Implementation of a geriatric in-reach service improves acute surgical unit outcomes; a retrospective before-and-after study.

BACKGROUND: Australia's ageing population is challenging for surgical units and there is a paucity of evidence for geriatric co-management in acute general surgery. We aimed to assess if initiating a Geriatric Medicine in-reach service improved outcomes for older adults in our Acute Surgical Unit (ASU). METHODS: The Older Adult Surgical Inpatient Service (OASIS) was integrated into ASU in 2021. We retrospectively reviewed all patients over age 65 admitted to ASU over a 12-month period before and after service integration with a length of stay (LOS) greater than 24 h. There was no subsequent truncation or selection. Primary outcomes were 30-day mortality, LOS, and 28-day readmissions. Secondary outcomes were discharge disposition, in-hospital mortality, and hospital-acquired complications (HACs). RESULTS: 1339 consecutive patients were included in each group, with no differences in baseline characteristics. There was a significant decrease in 28-day readmissions from 20.2% to 16.0% (P < 0.05), greatest in patients undergoing non-EL operative procedures (21.9% pre-OASIS vs. 12.6% post-OASIS; P < 0.05). Trends towards reduced 30-day mortality (7.17% vs. 5.90%; P = 0.211), in-hospital mortality (3.88% vs. 2.91%; P = 0.201), permanent care placement (7.77% vs. 7.09%; P = 0.843) and HACs (8.14% vs. 7.62%; P = 0.667) were seen, although statistical significance was not demonstrated. LOS remained unchanged at 4 days (P = 0.653). CONCLUSION: The addition of a geriatric in-reach service to a tertiary ASU led to a significant reduction in 28-day readmissions. Downtrends were seen in mortality, permanent care placement, and HAC rates, while LOS remained unchanged.

Practicing Surgeons' Perception of Barriers to Palliative Care Delivery in British Columbia.

BACKGROUND: Utilization of palliative care remains low among surgical patients. We aim to characterize general surgeons' perceptions of barriers to access palliative care in British Columbia (BC). METHODS: Semi-structured interviews were carried out with a total of 11 surgeons in BC. Interviews were transcribed for thematic analysis via interpretive description. Dominant themes were identified and agreed upon between the authors. RESULTS: Several barriers were identified, which include system and institution, communication and surgical workflow barriers. At the system and institutional level, there were difficulties accessing patient information and continuity of care. Themes in the communication included patient misconceptions about palliative care and communication challenges with consulting services. Surgical workflow barriers influenced the overall perceived role of surgeons when caring for patients with palliative care needs. CONCLUSION: Understanding surgeons' perspectives on barriers to palliative care is an important step in changing management. This can aid in the development of strategies that ease access to palliative care.

Views of health care professionals on the implementation of preoperative advance care planning in older patients with head and neck cancer: Q methodology.

Objective: To investigate the views of health care professionals in a head and neck surgical department toward the implementation of advance care planning prior to surgery for older patients with head and neck cancer. Method: Q methodology was used to explore and analyze participants' views by combining quantitative and qualitative methods. Participants were asked to rank 35 Q statements generated via semi-structured interviews and a literature review and to explain the reasons for their ranking in subsequent interviews. The data was then analyzed and used to develop a factor series to illustrate participants' views. Results: This study surveyed 15 health care professionals, including eight doctors and seven nurses. The views of health care professionals toward preoperative implementation of advance care planning discussions were varied and could be categorized into three types: defending the autonomy of patients, patients' knowledge and the Chinese traditional cultural context hinder the implementation of preoperative advance care planning, and lack of confidence in performing preoperative advance care planning. Conclusions: Although the health care professionals in the head and neck surgical department in this study recognized the benefits of preoperative discussions regarding advance care planning, patients' knowledge level, traditional Chinese values, inadequate capacity among health care professionals, and unsound legal policies have caused these professionals to have misgivings about preoperative counseling and discussing advance care planning with patients. Further studies should be conducted, and strategies to overcome barriers to discussions of preoperative advance care planning should be developed.

