bluuebunny/crossref_metadata_2025_split huggingface dataset:
613 The Use of an Online Sepsis Screening Tool to Improve the Initial Management of Sepsis
Authors: Richardson P S , Murphy B 
Published: August 2023

Abstract

Aim
The aim of the project was to improve the adherence to sepsis management guidelines in Trauma and Orthopaedic patients through the use of an online Sepsis Screening Tool (SST). This was created to increase recognition of the early signs of sepsis to guide time critical interventions thus improving patient care.

Method
A retrospective audit of adult Trauma and Orthopaedic inpatients with a NEWS2 score of over 5, or 3 in one parameter, or a new suspected infection within a seven-day period was conducted in July 2020, March 2021 and August 2021 for each audit cycle respectively. We then assessed whether the SST and time critical interventions had been completed.

Results
After the initial audit in July 2020 showed the use of the SST and achievement of time critical interventions was poor, we introduced several interventions including information posters, and sepsis teaching for junior doctors. Further interventions were implemented after repeat audit cycles, including the incorporation of the SST within daily nursing safety huddles. By August 2021 the use of the SST had increased from 10% to 54%. This was associated with improved adherence to the sepsis management guidelines including correct observation frequency and medical review within 1 hour. Communication of a sepsis diagnosis to patients and family members also improved.

Conclusions
The completion of the SST increased adherence to sepsis management guidelines in our patients. We therefore recommend the use of Sepsis Screening Tools to identify patients at risk of sepsis and to improve their initial management.
649 Closed Loop Audit: Improving Surgical Handover in a Major Trauma Centre (RSCH)
Authors: Nour H M , Malik Magsi A , Mohamed M , Qasim M , Swaminathan C , Sajid M S 
Published: August 2023

Abstract

Aim
The goal of handover is the accurate reliable communication of task-relevant information across shift changes or between teams. Effective and safe transfer of clinical information is critical for patient safety. The aim of this study to assess Surgical handover in Royal Sussex County Hospital comparing it to the RCS guidelines as standard as well as improving the current practice.

Method
We undertook two cycles each cycle lasted for 6 weeks. These cycles aimed to assess the surgical handover and comparing them with RCS guidelines using checklists. A teaching session was conducted between the two cycles. In addition, RCS guidelines were handed over to all surgical doctors.

Results
we discussed a total of 2348 patients in morning surgical handover, over a period of 12 weeks (first cycle: 1203, second cycle:1145). Following conduction of teaching sessions and handing over guidelines, there was a significant improvement in documentation of patients age (from 73% to 97%), responsible consultant (from 92% to 98%), significant investigations (from 60% to 93%) and management plan (from 64% to 96%).

Conclusions
Education about proper handover was proven to be successful in improving the quality of surgical handover in a major trauma center.
692 Standardised Management of Hallux Fractures Within Virtual Fracture Clinic: A Quality Improvement Project
Authors: Stevens S , Mirza S , Hodgson P 
Published: August 2023

Abstract

Aim
Hallux fractures are a common referral to Virtual Fracture Clinic (VFC), comprising 6% of all referrals made within our Major Trauma Centre (MTC). The cumulative time taken to process these cases equates to 3.75 hours per month.
This commitment of time and resources endeavoured us to evaluate these hallux fracture referrals with the aim to develop a clear treatment pathway to improve the efficiency of VFC whilst safeguarding patient safety.

Method
A database was created containing all patients seen in VFC between 01/01/2022 and 31/01/2022 (n = 279). From this database 15 hallux fracture cases were identified. Using this data, a treatment pathway was created that stratified hallux fractures into high, moderate and low risk groups. This pathway was then implemented within our local A&E department and surrounding minor injury units to allow clinicians to safely discharge uncomplicated hallux fractures back into the community with appropriate safety netting literature.
A 2nd cycle was carried out to evaluate the effectiveness of the treatment pathway by reviewing the number of hallux fracture cases referred to VFC between 17/10/2022 and 14/11/2022.

