bluuebunny/crossref_metadata_2025_split huggingface dataset:
742 Quality of Operative Notes for Renal Transplant Surgery - Is Our Documentation Satisfactory?
Authors: Gupta S , Mahesh S , Koimtzis G , Chalklin C , Ilham MA , Elker D , Stephens MR , Khalid U 
Published: November 2022

Abstract

Introduction
Operation notes are essential in providing details of the procedure undertaken. The Royal College of Surgeons (RCS) Good Surgical Practice (GSP) guidelines recommend a checklist of 18 documentation items. Although these guidelines are useful, their broad and non-specific nature provides limitations to fields like transplantation, where additional information is needed. Ghoneima et al recommended transplant specific GSP checklist of 32 criteria for operation notes in transplantation. Our aim is to evaluate renal transplantation operation notes against these criteria.

Method
A retrospective audit of renal transplant operation notes was undertaken within Cardiff Transplant Unit between October 2020–2021. Notes were reviewed against new transplant specific GSP checklist.

Results
A total of 85 renal transplants were performed by 8 Consultant Surgeons. Sixty-two (73%) operation notes were hand-written and 23 (27%) electronically typed. Eleven standards had documentation compliance of &gt;95% (e.g., date, surgeons’ names, recipient blood vessels, incision, allograft vascular anatomy, perfusion timings, closure, signature, etc).
Some important transplant-specific information (e.g., primary renal disease, details of current renal replacement therapy, reperfusion characteristics, donor details (e.g., age, comorbidities), HLA mismatch, prosthesis (ureteric stent) details) were poorly documented (0–27% documentation compliance). Antibiotic and DVT prophylaxis documentation was also very poor (1–30%). Post-operative instructions did not record target blood pressure (0%) and postoperative potassium and ultrasound scan instructions were recorded in 65% of notes.

Discussion
Clear documentation is important for good surgical practice. This study highlights the need for a transplant-specific operation notes template, to not only improve the documentation but to standardize the key information recorded for every transplant performed.
762 Completed Cycle Audit on Treatment Escalation Planning Documentation in ENT In-Patients
Authors: Ho R , Shakeel M 
Published: November 2022

Abstract

Aim
Treatment Escalation Planning (TEP) helps ensure treatment foals of patients are developed understood and respected. Treatment Escalation documentation is a communication tool that provides staff immediate and accessible guidance in times of crises. A standardised form was created to improve and standardise TEP documentation in ENT in-patients. This audit aimed to review form completion rates. A further cycle was done to assess whether interventions improved practice.

Method
A retrospective audit of TEP form completion rates and quality of documentation. Paediatric patients and patients from elective surgery discharged on the same day were excluded. Data tabulated included age, co-morbidities, reason for admission, type of admission (emergency/ elective), DNACPR documentation (community and in-hospital), TEP form completion.

Results
The median age for patients included in the study was 73.5 years old. 83% were emergency admissions. Patients were multi-morbid (Malignancy, cardio and cerebro vascular disease, COPD etc.) In the first cycle 23% had in hospital DNACPR forms, 0% had community DNACPR and 0% had TEP forms completed. Intervention included staff education and physical reminders on handover documentation. Second cycle showed improvement, 40% of TEP forms were completed however 1 patient had community DNACPR in place but no in-hospital DNACPR.

Conclusions
Our intervention showed improvement in treatment escalation plan documentation. This audit also picked up a problem i.e., community DNACPR not converted to inpatient DNACPR whilst patient is an inpatient. Next steps include further intervention to improve completion rates and further audit to ensure longlasting improvement.
765 Preoperative Coagulation Screening Audit in General Surgery
Authors: Yomi-Orungbe E , Fazili N 
Published: November 2022

Abstract

Aim
Routine preoperative coagulation screening is considered standard practice to predict peri-operative bleeding. However, according to British Society of Haematology, indiscriminate coagulation screening is not recommended as it may to inappropriate delay of surgery, lead to further unnecessary tests and is also associated with significant costs. Instead, they recommend detailed bleeding history, including family history and use of medications. This audit was to evaluate the current practice and improve.

