bluuebunny/crossref_metadata_2025_split huggingface dataset:
345 Not Just Metal Hips: Correcting Peri-Operative Anaemia and Iron Levels in Emergency Neck of Femur Surgery
Authors: Cai W , Daneshmend A , El Rhermoul FZ 
Published: November 2022

Abstract

Aim

Method
44 orthogeriatric patients’ records who underwent NOF surgery between December 2019 and March 2020 were examined in the first round. The following data were extracted from the electronic records: age, pre- and post-operative haemoglobin, uptake of pre- and post-operative haematinics, blood, and iron transfusions throughout the surgical period. Subsequently, two more rounds of data collection were undertaken, and they followed the same method. These involved 58 patients between January and April 2021 and the 26 patients between May and June 2021, respectively.

Results
Our first cycle saw uptake of pre-operative haematinics increase by 31% (from 20% to 51%). The final round saw uptake of pre-operative haematinics decrease to 27%. In addition, more than 1/3 patients (37%) who received blood had not met transfusion criteria according to NICE guidelines. Almost half of patients (46%) who received iron transfusion did not have confirmed iron deficiency anaemia.

Conclusions
Pre-operative anaemia continues to be poorly investigated despite an initial increase in haematinics uptake. This could be attributed to the changeover of teams in April. To sustain the level of previous improvement, a hospital-wide educational session for clinicians is needed and this is best incorporated into the induction programme.
350 Nutritional Management of Emergency and Elective Surgical Patients – Are We Doing Enough?
Authors: Hern D , Desai C , Rao V 
Published: November 2022

Abstract

Aim
Malnourished patients make poor surgical candidates, with an increased risk of post-operative complications. We assessed the peri-operative nutritional status of patients undergoing elective and emergency general surgical operations.

Method
Data was collected from 1 September 2021 to 1 November 2021. The inclusion criteria included: underwent surgery for gastro-intestinal pathology, length of stay ≥5 days, and high risk of malnutrition as per the Malnutrition Universal Screening Tool (MUST).

Results
50 emergency patients were identified. In the pre-operative to post-operative period, these patients had a mean albumin decrease from 30.5 to 23.7, against a decrease in CRP of 146 to 105.5, suggesting worsening nutrition rather than worsening inflammation. 48% of these patients had dietician referrals in-place with 54% of these on oral supplementation. Post-surgical complications increased in these patients without a dietician referral, with wound infection the most common cause (n=4).
50 elective patients were identified. 40% of these patients had dietician referrals in-place with 70% of these on oral supplementation. Post-surgical complications increased in these patients without a dietician referral with the most common complication being acute kidney injury followed by wound infection.

Conclusions
Optimal nutrition is key to optimal recovery. Most patients with dietician referrals had a plan of oral supplementation. This intervention can be commenced by the immediate surgical team. 56% of patients meeting the MUST tool criteria for high risk of malnutrition had no dietician referral. This can be addressed through early consideration for dietician referral, teaching sessions and educational posters distributed across surgical wards.
377 Audit of Barts Health NHS Trust Virtual Fracture Clinic
Authors: Stimler B , Banhidy N , Parducci M , Panagopoulos G 
Published: November 2022

Abstract

Aim
The British Orthopaedic Association recommends that all patients should be seen in a new fracture clinic within 72 hours of injury. The Virtual Fracture Clinic (VFC) at Barts Health NHS Trust was audited to assess compliance with the BOAST 7 Fracture Clinic Services guidelines, and to identify areas requiring improvement.

Method
All VFC referrals between 10/05/2021 to 28/05/21 were analysed across the Barts Health NHS Trust. Data was collected on discharge rates, type of injuries seen, inappropriate referrals, time to be seen, and time to further imaging.

