 who were treated with upfront surgery. With histopathology taken as standard the accuracy of preoperative MRI was calculated.

Results
The records of 47 rectal cancer patients were analysed who were offered primary surgery. The sensitivity and specificity of MRI for T1-T4 were 60%, 19%, 94% and 100% and 97%, 84%, 48% and 100% respectively. The sensitivity and specificity of N0- N2 staging were 46%, 57% and 50% and 61%, 53% and 95% respectively. The positive predictive value and negative predictive value of MRI for T and N staging were 69%, 85%, 44% and 77% respectively.

Conclusions
In our study, the results were not at par with other national and international studies. MRI is a useful tool for planning management of rectal cancer patients. The accurate preoperative staging is very important for planning the management of these patients.
475 Forgotten Antegrade Ureteric Stent: What Can We Do?
Authors: Desouky E , Koura M , Gill S , Omar M 
Published: August 2023

Abstract

Introduction
In the UK, forgotten ureteric stents are considered a ‘never event’ and hence can be a source of significant litigation. Forgotten ureteric stent was the most frequent postoperativerelated claim over 14 years in 2011.

Aim
To assess the possible risk factors for missing an antegrade (AG) stent in a patient.

Method
Retrospective data collection from Interventional radiology (IR) department: 1. Date of AG stent insertion 2. Date of request for the next step (definitive treatment either removal or exchange) To assess: • Time lag = Number of days between AG stent insertion and requesting the definitive procedure • Any other possible risk factors for ‘forgotten stent’ Audit

Results
Audit (01 Jan – 15 Dec 2019): • Total number of cases (N) = 45. • Time lag: Range 1 up to 73 days (Mean: 13.1 days).

Action plan
1-requests for AG stent insertion must come only via urology team 2-on AG stent request, provisional draft is already drafted 3-AG stent request generates auto,atci request for the next uro-radiology meeting as a safety net 4-in IR, documentin patient notes and flag to uro-radiology meeting 5-discharge summary to include stent management time frame.

Re-audit
Results (01 Jan – 30 Jun 2020): • Total number of cases (N) = 30. • Time lag: Range – 1 up to 11 days (Mean 3.5 days).

Conclusions
Safe practice of AG stent insertion requires coordination between urology and radiology departments to action a plan for stent removal /exchange can safety net such patients and avoid the hazard of a ‘forgotten stent’.
554 One Stop Flexible Cystoscopy; Impact of COVID-19
Authors: Corrigan A E , Jauhari S , Frater J , Ahmed I 
Published: August 2023

Abstract

Introduction
Due to the COVID-19, there has been a decrease in patient access to flexible cystoscopy within urology and an increase in telemedicine to assist with patient contact and care. It is pertinent to consider the impact of the pandemic on the patient experience, satisfaction, and awareness of services alongside clinical delays.

Aim
The aim was to assess degree of patient satisfaction across East Kent University Hospital Trust and illicit the prevalence of patient education across the cohort. The secondary aim was to report distribution of referral time as well as timings of CT/USS scans across the cohort.

Method
A retrospective analysis of hospital appointments from March-October 2020 and telephone surveying of the patient population was conducted. A 14-question survey was created to consider patient-reported outcomes and experiences.

Results
539 flexible cystoscopy appointments took place from March-October 2020. From these, 44.4% of CT/USS scans were done after the flexible cystoscopy, rather than before (16.40%). 76% of referral times took under 14 days. Patient satisfaction remained high, 60% and 27% reported feeling very satisfied and satisfied, respectively, with the service. However, 47.1% of the cohort did not completely understand the plan after discharge.

Conclusions
While patient experience appears to have remained positive despite the COVID-19 pandemic, there has been a significant impact on secondary investigation timings and patient education. There is a need to consider the clinical implications of delayed imaging and consider methods to improve patient care and information after discharge. QIPs are underway to address issues raised.
566 Improving Neurovascular Status Assessment and Documentation in the Emergency Department: A Closed-Loop Audit
Authors: Harper J , Freeman O , Esland J 
Published: August 2023

Abstract

Aim
To improve neurovascular status assessment and documentation in the Emergency Department.

Method
Clinical notes were reviewed for 55 consecutive patients presenting with extremity fractures during February and March 2022. Neurovascular (NV) assessment and documentation was reviewed at presentation and after any intervention to the limb. Semi-structured interviews were conducted with Emergency Department staff, to identify barriers to NV assessment and documentation. Changes were implemented and the audit cycle repeated in October 2022 for 56 consecutive patients.

Results
The main barriers to NV assessment and documentation were forgetfulness, lack of awareness of requirement to document NVS pre- and post-intervention, poor quality induction given to clinicians of the importance of documenting NVS and lack of awareness of track commands. Three changes were therefore implemented: a video on NV assessment for new starters; a teaching session for current staff; a ‘shortcut’ for typing the NV assessment in the electronic patient record.
Improvements were made in all domains; documentation of NVS for ankle fractures pre-manipulation increased from 73% to 96%, and from 31% to 46% for post-manipulation between loop 1 and 2. Documentation of NVS for wrist fractures pre-manipulation increased from 93% to 96%, and from 14% to 36% for documentation post-manipulation. Improvement was most noticeable in the documentation of individually named nerves, increasing by 16.4% (p&lt;0.05).