Surgeons vs ChatGPT: Assessment and Feedback Performance Based on Real Surgical Scenarios.

INTRODUCTION: Artificial intelligence tools are being progressively integrated into medicine and surgical education. Large language models, such as ChatGPT, could provide relevant feedback aimed at improving surgical skills. The purpose of this study is to assess ChatGPT´s ability to provide feedback based on surgical scenarios. METHODS: Surgical situations were transformed into texts using a neutral narrative. Texts were evaluated by ChatGPT 4.0 and 3 surgeons (A, B, C) after a brief instruction was delivered: identify errors and provide feedback accordingly. Surgical residents were provided with each of the situations and feedback obtained during the first stage, as written by each surgeon and ChatGPT, and were asked to assess the utility of feedback (FCUR) and its quality (FQ). As control measurement, an Education-Expert (EE) and a Clinical-Expert (CE) were asked to assess FCUR and FQ. RESULTS: Regarding residents' evaluations, 96.43% of times, outputs provided by ChatGPT were considered useful, comparable to what surgeons' B and C obtained. Assessing FQ, ChatGPT and all surgeons received similar scores. Regarding EE's assessment, ChatGPT obtained a significantly higher FQ score when compared to surgeons A and B (p = 0.019; p = 0.033) with a median score of 8 vs. 7 and 7.5, respectively; and no difference respect surgeon C (score of 8; p = 0.2). Regarding CE´s assessment, surgeon B obtained the highest FQ score while ChatGPT received scores comparable to that of surgeons A and C. When participants were asked to identify the source of the feedback, residents, CE, and EE perceived ChatGPT's outputs as human-provided in 33.9%, 28.5%, and 14.3% of cases, respectively. CONCLUSION: When given brief written surgical situations, ChatGPT was able to identify errors with a detection rate comparable to that of experienced surgeons and to generate feedback that was considered useful for skill improvement in a surgical context performing as well as surgical instructors across assessments made by general surgery residents, an experienced surgeon, and a nonsurgeon feedback expert.

Cutting Ties: General Surgery Residents Have Higher Attrition Rates Than Residents in Other Surgical Training Programs.

OBJECTIVE: Attrition rates among general surgery residents are notoriously high relative to other specialties. The aim of this study was to compare annual resident attrition rates between general surgery and other surgical subspecialties and to examine these trends in recent years. DESIGN: This was a retrospective study performed using Accreditation Council for Graduate Medical Education (ACGME) Data Resource Books from 2012-2022. Annual attrition rate and average ten-year attrition rate were calculated for general surgery and surgical specialties. Differences were assessed by Pearson chi-square test. SETTING: All ACGME accredited residency programs in the United States were included. RESULTS: General surgery residencies had a significantly higher average annual attrition rate (3.3%) than all other surgical specialties studied except thoracic surgery. Most attrition among general surgery residents was voluntary and these rates did not appear to be affected by the COVID-19 pandemic. CONCLUSIONS: Attrition among general surgery residents is higher than in other surgical specialties, suggesting that early specialization may be protective against resident attrition.

Resident perspectives on the role of gender in operative experience during general surgery residency training: A mixed-methods study.

BACKGROUND: It remains unclear why female general surgery residents perform fewer cases than male peers. This exploratory study investigated possible contributors to gender-based disparities and solutions for improving equity in operative experience. METHODS: Surveys, including Likert scale and free-text questions, were distributed to 21 accredited general surgery residency programs. RESULTS: There were 96 respondents, of whom 69% were female. 22% of females personally experienced barriers to operative experience versus 13% of males (p â€‹= â€‹0.41), while 52% of female residents believed operative training was affected by gender (p â€‹= â€‹0.004). Inductive analysis revealed the most common barrier to operating room participation was floor work/clinical tasks. The most common barrier for female residents was perceived sexism/gender bias, with subthemes of "misidentification," "feeling unwelcome," and "poor trust/autonomy." To improve parity, residents proposed structured program-level review, feedback, and transparent expectations about case assignments. CONCLUSION: Female general surgery residents believe gender bias impacts training. Further mixed-methods research is crucial to determine the cause of gender-based disparities in operative experience.