Results
A total of 1,039 patients were reviewed in VFC. 54% included upper limb injuries and 46% lower limb injuries. 51% of patients were discharged following initial VFC review by an orthopaedic consultant. Mean time from injury to VFC review was 2.33 days. Mean time VFC to face-to-face review was 15.17 days, and mean time to advanced imaging was 30 days. 9% of injuries did not match pre-existing injury diagnosis codes (including hand injuries and injuries without enough clinical detail provided).

Conclusions
This audit of the VFC at Barts Health NHS Trust identified several areas requiring improvement. Waiting times for investigations were often unacceptably long. Inappropriate referrals frequently led to delayed, or otherwise avoidable face-to-face appointments. Following these findings, the Orthopaedic department plans to address these identified weaknesses through means of increased funding and staffing; educational support to A&E staff; and updated VFC protocols. A re-audit will subsequently follow to assess the impact of these interventions.
385 Service Evaluation of the Management of Acute Cholecystitis in the Royal Gwent Hospital Pre and During the COVID-19 Pandemic
Authors: Mukhopadhyay S , Taylor L , Rasheed A 
Published: November 2022

Abstract

Aim
NICE guidelines set out the criteria for the treatment of patients with acute cholecystitis and the operative timescales for cholecystectomy. These targets were greatly affected during the Covid-19 pandemic. Therefore, we aimed to assess the impact that COVID-19 had on patients presenting with acute cholecystitis at a busy district general hospital. June 2020, compared with patients who presented with the same in June 2019.

Method
Patient cohorts were identified for matching seasons pre- and post-covid-19 (June 2019 and June 2020). Data of all patients who presented with acute cholecystitis was obtained using an electronic patient management system. Statistical analyses were performed using a Wilcoxon test.

Results
The results of the study indicate that waiting times post-covid are going down (p&lt;0.05). Thus, days until cholecystectomy have decreased but the number of patients being operated on too has decreased thus further worsening waiting times for elective patients. The median and IQR's of days to surgery post-covid are 198 (121.5–278) and pre-covid are 251 (89.5–586.5). Presentations of gallstone complications almost doubled post-covid and the percentage of patients operated on decreased by over 20%.

Conclusions
It is clear from the data that the NICE guidance on the management of acute cholecystitis has been difficult to adhere to during the pandemic. While the time from diagnosis to operation has reduced post-covid the total number of operations has decreased drastically, putting further strain on elective waiting lists. This, inevitably, will result in further presentations of complications from gallstones and adverse patient outcomes.
431 Writing the Right Way! Improvement of Operation Notes in an Orthopaedic Ward – a Closed Loop Audit
Authors: Ijaz O , Waqar Bhatti H , Ahmed R 
Published: November 2022

Abstract

Introduction
Operation notes are recognized as standard for documentation of details of operation but still it's often neglected. Proper documentation is necessary as it is correlated with good patient care, quality assurance, future decisions, and medico-legal issues.

Aim
The objective of this study is twofold: one to compare the documentation of notes against standard RCS (Royal College of Surgeons) guidelines and secondly making sure that surgeons follow these by educating them through presentations, brochures, aide memoires and introduction of proformas.

Method
We prospectively studied 50 post-op notes against standard RCS guidelines consecutively both pre and post intervention. Asymmetric data was analyzed after 4 weeks using the Fischer-Exact Test and statistical significance was set as &lt;0.05.

Results
A total of 18 guidelines were audited. First loop showed deficiencies in fields of elective/emergency, operative diagnosis, operative findings, complications, extra procedure performed, tissue removed/added, details of closure, blood loss and antibiotic prophylaxis. After intervention documentation improved and percentages rose and reached almost 100%.

Conclusion
Proper documentation is of great importance as it carries both medical and legal implications. Three step intervention showed remarkable improvement in documenting of these operation notes according to standard RCS guidelines.
472 Accuracy of Documentation and Handover of Surgical Operation Details in Cardiac Surgery
Authors: Hara N , Volpi S , Yates M , Corredor C , Shipolini A 
Published: November 2022

Abstract

Introduction
GMC Good Medical Practice Guideline states that documentation must be clear, accurate and legible. Accurate documentation of operation notes ensures proper postoperative care and forms important legal documents. This audit aims to assess the accurateness and consistency of recorded operation names throughout patients’ hospital stay following cardiac surgery, as well as the effect of standardisation of operation names to improve the accuracy of documentation.