Conclusions
Semi-structured interviews were helpful in illuminating areas for improvement. Importantly, these were sustained for over 6 months. A third cycle is in progress, where further incremental gains are sought.
661 Evaluating the Efficacy of Post-Operative VTE Prophylaxis in Fragility Hip Fractures: DOAC vs LMWH
Authors: Karthikeyan N , Efiannayi A , Karim D , Sutharson M , Al-Saffar B 
Published: August 2023

Abstract

Aim
Direct oral anticoagulants (DOACs) are licensed for use as venous thromboembolism (VTE) prophylaxis in elective hip surgery however low molecular weight heparin (LMWH) is the mainstay for VTE prophylaxis in hip surgery following fragility fractures. Due to social distancing regulations during the COVID pandemic in 2021, it became increasingly difficult for community nurses to administer LMWH injections post-operatively whilst DOACs offered a less invasive alternative. This study aims to evaluate efficacy of DOACs in comparison to LMWH as VTE prophylaxis following hip surgery in fragility fractures.

Method
Retrospective, population-based cohort study of patients discharged on VTE prophylaxis with LMWH and DOAC in 2019 and 2021 respectively following fragility hip fracture. Data was obtained through National Hip Fracture Database and electronic medical records. Data collected included patient demographics, comorbidities, current medications, time to surgery, level of independence pre- and post-discharge and length of stay. Main outcomes assessed were incidence of VTE within 6 months.

Results
A total of 200 randomly selected patients were included. Following discharge, incidence of VTE was 1% in the LMWH group (n = 100) and 1% in the DOAC group (n = 100). All patients received LMWH and TED anti-embolism stockings as an inpatient. Average length of time on DOAC following discharge was 3.5 weeks.

Conclusions
The study shows non-inferiority of DOACs in VTE prophylaxis post-operatively when compared to LMWH. It supports a case for their use in post-operative management of fragility hip fractures. Further data surrounding compliance to DOAC following discharge will allow accurate evaluation of its efficacy.
739 A Service Evaluation of Post-Operative Risks for Surgical Dental Procedures Following Paediatric Out-Patient General Anaesthetic
Authors: Loo Y , Budhdeo R , Newton L , Kabban M , Harrison M 
Published: August 2023

Abstract

Aim
To evaluate post-operative outcomes for paediatric patients who have undergone surgical procedures under general anaesthetic in the out-patient day surgery unit.

Method
A retrospective evaluation of all children under 16 years old who attended for Day Surgery procedures between 1/10/22 and 31/12/22 at Guy’s Hospital, London was completed.
Patient notes were assessed to identify surgical procedures, the risks the patient had been consented for pre-operatively and the incidence of post-operative risks.

Results
In the 2-month period, 303 patients were seen in Day Surgery. 209 completed a course of comprehensive dental care, 94 required exodontias only and 21 had a surgical extraction included in their treatment under general anaesthetic.
1 patient experienced a risk that had been planned for: an oro-antral communication following removal of an infra-occluded maxillary molar.
1 patient required an apically repositioned flap after unfavourable positioning of the orthodontic bracket during exposure and bonding of an unerupted tooth.
2 patients were offered a telephone review post-operatively and no patients required a face-to-face review.

Conclusions
All patients requiring dental surgical procedures should be consented for appropriate risks including damage to adjacent structures and possible altered sensation if nerve tissue is close to the expected surgical site. The possibility of oro-antral communication should also be addressed pre-operatively. Where exposure and bonding of orthodontic brackets are planned, the risk of a change in the gingival contour and health should be outlined. By comprehensively discussing possible post-operative complications, patient expectations and care can be optimised, and consent can be fully informed.
759 Electronic Discharge Summary Audit
Authors: Asif A , Elmaradny A 
Published: August 2023

Abstract

Aim
Electronic discharge summaries (EDS) in General Surgery were found to be lacking adequate clinical information. The Professional Records Standards Body (PRSB) released guidance, endorsed by NICE, with the information required in an electronic discharge summary. The aim of the study was to monitor and record how many EDS’s have been completed with all the relevant/required sections completed.

Method
A retrospective analysis of EDS of 50 patients admitted under general surgery at Worcestershire Royal Hospital was conducted. Yes, No or N/A were marked against 13 categories based on PRSB guidelines. 4 cycles were carried out between 2020 to 2022.
After cycle 1, a poster was introduced outlining the criteria for electronic discharge summaries (Figure 1). A printed version of the poster was placed in the doctor’s office. After cycle 2, feedback was collected from junior doctors who suggested a teaching session on how to write electronic discharge summaries. A teaching session was delivered to junior doctors prior to cycle 3 and 4.

