bluuebunny/crossref_metadata_2025_split huggingface dataset:
510 Improving Trauma & Orthopaedic Handover During a Pandemic: Keeping Patients Safe - A Closed Loop QIP
Authors: Tse S , Busby C , Bryson D 
Published: November 2022

Abstract

Aim
Lack of communication and incomplete handover leads to errors and patient harm. Staffing challenges caused by Covid-19 highlights the necessity for high-quality handover. Our aim was to assess the quality of T&O weekend ward handover and evaluate the implementation of a formal handover document to improve the process.

Method
Junior doctors completed a survey to measure the efficacy and safety of current handover. A formalised written handover document in line with RCS Safe Handover recommendations was created and included in the doctors’ inductions. Evaluation was after 5 weeks with post-intervention questionnaires and new doctor rotation feedback.

Results
Prior to introduction of the handover document, 78% stated they were unable to formally handover. 77% experienced incomplete or unclear handover when working on the weekend. Lack of a standard handover process was deemed ineffective and unsafe.
All respondents reported more efficient working with the new process. The perceived safety rating significantly increased from 2.33 out of 5 to 4.23 (p&lt;0.0001). The new cohort of junior doctors rated the safety of handover to be 3.54, showing there is still scope for improvement in patient safety.

Conclusions
The use of standardized handover tools had a positive impact, improving the safety and quality of weekend handover. Workload was prioritized appropriately with improved transfer of information between teams. Covid-19 creates numerous challenges for safe clinical care. Working in unfamiliar environments and last-minute rota changes need to be mitigated by robust handover processes.
527 The Challenge to Improve Patient Education for Newly Inserted Urinary Catheters on Discharge from the Emergency Department
Authors: Tyler G , Mills H 
Published: November 2022

Abstract

Aim
To improve education in patients with new urinary catheters on discharge from the Emergency Department (ED), decreasing the incidence and healthcare burden of subsequent catheter-associated complications.

Method
Qualitative study design was employed to survey all Healthcare Professionals (HCPs) working in the ED and establish the quality and means of information currently provided. A novel trust-endorsed proforma with information leaflet was created with urology team input and uploaded to the ED website. Staff were updated via email, WhatsApp and verbally and re-surveyed after 6 months. Survey responses were evaluated with descriptive statistical analysis.

Results
The majority of HCPs in the department reported nearly always/often providing information verbally to patients, with similar findings on re-surveying. The most commonly discussed topic with patients remained: “Common complications and where to seek advice”. HCPs reported never/rarely offering written information (75%, 74% before and after respectively) and nearly all HCPs surveyed did not know where to find patient information resources (81%, 79% respectively).

Conclusions
Written information provision remained poor despite creation of a proforma with information leaflet. A high departmental turnover of HCPs, alongside varying seasonal Covid burden may have reduced the efficacy of interventions. The findings may also be as a result of HCPs still not knowing where to locate such resources.
‘Nudge theory’ through placing leaflets next to catheter supplies, combined with improved education of new staff rotating through the department at individual inductions and the introduction of checklists are changes that have been since actioned and due to be re-surveyed in February 2022.
579 The Perfect OP Note - in the World of Surgery - QIP/Clinical Audit
Authors: Nasim O , Durrani A , Eskander B , Charalampos P 
Published: November 2022

Abstract

Aim
To audit by assessing the completeness of the operative note and if it follows the guidelines and the standard recommendations mentioned in the RCS & BMJ articles.

Method
The audit was registered with the clinical audit department prior to data collection and analysis of the results, Inpatient scanned records were analysed for all operative notes, From 1st June 2020 to 15 June 2020 - From 14th Feb 2021 to 21st Feb 2021 & 1st March 2021 to 7th March 2021 - All trauma and orthopaedic patients were included regardless of the type of procedure.
There were no exclusion criteria in place, All operative notes were analysed & scored against 34 operative criteria's according to ‘good surgical practice’ & BMJ article’

Results
These 96 operative notes were analysed against 34 unique criteria which were gathered from a combination of RCS guidance criteria for operative notes and different trusts operative note proforma headings
There was an increase of 40% in typed operative notes that increased the compliance with the 34 unique criteria. Improvement was seen in 11 unique criteria after the 3rd PDSA cycle.

