bluuebunny/crossref_metadata_2025_split huggingface dataset:
326 Is Patient Satisfaction Affected by Replacing Face-to-Face Appointments with Telephone Assessments for Balance Complaints?
Authors: Bastawrous D , Kaleva A , Singh P 
Published: November 2022

Abstract

Aim
It was found that 91% of surgeons conducted virtual consultations during COVID-19 pandemic. In March 2020, ENT UK recommended that telephone review should be the first approach for all outpatients who do not need urgent treatment. Dizziness diagnoses may be made primarily from the medical history, making telephone clinics suitable. This study aims are to determine the level of patient satisfaction with telephone consultations for balance complaints.

Method
The electronic patient records of ENT patients were reviewed retrospectively to identify all adult patients with first presentation of dizziness between October 2020 and May 2021.Patients were contacted by telephone and completed the short form patient satisfaction questionnaire (PQS-18). The statistical software SPSS was used for analysis.

Results
26 out of 37 patients contacted were reached successfully giving a response rate of 70%. There were 12 patients in the telephone consultation group and 14 patients in the face-to-face group. Average general satisfaction and satisfaction with technical quality were lower in the telephone consultation group (p-values of 0.012 and 0.007 respectively). Total average score was also lower in telephone consultation group with p-value of 0.028. 91% of patients who had initial assessment by telephone needed a follow up face to face consultation as opposed to only 14% in the face-to-face group.

Conclusion
Patients were less satisfied with primary assessment of balance complaints by telephone. Most of these patients required face-to-face follow up consultations.
354 Surgical Proforma Done by Surgical Doctors; Clinical Audit
Authors: Al-Ghazawi M , Toquero L , Li M , Pauk T 
Published: November 2022

Abstract

Aim
To improve the clerking performed by all surgical grades at our Trust and to prevent any implication might happen in case the clerking was insufficient such as medical errors, delay in treatment and poor quality of data for future research and audits.

Method
Two cycle audit in which the first cycle analysed one hundred fully randomized surgical entries for completeness of all aspects of history, examination & plan over two months in 2021. Then new surgical proforma was applied and used for all patients thereafter. Subsequently, second cycle performed later, and same randomization was applied.

Results
Whereas fully completed proformas compromised only 4% of all entries in first cycle, this percentage increased by more than six-fold to reach 26% in second one. Both history of present illness and physical exam showed the major improvement. Even though some sections such NEWS score and social history kept showing small, completed percentage, it was slightly higher than in the first cycle. 69% was the total improvement across all sections between two cycles.

Conclusion
New surgical proforma applied at our hospital improved the clerking done by surgical doctors and hence improved the care provided to patients in first place and served as a very rich environment to future research and Audits.
369 Do We Need to Standardise the Neurosurgery Post-Op Note: A QI Project
Authors: Al-Nusair L , Nouri P , Gikas N , Newall N , Tsang K 
Published: November 2022

Abstract

Aim
Accurate, informative, and consistent documentation in the postoperative period is an essential aspect enabling effective and safe communication between healthcare professionals. Limited documentation can increase the risk of errors and suboptimal care. The Royal College of Surgeons (RCS) identified 18 criteria for operation note documentation for ‘Good Surgical Practice’, enabling continuity of care. Currently, the structure and information documented in a tertiary neurosurgical department varied. The aim of this quality improvement project was to improve the documentation in the department using a proposed proforma.

Method
A proforma was identified using the RCS guidelines and distributed via email. Operation notes of all patients undergoing neurosurgical procedures were compared against RCS guidelines from November 1st – November 30th, 2020, pre-proforma introduction. Operation notes were then re-audited from July 1st – July 31st post-proforma introduction.

Results
66 operations were identified in the pre-proforma group, and 49 in the post-proforma group. Date, time, details of tissue alteration, operative findings, incision, prosthesis identification, antibiotic use and signature were well documented in both pre and post proforma introduction (&gt;90%). In the reaudited group there was an improvement in documentation of anaesthetist (37 vs 24%), complications (78 vs 35%), extra procedures (18 vs 2%), blood loss (22 vs 12%), and a small decrease in the documentation of DVT prophylaxis (59 vs 53%).

