bluuebunny/crossref_metadata_2025_split huggingface dataset:
722 Audit on Improving the Management of Pre-Operative Medication Prior to Elective Surgery
Authors: Ong W , Choo J H 
Published: August 2023

Abstract

Aim
Patients presenting for elective surgery frequently omit one or more regular medications. Inappropriate management of some medication classes may lead to pre or perioperative complications. Our objective was to assess if preoperative patients are receiving their prescribed medications correctly preoperatively.

Method
A 2 staged PDSA cycle was conducted. All patients admitted to the elective surgical ward were sampled. Patients’ drug chart was retrospectively reviewed to determine if their preoperative medications have been correctly prescribed. Our interventions included posters to be displayed in elective surgical wards following the first wound and local departmental teaching during the second cycle of the audit. This 1ST and 2nd cycle were re-audited at 2 month and 4 months interval respectively to assess compliance and monitor for improvement.

Results
In the first cycle, 50 patients were included in the first round and 45 in the re-audit. 19/50 (38%) patients received their medications correctly. Post implementation of the posters, this improved to 56% (n = 25/45). During the second cycle, the baseline data reported 55% (n = 33/60) of the patients had their medications correctly managed preoperatively. The reaudit statistics demonstrated a rise to 71% (n = 35/50).

Conclusions
This quality improvement audit shows that our interventions between audit cycles have made a significant improvement in patients receiving their medications and therefore this has a direct positive impact on patient safety and outcomes. Work to introduce an electronic record of drug chart to this NHS trust is still underway.
731 Acute Pancreatitis: The Experience of a District General Hospital Following the Introduction of a New Care Pathway
Authors: Raby-Smith W , Manley L 
Published: August 2023

Abstract

Aim
Acute pancreatitis is a common surgical condition associated with significant morbidity and mortality. Outcomes depend on establishing disease severity, identifying complications and prompt initiation of management. Despite the recognised complications and mortality, the management of acute pancreatitis is often found to be highly variable. This study aimed to examine the effect of a new care pathway on the documentation and management of patients admitted with acute pancreatitis at a district general hospital (DGH).

Method
This clinical audit measured the compliance of a general surgical department at a DGH with NICE (National Institute of Care and Health Excellence) and IAP (International Association of Pancreatology) guidelines. Through a retrospective case note review, documentation and management were assessed for patients admitted with acute pancreatitis over two four-month periods before and after the introduction of a new care pathway.

Results
Following the introduction of the care pathway, we observed that compliance with guidelines improved across all measured outcomes including admission documentation, the use of diagnostic imaging, nutritional recommendations, and the use of the Modified Glasgow score to predict severe pancreatitis.

Conclusions
Based on these findings, we advocate for the use of a comprehensive care pathway, such as the one introduced in this audit, to standardise the documentation and management of patients admitted with acute pancreatitis and improve compliance with NICE and IAP guidelines.
760 Single Centre Evaluation of the Risk of Bleeding Following Cutaneous Skin Surgery in Patients with Long-Term Antithrombotic Drugs
Authors: Gujjuri R R , Nagra R S , Salibi A 
Published: August 2023

Abstract

Aim
The peri-operative management of antithrombotic drugs for skin surgery remains heterogenous with varying practice regarding the interruption of these drugs. This audit aimed to evaluate the risk of bleeding following cutaneous surgery in line with the British Society for Dermatological Surgery (BSDS) guidance on antithrombotic and skin surgery.

Method
All patients undergoing cutaneous surgery in a single centre were identified following a retrospective review of electronic health records between September to October 2022. Patients were included if they were on antithrombotic therapy in the operative period. Data were collected on demographics, operation type and site, reconstruction, antithrombotic agent and post-operative complications. The primary outcome was the rate of postoperative bleeding. Secondary outcomes included post-operative infection rate, bleeding risk of the cutaneous procedure and other surgical complications.

Results
This audit included a total of 71 patients who underwent surgery while on antithrombotic drugs, with 55, 12 and 4 procedures being determined as low-, moderate- and high-risk as per the BSDS classification. Of all patients, 8.5% experienced bleeding as a post-operative complication and 50% of these patients were on direct oral anticoagulants (DOACs). In moderate- and high-risk procedures, 37.5% of patients experienced either bleeding or infection.