Conclusion
Facilitation of generic templates, and findings of the Audit itself and then the presentation - brought about a positive change - with more detailed operative notes and improved the quality of the documentation.
619 Plastic Surgery Trauma Operating Theatre: The Impact of a Golden Patient Protocol on Theatre Usage Metrics
Authors: Clough R , Towning R , Mohan A 
Published: November 2022

Abstract

Aim
A golden patient protocol was introduced for the dedicated plastic surgery trauma operating list at St Mary's Hospital, London on 05/10/2020. Criteria preferable for golden patient selection included patients with routine anaesthetic requirements, day case surgery, local anaesthetic cases and those requiring the least equipment. The protocol included distribution of a theatre list with a named golden patient the day prior to operating and communication of this to the anaesthetist and theatre co-ordinator. This study sought to determine the effect of this protocol on theatre efficiency and other key metrics.

Method
Operation timings were retrospectively and prospectively collected from the hospital Cerner® Surginet database prior to and following introduction of the golden patient protocol, respectively. Fields included were anaesthetic start time, surgery start time, surgery end time and time patient left operating theatre. Statistical analysis was performed using the unpaired t-test method.

Result
Data was collected for 73 and 152 operating days before and after the introduction of the golden patient protocol, respectively. Following introduction of the golden patient protocol there was significantly greater mean operations performed per day (2.84 vs 3.29, p=0.0130), reduced mean late start time (34 minutes vs 16 minutes, p=0.0002) and reduced mean overrun time (37 minutes vs 9 minutes, p=0.0001). No significant difference was observed in theatre efficiency (64% vs 67%, p=0.18).

Conclusions
Optimising first patient choice and enhancing communication of this with members of the theatre team can result in more procedures being performed and reduced loss of time at the start of an operating list.
679 Trainee Perceptions of Safety in General Surgery Handover – a Quality Improvement Project
Authors: Egbe A , Cruddas L , Greenfield S 
Published: November 2022

Abstract

Aim
Effective patient handover is an important cornerstone of clinical care and patient safety. The aim of this study was to measure trainee perceptions of handover safety, and to improve the safety of handover.

Method
An anonymous questionnaire was sent to all junior doctors in a general surgery department with a two-stage evening handover, as registrars change over at 17.00 and senior house officers at 20.00.
The intervention involved introduction of a new standard of handover, including a set location and printed patient lists.
Following one month of intervention, a second questionnaire was distributed to assess its impact.

Results
There were 15 respondents to the pre-intervention questionnaire and 16 respondents to the post-intervention questionnaire.
Perception of safety at the 17.00 handover increased from 27% to 56% following the intervention, and at 20.00 this increased from 60% to 88%.
The proportion of respondents who felt that new admissions were handed over well at 17.00 increased from 27% to 38%, with an increase from 67% to 81% for the 20.00 handover.
The proportion of respondents who felt that the ward patients were handed over well at 20.00 increased from 40% to 81%.
The generation of a patient handover list at 20.00 increased from 7% to 25%.

Conclusions
Simple interventions appear to be effective at improving trainee perceptions of safety in patient handover in general surgery.
Ensuring the quality of patient handover must be a priority for all clinicians; however, approaches may need to be tailored to the working shift patterns within a department.
695 Improving Consent Forms for Laparoscopic Cholecystectomy; a Visual Consent Form Toolkit
Authors: Jeilani M , Super J , Riad M , Jayasankar B 
Published: November 2022

Abstract

Aim
Laparoscopic cholecystectomy is a common elective operation with significant complication risks. GMC guidance on consent emphasises informed consent, and failure to warn patients of significant complications can lead to medico-legal implications. We aimed to assess the quality of risk documentation for laparoscopic cholecystectomies performed at our trust. In particular, we aimed to assess improvement since previous cycles after circulation of our boutique ‘Visual Consent Form Toolkit’, an easily accessible resource for risks associated with common procedures.