Conclusions
A structured proforma is useful for enhancing communication in the post-operative period. We aim to create a standardised template in the trust's note-taking system to standardise the documentation process and provide further training on the importance of documentation.
392 The Role of MRI in the Management of Scaphoid Fractures: A Closed-Loop Audit by Dorset County Hospital, UK
Authors: Finch B , Andrew S , Crook T 
Published: November 2022

Abstract
Prompt and accurate diagnosis of scaphoid fractures are crucial in preventing complications such as non-union, avascular necrosis & early-onset arthritis. Research has shown that initial radiographs detect a fracture in 85–90% of cases, but it can be occult in up to 10–15%. In 2016 NICE recommended that MRI should be considered for first-line imaging in patients with suspected scaphoid fractures. Our aim is to determine whether the clinical practice at DCH is matched with the recommendations set by NICE, and whether the implementation of a ‘Scaphoid Management Protocol’ led to increased compliance.
Retrospective analysis of all patients with suspected scaphoid fracture presenting to ED between May – September 2017, with reaudit between December 2017 - February 2018 and June – October 2020. Those patients who had gone on to have further MRI imaging were then identified, and the average time taken to MRI requests to MRI being performed was evaluated.
Prior to the protocol, 16% of patients with normal X-ray but clinical signs weren't referred to further MRI imaging – this reduced to 1% in re-audit. The average recorded time to MRI from the requested date improved with each audit cycle, with 37.6, 19.9 & 11.4 days, respectively. However, a new finding found that 35% of patients presenting to ED with scaphoid injury were not referred further for Orthopaedic assessment to exclude scaphoid fracture.
Implementation of a ‘Scaphoid Management Protocol’ significantly improved compliance to NICE guidelines of MRI imaging resulting in earlier fracture diagnosis and improved prognosis, as well as improving time to MRI from the request date.
397 Improving the Quality of Consent Forms in Emergency Laparotomy
Authors: Probert S , Ballanamada Appaiah N , Khan L 
Published: November 2022

Abstract

Aim
To improve the quality and completion of consent forms for patients undergoing emergency laparotomy.

Methods
A standard for emergency laparotomy consent forms, guided by recommendations from the National Emergency Laparotomy Audit (NELA) was established. This standard was used to score consent forms. Our initial audit of 20 consent forms scored an average of 41.9%.
A template sticker, specific to emergency laparotomy, was created. This contains all of the information deemed important by our standard. The sticker allows the surgeon completing the consent process to simply tick off the individual components once discussed with the patient and apply it to the regular consent form. The stickers were introduced to all of those involved in consenting patients, and their use was strongly encouraged.

Results
Consent forms were collected and scored over the following 2-months. Of the 18 consent forms, 33% made use of the consent form sticker, with an average score of 65.2% (improvement of 23.3%). In analysing scores for both the pre- and post-intervention consent forms, we found a P value of &lt; 0.0001.

Conclusions
The use of consent templates specific to surgical procedures improves the quality of consent forms and ensures that all possible complications are discussed with patients. The use of stickers for emergency laparotomy has improved the quality of our consent forms. With ongoing use, we aim to ensure that all patients undergoing this procedure are adequately consented. There remains room for continued improvement, and we believe ongoing exposure to these stickers will lead to an up-take in use.
419 District General Theatre Efficiency: What Is the Patient Experience?
Authors: Sambhwani S , Essak K , Rayan F , Krishnaiyan R , Khairandish H , Hirschowitz D 
Published: November 2022

Abstract

Aim
The NHS Institute for Innovations and Improvement (NIII) has determined that a £7 million saving can be achieved per trust by improving theatre efficiency. With an increasing influx of admissions and trauma, alongside increasing trends pertaining to the pandemic and winter pressures, it is vital to optimise our patients’ journey.