A Comparative Analysis of "Surgery First" vs. "Endoscopy First" for Pediatric Choledocholithiasis Presenting at the End of the Week.

BACKGROUND: Choledocholithiasis in children is commonly managed with an "endoscopy first" (EF) strategy (endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) under a separate anesthetic). Endoscopic Retrograde Cholangiopancreatography is limited at the end of the week (EoW). We hypothesize that a "surgery first" (SF) approach with LC, intraoperative cholangiogram (IOC), and possible laparoscopic common bile duct exploration (LCBDE) can decrease length of stay (LOS) and time to definitive intervention (TTDI). METHODS: This is a retrospective single-center cohort study conducted between 2018 and 2023 in pediatric patients with suspected choledocholithiasis. Work week (WW) presentation included admission between Monday and Thursday. Time to definitive intervention was defined as time to LC. RESULTS: 88 pediatric patients were identified, 61 managed with SF (33 WW and 28 EoW) and 27 managed with EF (18 WW and 9 EoW). Both SF groups had shorter mean LOS for WW and EoW presentation (64.5 h, 92.4 h, 112.9 h, and 113.0 h; P < .05). There was a downtreading TTDI in the SF groups (SF: WW 24.7 h and EoW 21.7 h; EF: WW 31.7 h and EoW 35.9 h; P = .11). 44 patients underwent LCBDE with similar success rates (91.6% WW and 85% EoW; P = 1.0). All EF patients received 2 procedures; 69% of SF patients were definitively managed with one. CONCLUSION: Children with choledocholithiasis at the EoW have a longer LOS and TTDI. These findings are amplified when children enter an EF treatment pathway. An SF approach results in shorter LOS with fewer procedures, regardless of the time of presentation.

Cost, Operative Delay, and X-Rays for Incorrect Surgical Counts.

At Cleveland clinic, an incorrect surgical count triggers Code Rust; a protocol that mandates an intraoperative patient X-ray, staff radiology read, and discussion with the surgeon before the incision is closed. Code Rust calls from November 2014 to December 2022 were retrospectively reviewed. Realtime workflow and operative details of Code Rust cases were analyzed.1277 Code Rusts were identified. Average time from ordering the X-ray to final radiology report was 50 minutes, totalling $2,362,450.00 spent on operating room time. Code Rust was called twice as frequently during urgent or emergent cases, compared to elective. There were more staff in Code Rust rooms compared to non-Code Rust rooms. A foreign body on X-ray was identified in 42/1277 (3.3%) cases. Code Rust is a resource intensive process that is more common in emergent cases that involve multiple staff. While retained foreign bodies are identified in a small percentage of cases, the current system should be revisited to reduce operating time and expense.

SPARC - A multi-disciplinary team program for retroperitoneal sarcoma: the Royal Prince Alfred Hospital and Chris O'Brien Lifehouse Collaboration.

BACKGROUND: The Royal Prince Alfred Hospital (RPAH) and Chris O'Brien Lifehouse (COBLH) established a formal Sarcoma of the Pelvic and Abdominal Retroperitoneum Collaboration (SPARC) in November 2020. An established multidisciplinary team (MDT) with the aims to centralise patient referrals and treatment, establish database and research, coordinate surgical resections is critical in improving patient outcomes and quality of life. METHODS: A prospective database was established in October 2021. Clinical, pathological and radiological data points were recorded for all patients since the inception of SPARC. Quality of Life questionnaires were included and follow-up planned regularly for 5 years. RESULTS: From November 2020 to Feb 2024, 294 new referrals were discussed at the MDT meeting. Majority were from the metropolitan area (182) followed by regional NSW (87), interstate (20) and five internationals. 141 operations were performed during this period compared to 119 operations from 2010 to November 2020 in RPAH. The inception of the SPARC program has resulted in exponential growth in operations, improving from the previous rate of 15 cases annually to 35. Liposarcomas followed by leiomyosarcomas are the most common types of sarcomas resected. The majority were extended resections (81.6%) and 22% were pelvic exenterations. Overall R0 rate is 54.6%, R1 38.3% and R2 1.4% (131 (92.9%) had R0/R1 resections. Overall complication rate is 35.5% with one in-hospital mortality. CONCLUSION: Success and expansion of a robust retroperitoneal sarcoma program requires a collaborative surgical approach, an MDT meeting, centralized referral process, and a research team in specialized tertiary institutions.