Conclusions
Patients on antithrombotic drugs undergoing cutaneous skin surgery may be at an increased risk of post-operative bleeding and infection. Patients who are due to undergo moderate to high-risk cutaneous surgery and are established on DOACs or potent antiplatelet drugs should have these agents paused prior to surgery in an effort to minimise complications.
802 Are Patients with Malignant Melanoma Operated on Within National Cancer Waiting Time Standards?
Authors: Khatun A , Clark S 
Published: August 2023

Abstract

Aim
This audit evaluated the performance of the local melanoma referral pathway against national cancer wait times, to identify limiting factors and find solutions to deliver service in a safe and streamlined manner.

Method
Patients with malignant melanoma referred to general surgeons between March and June 2022 were identified retrospectively. Patients with other skin cancers, concurrent malignancy, metastatic melanoma, or those declining surgery were excluded.
The date of each step of the referral pathway was noted for each patient using Microsoft Excel, and the difference between the dates was calculated. The percentage of compliance with the 31-day and 62-day wait was compared against the national operational standard.

Results
During the audit period, 59 patients with malignant melanoma were referred to the general surgeons, 22 of these were excluded for the aforementioned reasons. Of the remaining 37 patients, 65% were male and the average age was 66 years old. 83% of patients received their first treatment from diagnosis within 31 days, falling short of the 96% target. Only 60% of patients received surgery within the following 31 days. On average it took 56.8 days from diagnosis to surgical treatment, with wait time to operation varying from 15 days to 101 days.

Conclusions
Overall, the average time to surgery for patients with malignant melanoma was less than the target 62 days, however there was notable variation in the number of days patients waited for their operation. Further detailed analysis of cases with long wait times is required to reduce the risk of delaying vital cancer treatment.
804 Audit of Hand-Written Consent Form Documentation for Skin Lesion Excisions in the Plastic Surgery Procedure Room
Authors: Egbuji O , Zengin H , Saad M , Rosich-Medina A , Sheppard N 
Published: August 2023

Abstract

Aim
To audit the hand-written consent forms for elective excision of skin lesions in the Procedure Room.

Method
The notes and consent forms from 11 Procedure Room sessions were analysed. The total number of notes reviewed were 24. Our audit standards focused on the consenter and the completion of sections of the audit form. There are no standard guidelines for the complications of skin lesion excision, therefore a consensus from the general consultant body was used.

Results
Our patient demographic mostly consisted of male patients (15, 63%) with a mean age of 50 (range 17 – 75). 83% of the procedures required no reconstruction, 8% were biopsies and 8% required a full thickness skin graft (FTSG). 75% of the consenting clinicians were Registrars. The rest were Senior House Officers. All the consenters documented their job title, signed and dated their signature. All were trained in consenting and each consenter performed the procedure. 100% of clinicians used the correct consent form, documented the proposed procedure, clearly documented the site and risks and placed a label on every page. 83% completed the ‘intended benefits’ section. 58% wrote the procedure name in full. Every clinician documented bleeding and infection as a risk factor. 54% pain, 75% re-excision of margins, 71% recurrence and wound breakdown, 96% scarring, 46% injury to surrounding structures and 0% anaesthetic risk. All patients who received a FTSG, had graft loss documented as a risk.

Conclusions
The quality of hand-written consent forms is user dependent. A pre-filled consent form is proposed to increase compliance.
807 Lower Limb Pathological Fracture Audit
Authors: Nawaz S M , Karayiannis P , Heyes G 
Published: August 2023

Abstract

Aim
To minimise the delays in surgical management and differentiate among patients with suspected and not suspected pathological fracture.

Method
Review of all patients admitted since January 2022 with pathological fracture or suspected Pathological fracture. Reviewed gospels (previous recorded/saved files) and then ECR/radiology systems for outcomes. All spinal patients and all upper limb patients were excluded as they are ambulatory.