Method
A retrospective audit of 148 post-operative patients, randomly selected in Northwick Park Hospital admitted under the General Surgery between 01.04.2021 to 14.05.2021 at the initial audit and between 20.09.2021 to 07.10.2021 at the re-audit.

Results
The initial audit was done over a 6-week period with 98 cases selected. 19% of them had appropriate requests with 81% of the tests done being inappropriate. There was significant improvement by the re-audit with appropriate requests increasing to 56% and inappropriate tests dropping at 44%. The criteria for appropriate were a) Not requested as no significant medical history. b) Requested as clinically indicated. With each coagulation screening costing an average of £29.42, an overall estimate of £2971.42 was expended in inappropriate requests

Conclusion
All patients had relevant blood requests and PMH were documented but many inappropriate requests were made. It was recommended that instead of indiscriminate coagulation testing, a thorough history was advised to determine appropriate testing. There was a marked improvement at the re-audit with more appropriate requests being made.

Recommendations
Further meetings with the Anaesthesiologists to ensure a joint effort in achieving the target goal
769 Introduction of Electronic Proforma Improves Compliance of Operation Notes with the Royal College of Surgeons Guidelines: Results of a Closed Loop Audit
Authors: Oladeji E , Singh S , Katsos K , Kumapley L 
Published: November 2022

Abstract

Aim
Operative notes (op notes) are vital and confidential data. They serve as a fundamental means of communicating operative findings and procedure details and provide information on post-operative patient care. Their accuracy or otherwise have clinical, academic, and medico-legal implications.
This closed loop audit assessed the compliance of local general surgery operative notes with the guidance provided by the Royal College of Surgeons (RCS).

Method
Retrospective review of the general surgery operation notes completed locally to assess their various characteristics. 98 op notes were assessed for adherence to guidelines, followed by introduction of an Electronic Proforma (EP) and re-audit of 102 op notes 6 months after implementation of the EP.

Results
The overall compliance from the initial audit was below 80%. 7 parameters were identified with low compliance, their adherence ranged between 5% and 77%. The re-audit demonstrated increased adherence following implementation of the EP. There was improved compliance with the guidelines and documentation was generally found to be more accurate. Overall compliance was above 98%.

Conclusions
We achieved a sustainable change in the quality of op notes through the use of electronic op note template. This was made possible by collaborating with the IT department – this also underscores the importance of interdepartmental collaboration to effect changes.
798 Emergency Department Acute Urinary Retention Pathway Audit
Authors: Collis J , Pain TM 
Published: November 2022

Abstract

Aim

Method
Retrospective review of notes of patients coded as presenting with urinary retention in the ED between 01/02/2021 – 30/04/2021. Data collected from the hospital electronic patient system.

Results
Total 147 patients coded for presenting to the ED with urinary retention. 64 patients removed as not applicable. 83 patients audited: 61 male and 22 female. 61 male patients analysed.
A DRE was performed in 18% of those presenting with AUR. The residual volume was documented in 64%. Tamsulosin was started in 36%, not started in 36% and 16% were already on. Laxatives were started in 8%, not started in 69% and 16% were already on.
TWOC was successful in 43%, unsuccessful in 21% and not applicable in 26% (E.g., Listed for TURP).
A successful TWOC was achieved in 75% on both Tamsulosin and laxatives, 68% on Tamsulosin alone and 56% on neither.

Conclusion
A DRE is not being regularly performed on initial presentation to the ED. Residual volumes are being more regularly recorded. The combination of Tamsulosin and laxatives provided the highest success rate for TWOC whilst not providing any medication provided the lowest. There is scope to increase adherence to the ED AUR pathway which may improve the rates of successful TWOC's and guide future management.
823 Compliance with TED Stocking Usage in Surgical Patients in ELHT Surgical Wards
Authors: Abdel Jalil O , Yasin M , Lim S , Abdelrahim A 
Published: November 2022

Abstract

Introduction
Anti-embolic stocking (AES) is elastic stocking specifically designed to reduce the risk of VTE events. Multiple studies proved the effectiveness of AES in reducing the risk of DVT in hospitalized patients undergoing surgerical procedures.