Assessment of the Quality of Patient-Oriented Internet Information on Fluorescence Imaging in Surgery.

BACKGROUND: In the digital age, patients are increasingly turning to the Internet to seek medical information to aid in their decision-making process before undergoing medical treatments. Fluorescence imaging is an emerging technological tool that holds promise in enhancing intra-operative decision-making during surgical procedures. This study aims to evaluate the quality of patient information available online regarding fluorescence imaging in surgery and assesses whether it adequately supports informed decision-making. METHOD: The term "patient information on fluorescence imaging in surgery" was searched on Google. The websites that fulfilled the inclusion criteria were assessed using 2 scoring instruments. DISCERN was used to evaluate the reliability of consumer health information. QUEST was used to assess authorship, tone, conflict of interest and complementarity. RESULTS: Out of the 50 websites identified from the initial search, 10 fulfilled the inclusion criteria. Only two of these websites were updated in the last two years. The definition of fluorescence imaging was stated in only 50% of the websites. Although all websites mentioned the benefits of fluorescence imaging, none mentioned potential risks. Assessment by DISCERN showed that 30% of the websites were rated low and 70% were rated moderate. With QUEST, the websites demonstrated an average score of 62.5%. CONCLUSION: This study highlights the importance of providing patients with accurate and balanced information about medical technologies and procedures they may undergo. Fluorescence imaging in surgery is a promising technology that can potentially improve surgical outcomes. However, patients need to be well-informed about its benefits and limitations in order to make informed decisions about their healthcare.

Residents underestimate their robotic performance: evaluating resident robotic console participation time.

Lack of formal national robotic curriculum results in a void of knowledge regarding appropriate progression of autonomy in robotic general surgery training. One midwestern academic surgical training program has demonstrated that residents expect to independently operate more on the robotic console than they perceive themselves to do. As such, our study sought to evaluate expectations of residents and faculty regarding resident participation versus actual console participation time (CPT) at a community general surgery training program. We surveyed residents and faculty in two phases. Initially, participants were asked to reflect on their perceptions and expectations from the previous six months. The second phase included surveys (collected over six months) after individual cases with subjective estimation of participation versus CPT calculated by the Intuitive Surgical, Inc. MyIntuitive application. Using Mann-Whitney U-Test, we compared resident perceptions of CPT to actual CPT by case complexity and post-graduate year (PGY). Faculty (n = 7) estimated they allowed residents to complete a median of 26-50% of simple and 0-25% of complex cases in the six months prior to the study. They expected senior residents (PGY-4 and PGY-5) to complete more: 51-75% of simple and 26-50% of complex cases. Residents (n = 13), PGY-2-PGY-5, estimated they completed less than faculty perceived (0-25% of simple and 0-25% of complex cases). Sixty-six post-case (after partial colectomy, abdominoperoneal resection, low anterior resection, cholecystectomy, inguinal/ventral hernia repair, and others) surveys were completed. Residents estimated after any case that they had completed 26-50% of the case. However, once examining their MyIntuitive report, they actually completed 51-75% of the case (median). Residents, especially PGY-4 and 5, completed a higher percentage than estimated of robotic cases. Our study confirms that residents can and should complete more of (and increasingly complex) robotic cases throughout training, like the transition of autonomy in open and laparoscopic surgery.

Efficacy of Unilateral External Oblique Intercostal Fascial Plane Block Versus Subcostal TAP Block in Laparoscopic Cholecystectomy: Randomized, Prospective Study.