Method
The journey of transition from pre-theatre to recovery was mapped and retrospective data on a single weekday theatre trauma list was collected over a one month stretch using ORMIS and 77 patients were identified and analysed.

Results
The average case load was found to be 3.7 cases with lowest case load during the end of the week.
The average send time for a patient was documented to being 8:45 (range:8:15–9:934) with an average turnaround time being 65 minutes for the first case and 37 minutes for subsequent cases.
The average knife-to-skin time was found to be 10:00 for the first case (range:9:21–10:34). The median intercase time (time take from the patient leaving theatre to the next patient entering theatre) was found to be 47 minutes (range:15–49).

Conclusions
Causes for delays in theatre flow were largely multifactorial and this impacted the first patient the most leading to a knock-on effect on subsequent patients on the list. With the NIII attributing an efficiency cost of £24.77/minute, there is a lot to be gained by maximising theatre efficiency particularly with current limited resources. A joint surgical and anaesthetic quality improvement project focusing on the golden patient was introduced with a patient focused approach.
421 Improving Confidence with Difficult Catheterisations
Authors: Olukoya O , Ng A , Bekarma H 
Published: November 2022

Abstract

Aim
The use of catheters is common amongst inpatients with variable successful completion rates resulting in frequent calls to the on-call urology team for assistance. A common concern from the urology team is that there is inadequate equipment stocked in A&E or CAU across NHS Ayrshire & Arran. Additionally, it is felt anecdotally that most “difficult” catheters are in fact easily inserted by urologists via the use of a larger silicone catheter. The aim was therefore to improve confidence with difficult catheters and knowledge of when to refer to Urology; and to improve access to equipment required for a difficult catheter.

Method
A questionnaire using Likert scales was distributed to medical and nursing staff across both acute sites within the health board to establish baseline confidence and ease of finding equipment. An intervention in the form of a guide to difficult catheters was introduced with work started on a difficult catheters trolley. A follow up questionnaire using Likert scales was distributed to assess confidence. The subsequent data was then collated and analysed.

Results
1st Cycle: 30 responses; 36.70% confident/very confident. 2nd Cycle: 7 responses; 85.70% confident/very confident and know when to refer; Ease of finding equipment remains variable; 71.5% found the guide to be clear/very clear.

Conclusions
Despite the lower response rate in the second cycle, the guide has been effective in improving the confidence of staff with difficult catheters and their knowledge of when to refer. Ease of finding equipment remains variable, however, due to the relative delay in establishing the trolley.
432 Improving the Use of Acute ENT Clinic in a DGH During the COVID19 Pandemic
Authors: Bondje S , Bateman L , Stephens J 
Published: November 2022

Abstract

Aim
The SHO led acute ENT clinic is used to assess and treat a variety of ENT pathology. Following the COVID19 pandemic, the department has seen an increase in referrals for conditions that do not meet departmental guidelines. To meet demand, our clinics were always overbooked and over running as juniors sought help from seniors for more complex referrals.

Method
A quality improvement project was initially set to be performed over a few months; however, due to COVID, data was collected over a year from December 2019 to 2020. We looked specifically at number of patients referred, reason for referral, number of follow-up appointments, senior review required and how COVID affected the running of the clinics.

Results
Compared with the clinic's standard operating procedure, 77.2% of clinics were overbooked and 69.8% of patients had unsuitable referrals. This prompted changes such as increasing clinic capacity by introducing full day clinics and increasing senior support by moving to the outpatient department, then clinics were only overbooked 1% of the time. Other areas for improvement highlighted such as advice given to patients as well as referral to main ENT clinic.

Conclusion
It was clear that the capacity of the acute clinic did not meet demand, and this was needed to ensure patient safety and adhere to ENT UK guidance. We implemented a more stringent referral system to increase patient safety by ensuring patients with appropriate pathology are seen in this clinic or referred to other relevant clinics where they can be seen earlier by seniors.
433 Antibiotic Compliance in Paediatric Appendicectomies: A Two Cycle QIP in a Tertiary Centre
Authors: McLean E , Gupta T , Little J , Hallows R 
Published: November 2022

Abstract

Aim
Acute appendicitis is the most common surgical condition in children in the UK. We did a Quality Improvement Project to determine if our hospital's paediatric appendicitis antibiotic guidelines were being followed.

