bluuebunny/crossref_metadata_2025_split huggingface dataset:
287 A Sigma Six Approach to Improving Nephrostomy and Antegrade Stent Services After a Trust Merger – a Quality Improvement Project
Authors: Gami M. , McCafferty S. 
Published: February 2022

Abstract

Introduction
As hospitals merge into larger trusts there becomes a centralisation of some services. Urology relies on Interventional Radiology (IR) for Nephrostomy insertions and Anterograde stents in particular. Two lR lists run at Broomfield after centralisation. We aimed to innovate, through improving communication and appropriate prioritization of patients, to ensure patient safety and maximum utilisation of these lists.

Method
We used a sigma six, DMAIC approach. Data was collected over a 30-week period. Analysis was multifaceted, focused interviews with a thematic and stakeholder analysis. Value stream maps were created to assess waste, fishbone analysis to evaluate delayed cases, and a future state map was created, implemented, and controlled.

Results
Prior to the intervention, the average wait for IR was 3.66 (n = 74) days above the agreed standard of 3.5 days. Thematic analysis outlined lack of standardisation. Bottlenecks in the mapping process resulted from lack of communication. The fishbone analysis outlined organisational factors, such as rota publishing issues and task factors, such as lack of protocols and escalation clarity. The intervention was a standardised proforma, a new consultant to consultant communication channel, scan discussions at a registrar level and a point of escalation. Post intervention showed patient wait to be 1.22 day and staff satisfaction to increase 3-fold.

Conclusions
The DMAIC method proved for a comprehensive assessment of improvement. Patient waiting times can be reduced in hospitals with similar experience using such methods. Future Plan-Do-Study-Act can be used to continually improve once special cause variation has been eliminated – as it likely has in this case.
288 Do Frailty Assessments Improve Outcomes for Emergency Laparotomy Patients? A Quality Improvement Project
Authors: Bretherton K. , Charles-Rudwick M. , Velchuru V. 
Published: February 2022

Abstract

Aim
Our aim of the project is to increase completion rates of frailty assessments in emergency laparotomies to improve patient outcomes.

Method
This QI project focused on completion of the Rockwood Clinical Frailty Score (RCFS), Comprehensive Geriatric Assessment (CGA), Abbreviated Mental Test Score (AMTS), memory screening, place of residence and care level in patients over 65 years undergoing emergency laparotomies. Criteria was generated using British Geriatric Society recommendations and local hospital guidance.
A year was sampled pre-intervention with the criteria, time clerked and grade. Data was assessed for admission and mortality statistics, and re-admission rates. A presentation to surgical juniors relating to frailty, frailty assessments and guidelines was used as an intervention. The data was re-sampled to identify changes post-intervention.

Results
Fifty-four laparotomy patients were sampled. 28% had a completed RCFS, 15% had a CGA, 67% had a place of residence, 41% had level of care documented, 13% had a memory screen and 7% had an AMTS. The small sample size restricted data analysis, however, there was a general decrease in length of admission and time to medically fit with increased frailty score completion.
Post-intervention, completion of the RCFS, CGA, place of residence and care level increased. Completion of memory screening and AMTS decreased. Compliance increased in FY1s, SHOs and registrars.

Conclusions
The intervention had a positive impact: the average number of frailty criteria completed per patient increased by 39%, Foundation Year trainees now have frailty teaching, and the clerking booklet was reviewed. A re-audit is planned to ensure ongoing improvement.
290 ‘Save Blood' - Strategies to Reduce Inappropriate Routine Bloods Tests in a Surgical Department
Authors: McFadyen R. , Ewing A. , Jenks* S. , Deans C. 
Published: February 2022

Abstract

Aim
To quantify the number of inappropriate blood tests in our 72-bed Surgical Department and identify strategies that reduce the number of unnecessary electronic blood test requests. This should reduce patient harm, demands on staff time, laboratory processing burden and financial expenditure.