BACKGROUND: This study aimed to evaluate the effectiveness of unilateral external oblique intercostal nerve block (EOIB) in laparoscopic cholecystectomy surgery. MATERIAL AND METHODS: After ethics committee approval, ASA I-II patients aged 18-70 who would undergo laparoscopic cholecystectomy surgery were included in the study. The patients were divided into two groups, external oblique intercostal nerve block (Group EOIB) and oblique subcostal transversus abdominis plane block (Group OSTAP). After surgery, EOIB or OSTAP block was administered with 20 mL of .25% bupivacaine then routine analgesia protocol was applied with iv paracetamol, and tramadol. Visual analog scale (VAS) scores and patient-controlled analgesia (PCA) consumption were monitored 24 hours after the operation. It was administered 25 mg pethidine as a rescue analgesic to patients with VAS ≥4. RESULTS: Thirty six patients for Group EOIB and thirty four patients for Group OSTAP were included in the study. Lower VAS scores were observed in all groups. When PCA consumption, side effects, rescue analgesia consumption, and patient satisfaction were evaluated, there was no statistically significant difference between the groups (P > .05). CONCLUSION: It was observed that EOIB showed similar analgesic activity to the OSTAP block. EOIB may also be a part of postoperative multimodal analgesia by reducing postoperative opioid consumption in LC.

Large retroperitoneal lymphangioma.

Abnormal cystic lymphangioma is a rare, benign tumour of lymphatic origin that often presents with subtle clinical symptoms. A man in his 20s sought medical attention for a progressively tender mass located in the right lower quadrant. Following ultrasound and CT imaging, surgical pathology confirmed the presence of abnormal cystic lymphangioma. This case is noteworthy because of the patient's young age and the retroperitoneal location. An exploratory laparotomy was performed, mitigating the risk of recurrence. In the future, if imaging identifies a cystic mass, consideration of abnormal cystic lymphangioma within the differential diagnosis is imperative. Despite its predominantly subtle symptoms and non-malignant nature, the mass effect by the abnormal cystic lymphangioma can compromise surrounding structures. Overall, clinicians confronted with a cystic mass should adopt a comprehensive diagnostic approach, encompassing abnormal cystic lymphangioma in the differential diagnosis due to its unknown and complex nature.

Nationwide Trends in Utilization of Minimally Invasive Techniques for Blunt Abdominal Trauma.

BACKGROUND: Despite increasing use of minimally invasive surgical (MIS) techniques for trauma, limited large-scale studies have evaluated trends, outcomes, and resource utilization at centers that utilize MIS modalities for blunt abdominal trauma. METHODS: Operative adult admissions after blunt assault, falls, or vehicular collisions were tabulated from the 2016-2020 National Inpatient Sample. Patients who received diagnostic laparoscopy or other laparoscopic and robotic intervention were classified as MIS. Institutions with at least one MIS trauma operation in a year were defined as an MIS Performing Institution (MPI; rest: non-MPI). The primary endpoint was mortality, with secondary outcomes of reoperation, complication, postoperative length of stay (LOS), and hospitalization costs. Mixed regression models were used to determine the association of MPI status on the outcomes of interest. RESULTS: Throughout the study period, the proportion of MIS operations and MPI significantly increased from 22.6 to 29.8% and 45.9 to 58.8%, respectively. Of an estimated 77,480 patients, 66.7% underwent care at MPI. After adjustment, MPI status was not associated with increased odds of mortality (adjusted odds ratio [AOR] 1.09, 95% confidence interval [CI] [.96,1.24]), reoperation (AOR 1.02, CI [.87,1.19]), or any of the tabulated complications. There was additionally no difference in adjusted LOS (ß-.18, CI [-.85, +.49]) or costs (ß+$1600, CI [-1600, +4800]), between MPI and non-MPI. DISCUSSION: The use of MIS operations in blunt abdominal trauma has significantly increased, with performing centers experiencing no difference in mortality or resource utilization. Prospectively collected data on outcomes following MIS trauma surgery is necessary to elucidate appropriate applications.