Results
After implementing our treatment pathway, we saw a 62% reduction in the number of inappropriate referrals made to VFC. Furthermore, we saw a 100% increase in the number of appropriate complex fractures that were brought back to fracture clinic for formal review.

Conclusions
Our treatment pathway has demonstrated a significant difference in how hallux fractures are managed within our MTC in a manner that improves efficiency without compromising patient safety.
732 Who’s Your Consultant Surgeon? - a Quality Improvement Project
Authors: Hinchcliffe Z , Siah Q Z , Ali J , Iacob G , Gelber E 
Published: August 2023

Abstract

Aim
Recommendation 236 of the Francis Inquiry Report (2013) states that all inpatients should have a nominated clinician responsible for their overall admission, improving accountability, safety, and continuity of care. This relies heavily on effective communication, which can be challenging amongst surgical patients due to illness severity and urgent admission process. This Quality Improvement Project (QIP) aimed to investigate recommendation compliance through patient awareness of their named surgical care-teams.

Method
A two-cycle closed-loop QIP was performed across seven surgical wards at a District General Hospital (May-June 2022). A questionnaire was designed to survey baseline patient knowledge of consultant surgeon and nominated nurse’s names. Data on ward/headboard information was also collected. To implement change, junior doctor education was delivered to encourage communication with patients on their responsible care-teams. Post-intervention, results were re-audited as above.

Results
Forty-two patients were included in the baseline cycle; most did not know their surgeon or nurse’s names at 71% and 62% respectively. Post-intervention, from the 49 patients audited, a 14% improvement in awareness of surgeon’s name was shown. At baseline, 76% of ward whiteboards contained correct information on nominated staff, however only 2% of bed-headboards contained the surgeon’s details. Following intervention, this improved to 95% and 24% respectively.

Conclusions
Patient awareness of their responsible surgeon was poor, creating potential issues in compromised care and patient satisfaction. The intervention was successful in raising surgical inpatient awareness of their responsible consultant surgeon and improving compliance in updating ward/headboard information.
1049 Reducing Postoperative Length of Stay After Thyroidectomy by Implementing Standardized Post-Operative Pathways
Authors: Naseer A , Elkorety M , Haesman F , Shadwell A , Bhatti T 
Published: August 2023

Abstract

Aim
Reducing length of stay programme (RLoS) was conceived to ensure better outcome and experience while preserving capacity. Our unit was an outlier in length of stay after thyroidectomy according to British Association of Endocrine and Thyroid Surgeons (BAETS) annual report. We present the results of implementation of a standardized postoperative care pathway to reduce the length of stay.

Method
Patient expectations were managed for an early discharge. A multidisciplinary postoperative care pathway was developed to facilitate early discharge. Protocol was well publicized among the surgical team and the nursing staff.
We evaluated the implementation and efficacy of the pathway. Discharge data was collected on all total thyroidectomies prospectively over 12 months. Comparison was made with two years data of thyroidectomies prior to implementation of protocol.

Results
Prior to protocol implementation, 29 Thyroidectomies were done for benign disease. They were discharged, on post-operative day one 0% (67%), day two 45% (23%), day three 41% (6%), day four 0% (3%) and day five 7% (1%). Figures in parenthesis are national figures from BAETS annual report.
After protocol implementation, 17 thyroidectomies were carried out for benign disease. 87% were discharged on first postoperative day and 13% on second day. No patients stayed longer than two days. There were no patient safety events as a result of implementation of protocol and early discharge.

Conclusions
A structured and well publicized post-operative care protocol and managing patient expectations can significantly reduce postoperative length of stay after thyroidectomy without compromising patient safety.
1080 A Quality Improvement Project Developing a 'Return to Scan' Failsafe Protocol for Barnsley Hospital Emergency Department Patients with Suspected Cauda Equina and Renal Colic
Authors: Luesley A , Ginnis C , Emberey J , Soar I , Pitt S 
Published: August 2023

Abstract

Aim
A staff survey noted patients returning for scans for suspected cauda equina and renal colic were on occasion not returning or returning late. Overall, staff and patient experience were poor and posed risk to patients. To improve this, aims were to develop a standard process for recording ED patients due to return for scan and formalised information about this process to be provided to the patient.