Method
Each audit involved logging all blood tests for every surgical inpatient over two consecutive days. Upon reviewing the clinical records, it was decided whether tests were clinically indicated or ‘inappropriate’.
Following a baseline audit, three interventions were sequentially introduced over a one-year period, and the department re-audited after each: (1) educational sessions with junior medical staff and creation of ordering guidelines, (2) poster presentations, and (3) policing of requests by middle-grade doctors and removal of electronic blood test ordering bundles.

Results
Across the baseline audit to interventions 1–3, numbers of patients with at least one inappropriate test were recorded as 45/73 (62%), 51/63 (81%), 41/57 (72%), and 27/32 (84%), accruing totals of 363, 289, 303, and 149 inappropriate tests respectively. This gave an overall reduction in the rate of inappropriate blood tests per patient per day from a baseline of 0.9, to 0.9 then 0.8 to 0.5 with successive interventions.

Conclusions
Despite the innovation of electronic ordering systems enabling close audit of test schedules, inappropriate tests remain common. Educational sessions for junior doctors, written guidelines, and poster presentations had little influence on this.
However, rationalising electronic order bundles and involving senior doctors in decision-making, almost halved the rate of inappropriate tests. These more effective strategies will be disseminated throughout our hospital.
291 Single Centre Retrospective Study of Outcomes of Neck of Femur Fractures
Authors: Gungadin P. , Ferns J. , Gupta S. , Sharpe K. 
Published: February 2022

Abstract

Aim
To assess operative decision-making for patients with neck of femur fractures.

Method
2-year retrospective analysis of 150 patients in a single centre looking at outcomes focusing on complication rates and mortality.

Results
Mortality stood at 6% at 1 month and 25% at 1 year compared to quoted literature (10% at 1 month and 30% at 1 year). Surgical complication rates varied between fracture pattern and operative choice. Notably, the use of cannulated screws in displaced intracapsular fractures had a very high rate of failure at 80% (4 out of 5) compared to 0% for dynamic hip screws (0 out of 5). In undisplaced intracapsular fractures, the failure rate of cannulated screws remains high at 15% (2 out of 13) which is in-keeping with current literature. Surgical complications of hemi-arthroplasty remain low with only 3 out of 73 patients having significant complications (intra-operative fracture, dislocation, and acetabular erosion).

Conclusions
Cannulated screw fixation should be carefully considered, especially in the setting of displaced intracapsular fractures. Hemi-arthroplasty or two-hole DHS may have superior results in the fracture pattern and indeed, in undisplaced fractures.
294 Implementation of Colorectal Robotic Assisted Surgical Programme During a Global Pandemic: Collaboration Between Territorial and National Waiting Times Centre
Authors: Hughes R. , Massie E. , Saldanha J. , Komolafe S. , Chapman R. , Kirk A. , Vella M. , Moug S. , MacArthur C. , Mackie H. 
Published: February 2022

Abstract

Introduction
Golden Jubilee National Hospital (GJNH) established a thoracic Robotic Assisted Surgical (RAS) programme in 2018. In March 2021, GJNH invested in a new elective colorectal service and in response to the Scottish Government robotic investment established a collaboration with a territorial health board to host their robot and start a RAS colorectal programme. We provide an overview of barriers and facilitators leading to establishing this new collaboration.

Method
An observational review of RAS training timeline. Demographics, surgical operations, and hospital length of stay were documented. Surgeons, perioperative team, management, and industry (Intuitive) were interviewed to provide insights into implementation and training.

Results
Boards approved RAS business case in April 2021, robot on-site with GJNH governance approval in May. First cohort of colorectal surgeons completed proctored training July 2021. To date, 17 RAS resections performed (mean age 64, 9 males: 8 female). Mean length of stay 4.65 days. No anastomotic leaks and no mortality reported. Interviews revealed key facilitators: advantage of having an established RAS perioperative team and building on pre-existing industry links; developing and strengthening collaborative working between different health boards and surgeons. Barriers included: education of all team members to ensure patient safety for new specialty; multisite collaborative working.