Association of preoperative workup and comorbidities with risk of gastroesophageal surgery failure.

Background: While surgical failure rates for fundoplication and hiatal hernia repair are low, there has been no clear evaluation of the preoperative risk factors associated with surgical failure. This study aimed to identify risk factors predisposing patients to surgical failure. Methods: Patients who underwent antireflux surgery during a 3-year period were evaluated for evidence of surgical complications and placed accordingly into the failure or control group. Demographic data, comorbidities, clinical presentation, preoperative evaluation, and surgical data were collected and compared between the groups. Results: In total, 86 patients with failure and 42 controls were identified among our cohort. No significant differences were found between groups based on sex (P=0.640). However, patients with failure were younger than controls (57.0 vs. 64.7 years, P=0.0001). Body mass index, tobacco use and alcohol use did not differ significantly between the groups (P=0.189, P=0.0999, P=0.060). Notably, psychiatric illness was more common in the failure group (P=0.0086). Neither hypertension (P=0.134) nor diabetes (P=0.335) had significant differences between groups. For procedures, no significant differences were found for the frequencies of preoperative imaging (P=0.395) or manometry (P=0.374), but pH/BRAVO studies (P=0.0193) and endoscopy (P<0.001) were both performed more frequently in the failure group. Conclusions: Patients with psychiatric comorbidities are at higher risk of surgical failure. Alcohol use trended toward significance, which warrants further investigation. We also noted an increase in rates of preoperative pH and endoscopy studies, contrary to the prior literature; this is likely due to more complex cases requiring additional workup.

Repair of type II paraesophageal hernia with Nissen fundoplication in a patient with von Willebrand disease and spondylolisthesis - a clinical case report.

Hiatal hernias continue to be fairly common in clinical practice. However, the variety of different symptoms presented by patients may hinder establishing the ultimate diagnosis. Nevertheless, currently, the diagnosis of hiatal hernia can be easily established, based on barium swallow radiography. We would like to present a clinical case report of a patient with complex medical history, including von Willebrand disease, degenerative spinal disease, and chronic sinusitis, who was finally diagnosed with hiatal hernia and treated with a standard laparoscopic Nissen fundoplication. Our case focuses on the significance of comorbidities on patients' symptoms, which sometimes may mislead the therapeutic process.

Safety of surgery: quality assessment of meta-analyses on the WHO checklist.

Objectives: To assess the quality of the meta-analyses that review the WHO surgical safety checklist. Methods: A systematic review of meta-analysis studies was undertaken using the search terms "World Health Organization Surgical Safety Checklist" in PubMed, Embase, and Lilacs databases. The selected meta-analyses were rated using the AMSTAR 2 assessment tool. Results: In the three meta-analyses evaluated, the checklist was associated with a decrease in the rates of complications and mortality. Overall confidence in the results of the evaluated meta-analysis was critically low. Conclusions: The meta-analysis coincides with obtaining lower complications and mortality rates with the WHO surgical safety checklist. However, the studies included in the meta-analyses were mostly observational, with potential biases, and according to the AMSTAR 2 tool, the overall confidence in the results of the evaluated studies was critically low.

A Method to Reduce Tension Differences in Pull/Push Manipulation for a Robot in Fluorescence Emission-Guided Surgical Microscopy.

MOTIVATION: A fluorescence emission-guided microscope used to monitor the outcome of cancer removal surgery is highly effective when employing a manipulator to motorize and switch the observation direction. It is necessary to minimize the alignment of looper tension between the stands for pull/push to change the direction of the manipulator and reduce the error rate caused by tension differences. This paper presents a method to minimize the error rate of looper tension between the stands. METHODS: \The looper is inserted between the stands of the manipulator to minimize the difference in tension and make the stress on the pull and push of the looper constant. The constant stress allows the manipulator to move stably in left/right, up/down, and left/right movements, which will be effective for full-camera observation and close-up shots of the end effector. RESULTS: Reducing the tolerance for differences in the manipulator's looper tension (angle and tension) is crucial. When the input value of the looper tension angle is 50°, the output should closely match 50°. Consequently, the measured response has a tolerance of ±49.98%, resulting in an error rate of .02% (1/50th level). CONCLUSION: A method is proposed to minimize the error rate of the manipulator's looper tension in a robot-based fluorescence emission-guided microscope used to observe the status of cancer surgery. As a result, a stable manipulator with a minimal error rate can achieve a 3.986x magnification for close-up observation by switching between high and low orientations.