Method
Consent forms for 49 elective laparoscopic cholecystectomies performed at a busy district general hospital between September and November 2021 were retrospectively analysed. Risk documentation was audited against a standard of 15 common complications associated with laparoscopic cholecystectomy.

Results
There was significant improvement across the board. Risks previously documented at 100% remained at this level (infection & bleeding). Those previously well-documented showed further improvement (CBD injury, bile leak, damage to local structures, open conversion & VTE). Of those not previously well-documented (the rest), all except two (diarrhoea & pancreatitis) showed improvement. In particular anaesthetic risks, which was emphasised in our toolkit, saw the largest improvement.

Conclusions
Risk documentation on consent forms has overall considerably improved with the circulation of our ‘Visual Consent Form Toolkit’. More risks now fully or partially meet the expected standard. From those risks not meeting the expected standard despite numerous audit cycles, we understand that surgeons do not feel these risks should be documented in all situations for all patients, and therefore that an expected standard does not necessarily apply for these risks.
710 Developing a Standardised Form to Improve Communications Between General Surgical Juniors and Microbiologists
Authors: Edmonds R , Jamadar T , Coronelli M , Weerasinghe D , Ali N , Magro T 
Published: November 2022

Abstract

Aim
To improve discussions between microbiology and surgical juniors.

Method
As a group we identified that discussions with microbiology were documented in notes, but not easily found when further discussions were required. We also found that some discussions were more difficult if the junior did not have all of the appropriate information to hand. We created a separate form to document microbiology discussions, bring together the essential information that they required for the conversations and enable quick reference for future discussions. We sent out a questionnaire to assess the level of the difficulties, introduced the form and documented any additional information that was asked for during discussions. We then repeated the questionnaire to assess if there were any improvements.

Results
The original version was insufficient, in that it was not distinct from other paper notes so could be difficult to find, and some questions were asked frequently that we did not have answers for. The discussions however were improved, and the recording of reasoning for decisions enabled more consistent recommendations.

Conclusions
By creating the form we helped juniors prepare for more constructive calls to microbiology, were able to answer some of their questions regarding why prior decisions were made and at the end have the most sensible suggestions and plans from microbiology for surgical patients. While we still use paper notes, the concept and format are suitable for transfer to other specialities and electronic records where available.
714 ‘Administration of Tranexamic Acid in Traumatic Brain Injury in a Major London Trauma Centre’
Authors: Oskooee N , Tsang K 
Published: November 2022

Abstract

Aim
Traumatic brain injury contributes to worldwide death and disability more than any other traumatic insult. CRASH-3 demonstrated tranexamic acid is safe in mild to moderate traumatic brain injury and head injury-related death was reduced when given within 3 hours of injury. This project aims to review adherence to the recommendations at a major trauma centre and implement changes with the view of improving outcomes.

Method
Patients presenting at St Mary's Hospital with a traumatic head injury over a 6-month period were identified. Data collection included: timings of injury and tranexamic acid administration, Glasgow Coma Scale at the scene and admission, and bolus vs. bolus and infusion. Results presented at the regional trauma network meeting with summary poster designed for display in the department. A second cycle of data collection was completed over 2 months following the interventions.

Results
There was an increase in the proportion of patients who received tranexamic acid from 29% in cycle 1 to 51% in cycle 2. The proportion of patients receiving both the initial bolus and infusion also increased from 25% in cycle 1 to 45% in cycle 2. The average time from injury to first dose of tranexamic acid was reduced from 2 hours 16 minutes to 1 hour 33 minutes.