Method
Three cycles were completed. Staff surveys identified areas of concern, supported by a fishbone diagram and process map. A proforma and patient information sheet were developed. Further staff surveys assessed satisfaction and effectiveness of the changes, leading to replacement of the proforma with a patient notes sticker. A booking system was created identifying patients to reception staff. Further cycles identified 64 patients in a 3-month period by suspected diagnosis using SNOMED codes. Records were accessed electronically using Mediviewer to review documentation and time returned for scan.

Results
98% of patients returned for scan. Process followed: 36% of patients returned late, with an average of 22 minutes and maximum of 40 minutes late. Process not followed: 36% of patients returned late, with an average of 58 minutes and maximum of 219 minutes late. The process was followed correctly in 17% of cases.

Conclusions
Patients were late by a shorter on average time when the process was followed - with providing patient information having the greatest positive impact. Staff education may improve process compliance which is poor. Patient experience and barriers to returning on time must be explored.
1186 Cholecystectomy Operation Notes - a Review and Core Trainee Survey
Authors: Kho J , Kuan J Y , Rajendran I 
Published: August 2023

Abstract

Aim
The “Good Surgical Practice” document by Royal College of Surgeons (RCS) England, in line with GMC’s “Good Medical Practice” emphasises the importance of “clear operative notes for every procedure”. The importance of clear documentation is well-established, facilitates effective handover and represents a legal document. A study was conducted to assess current documentation standards, including a survey amongst core surgical trainees on the use of a proforma for documenting cholecystectomies.

Method
A retrospective review of cholecystectomy operation notes collected from hospital database was performed between February 2022 and July 2022. Operative documentation was compared to the guideline published by RCS England. Specific information relevant to cholecystectomy operation were reviewed; critical view of safety/Calot’s triangle, number and type of clips, gallbladder dissection difficulty and spillage of bile/stones. Compliance to RCS standards was considered satisfactory at ≥80%.

Results
109 typed operation notes were reviewed. Majority of information including date and time (100%), procedure name (99%), name of surgeon and assistant (100%), operative findings (100%) and post-operative care instructions including VTE prophylaxis (92%) were clearly documented. Shortfalls in documentation included priority of operation (63%), intraoperative complications (66%), gallbladder dissection difficulty (53%), anaesthetist name (52%), removal of ports under vision (33%) and local anaesthetic details (70%). Survey of eight core surgical trainees found a consensus that a proforma would improve understanding and documentation of the procedure.

Conclusions
The use of an operation note proforma in cholecystectomies could improve patient care and compliance with RCS guideline, and act as a learning modality for surgical trainees.
538 Audit of Robotic Activities at a Tertiary Centre, an Attempt to Identify training Opportunities
Authors: Brodie A , Ullah M F , Khan S , Runau F , Singh B , Chaudhri S , Sangal S 
Published: August 2023

Abstract

Aim
Training in Robotic surgery is still in the development phase. The training opportunities are competitive with consultants and trainees in the learning phase at many centres. We aimed to analyse the use of robotic activity at a tertiary centre across different specialities to find out parallel training opportunities.

Method
Data was collected retrospectively from a prospectively maintained Electronic Theatre record over an eight-month period. We recorded number of days surgical robots are in use per month, number of operations per day and operating times for three subspecialties. Data was analysed using SPSS version 26

Results
The results show the robot was used on average 14.6 days per month. which equated to an average of 20.25 operations per month with an average operating time of 214.43 minutes per operation. The robot was used by Urology for on average 10 days per month, Gynaecology 3.38, and General surgery 1.5 days. The use depends on days allocated to specialities and ITU bed availability. Urology performed on average 13.75 operations per month compared to 5 for gynaecology and 1.5 for general surgery. Average case finishing time for single operation was 15:29, for two operations in a day was 17:36.