Clinicians' perceptions of "enhanced recovery after surgery" (ERAS) protocols to improve patient safety in surgery: a national survey from Australia.

BACKGROUND: Surgical patients are at risk of postoperative complications, which may lead to increased morbidity, mortality, hospital length-of-stay and healthcare costs. Enhanced Recovery After Surgery (ERAS®) protocols are evidence-based and have demonstrated effectiveness in decreasing complications and associated consequences. However, their adoption in Australia has been limited and the reason for this is unclear. This study aimed to describe clinicians' perceptions of ERAS protocols in Australia. METHODS: A national online survey of anaesthetists, surgeons and nurses was undertaken. Invitations to participate were distributed via emails from professional colleges. The 30-item survey captured respondent characteristics, ERAS perceptions, beliefs, education and learning preferences and future planning considerations. The final question was open-ended for elaboration of perceptions of ERAS. Descriptive and inferential statistics were used to describe and compare group differences across disciplines relative to perceptions of ERAS. RESULTS: The sample included 178 responses (116 nurses, 65.2%; 36 surgeons, 20.2%; 26 anaesthetists, 14.6%) across six states and two territories. More than half (n = 104; 58.8%) had used ERAS protocols in patient care, and most perceived they were 'very knowledgeable' (n = 24; 13.6%) or 'knowledgeable' (n = 71; 40.3%) of ERAS. However, fewer nurses had cared for a patient using ERAS (p <.01) and nurses reported lower levels of knowledge (p <.001) than their medical counterparts. Most respondents agreed ERAS protocols improved patient care and financial efficiency and were a reasonable time investment (overall Md 3-5), but nurses generally recorded lower levels of agreement (p.013 to < 0.001). Lack of information was the greatest barrier to ERAS knowledge (n = 97; 62.6%), while seminars/lectures from international and national leaders were the preferred learning method (n = 59; 41.3%). Most supported broad implementation of ERAS (n = 130; 87.8%). CONCLUSION: There is a need to promote ERAS and provide education, which may be nuanced based on the results, to improve implementation in Australia. Nurses particularly need to be engaged in ERAS protocols given their significant presence throughout the surgical journey. There is also a need to co-design implementation strategies with stakeholders that target identified facilitators and barriers, including lack of support from senior administration, managers and clinicians and resource constraints.

Creation of a Patient Information Video to Improve the Patient Experience of the Surgical Assessment Unit.

BACKGROUND: Patients who attend emergency surgical services are entering an unfamiliar environment whilst often being unwell and in pain. Patient satisfaction in emergency surgical units is often low due to poor communication with attendees and long wait times. METHODS: A pilot patient questionnaire identified areas where patient satisfaction was low during attendance at the surgical assessment unit (SAU). The aim of this intervention was to improve patient satisfaction with their experience whilst attending the SAU. An education video was filmed to address the areas where services were falling short of expectations, and this was played in the waiting room. Further questionnaire results tailored the frequency of the video to achieve maximum impact. RESULTS: Data were collected at three time points: firstly, prior to the introduction of the video (n=34); secondly, with the video played hourly (n=15); and finally with the video played every 30 minutes at a higher volume (n=15). Mean satisfaction scores after the final cycle improved to 7.3 from 4.9 (p=0.0009). Additionally, 94% of patients agreed that the video was in keeping with their personal experience of the SAU and agreed that the video improved their understanding of what to expect from the visit. CONCLUSIONS: Interventions that improve communication with patients and adjust their expectations play an important role in improving patient satisfaction and their overall perception of care. This can be achieved with a simple patient information video.