Aim
Our Audit aimed to examine our doctors' compliance in prescribing AES, as well as the nursing staff's compliance in distributing the stockings to patients. We also aimed at investigating if any discrepancies are present between the different surgical wards in our hospital, or between weekdays and weekends.

Method
Data were collected by bedside observation of patients to see if they are wearing the stockings as well as inspecting the prescription charts.
The data collection occurred over 2 weeks with a random day picked on a weekday and on a weekend each week. Each surgical ward was reported separately to compare the results.
After presenting the results, a poster was distributed to educate doctors and nursing staff about the importance and true contraindications of AES. In addition, a sticker indicating the AES was added to the patient's board to check. A re-audit was done after one month.

Results
Initially, average in compliance with wearing the stocking was 50–70%, while the prescription rate was 44–84%. No major changes were noted between wards and between different days of the week. After the changes, slight improvement in the compliance was noted but not in prescription.

Conclusion
Educating staff and doctors about the importance of AES is essential for compliance, in addition to the need for repeated audits to check sustainability of changes.
830 Audit of Readmissions Within 30 Days of Total Knee Replacement (TKR)
Authors: Basha A , Chaudry A , El-Tawil S 
Published: November 2022

Abstract

Background
Total knee replacement (TKR) is a very successful operation but like all surgery carries risks. Patients can be readmitted, but not all necessarily linked to post-operative complications. National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man: 17th annual report, 2020, Prosthetic infection after total knee replacement is (TKR) of average 0.92%.

Aim
To identify causes of readmission after TKR & their frequency, within 30 days of surgery.

Method
Data spanning 2 years (Apr 2018- Apr 2020) were analysed. Patients’ details were retrieved for those with at least one readmission within 30 days of TKR and details include:

Results

Conclusion
842 An audit to assess adherence to the Tongue Reduction Integrated Care Pathway for Beckwith Wiedemann Syndrome
Authors: Howard T , Gabuniya N , Kerr S , Cornejo P 
Published: November 2022

Abstract

Aim
Beckwith-Wiedemann Syndrome (BWS) is a congenital overgrowth syndrome that occurs in approximately 1 in 15,000 births. A cardinal is macroglossia which can lead to sleep apnoea, difficulties feeding, speech, drooling and malalignment of teeth/jaw. Some children require tongue reduction surgery and are managed with a specific protocol to ensure the correct analgesia, fluid regime and commencement of oral feeds are delivered post-operatively. The aim of the audit was to improve adherence and awareness of the protocol to improve the patient journey.

Method
Initial audit cycle between 22/01/21 – 03/02/21 in the form of anonymous staff survey. Following initial results staff underwent two separate teaching sessions and posters were applied in key wards and staff areas. Repeat audit was completed between 01/07/2021 – 01/08/2021.

Results
Initial audit results demonstrated 44% (11/25) of ward staff were unaware of the Tongue Reduction Integrated Care Pathway and 56% (14/25) did not know which condition this protocol and surgical procedure was related to. Following both sets of interventions there was an improvement to 77.8% (14/18) of staff being aware of the protocol and 88.9% (16/18) of staff members knew which syndrome was associated with this pathology. Additionally, in the re-audit we demonstrated that 100% of participants were aware of the analgesia protocol. Correct rationale for fluid regime was demonstrated in 56% vs 24% demonstrating there is still room for improvement in this domain.