Conclusions
This work provides a template model for future RAS collaborations between different sites and health boards. Collaborative working in a green-hospital setting may improve equity of access for patients whilst future-proofing surgery against further waves of the pandemic.
297 Variations in Orthopaedic Trauma Presentation During COVID-19 Lockdown
Authors: Ahmad M. , Chaudhry M.N. , Shaikh A.A. 
Published: February 2022

Abstract

Introduction
In living memory there has never been a start to the year as 2020, due to Covid -19 Pandemic. Like every other surgical speciality, Orthopaedic trauma surgery faced significant challenges during this period in terms of numbers as well as variation in trauma patients’ presentation.

Aim
The purpose of our study is to analyse the numbers and variations in orthopaedic trauma and its presentations during the pandemic in comparison with 2018 and 2019.

Methods
The data for this audit was collected from orthopaedic register of Our lady of Lourdes Hospital, Ireland. Patients operated under orthopaedic trauma team in three months period (March, April & May) in 2018, 2019 and 2020 were selected for analysis and comparison.

Results
In 2020, total number of surgeries were 32% less than the average of previous 2 years. (373 in 2020 vs 543 in 2019 and 551 in 2018). Similarly, the paediatric trauma surgeries dropped by 32 % in this period. Significantly lower proportion of sport related injuries, RTAs, and assaults presented in 2020. Higher proportion of trauma resulting from simple slip, falls from height and trampoline was observed in this period compared to previous two years. Slightly higher proportion of tibial pilon, calcaneum and peri-prosthetic fractures was noted as compared to previous years.

Conclusions
Significant reduction in total number of trauma cases as well as high energy trauma (Road Traffic Accidents, Sports Trauma) was observed due to limited mobility in pandemic, whereas higher proportion of low energy fractures occurred during this period of restrictions.
302 Metastatic: Benign Lymph Node Ratio (LNR) and Lymph Node Yield (LNY) as Predictors of Survival in Resected Colorectal Cancer (CRC)
Authors: Issa M. , Ahmad S. , Vijayagopal K.A. , Freeborn S. , Omolokun O. , Griffine A. , Wilson J. , Magee C. 
Published: February 2022

Abstract

Background
Lymphadenectomy is central to tumor prognosis. 12 LNY during CRC resection is a standard of good oncological resection, but 30–50 percent of resections do not achieve this. LNR was suggested to be a more accurate predictive factor.

Aim
To examine the prognostic significance of LNY and LNR on survival in patients with non-metastatic CRC.

Method
A retrospective study on patients with CRC treated at a DGH from January 2015 to February 2017. Outcome measures were Disease-Free (DFS) and Overall Survival (OS).

Results
265 cases were identified. The mean age was (71.4±11.3) years with a median follow-up of 56 (range 0–72) months. Median LNY was 18 (range 0–66) nodes. 74.9% of the cases have&gt; 12 LNY and only 25.1% of the cases have &lt; 12 LN yielded in the specimen; however, 76.4% have LNR of 0-&lt;0.25. Increasing LNR was associated with poorer OS and
DFS (p-value 0.0001). An LNR of (0.75–1) was associated with a very poor prognosis (p-value 0.0001); it showed 30 and 33 months less in median OS and DFS retrospectively than LNR
(0-&lt;0.25). LNY did not show any statistically significant predictive factor in survival.
Multivariate analysis showed OS and DFS are affected (R2 = 27.3% and 26.1% retrospectively) mainly by LNR. It did not show statistical significance with the other variables, including TNM, LNY, and Dukes' stages.

Conclusions
Increasing LNR was a marker of poor survival; however, LNY was not a statistically significant predictive factor. LNR is better in predicting survival than TNM and Dukes' staging.
303 Mapping the Landscape of Surgical Registries in the United Kingdom
Authors: Moore C. , Avery K. , Young A. , Hinchliffe R. , Potter S. 
Published: February 2022

Abstract

Introduction
Well-designed surgical registries are essential for high-quality patient-centred evaluation of implantable devices and surgical procedures. The importance of registries was highlighted in the recent Cumberlege report that detailed important innovation failures such as the use of vaginal mesh. Many surgical registries exist, but it is currently unclear how different registries are funded; designed; what data are collected; how databases are hosted and if the data can be linked to other datasets. There is therefore a need to understand the characteristics of and variation in existing surgical registries to make recommendations for how these could be improved. The aim of this work is to identify existing surgical registries in the UK and describe and summarise their key characteristics to inform recommendations for how surgical registries may be improved.