Conclusions
The interventions implemented between cycles 1 and 2 led to an overall improvement in the major trauma unit's adherence to the CRASH-3 recommendations. Decisions where tranexamic acid is withheld are down to clinical judgement however it is recommended that the reasoning is also documented.
737 Recording and Evaluating Affect and Coping During COVID19 in Healthcare-Workers and Outcomes (REACCH-Out): Mental Health Implications for Our Junior Doctor Cohort
Authors: Akbar S 
Published: November 2022

Abstract
The announcement of the COVID19 pandemic has had a huge impact on surgical practice in the UK. Many surgical trainees were redeployed to areas within the hospital to provide additional cover during the pandemic. Providing adequate wellbeing and support to trainees is imperative during this time of hardship.
18 plastic surgery junior doctors were redeployed to either intensive care units, emergency departments or medical wards during the period of study. A mixed methods survey was completed by trainees exploring rates of anxiety, depression and coping during the first peak of the pandemic. A “COVID care package” was provided to support surgical junior doctors.
The average anxiety score for trainees exceeded that regarded as ‘normal’ as predicted by the Hospital Anxiety and Depression Scale. SHOs were found to show higher scores of anxieties and depression throughout the course of study as compared to their registrar counterparts. 43.8% of junior doctors reported greater levels of stress since the announcement of the pandemic. 81% of junior doctors preferred to have regular check-ins with work colleagues during difficult times.
Providing a strong support system for trainees is vital to ensure doctors are not overwhelmed at this volatile time in their careers. The use of psychological monitoring tools to guide the implementation of appropriate levels of support for individuals could aid in enhanced junior doctor wellbeing and support. Feedback suggests that surgical trainees agree that contact with their parent team and colleagues has a positive impact on their wellbeing and prefer these regular “check-ins” to occur on a monthly basis.
746 A Novel Method of Remotely Managing Complex HHT Patients via Telephone Clinic to Reduce Severity and Frequency of Nosebleeds
Authors: Mehtani N , Acharya V , Bullock E , Rennie C 
Published: November 2022

Abstract

Introduction
Hereditary haemorrhagic telangiectasia (HHT) is a complex, multisystemic vascular dysplasia affecting approximately 85,000 European Citizens. Patients who have hereditary haemorrhagic telangiectasia can have severe debilitating manifestation of symptoms which can severely affect their quality of life. One of the severe manifestations is epistaxis, this can often lead to being anaemic, needing blood transfusion and hospital admission.

Method
Patient data was analysed to record number of hospital visits, A&E attendances, and hospital admissions. Multidisciplinary approach to involve various teams including but not limited to specialist nurses and clinicians.

Results
Virtual clinics facilitate management of HHT patients with complex needs. Provision of (nurse led) specialist virtual clinic in the form of telephone consults giving advice regarding maintenance and emergency care in case of a nosebleeds. This facilitates safe pathway for emergent care and avoids hospital visit with every episode. The patients are provided with an emergency pack and a prevention pack. The emergency pack contains nasal packs, tranexamic acid mouthwash 5%, nasopore, kaltostat whereas the prevention pack contains triple therapy. Analysis of patient data suggests reduced number of hospital visits, A&E attendances, and hospital admissions to seek specialist treatment.

Conclusions
Virtual clinics are an upcoming novel method of managing complex patients. They are beneficial for patients allowing them specialist access to medical advice to manage their symptoms at home. Improved patient care pathway allowing easy access of specialist medical advice. Safer management of complex HHT patients reducing frequent hospital visits for reasons like consultations, blood tests, admissions, and blood transfusion.
839 Improving Oxygen Prescribing on Kardex in Ward Level Care
Authors: Maniarasu V , Sandhu HS , Gunasekaran G 
Published: November 2022

Abstract

Aim
The aim of the QIP was to raise awareness about the importance of oxygen prescription amongst healthcare staff and improve the oxygen prescription rate on Kardex by 50% in 3 weeks at both surgical and medical wards.

Background
Oxygen is considered a type of drug and should be prescribed on the Kardex. The administration of inappropriate oxygen concentration can have fatal consequences such as prolonged hypoxaemia or hyperoxia. Therefore, it is good practice to prescribe oxygen on the Kardex.

Method
Data was collected from 25 patients from surgical and medical wards once weekly. 3 plan-do-study-act (PDSA) interventions were undertaken. Source of information were the Kardex, NEWS observation chart, direct observation of oxygen delivery at patient's bedside and ward round documentation. The reason both surgical and medical wards were selected was to showcase just how prevalent the use of oxygen is in the hospital regardless of the underlying diagnosis.