Conclusion
We have demonstrated that through teaching and the implementation of a poster we have improved the awareness of the Tongue Reduction Protocol.
843 Improving Antibiotic Prophylaxis Prescribing in Arthroplasty Surgery Following Neck of Femur Fracture (NOF#): A Clinical Audit Revealing Multi-Factorial Influences on Prescribing Accuracy
Authors: Ayathamattam J , Ansari A 
Published: November 2022

Abstract

Introduction
Post-op infection is a serious complication in surgery, particularly in arthroplasty. NICE guidelines advise antibiotic prophylaxis for all arthroplasty procedures to avoid this. This audit aimed to assess our concordance with our local guidelines and achieve improvements where we were deficient.

Method
Electronic prescribing records were analysed for 60 patients who underwent arthroplasty following NOF# across St. Richard's and Worthing Hospitals between 4/3/19 – 17/6/19. We presented these initial findings at our local orthopaedic clinical governance meeting to educate team members. We then collected a second cycle of data between 1/11/20 – 16/12/20.

Results
Patients receiving some form of antibiotic prophylaxis improved from 90% to 100%. Patients receiving the appropriate prophylaxis as per local guidelines increased from 78% to 83%. However, more patients were given incomplete prophylaxis in the second cycle: 5% of patients were on concurrent antibiotics for chest infection and were not given full prophylaxis, 5% of patients were under-dosed on gentamicin and 3% of patients were not given the full 24 hours’ worth of flucloxacillin. No patients developed joint infections post-op after following up for 6 months.

Conclusions
Although all patients were given prophylaxis in the second cycle, patients not receiving the full recommended course of antibiotics represents an avoidable risk in developing post-op infection. We identified that communication between orthopaedic surgeons, anaesthetists and orthogeriatric ward team members and awareness of prescribing responsibility were implicated in accurate prescribing of prophylactic antibiotics. We aim to address these with further education and amendments to performas and then re-audit to look for further improvements.
845 Assessing How Effectively Ankle Fractures Are Managed in Accordance with the BOAST Guidelines at a Major Trauma Centre
Authors: Jobson J , Saad A , Fernandes R , Jaly I , Burahee A 
Published: November 2022

Abstract

Aim
Ankle fractures constitute approximately 10.2% of all bony injuries. Due to pressures exerted by the COVID-19 pandemic, a series of modifications have evolved within subspecialty fracture management. The aim of our study was to evaluate our adaptations to the COVID-19 pandemic and assess our management of ankle fractures according to the BOAST guidelines.

Method
We performed a retrospective review of 30 skeletally mature patients with a closed ankle fracture presenting to a major tertiary centre. Our inclusion criteria comprised of the ‘BOAST guidelines for ankle fracture management’ published in 2016.

Results
Of the 30 patients within our cohort, 40% (n= 12) had stable ankle fractures, whereas 60% (n= 18) were unstable (based on the weber classification and evidence of syndesmotic instability). 63% (n= 10) had fracture manipulations prior to surgery. 50% (n= 5) had a documented re-examination of neurovascular status. All patients had a post reduction image. 88% (n= 16) with unstable fractures underwent operative fixation. 6 patients underwent external fixation prior to definitive management. The average time from injury to definitive fixation was 12 days with a range from 0–22 days. Only 8 patients had clear documentation of intraoperative syndesmotic stability.

Conclusions
The BOAST guidelines outline a range of standards that should be utilised when treating ankle fracture patients. We intend to use our study to educate healthcare professionals on the importance of accurate documentation and encourage shorter operative waiting times to improve standard of care and patient outcomes.
891 Improvement in VTE Prophylaxis and Hospital Admission Time for Colorectal Cancer Patients Following the Introduction of an Enhanced Recover After Surgery (ERAS) Nurse
Authors: Zhu XM , Cribb E , Smith J , Ashton G , Pawa N 
Published: November 2022

Abstract

Aim
Patients undergoing abdominopelvic surgery at high risk of developing VTE and NICE guidelines mandate a 28-day course of post-operative pharmacological prophylaxis for these patients. We completed a closed loop re-audit to examine the local trust adherence to national guidelines.

Method
A closed loop re-audit was performed to check for appropriate VTE prescription. 62 patients undergoing elective surgery for colorectal cancer were identified from May 2017 to April 2018. An ERAS nurse was appointed following the initial audit and subsequent data was collected on a cohort of 80 eligible patients from April 2021 to October 2021.