Method
Data was collected retrospectively for all patients admitted with acute appendicitis between 01/05/2021 and 14/09/2021 at a tertiary paediatric centre. The compliance to centre protocol for antibiotic administration was assessed, including cefuroxime dose per kilogram. Following educational intervention, a second cycle of prospective data collection was performed 29/09/2021 to 18/11/2021 to reassess compliance and close the loop.

Results
Initial data collection (n=34) showed protocol compliance at 57.6%; where compliance was correct dose, duration, and combination of antibiotics. Notably, we showed 4 patients developed collections despite being on triple antibiotic therapy. Of these 3 were on the lower dose 20mg/kg Cefuroxime regime despite intraoperative findings. Following a Departmental meeting, the protocol standard dose of Cefuroxime was changed to 50mg/kg (max 1.5 grams as per BNF) for all presentations of acute appendicitis. Results were then fed back to the team and changes implemented; including updating the previous flowchart posters found in A&E, theatres, and ward. Second round of data collection (n=12) showed 91.7% compliance with protocol. Of the patients in this time, none developed abdominal collections.

Conclusions
This quality improvement project shows significant improvements in outcomes of appendicectomy, as well as improvements in protocol compliance achieved with education and simple interventions. We have shown an increase in compliance
438 Packed Red Cell Transfusion in Acute Surgical Patients, Are We Over-Transfusing?
Authors: Bright H 
Published: November 2022

Abstract

Aim
To improve a general surgical department's adherence to NICE guidelines on transfusion of packed red cells for low haemoglobin by improving knowledge of relevant haemoglobin thresholds (70g/L or 80g/L in ACS or renal failure requiring chronic transfusion).

Method
All patients admitted to a large London teaching hospital under the general surgical team in a 4-month period (2020–2021) were audited using their electronic records. Audited data was units transfused; pre-transfusion haemoglobin, heart rate, and blood pressure; pertinent medical history; and location of transfusion (ward/theatre). 10 patients were excluded due to being transfused perioperative or because of haemodynamic instability (covered under different guidelines). 16 patients and a total of 31 units were included in the audit. The interventions were 1) distribution of a poster showing the NICE guideline, reasoning for the guideline, and baseline data; and 2) a teaching session for junior doctors (FY1 to registrar).

Results
The proportion of transfusions adhering to guidelines increased from 33% (6/18) at baseline to 60% (3/5) after intervention 1 and 100% (8/8) after intervention 2. The combined post-intervention score of 85% (11/13) was statistically significant compared to the baseline (p=0.013).

Conclusions
Acute surgical patients were frequently over-transfused with packed red cells; risking adverse reactions and increased re-bleeding. An education programme aimed at junior doctors was successful in significantly increasing adherence to national guidelines on transfusion and improving patient care. Simple educational methods are therefore effective at improving care by promoting evidence-based practice. Future auditing would aid in assessing the sustainability of this improvement.
465 Ensuring Optimal Timing of Gastrografin and Imaging in Patients with Adhesive Small Bowel Obstruction
Authors: Yiu A , Edirisooriya M , Balendran B , Wheatstone S 
Published: November 2022

Abstract

Aim
This Quality Improvement Project (QIP) aimed to optimise outcomes for patients with adhesive small bowel obstruction (aSBO) by standardising Gastrografin prescriptions and the timing of subsequent abdominal X-rays (AXRs).

Method
Baseline data on Gastrografin prescription and timing of AXR for patients with aSBO was collected retrospectively over a 1-year period. From this, we identified potential interventions to reduce variation in the management of aSBO. We implemented a Plan-Do-Study-Act (PDSA) Cycle over a 4-month period by creating a prescribing protocol for Gastrografin on the Trust's electronic prescribing system with input from key stakeholders including surgeons, pharmacists, radiologists, and radiographers. We measured Gastrografin prescription accuracy and timing of AXR post-Gastrografin.