Results
In PDSA 1, only 8% of the patients had oxygen prescribed. First intervention was to educate the doctors and nurses at the wards on the importance of oxygen prescription and the harmful effects of inaccurate target oxygen saturations. Following this, oxygen prescription increased to 45% in PDSA 2. In the second intervention, visual prompts were displayed in the wards. The oxygen prescription rate in PDSA 3 reached 53%.

Conclusions
We achieved our goal of this QI project through 3 PDSA cycles, which is to improve oxygen prescription by 50%. However, there is still room for improvement to sustain this good clinical practice.
863 Improving the Outcomes of Inpatient Admissions and Optimising Referrals to a Regional Burns Unit Through Introduction of a Specialist Nurse-Led Burns Clinic
Authors: Carvill M , Milto K , Robb L , Jordan D , Widdowson D , Bahia H 
Published: November 2022

Abstract

Aim
We aimed to measure the effect of a specialist nurse-led clinic and referral pathway on admission rate, patient length of stay (LOS), and total bed days. We hypothesised that this intervention would contribute to the optimisation of the patient pathway in a regional burn's unit.

Method
Retrospective analysis of inpatient records in a six-month period over three years at a regional burn's unit (June-November 2018,2019,2020). Analysis of demographics, TBSA, admissions, and length of stay before and after clinic introduction. Statistical analysis included one-way ANOVA.

Results
A reduction in admissions was observed in 2020 compared to 2019 and 2018 (7.3% and 6.7%) for a patient group with equivalent median TBSA (2%) and comparable median age (41 vs. 43.5 and 42.5). Median LOS was significantly shortened compared to 2019 (42.9%, F=4.07, p=0.046) and 2018 (42.9%, F=6.59, p=0.011). Minor burns showed reduced admission rates compared to 2019 (8.5%), and reduced median LOS (42.9% and 33.3%), and reduced total bed days (29.4% and 27.1%) compared to 2019 and 2018 respectively. Referrals to the regional burn's unit as a percentage total of regional A&E burns presentations increased in 2020 compared to 2019 and 2018 (16% vs. 14.4% and 12.1%).

Conclusions
The results suggest that the introduction of a specialist clinic has shortened in-patient stay with a significant effect on minor burns, against a backdrop of increased referrals. We suggest that continuity between clinic and inpatient care by a specialist nursing team has helped to optimise the regional burns unit.
931 Timeline in Management of Urinary Retention: Trial Without Catheter (TWOC) Clinic – Single Centre Outcomes of District General Hospital
Authors: Chkir B , Saqib M 
Published: November 2022

Abstract

Aim
Urinary retention is a common urological emergency, but the management is not standardised due to lack of clinical guidelines & various options available to a complex problem. We aim to assess the timeline of patients going into acute urinary retention & their first/second TWOC appointment until clinic appointment and decision for definitive treatment as-well as to reduce waiting time&improve patients’ safety/experience.

Method
Using retrospectively collected data, all TWOC admissions from June 2019-December 2019 and June 2020-December 2020 were included. Data was extracted from various sections across our e-system. Outpatient letter appointments also checked to complete the timeline.

Results
Total of 93-TWOC admissions in total, 45 of which were in2019 and 48 in2020. 26%(n=24) of patients have passed their TWOC. 74%(n=69) of patients have failed their TWOC necessitating re-catheterisation/consideration for TURP/re-TWOC.
Time from urinary retention/catheterisation to TWOC admission in 2019 had an average of 36.2days, whereas it was 37.9days in 2020.
Time from urinary catheterisation to clinic also showed variation with an average of 83.9days in 2019 and 56.3days in 2020, ultimately resulting in long waiting-period for an operation.

Conclusions
A TWOC-clinic, where patients can be seen once-a-week to reduce clinic waiting time & improve safety by performing DRE & checking PSA in timely-manner, was proposed. It allows effective use of TWOC slots & timely decision of suitable patients for surgery rather than simply-listing patients for unnecessary further TWOC. It also serves as a platform to safety-net patients with possible underlying prostate-cancer by checking PSA & performing DRE early in their journey for early-management.