Results
Previous compliance against national guidance set by NICE was 32% for patients screened from May 2017 to April 2018. There was a significant improvement to a 74% compliance rate following the introduction of an ERAS nurse. The appointment of the ERAS nurses also resulted in a reduction in postoperative hospital stay of 1.2 days.

Conclusions
A significant improvement in appropriate VTE prophylaxis was provided to patients following the introduction of a dedicated ERAS nurse. In addition, patients had a mean reduction in hospital stay length.
Several points for future investigation based on findings: identification of cause behind missed prescriptions, patient education on self-administration of LMWH on discharge when applicable, and whether any VTE related complications occurred in either cohort.
899 A Closed Loop Audit of Imaging Rate in Suspected Complicated Acute Diverticulitis
Authors: Rayner A , Adepoju O , Wong G , Mobasheri M 
Published: November 2022

Abstract

Aim
Diverticular disease is commonly encountered in western populations, with complicated acute diverticulitis potentially leading to significant morbidity and mortality. The National Institute for Health and Care Excellence (NICE) recommend imaging these patients within 24-hours of admission, which is essential to confirm diagnosis and guide further management. We aimed to audit the imaging rate in suspected complicated acute diverticulitis within our department and identify ways to improve this.

Method
Data were collected from all patients admitted from January to June 2021 with suspected complicated acute diverticulitis as defined by NICE. Patients with normal inflammatory markers were excluded. Electronic records were reviewed for evidence of imaging performed within 24-hours of hospital admission and the imaging rate was compared with the previous audit cycle.

Results
96 patients were admitted with suspected complicated acute diverticulitis. 83 patients had raised inflammatory markers. 76 (91.6%) of these had contrast computer tomography (CT) scans performed within 24-hours of admission. Of the 7 (8.4%) patients who did not undergo imaging within 24-hours, 3 had recent imaging suggestive of diverticular disease or diverticulitis, 2 were treated with antibiotics, 1 patient refused, and 1 had CT within 48-hours due to delays waiting for dialysis.

Conclusions
We have shown continued good compliance with NICE guidelines, though the imaging rate has declined slightly compared with the previous audit cycle (94.3%). In order to maintain and improve these standards, we will offer educational sessions within our department to underline the importance of timely imaging in this patient group and continue to audit our performance.
903 Improving Documentation of Tourniquet Use in a Trauma Unit in Line with New BOAST Guidelines
Authors: Fitzpatrick N , Arneill M , Wilson L 
Published: November 2022

Abstract

Aim
Local tissue damage is a significant potential consequence of intraoperative pneumatic tourniquet use, via pressure-related damage or chemical injury. The British Orthopaedic Association released a guideline relating to the safe intraoperative tourniquet use in October 2021, dictating standards for documentation in operative records. Initial audit suggested that only 15% of the required information was documented. With updated operative record paperwork and electronic templates, we aimed to improve adherence to updated BOAST guidance.

Method
Following analysis of 14 days' worth of trauma operation records, results of local documentation of tourniquet use were presented at a departmental audit meeting. With departmental permission, changes were made to the operation notes template, to include tickboxes relating to the use of tourniquets, skin condition pre/post-operatively, method of isolation, method of exsanguination, and the pressure of tourniquet and duration of use in line with new guidelines. Additionally, a new, time-efficient template was designed for those using electronic records. Results were re-audited over a 14-day period following dissemination of the relevant templates.

Results
Initial results suggested that only 15% of required data surrounding tourniquet use was being documented, with none recording information relating to skin condition pre/post-operatively, method of isolation or exsanguination. Following aforementioned interventions led to an improvement in documentation from 15% compliance to 64% compliance.

Conclusions
Further efforts are required in order to further improve documentation of tourniquet use, particularly when in electronic format, initial re-audit results are encouraging for improved adherence to new BOAST guidance in a local trauma unit.