Conclusions
Given the robot was used less than half a month on average for operations, we can increase training opportunities by utilising them for training activities on non-operating days. More studies are needed at national level to help in creating a hub and spoke model by using Robots in non-operating times.
872 Two Years of Levelling the Playing Field. Challenges in Sustainability Providing a Free Online National Webinar Series and Mock Interview Scheme
Authors: Richardson D , Wang Y A , Barton J , Doshi A 
Published: August 2023

Abstract

Aim
The Specialised Foundation Programme (SFP) is a competitive training programme for UK medical graduates providing opportunities to pursue academic, educational, or managerial roles alongside clinical work. SFP interviews require knowledge of research methods and critical appraisal, applicants are also assessed in their approach to managing unwell patients. Information and guidance around the SFP vary greatly between medical schools. Where institutional support is lacking, expensive and poorly evidenced preparation courses have flourished, exploiting applicants, and creating a barrier to access.
We sought to address this inequality by providing a free, national, structured teaching programme and running mock interviews.

Method
For two application cycles we conducted a virtual preparation programme followed by mock interviews with clinical academics, aiming to improve perceived preparation and confidence. Outcomes were assessed using questionnaires following webinars and mock interviews.

Results
In each cohort, &gt;120 students from 33 Universities, attended webinars. On average, students found the webinars helpful (4.75/5) and interesting (4.72/5). Following the webinars students felt more prepared (p&lt;0.0001) and confident (p&lt;0.0001). Similarly, confidence was significantly improved (p&lt;0.001) by mocks for both cohorts. Recruitment of mentors or interviewers from cohort one for the second cohort was only 7%.

Conclusions
We have demonstrated that SFP applicant confidence and competence for interview can be improved via delivery of a free virtual preparation programme. Such a programme can be delivered through recruitment of a cohort of motivated clinical academics at zero cost. However, despite the clear benefits reported by applicants, retainment of interviewers and thus sustainability of this programme remain challenging.
61 “Research in Surgery – Building the Foundations” – a Mixed-Methods Evaluation of a New Collaborative Regional Teaching Series
Authors: Filan J , Rao E , Baxter N , Vyas A , Taylor E , Moir J 
Published: August 2023

Abstract

Aim
Research is integral to the progression of the surgical profession and requires a sustainable pipeline of diverse academics. Interest in academia begins at undergraduate level, however lack of exposure acts as a barrier to participation. We aimed to provide exposure to surgical academia via webinars and review the impact of this series.

Method
Four monthly sessions were delivered and facilitated in collaboration with medical students, foundation trainees, and surgical academics. Sessions covered core topics for students and foundation trainees, including audit/quality improvement, statistics, and research funding. Data were collected via post-event surveys which included scaled-based and free-text responses. These were analysed with appropriate statistics and thematic content analysis respectively.

Results
Across the sessions there were 79 attendances by 58 individuals. n = 52/58 were students, with 38% (n = 20/52) studying outside the region. The median overall rating was 8/10 (quartiles 8-10) and 98.7% (n = 78/79) would recommend to a colleague. Post-session confidence improved significantly for all sessions compared to pre-session confidence (p≤0.010 in all cases).
Thematic content analysis summarised attendees learning points into three semantic themes. (1) how to access research opportunities, (2) pragmatic learning on undertaking research (including funding, statistics, and dissemination) and (3) the importance of mentorship and networking. Respondents valued the insights and experiences of facilitators. Improvements included shorter sessions and clearly explaining novel language.

Conclusions
Our results highlight the benefits of these sessions for providing exposure and improving understanding of surgical academia, with relevance for others aiming to engage students and doctors in academia. We plan future sessions building on this.
973 Plastering Skills and Experience Among Junior Orthopaedic Doctors
Authors: Dellis S , Shabeer M , Ghosh S , Robinson A 
Published: August 2023

Abstract

Aim
The conservative management of fractures with the use of plasters is an essential skill and still forms the bulk of the orthopaedic surgeon’s workload. There is currently concern that junior orthopaedic doctors are receiving limited training in plastering and effectively becoming deskilled. The aim of this study is to provide an insight of the skills and experience of junior orthopaedic doctors in our trust.

Method
An electronic study was conducted in our trust in December 2022.

