Reducing the use of inappropriate coagulation testing in emergency general surgical patients.

Background and aims Indiscriminate coagulation testing in emergency general surgical patients can lead to inappropriate delay in surgery, cause unnecessary concern and is associated with significant cost. The British Committee for Standards in Haematology recommends against coagulation testing to predict peri-operative bleeding risk in unselected patients. Our aim was to assess the appropriateness of coagulation tests performed in emergency general surgical patients and evaluate the effect of a series of educational interventions on clinical practice. Methods and results Appropriate indications for performing coagulation testing included a positive bleeding history, the presence of liver disease/cholestasis, sepsis or use of anticoagulants. Initial data on 142 patients were collected over 2 weeks of receiving. Following analysis, indications for appropriate coagulation testing were highlighted and data were collected on a further 190 patients. Comparing the audit cycles, we observed a decrease in the proportion of patients who underwent routine testing (49.3% vs 32.6%; p = 0.002) and inappropriate testing (67% of tests vs 34% of tests; p < 0.001). Despite being highlighted, there was no evidence of improved documentation of bleeding histories on admission. Conclusions This observational study suggests that simple educational messages can reduce the inappropriate use of coagulation screening tests in general surgical emergencies. This seems to result from clarification of the appropriate surgical indications for coagulation testing in this group.

The utility of Problem Areas in Diabetes (PAID) scale amongst patients with Type 2 diabetes (T2DM): An experience from a teaching hospital in Southern India.

OBJECTIVES: The purpose of this study was to establish the prevalence of diabetes-specific psychological distress (DSPD) among patients with type 2 diabetes mellitus (T2DM) using the "Problem areas in diabetes" (PAID) scale at a teaching hospital in southern India. Other objectives included observing the relationship between socio-demographic factors and DSPD and, finally exploring the level of acceptance of the PAID scale by Asian-Indian patients. METHODS: The patients with T2DM aged >18 years attending the diabetes outpatient clinic were recruited. They completed two sets of questionnaires; PAID and a satisfactory questionnaire, which included socio-demographic characteristics and questions relating to the acceptance of PAID. Statistical analysis was performed using Stata 13.1 and Excel. RESULTS: A total of 253 questionnaires were completed, including 157 (62.1%) male and 96 (37.9%) female patients. The prevalence of DSPD was 32.8% (83/253). Younger age (OR 3.65, 95% CI 1.36-9.80) and presence of retinopathy (OR 2.60, 95% CI 1.12-6.04) were significantly associated with DSPD. However, it was observed that one-third of the patients had an elevated level of distress regardless of socio-demographic or clinical factors. PAID was well accepted by the participants and 84.6% (214/253) were pleased to complete it again. CONCLUSION: About one-third of the patients with T2DM had DSPD. Psychological distress was higher in the younger age group and those with retinopathy. PAID is an easy, well-accepted questionnaire and would serve as a useful tool to screen for DSPD.

Assessment of inpatient diabetes knowledge among healthcare professionals in a district general hospital.

AIMS: Diabetes mellitus is a commonly encountered diagnosis in hospitalised patients that is associated with prolonged admissions and mortality. One in six hospital beds in the UK are occupied by diabetes patients. Therefore, healthcare providers need to have a sound knowledge in managing in-patients with diabetes. Thus the aim of this clinical survey was to assess the diabetes-related knowledge of healthcare professionals in a district general hospital. METHODS: A 24-item questionnaire, based on the 'Think Check Act (TCA)' diabetes modules implemented by the Healthcare Improvement Scotland was issued to the medical and nursing staff. Simple statistics were used for data collation and analysis. RESULTS: 30 questionnaires were completed by 10 doctors at varying stages of training, 17 nurses, 1 physician associate and 2 healthcare assistants. The mean percentage score of the participants were 57.4%. 22 (73.3%) correctly defined hypoglycaemia and 27 (90%) knew the location of hypo box and 7 (23.3%) were aware of TCA. Responses to other management related to diabetes emergencies were average. The responses between doctors and nurses were insignificant except for hypo box location (p = 0.0413). CONCLUSION: Knowledge about managing inpatient diabetes problems amongst healthcare professional at a district general hospital appears mediocre. Significant gaps have been identified which would be targeted for future educational events.