Results
Initially identified 24 patients, 10 excluded and 14 patients included. 10 were females and 14 were males. Mean age was 69 (range 45 – 90). Majority site of lesions were on hip (with 11 patients). Majority of investigations were CT scan, MRI and bone scan which took mean time of 14 days for completion and mean time to theatre was 26 days.
Mean length of stay – 21 days (range 3 – 77, mean 16 with outliers excluded). 50% patients died at 6 months follow up. 1 patient passed away as inpatient and 1 dislocated Pelvic floor repair but was not suitable for further surgery whereas 1 requiring return to theatre for washout and debridement.

Conclusions
A patient with a suspected pathological fracture is at risk of hugely significant delay to life saving or life prolonging operation. Patient who requires biopsy at present will not get to theatre within 3 weeks of injury.
843 Asymptomatic Bacteriuria at Flexible Cystoscopy- Can We Reduce Cancellations?
Authors: Jeevanandan P , Baby A , Mahesan T 
Published: August 2023

Abstract

Introduction
At our trust patients with nitrite positive urinalysis attending for flexible cystoscopy (FC) are rescheduled, placing a heavy burden on over stretched NHS resources. It is accepted that asymptomatic bacteriuria (AB) affects up to 20% of patients over 70. Catheters, stents, and recent antibiotics for a urinary tract infection also significantly increases this risk.
Recent evidence suggests that proceeding to cystoscopy in patients with AB is safe, and we evaluated our cohort of patients to identify what proportion of our patients it would be safe to proceed in.

Method
We reviewed all outpatient FC over a four-month period. We interrogated cancelled FC procedures where patients were cancelled for a nitrite positive urinalysis. Information recorded included result of urine culture, whether an antibiotic was prescribed and risk factors for AB.

Results
1241 FC were performed. Mean age was 78.4. In a total, 61 patients (4.9%) were postponed due to nitrite positive urinalysis. 58 (95.1%) patients were asymptomatic, of which 31 (53.4%) demonstrated bacterial growth on culture. Risk factors for AB included catheters (n = 14), a ureteric stent (n = 2), regular antibiotics for recurrent UTIs (n = 27).

Conclusions
Data collected confirms our cohort is at high risk of AB. Based on the findings from Trail et al, we propose that proceeding to FC in patients with asymptomatic bacteriuria is safe and intend to implement this change in our department. This will reduce demand on FC waiting lists and improve time to diagnosis.
858 The Effect of a ‘Rib Fracture Pathway’ on the Efficiency of Rib Block Delivery at a UK Major Trauma Centre
Authors: Bethel J , Christodoulou A , Smart Y W , Emer N , Fernando K , Vasireddy A 
Published: August 2023

Abstract

Aim
Rib fractures carry a mortality rate of 10% which is doubled in the elderly population. They are common following blunt thoracic trauma and are a marker of injury severity. Timely delivery of regional analgesia is crucial to prevent secondary respiratory complications. We compare the time taken from admission to administration of a regional block in patients with &gt;2 rib fractures before and after the implementation of a rib fracture pathway.

Method
Retrospective data was collected from 22 pre-pathway and 47 post-pathway patients who were given a regional block after suffering &gt;2 rib fractures. Demographic data, ISS, length of stay and respiratory complications were collected. Need for block was determined by clinical factors including uncontrolled pain and limited respiratory effort.

Results
Time to block from admission was longer in pre-pathway patients (41.9±33.8 vs 23.9±21.2 hours, p = 0.03). There was no significant difference in length of stay (21.6±14.2 vs 19.9±14.5, p = 0.3).
Pre-pathway patients were significantly younger (54.6±15.0 vs 66.8±17.4 years, p = 0.006) and had fewer rib fractures (5.4±2.3 vs 7.4±3.5, p = 0.02).
The mean ISS was 24.1±10.3 and 18.1±8.5 in the pre- and post-pathway patients, respectfully (p = 0.02). There was no significant difference in post-admission chest infection rates (18.2% vs 23.4%, p = 0.4).

