Variability in interval from diagnostic biopsy to definitive surgical treatment of malignant melanoma in an Irish tertiary-referral centre
Authors: Michael R. Boland, Gary A. Bass, Nicola M. Hughes, Zahraa Al-Hilli, Ruth S. Prichard, Denis Evoy, Enda W. McDermott
Journal: International Journal of Surgery (2013)

s / International Journal of Surgery 11 (2013) 589e685 653 ABSTRACTS Aim: We evaluated the use of CT in the diagnosis of acute appendicitis, comparing its efficacy to clinical diagnosis alone. Method: A 1-year retrospective review of the medical records of all patients who underwent appendectomy was conducted. Results: 116 patients were included. 83.6% of patients were histologically confirmed to have appendicitis. The sensitivity and positive predictive value (PPV) of CT for diagnosis of appendicitis were both 0.94. Clinical diagnosis alone had a sensitivity of 0.92 and PPV of 0.86. In terms of overall accuracy, CT and clinical diagnosis made the correct prediction in 89% and 81% of cases, respectively. Patients who underwent CT scanning were found to have a significantly longer (p1⁄40.014) hospital length of stay. Conclusions: CT scanning had higher sensitivity, positive predictive value and overall accuracy than clinical diagnosis alone. However, the differences were not significant. Furthermore, CT scanning was associated with a significantly longer hospital length of stay. Our findings do not support a significant added benefit of CT scanning in the routine diagnosis of appendicitis. Given its radiation exposure and high cost, its use in the diagnosis of appendicitis should be carefully considered. Nevertheless, CT scanning may be useful when clinical diagnosis is difficult. 0895: VARIABILITY IN INTERVAL FROM DIAGNOSTIC BIOPSY TO DEFINITIVE SURGICAL TREATMENT OF MALIGNANT MELANOMA IN AN IRISH TERTIARY-REFERRAL CENTRE Michael R. Boland, Gary A. Bass, Nicola M. Hughes, Zahraa Al-Hilli, Ruth S. Prichard, Denis Evoy, Enda W. McDermott. Department of General/ Breast/Endocrine Surgery, St Vincents University Hospital, Dublin, Ireland. Introduction: Diagnostic excisional biopsy with follow-up definitive surgery remains the mainstay of treatment of malignant melanoma. This study sought to determine the surgical interval (S.I.) between diagnostic biopsy and definitive surgery and to elucidate factors associated with delayed definitive management. Methods: A cohort of 110 consecutive patients who had a diagnostic biopsy and subsequent wide local excision at our institution between January 2011 and June 2012, was identified from MDT records. Patient demographics, tumour characteristics, mode of referral and surgical intervals were documented. Results: The mean age was 60 2 (range 17 -93) years, and the male to female ratio was 1.3:1. The median duration of the S.I. was 36 3 days (Range: 6-143 days). The S.I. was longer if a dermatologist performed the diagnostic biopsy as opposed to a general surgeon (35 3 vs. 54 5 days, p 1⁄4 0.005). The S.I. was longer for lesions involving the head/neck compared with other sites (58.2 6 vs. 40.7 3 days, p 1⁄4 0.002). Reasons for a prolonged S.I. included referral for definitive surgery and time for preoperative staging investigations. Conclusions: Significant variations were noted in the surgical interval. Protocolized referral pathways would decrease the SI, allowing for optimal surgical management, especially for lesions of head/neck. 0927: CAN BLOOD TEST RATIONALISATION IN EMERGENCY GENERAL SURGICAL PATIENTS BE BENEFICIAL ACROSS DIFFERENT NHS TRUSTS? Peter Rees, Mohammed Ashrafi, Komal Patel, Jonathan Heath. Blackpool Victoria Hospital, Blackpool, UK. Aim: A recent audit at a district general hospital identified that the introduction of guidelines could lead to a rationalisation of blood tests performed and significant savings. This study aimed to identify if this guideline could be successfully implemented at other trusts with similarly beneficial outcomes. Method: All general surgical emergency admissions over 1 week were identifiedandprospectivelyanalysed.Data collected includedpresentingcomplaint andblood testsonadmission.Apreviouslydescribedguidelinewasappliedand comparison made between predicted and actual blood tests performed. Results:Of the 59patients (31 female, 28male),15/59 (25%)were outside the remit of the proposed guideline. Only a minority adhered to the proposed guideline. CRP and amylase (26/43 and 26/41, performed vs recommended) were frequently missed, while an excess of coagulation screens were performed(23/3, performedvs recommended). Strict adherence to theguideline would have resulted in a saving of £1.93 per patient. Conclusion: Inappropriate blood test ordering is widespread throughout the NHS. It is possible to implement a simple guideline, that would improve patient care and result in huge cost savings, across many trusts. 0940: CHANGES IN SURGICAL HANDOVER AND SCOPE FOR FUTURE IMPROVEMENT Emma Blower, Teresa MacCarrick, Helen Forster, Paul Sutton, Dale Vimalachandran. Countess of Chester Hospital, Chester, UK. Aims: Compliance with working time regulations in surgical practice has resulted in an increased number of clinicians caring for patients and subsequent handovers. In 2007, the Royal College of Surgeons produced guidelines on the minimum data-set for ‘Safe Handover’. This audit examined compliance with these guidelines before and after adopting a more detailed handover ‘template’ with the intention of improving handover quality and safety. Methods: Pre-existing surgical ‘take’ electronic handover sheets were reviewed daily for two weeks to assess compliance. A new proforma was introduced, training given and concordance re-audited. Chi-squared analysis was performed. Results: In cycles 1 and 2, 118 and 114 patients respectively were audited. Name and responsible consultant were recorded in all cases. Age (52%,85%,p1⁄4<0.01), location (77%,95%,p1⁄4<0.01), admission date (0%,39%,p1⁄4<0.01), medical history (82%,94%,p1⁄40.01), diagnosis (55%,93%,p1⁄4<0.01) and management (81%,97%,p1⁄4<0.01) showed a statistically significant improvement with the new proforma. Presenting complaint (93%,98%) and investigation (90%,90%) data remained good. Review frequency (5%,11%) and outstanding tasks (21%,27%) were poorly documented. Conclusions: Significant improvement was seen in the amount of information handed-over following the introduction of the new proforma with likely positive implications on patient safety and standard of care. However, there is still further room for improvement, possibly aided by training. 0962: IS THE OPEN SURGICAL TECHNIQUE OF PERITONEAL DIALYSIS CATHETER INSERTION DATED AND TO BE DISCONTINUED? Reena Shah, Anusha Edwards, Patrick Gordon. North Bristol NHS Trust,