Method
Existing surgical registries will be identified using multiple different sources, including society websites; search engine review; a targeted search of Medline and Embase databases and expert knowledge. Details of each registry will be extracted using a standardised data extraction proforma developed by the study team. Characteristics of identified registries will be summarised into a narrative review.

Results
Identification of registries is ongoing. Preliminary data extraction has highlighted marked heterogeneity in the design, content, and structure of existing surgical registries. Data extraction is ongoing, but results will be available for presentation at the ASIT meeting.

Conclusions
There is considerable heterogeneity in existing surgical registries. Further work is needed to establish the extent of this variation and identify areas that can be improved.
305 Effect of COVID 19 on Ward Notes Documentation Standards
Authors: Salik M. , Mir M.H. , Arafa M. , Sanjay P. 
Published: February 2022

Abstract

Aim
To assess the effect of COVID 19 on ward notes documentation standards

Method
100 ward notes entries (before COVID, during COVID Peak, and after COVID Peak, 100 each) were evaluated against set ward notes documentation standards derived from the GMC Good Medical Practice document. The results were analysed, and the three data sets were compared to assess any effect of the COVID 19 pandemic on ward notes documentation standards.

Results
Individually, clear handwriting and documenting signatures showed a slight decline, and a slight increase was seen in the use of unknown abbreviations during the COVID-19 Peak. However, documentations standards were maintained across other categories and even showed improvement in some standards. Overall compliance showed a small improvement rather than a decline during the COVID 19 Peak.

Conclusions
COVID 19 Pandemic has certainly had an effect on every aspect of life globally. The health sector came under significant pressure and saw unprecedented stressful working conditions during the peak of the pandemic. However, even under the unprecedented pressures of COVID 19, we were able to maintain remarkable documentation standards and even showed improvements across various standards.
It should be kept in mind that there are limitations to this Audit and further studies are needed to confirm these findings.
306 In the COVID Aftermath, Using an Innovative Collaborative Approach to Improve Wait Times for Skin Cancer Patients
Authors: Brennan C. , Stone M. , Pinder R. , Gowda A. 
Published: February 2022

Abstract
COVID-19 led to drastic reductions in non-urgent medical visits and cancer care. Surgical patient backlogs mean new strategies are required to decrease wait times and administrative costs whilst improving patient outcomes. We review the impact of combined speciality Plastic Surgery and Dermatology 2 week-wait (2ww) clinics on wait times and hospital attendances and associated cost implications when compared to the single speciality clinics.
Retrospective analysis comparing Plastic surgery (PS) and Dermatology (DM) 2ww clinics against combined Dermatology and Plastic surgery (DP) clinics across the same 3-month period in 2018 and 2019 at a single UK tertiary centre.
283 patients reviewed across the same 3-month period in 2018 and 2019 (PS n = 53, DM n = 158, PD n = 72). PD reviewed most patients per clinic (Averages: PD n = 18.0, PS n = 8.8, DM n = 12.1). Hospital attendance decreased from 1.84 to 1.51 visits. 42.9% of excisional biopsies were performed on the same day as initial assessment compared to 18.0% in PS/DM clinics. Referral to surgery time decreased from 67.7days to 50.4 days, and tertiary assessment to surgery from 49.5days to 36.9days. PD attracted tariffs of up to £29.78 more per patient.
Combined clinics see more patients and attract higher tariffs per patient, whilst reducing outpatient attendances and wait times to surgery. This has significant cost-saving implications whilst optimising cancer care.
307 Improved Compliance with Enhanced Recovery Protocol Medications for Elective Joint Replacements Using the E-Lective App
Authors: Dela Cruz N.J.M. , Gibbons C. 
Published: February 2022

Abstract

Aim
Enhanced recovery pathway(ERP) in elective joint replacements has been shown to reduce length of stay, reduce re-admission rates, and can improve early functional recovery. Local analgesia and VTE prophylaxis protocol in current use has been produced by members of the multidisciplinary team but awareness of it needs to be optimised.