Method
Patients undergoing cardiac surgery at St. Bartholomew's Hospital from November 29 to December 10, 2021, had data prospectively collected from their electronic patient records, which were compared to the standardised operation name. After the first audit cycle, junior medical staff were educated on the standardisation of operation names. Electronic patient records were reviewed again for patients undergoing cardiac surgery from January 10 to January 20, 2022.

Results
Following intervention, there were significant improvements in the accuracy of documented operation details. Initially, 65% of operation notes were accurately documented, whereas 96% of operation notes were completed to the ideal standard post-intervention. There was a 37% increase in the number of accurate discharge summaries, while inaccuracies and missing operation names were reduced to 0% from the initial 12%.

Conclusions
Accurate documentation of operation details is expected by GMC standards. Poor documentation can hinder the quality-of-care patients receive postoperatively. We have shown variation in descriptions of standard operations and multiple inaccuracies throughout patients’ hospital stay. We suggest agreed standardisation of operation details and education of junior medical staff regarding accuracy of documentation to enhance compliance with the GMC standard.
489 Imaging of Acute Pancreatitis in a UK District General Hospital
Authors: Lee CH , Taneja J , Kotamarthi A , Nita G 
Published: November 2022

Abstract

Aim
Imaging should not be routinely used in the diagnosis of Acute Pancreatitis unless there is: diagnostic uncertainty; failure to responding to conservative management; severity confirmation needed. It is suggested that optimal timing for CT assessment should be at least 72 hours after the onset of symptoms. We aimed to benchmark our unit and assess the imaging of Acute Pancreatitis and compare this against the standards set up by the Royal College of Radiologists (RCR).

Method
Patients with a CT proven diagnosis of Acute pancreatitis were included with data retrospectively collated and analysed over a 5-month period in 2021.

Results
30 consecutive patients with CT confirmed Acute Pancreatitis were included (57% male, 43% female; mean age: 53 years). 50% had optimal timing of scans (72 hours after onset of symptoms), 67% of scans were deemed appropriate (diagnostic uncertainty, assessing severity). 40% of CT reports did not comment on all 3 prognostic factors (presence of pancreatic necrosis; free intraperitoneal fluid; extensive peripancreatic fat stranding). Only 27% of patients had an ultrasound of the gallbladder within 24 hours of Acute Pancreatitis diagnosis.

Conclusion
The findings of this snapshot study is in line with the existing literature. Our unit does not meet the targets set out by the RCR (95%). There remains a need to standardise the approach to imaging and we aim to aid this by disseminating the study findings to the relevant departments and increasing knowledge amongst the clinicians. Re-audit is planned in the coming months.
515 Operative Documentation Audit of General Surgery
Authors: Darbi E , Ong CT , Mroczek T 
Published: November 2022

Abstract

Introduction
Documentation is an important part of healthcare practitioners’ daily routine. The importance of documentation is well stress in the literature and by the GMC's good medical practice. Good documentation ensures patients receive the best possible clinical care. Recently, the Royal College of Surgeons (RCS) published guidance aiming to improve the reported poor quality of operative documentation.

Method
The RCS operative notes guidelines were used as the audit criteria. These guidelines consisted of 19 domains and the adherence of the general surgery department operative documentation to each of these domains was measured. A 100% adherence to the RCS guidance was set as the audit standard. Data was collected during a period of four weeks from a set of General Surgery patients under the care of a random range of consultant surgeons.