Results
The initial data collection (n=89) showed Gastrografin was used in 63% of SBO episodes and prescribed correctly in 79% of cases. AXR was performed in 77% of cases, with a mean time of 9:02 hours post-Gastrografin administration. 42% of patients underwent surgery. After implementation of our PDSA cycle (n=20), Gastrografin was prescribed in 71% of cases, with 100% prescription accuracy. AXR was performed in 88% of cases, with a mean time of 7:47 hours post-Gastrografin. 10% of patients underwent surgery.

Conclusions
We have successfully achieved our aim of reducing variation in Gastrografin prescription for patients with aSBO by demonstrating an increase in prescription accuracy from 79% to 100%. We have also shown an improvement in the efficiency of post-Gastrografin imaging for patients with aSBO.
483 Surgical Virtual Clinic: A Safe and Effective Alternative to Acute Surgical Clinics for Semi-Urgent, Ambulatory Patients
Authors: Osunlusi O , Patel S , Ashok A , Stonelake S 
Published: November 2022

Abstract

Introduction
Many ‘Hot Clinics’ deal with ambulatory patients only requiring semi-urgent investigation and treatment, potentially avoiding hospital admission. These clinics often use the same staff and resources being utilised for acute surgical admission and treatment. We present data showing that “Virtual Clinics” (VC) are safe alternatives to this system, improving patient service and relieving a significant burden on the acute surgical units.

Method
78 patients who came through the established VC between 23/12/2020 and 19/01/2021 (4 weeks), were assessed for delays in scan date, call-backs, diagnosis, referral patterns, readmission rates and eventual outcomes for those who needed surgical interventions.

Results
83% of patients had their scans within the set-out time of 72 hours. 89.7% of scans were reported on the same day. Only 18% of the patients had a surgical diagnosis. 51% had no diagnosis at all and were discharged safely from the clinic. 16.7% were still symptomatic at the time of the VC with 3.8% of these having a surgical pathology. 22% were referred to other specialities. 2 patients were referred to MDT.
In total, 6 patients were re-admitted to the hospital (7.6%). 4 patients were listed for surgery following the VC.

Conclusions
The VC proves to be a safe and effective system for semi-urgent, ambulatory patients. Re-admission rates are low, justifying the discharge of these patients from the acute surgical assessment unit to a virtual follow up environment.
491 Improving the Return Rate of the 6 Week Post Procedure Forms at King's College Hospital Tongue Tie Clinic
Authors: Horseman L , Patel S 
Published: November 2022

Abstract

Aim
The aim of the audit was to assess, and improve, the return yield of feedback forms from parents using the King's College Hospital tongue-tie service. In a procedure that's primary objective is to improve the mother and baby experience of breast-feeding, it is vital that we are aware of maternal perceptions on any improvements that the procedure conveys.

Method
Baseline return yields were initially collected and assessed using clinic and feedback data from January 2020. A focus group was held with the tongue-tie MDT to ascertain current procedures for feedback collection. During this it was identified that parents were never reminded to return the feedback form. Change was instigated in December 2020 with “Envoy Patient Messenger”, a software employed to send a text reminder to parents 5 days before feedback forms were due. January 2021 was used as a comparable month to analyse the effectiveness of the change.

Results
In January 2020, 4 (6.15%) parent feedback forms were returned out of the 65 babies undergoing tongue-tie procedures. Following initiation of the text reminder service, in January 2021, 15 (33.3%) of parent feedback forms were returned out of a possible 45, giving a 5.41x increase in return yield.

Conclusions
This audit demonstrated that simple measures such a text reminder service significantly increased the return yield of parent feedback forms following tongue-tie procedure. Work is ongoing with Patient Outcomes team regarding the introduction of an online feedback form.