Method
We performed a retrospective review of discharge summaries and prescriptions from April 1 to April 30, 2021, of all primary joint replacements at Chelsea and Westminster Hospital. These were assessed against the local ERP Protocols for elective arthroplasties. ‘E-Lective App’ - a peer to peer shared mobile application containing an offline repository of existing Enhanced Recovery medication protocols, ward directory and follow-up booking feature was presented to clinical staff at the clinical governance meeting. Prior to these, protocols were only accessed or shared through WhatsApp. Re-assessment was done a three months later for a period of one month’s July 1 to July 31, 2021.

Results
Prior to launching ‘E-Lective App,’ compliance with the ERP Discharge Medications protocol was 70.1%. At last review in July 2021 this had significantly improved to 96% on average (p&lt;0.05). Readmission rate due to pain and swelling had decreased by 65%.

Conclusions
This quality improvement project highlights the need to innovate to improve compliance to current standards of prescribing medications as part of the Enhanced Recovery Protocol. ’E-lective app’ is a novel and effective guide on maximising ERP pathway for joint replacements.
309 Adherence to BSG Guidelines Regarding Definitive Management of Gallstone Pancreatitis at Epsom and St Helier Hospitals
Authors: Singh S. , Oladeji E. 
Published: February 2022

Abstract

Aim
To audit the definitive management of gallstone pancreatitis in terms of cholecystectomy and ERCP at St Helier Hospital and comparing with the standard British Society of Gastroenterology guidelines (BSG), between Nov 2019 to Nov 2020.

Method
It's a local audit and data was collected retrospectively. A total of 72 patients with gallstone pancreatitis in a year were identified.

Results
The total number of patients managed according to guidelines, i.e., within two weeks of diagnosis (Lap chole + ERCP) were 20 patients (27.78%). Timing of ERCP, when needed was adequate (7 out of 9). No intervention has been done yet in 43% of the patients. Declined/ unsuitable for any intervention/surgery (35%), Patient transferred to another trust (16%) and death of the patients are the most common causes of the no-intervention.

Conclusions
Gallstone pancreatitis patients will come under P2 as a priority which means these patients will get priority over biliary colic/symptomatic gallstones for the early date of surgery. Recommendations have been submitted for another theatre slot for emergency laparoscopic cholecystectomy.
310 Ethical Challenges Facing Autonomous Surgical Robots
Authors: Mughal H. 
Published: February 2022

Abstract

Aim
Despite delays, automation is expected across all fields, with notable interest in surgical robotics. With this comes many of the ethical and moral dilemmas the industry is expected to face in bringing autonomation, to surgical robots, into clinical practice.

Method
A review of the available literature published on automation, machine ethics and surgical robotics.

Results
One of the key issues at the heart of autonomous surgical robotics lies the responsibility in the event of complications. Does it lie at the hand of the robotics manufacturer, the clinician or clinical organisation or possibly the patient? A question that remains unanswered despite the relative expectation of autonomous robotics into clinical practice in the coming years.
Furthermore, how should a robot proceed in an emergency? An automated surgical robot, which lacks a moral framework, may be unable to deal with emergencies especially within the context of fluctuating local environment where the needs of patients are distinct and everchanging.
In addition to this, a political and ethical concern is the expected number of job losses of highly skilled professionals and the training need to adapt to changing work. Can these professionals be employed in a different capacity? Moreover, data concerns have been highlighted, how best to use patient data to improve the technologies whilst preventing misuse of sensitive information.

Conclusions
Based on current literature, greater work is needed to be done to address the ethical issues before implementation of autonomous surgical robotics.