Results
Data from 50 general surgery patients between 13/10/21 and 04/11/2021 were analysed. 47% of the 19 documentation domains stated by the RCS had 100% adherence. In addition, only 4% of the 50 patients’ operative notes had 100% adherence to all the 19 domains specified by the RCS.

Conclusion
Current operative notes documentation in the general surgery department does not meet the standards of this audit. However, possible areas of improvement are identified to bring current practice closer to the RCS operative notes guidance.
530 Communication Not Technology: How an Electronic Patient Referral Process Affects Patient Care in Acute General Surgery
Authors: Magnisio S , Howitt A , Lockwood SL 
Published: November 2022

Abstract

Introduction
The Royal College of Surgeons (RCS) high-risk general surgical patient guidelines recommend that a patient who needs emergency surgical assessment must be seen within 30 minutes in the case of a life-threatening emergency, and within 60 minutes for a routine emergency referral. The aim of this audit was to assess the efficiency of a new electronic referral system in expediting surgical assessment compared with direct referrals to the surgical oncall team.

Method
The study assessed the referral process and time to surgical review over two weeks. We included patients assessed in SAU and excluded patients reviewed in the emergency department (ED). Referrals were received from ED, general practitioners (GP) or surgical outpatient clinics.

Results
A total of 214 patients were included, 54% (116) referred from ED, 32% (69) from GP, 12% (26) from outpatients’ clinic, 1% (3) self -presenting. The median waiting time was 108 minutes. Direct referrals had a median waiting time of 84 minutes (RR 0–347). Patients allocated to the electronic transfer list waited a median of 120 minutes (RR 6–720).

Conclusion
All patients waited longer for review than recommended by RCS guidelines. The electronic transfer system failed to expedite surgical review and may have contributed to delays in some cases. Communication between colleagues, not technology, is imperative to ensure timely assessment of the acute surgical patient.
575 Are More Patients Being Harmed Than Treated with VTE Prophylaxis in Plastic Surgery? A Single-Centre Cycled Audit Reviewing Prescribing Practices
Authors: Kazzazi F , McKean A , Magill H , Noton T , Mitchell C , Jatan A 
Published: November 2022

Abstract

Aim
Venous thromboembolism prophylaxis (VTEP) was introduced following research showing that it was successful at preventing thrombotic complications in surgery patients. However, recent evidence demonstrates that patients in this cohort had subclinical venous thromboembolic disease and the benefit of VTEP was over-estimated. The Number Needed to Harm (NNH) is 26–67 while the Number Needed to Treat (NNT) is 147. This retrospective analysis attempted to identify if incorrect prescriptions in patients undergoing plastic surgery was possibly causing greater harm in a single plastic surgery centre.

Method
A retrospective analysis of the notes of all admissions in 1 month was conducted. VTEP forms and prescriptions were reviewed and compared against recommendations from the National Institute for Health and Care Excellence as well as local policy. A teaching session was delivered to explain to the department issues with prescriptions, then another 1 month of notes were analysed.

Results

Conclusion
There was an over-prescription of VTEP in plastic surgery patients in our cohort leading to a potential greater number of harmed than treated patients. This may require an attitude change towards VTEP to reduce patient harm.
652 Quality of Ultrasound Report in Patients with Biliary Symptoms in the Context of Surgical Diseases
Authors: Hakeem A , Chedid Y , Mateescu D , Chattopadhyay D 
Published: November 2022

Abstract

Aim
The diagnosis of surgical pathology in patients presenting with biliary symptoms is highly reliant on a good quality ultrasound report, our aim was to identify if there are any deficiencies in reports of ultrasound which are important diagnostic parameters of upper GI abnormalities.

Method
Patients presenting to Bedford hospital with biliary symptoms who require an ultrasound of biliary diseases were included, 8 parameters from the guidelines of Society and College of Radiographers were taken and analysed, means of missing data was calculated, CBD diameter was considered as a significant parameter. Quality of report for CBD was further scrutinized with patients who required 2nd investigations like MRCP and CTAP using crosstabs.