Conclusions
The time taken from admission to block in patients with multiple rib fractures significantly reduced following the implementation of a ‘Rib Fracture Pathway’ at a UK Major Trauma Centre. Further work is required to determine whether this will affect length of stay or patient outcomes.
877 Utility Value of Colonoscopy in the Over 80's
Authors: Challapalli P , Gokul K , Artiuokh D 
Published: August 2023

Abstract

Aim
To audit the rationale and efficacy of colonoscopy in the over 80’s over a year period at Southport hospital which caters to a geriatrically skewed population. Currently protocol driven diagnostic pathways often lead to direct triaging of patients to endoscopy preventing assessment of biological age of patient, practicalities of the procedure and risk-benefit ratio.

Method
A retrospective audit with data in 105 patients over the age of 80 who underwent colonoscopy in 2021 January – December 2021 was collated. An audit proforma looking at pre-, during- and post -colonoscopy data was evaluated using the hospital endoscopy records and clinical records.

Results
Pre-colonoscopy demographics showed that anaemia (31%) and change in bowel habit (26%) were the most common indications for colonoscopy. Completion rates, diagnostic yield and complication rates were evaluated. Completion rate was 73%. Positive findings were diverticulosis (52%), polyps (9%), colitis (3%) and malignancy in 15%. Mitigating factors for non-completion and poor efficacy were discomfort, angulation, poor bowel prep as well as incriminating polypharmacy and comorbidity.

Conclusions
Based on the audit findings targeted endoscopy in this age group is a better management rather than its usage as first line investigation to achieve maximum efficacy.
887 Developing Patient Information Leaflets for Patients Undergoing Emergency Laparoscopic Appendicectomy & Cholecystectomy
Authors: Finch B , Imran H , Wakefield C 
Published: August 2023

Abstract

Aim
Appendicectomy and Cholecystectomy operations are the two most common general surgical emergency operations performed at Royal Hampshire County Hospital. Despite this, patient information leaflets (PILs) about these emergency operations are unavailable, compromising standards of care and uncompliance with Trust policy and National guidelines. The project aimed to establish levels of written information offered to patients undergoing an emergency appendicectomy or cholecystectomy, and to assess the impact on patient’s understanding regarding all aspects of their operation after the development of PILs.

Method
Baseline data was collected via prospective analysis of all patients undergoing an emergency appendicectomy or cholecystectomy between December 2021 – February 2022. Questionnaires were given to patients post-operatively to assess their understanding on all operative domains. A PIL was designed and approved by the Trust’s Communications-Team, published online via Trust Extranet and distributed onto surgical wards with staff education. A re-audit was completed between April-June 2022.

Results
0% (0/14) of patients were offered written information at baseline, despite 86% reporting PILs would have been useful. PIL compliance rose substantially to 80% (12/15) in our re-audit. Implementation of a PIL led to greater understanding of the operative complications and the recovery-period, as well as an overall improved hospital experience.

Conclusions
This project indicates that provision of written information is poor despite it being highly valued by patients. Implementation of PIL for emergency operations led to greater patient understanding and hospital experience, thus improved compliance to National guidelines. However, continued education of staff is essential to embed good practice over the long term.
899 Administration of Fascia-Iliaca Blocks for Hip Fracture Patients on Admission to the A&E Department at Southport DGH
Authors: Moss M , Sha S , Sangani C , Gledhill P 
Published: August 2023

Abstract

Aim
Fascia-iliaca block (FIB) is regional anaesthetic used in A&E for hip fractures; they’re performed under landmark guidance in Southport A&E. NICE recommend FIBs for hip fractures if PO/IV paracetamol/opiates provide insufficient relief; it’s shown to provide superior analgesia and reduce opiate consumption. RCEM state FIBs should be administered promptly in A&E by trained personnel and are a listed ACCS competency.
The audit aim was to review the number/percentage of hip fracture patients receiving FIBs, with documentation, in Southport A&E. Hip fracture patients should have documented FIBs, the standard for the audit was ≥90% patients.

Method
This audit was a retrospective analysis of the 6-week period 08/08/2022-20/09/2022 for hip fracture patients at Southport DGH. Data was collected from the National Hip Fracture Database. Patients weren’t delayed to surgery on FIB administration. Online inpatient/A&E notes and drug charts were analysed for FIB documentation.