Results
Only 10% of the respondents had a plaster room induction, and only 40% had attended a plastering course. Half of the respondents had no official plastering training. The majority of junior orthopaedic doctors (80%) stated that during their on call most plasters were applied by A&E nurses and doctors. Only one third of junior T&O doctors were very confident applying a simple Colles’ plaster or a below knee backslab, while one third was not competent at all. All respondents agreed that plastering is a useful and essential skill to acquire for doctors working in T&O or considering a career in orthopaedics.

Conclusions
Application of a correct plaster cast is an essential part of orthopaedic management. It is worrying that junior doctors working in orthopaedics have little to no experience in plaster application and training is limited. All doctors agreed that plastering was a useful skill and should be taught as part of orthopaedic training.
1122 Improving Medical Students’ Confidence in the Theatre Environment and Surgical Scrubbing Technique Through Pre-Placement ‘Theatre Prep’ Teaching: A Quality Improvement Project
Authors: Politis A , Ibrahim Y , Bottomley S 
Published: August 2023

Abstract

Aim
As the GMC states, medical students should be proficient in surgically related procedural skills, including scrubbing up, to ensure patient safety is maintained. Although students and consultants report these skills as top learning objectives for surgical placements, research shows students feel unprepared going into theatres. Evidence suggests that preparatory teaching increases confidence and maximises learning opportunities.
This project aimed to improve confidence and preparedness for theatre amongst students at a large UK Medical School through the delivery of ‘theatre prep’ teaching.

Method
A PDSA structure was utilised through multiple cycles from September to December 2022, using a baseline questionnaire to compare each cycle’s outcomes against a control group. Feedback from students and stakeholders informed lesson plan updates after each cycle. Content focussed on theatre etiquette and practical scrubbing up teaching.

Results
A Likert scale established self-reported students’ confidence, graded from 1 (very unconfident) to 5 (very confident). Data across all cycles showed that prior to attending theatre, students’ confidence in going into theatres, and scrubbing up, was low (average 2.14 and 1.66 respectively). Control group data showed that students’ reported confidence improved by an average of 1.52 and 1.48 respectively post-placement. Comparatively, following 'theatre prep' teaching, groups reported an increase in confidence of 2.13 and 2.53 for cycle one, and 2.2 and 2.67 for cycle two.

Conclusions
Medical students report low confidence before going into theatre, particularly regarding scrubbing up. Confidence in both domains was greatly improved by having a ‘theatre prep’ teaching session. We recommend all medical school curricula incorporate similar content.
1241 A Review: How Is Anatomy Best Taught in Postgraduate Surgical Education?
Authors: Chaudhuri T , George A 
Published: August 2023

Abstract

Introduction
Successful surgery relies on complete appreciation of the appropriate anatomy, with inadequate expertise noted as a key cause of surgical errors. Despite this, there are fewer formal sessions dedicated to anatomy tuition, with surgical trainees expected to be taught “at the operating table” (Older, 2004).

Aim
We investigated how various anatomy teaching methods were received by core surgical trainees (CSTs).

Method
28 CSTs from West Midlands deanery attended a training day at Keele Anatomy and Surgical Training Centre, comprising tuition using cadavers and Primal Pictures software. Feedback forms investigating several factors, including progress through postgraduate surgical examinations, and opinions on resources used for revision, were sent out one week and 3-6 months after the session.

Results
Of the attending delegates, 37.9% had failed Part A MRCS, 27.6% had passed Part A, with a further 10.3% having also passed Part B. Principal resources used for anatomy revision were textbooks and videos, with question banks and anatomy apps also used. Access to cadavers was highlighted as a significant benefit, allowing for “real-life” learning, with 86% of delegates preferring anatomy tuition using cadavers outright or in combination with Primal Pictures.

Conclusions
The opportunity to access human specimens appears unparalleled in its ability to illustrate “real-life” anatomy. However, these are scarce resources, and require experts to facilitate tuition, creating significant limitations to providing regular and reliable teaching. Anatomy textbooks remain a consistent choice, but with the modern migration to a world permeated with a virtual presence, the internet, videos, and apps are becoming prevalent and viable considerations.