Results
A total of 278 patients were included in the study, 97.9% were due to gallstone diseases and 2.1% were for post-cholecystectomy. 89.7% had mentioned the normality of CBD while only 21.1% mentioned the actual value of CBD. 93% reports mentioned flow of portal vein, 7% did not mention portal vein flow. Interestingly 2.1% of ultrasounds were for post cholecystectomy but during scans, 4.6% of patients had absent gallbladder. 98 (34.5%) patients had one or more secondary investigations. 22.9% of normally reported CBD on ultrasound had positive CBD findings on MRCP.

Conclusions
This audit demonstrates the importance of a good quality ultrasound report. A good quality ultrasound can aid in clinical diagnosis and guidance of further investigations. Important factors to consider are the value of CBD Diameter, portal vein flow and quality of biliary stone/sludge.
661 A Closed Loop Audit Assessing Adherence to IR(ME)R 2017 Guidelines in Reporting Intra-Operative Ionising Radiation Images in Trauma and Orthopaedic Operation Notes
Authors: Rottenburg H , Kopec C , Reed J , Ashworth M 
Published: November 2022

Abstract

Aim
To determine whether operation notes adhere to IR(ME)R guidelines when reporting intra-operative ionising radiation images.

Method
Trauma and Orthopaedic operation notes were selected using a random number generator. These were assessed for a clear record of ionising radiation usage, and a clear description of and/or diagnostic implications of the imaging. An operation note template was created to encourage mandatory reporting of images taken intra-operatively. The operation notes were assessed again, and data collected.

Results
In total 90 operation notes were assessed. Before implementation of the image reporting template, 87% showed clear use of ionising radiation, and 60% a clear description or diagnostic implications of images. After implementation of the template, 73% of reporters used it. Of those that used it, 100% showed clear use of ionising radiation and 100% a clear description or diagnostic implications of images. Of those not using the template, 62.5% showed clear use of ionising radiation and 50% a clear description or diagnostic implications of images.

Conclusions
IR(ME)R 2017 guidelines require a documented clinical evaluation recorded for each exposure to ionising radiation, and exposures not clinically evaluated are not justified. Ionising radiation carries a small but compound risk of cancer, and therefore all radiation should be clinically justifiable. This study shows that the introduction of a template to operation reporting systems increased the reporting of intra-operative images to 100%. One limitation is that the template can be easily bypassed, enabling the reporter to skip the image reporting section and not document their evaluation.
732 Re-Audit: Surgical Handover Documentation
Authors: Koroma P , Shehrazi SR , Shetty VD 
Published: November 2022

Abstract

Aim
Surgical handover aims to convey accurate, appropriate & concise clinical information that is correct and up to date. It is essential in providing continuity of care, ensuring patient safety, and avoiding clinical errors. This process should be led by the Consultant on call. In this audit we aimed to compare our handover documentation practice against guidelines formulated by RCS England.

Method
Surgical Handover sheets from September 2020 and March 2021 were used for data collection. A total of 66 & 41 new patients were included in the initial and re audit respectively. Essential and desirable criteria guidelines by RCS England were used to compare our documentation. Essential criteria documentation should be 100% as per RCS guidelines.

Results
Initial audit showed room for improvement in documentation of both essential & desirable criteria.
A new handover template was introduced, we displayed posters and sent email reminders of the RCS guidelines.
Re audit showed significant improvement in essential criteria: date of admission 47% to 60%, responsible consultant 0 to 100%, current diagnosis 83% to 100% and investigations 84% to 100%. In desirable criteria: Past medical documentation improved from 42 to 62%, management plans from 96 to 100% and COVID status from 52 to 79%, VTE was documented in 58% of patients.

Conclusions
Surgical Handover documentation improved after implementation of changes. Busy ward rounds, multiple clinicians leading rounds, frequent relocation of patients and patients in non-surgical wards can make the process complex.