Results
The sample included 46 patients, 8 male and 38 female. 13 had documented FIBs on admission, 33 had no documented FIB, meaning 28.2% of patients received FIBs in A&E over 6-weeks.

Conclusions
This audit shows too few hip fracture patients are receiving FIBs in Southport A&E as analgesia, with 28.2% documented compared to the desired ≥90% standard. Patients are either not receiving FIBs or not having them documented. FIB use can be improved by clinical audit, and interventions are being implemented to improve use in Southport A&E, including posters, hip fracture proforma additions, and department education.
900 Assessing the Use of GIRFT Guidelines and the Role of a Natural Language Processing Artificial Intelligence System for Operation Note Documentation in Emergency General Surgery – a Closed Loop Prospective Audit & Comparative Study
Authors: Karki B , Rossi L , Peckham Cooper A , Burke J 
Published: August 2023

Abstract

Aim
4.6 million NHS operation notes (ONs) are generated annually. The Getting it Right First Time (GIRFT) Initiative created procedure-specific guidelines for ON documentation. Natural Language Processing (NLP) Artificial Intelligence systems have the potential to improve documentation quality. This audit aimed to test the potential of GIRFT guidelines (P1) and a novel NLP programme against surgeons (P2) to improve ON documentation quality.

Method
P1: The five most recent, consecutive ONs from a tertiary-centre CEPOD list for Laparoscopic Appendicectomy (LA), Laparoscopic Cholecystectomy (LC), Open Inguinal Hernia (IH), Emergency Laparotomy and Small Bowel Resection (ELS) were collected, anonymised, and assessed against GIRFT guidelines by two independent reviewers. All surgeons were then educated on the four guidelines (intervention) and the audit loop was closed. P2: NLP ONs using ChatGPT (OpenAI-USA-Ver.15/12/22) were produced using five iterative response generations.

Results
P1: 40 ONs were assessed across 2200 marking points. Post-intervention, median documentation scores improved by +12.3% [p = 0.033] (LA), +0.6% [p = 0.500] (LC), +25.5% [p = 0.006] (IH) and +9.5% [p = 0.030] (ELS). The most accurate documentation was LA in cycle 2, median score 72.7% [IQR = 8.5].
P2: ChatGPT performance improved by a median of +29.7% [IQR = 9.4] between response generation 1 to 5. ChatGPT scores were inferior to cycle 2 surgeon scores: -37.4% [p = 0.006] (LA), -47.7% [p = 0.002] (LC), -39.6% [p = 0.002] (IH) and -32.3% [p = 0.006] (ELS).

Conclusions
Using GIRFT documentation guidelines can improve the quality of ON documentation. ChatGPT performed significantly worse than surgeons across four EGS procedures. However, average NLP scores improved by 1/3, by the fifth-generation response, indicating promise as a future adjunct.
901 Assessing Adherence to RCSEng Standards for Operation Notes in Patients With Neck of Femur Fractures: A Closed Loop Audit
Authors: Bull D , Cai J , Ensor D , Greenfield M , Boardman D 
Published: August 2023

Abstract

Aim
To determine the accuracy with which Royal College of Surgeons of England (RCSEng) standards for documenting surgical procedures were met within a defined patient group, with the goal of improving patient safety, and improving documentation for medicolegal purposes.

Method
We conducted a closed loop audit on adherence to RCSEng standards for operation notes. We calculated the percentage adherence for each measurable standard and overall note, and presented the data at a local clinical governance meeting. We implemented autotext templates for operations to improve quality of operation notes in following RCSEng standards. We collected data retrospectively after 3 months to complete the audit cycle.

Results
We included 24 patients in the first cycle and 16 patients in the second cycle. Prior to intervention, the overall percentage of measurable standards met was 69.4%, which increased to 76.4% after intervention. The five least adherent standards all improved in percentage, with the largest increase from 33.3% to 93.8%.

Conclusions
In the first cycle, 3 of the measurable standards were met 100% of the time, which increased to 4 in the second cycle. Along with the general improvement of standards met, the interventions improved patient safety and surgeon documentation. Operation notes using templates generally recorded higher percentages of standards met than those without templates, but further work is needed to ensure more standards meet the 100% ideal.