Results
The overall level of compliance for each cycle was as follows-Cycle 1- 8% complianceCycle 2- 22% complianceCycle 3- 34% complianceCycle 4- 69% compliance

Conclusions
The poster and teaching session proved effective at improving compliance.It was found there was poor compliance in completing the comorbidities section in the EDS. Acknowledging feedback from the junior doctors helped provide useful teaching sessions so we will continue regular teaching sessions. Continue annual audit of EDS' to increase compliance.
783 Do We Need Laminar Flow in Trauma?
Authors: Lewandowski D , Hussain A , Ahuja S , Matthew A 
Published: August 2023

Abstract

Aim
Laminar flow in theatres has become standard of care in orthopaedic implant surgery. Most of the evidence for laminar flow use is based on arthroplasty surgery, with early studies showing significant reduction in infections. We conducted a retrospective comparative study to assess Surgical Site Infection (SSI) rates in consecutive patients undergoing surgery for trauma in laminar and non-laminar flow theatres.

Method
Due to COVID restrictions our trauma care provision was restructured. This resulted in trauma surgery being performed in non-laminar flow theatres. We identified consecutive patients who had trauma surgery pre and post pandemic from February 2019 to June 2021 to avoid selection bias. There were 1010 in laminar theatre group and 1000 in non-laminar theatre group. SSI rates within the first 90 days. The two groups were statistically similar in terms of age and gender of the patients.

Results
28 patients developed surgical site infections in non-laminar flow theatres and 29 patients in laminar flow theatres. There was no significant difference between the SSI rate in laminar flow theatres (2.87%), as compared to non-laminar flow theatres (2.80%) (p = 0.92034). There was no link between infections and duration of surgery. 2 patients in the laminar flow group were MRSA positive and were excluded.

Conclusions
In our study, laminar flow theatres did not show a statistically significant reduction in surgical site infections. We conclude in the practical environment of trauma theatres; the theoretical advantage of laminar flow does not translate to an observable reduction of infections.
854 Paediatric Tracheostomy Decannulation: An Updated Protocol at Nottingham University Hospitals (NUH)
Authors: Hyland L 
Published: August 2023

Abstract

Introduction
Tracheostomy decannulation is an extremely important part of tracheostomy care in paediatric patients. Due to the increased risk of morbidity1 (bleeding, respiratory infection, airway plugging, accidental decannulation) and mortality2 (0.5-3.6%) associated with prolonged tracheostomies, it is strongly advised to decannulate the paediatric patient as soon as the underlying cause for tracheostomy placement is corrected or resolved3. A simple to navigate protocol is required in order to establish a safe and efficient way of decannulation as well as knowing when and how to decannulate. The literature varies widely in regard to an optimal method and the process leading to decannulation can often be different for each individual patient; as such, this may require review on a case-by-case basis.

Protocol
We have developed an NUH specific protocol in the format of a flow chart to act as a guideline in successfully decannulating paediatric tracheostomies. It provides the foundations in assessing each paediatric patient’s clinical readiness and subsequent progression of decannulation. We have incorporated Mitchell et al’s 2013 clinical consensus statement on tracheostomy care as the primary resource for the creation of this protocol. It is suitable for any member of staff looking after paediatric patients with tracheostomies, whether they be situated on a paediatric ward, PHDU or PICU. In addition to care from parent teams and nursing staff, it is important for each paediatric tracheostomy patient to have input from the long-term ventilation (LTV) team who can offer support in the timing and progression of decannulation.
948 The National Consultant Information Programme (NCIP) and Its Effect on Current Colorectal Surgical Practice, Specifically Looking at Exenteration of Pelvis for Lower Gastrointestinal Cancer
Authors: Galla A , Maxwell-Armstrong C , Young L , Booth M 
Published: August 2023

Abstract

Aim
Extract and contextualise relevant data from NCIP data set on exenteration of pelvis for lower gastrointestinal cancer. Identify and analyse trends to understand Covid's impact on surgical practice, understand any variations seen at trust and national level, and understand the importance and application of NCIP.

Method
Pseudonymised data extracted from NCIP dashboard as an Excel document by NHS England Improvement data analysts. NCIP data is primarily from Hospital Episode Statistics, and other relevant databases and registries. Data includes various metrics including demographics, length of stay (LOS), and anonymised provider codes.Visual aids created from analysed data to explain various metrics, and observed trends. Data contextualised by comparing observed data with previous literature, if possible.

Results
687 patient cases from April 2018-March 2022. All elective, all 17+ years.
340 cases between April 2018 to March 2020 and 347 cases between April 2020 to March 2022.
4 procedure types: 11 Lateral Lymphadenectomies, 20 Other Exenterations, 161 Posterior Exenterations, 495 Total Exenterations. Decrease observed in cases done post-covid for all procedure sub-groups except total exenteration (5% increase).
40 centers across England, 99.27% of cases performed at NHS trusts. Center variation observed with numerous providers doing &lt;10 cases in the 4-year period.
Average LOS: 23.65 days, however maximum LOS of 154 days for 2 total exenteration procedures.

Conclusions
Impact of Covid pandemic not observed in the data. Significant variation observed at provider level for each procedure sub-group, possibly contributing to variation observed in metrics such as LOS. Data suggests the need for further exploration into observed variation.