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Objectives: This study aimed to determine the prevalence, most common symptoms and sociodemographic factors associated with depression among physicians in a government COVID-Center in Davao City, Philippines. Methodology: This cross-sectional study collected data from resident physicians from July to August 2020. Result(s): Two hundred fifty-one (251) out of 376 physicians responded (68.39% response rate). The average age was 30 years old, majority were female (58.57%, 147), single (78.88%, 198), frontline workers (77.29%, 194), with average hospital experience of 2.0 years. Ninety-six (38.26%) were assigned in surgical departments while 155 (61.75%) worked in nonsurgical departments. There were twelve respondents (4.78%) who had a history of psychiatric illness and 31 (12.35%) had previous psychiatric intervention, while 66 (26.29%) had a history of medical illness. Eighty-five (33.86%) had depression using PHQ-9;57 (22.71%) as mild, 19 (7.57%) moderate, 7 (2.79%) moderately severe and 2 (0.8%) severe. Out of 85 residents who were depressed, the most common symptoms were: low energy (81, 95.29%);anhedonia (76, 89.41%);and feeling depressed (72, 84.70%). Medical illness was associated with higher levels of depression. Physicians with a history of psychiatric illness, psychiatric intervention and medical illness had significantly higher levels of depression. Conclusion(s): More than a third (33.86%) of physicians screened positive for depression. Current mental health programs must be strengthened and made specific, to prevent and address depression especially among those who have a history of psychiatric and medical illness.Copyright © 2023
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BACKGROUND: Workplace violence is a global threat to healthcare professionals' occupational health and safety and the situation has worsened during the COVID-19 pandemic. This study aimed to explore workplace violence directed against assistant and registered nurses working on surgical wards in Sweden. METHODS: This cross-sectional study was conducted in April 2022. Using a convenience sampling procedure, 198 assistant and registered nurses responded to an online questionnaire developed for this specific study. The questionnaire comprised 52 items and included, among other items, subscales from validated and previously used instruments. Data analysis included descriptive statistics, the chi-square test, and independent-samples t-test. RESULTS: The most frequently reported type of workplace violence was humiliation (28.8%), followed by physical violence (24.2%), threats (17.7%), and unwanted sexual attention (12.1%). Patients and patients' visitors were reported as the main perpetrators of all kinds of exposure. Additionally, one third of the respondents had experienced humiliation from colleagues. Both threats and humiliation showed negative associations with work motivation and health (p < 0.05). Respondents classified as working in a high- or moderate-risk environment were more frequently exposed to threats (p = 0.025) and humiliation (p = 0.003). Meanwhile, half of the respondents were unaware of any action plans or training regarding workplace violence. However, of those who indicated that they had been exposed to workplace violence, the majority had received quite a lot or a lot of support, mainly from colleagues (range 70.8-80.8%). CONCLUSION: Despite a high prevalence of workplace violence, and especially of humiliating acts, there appeared to be low preparedness within the hospital organizations to prevent and/or handle such incidents. To improve these conditions, hospital organizations should place more emphasis on preventive measures as part of their systematic work environment management. To help inform such initiatives, it is suggested that future research should focus on the identification of suitable measures regarding different types of incidents, perpetrators, and settings.
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Nurses are one of the most important personnel that plays a major role in ensuring safe and high-quality care to the patients. Their attitudes toward patient safety could affect the patient experience in the hospital setting. Contrasting evidence in the previous study on the relationship between duration of working experience with the attitude toward patient safety warranted further exploration in the current pandemic era. The purpose of this study was to determine the perception of attitude towards patient safety and other associated factors. A cross-sectional study was conducted involving nurses from selected teaching hospitals in Klang Valley, Malaysia during the Covid-19 pandemic period. Data was collected using validated online Safety Attitude Questionnaires (SAQ). The target group was nurses in charge of general medical and surgical wards and was conveniently sampled. A total of 152 nurses participated and had working experience of more than 2 years (93.4%). The majority of positive responses were observed in 4 domains which were the teamwork climate, safety climate, job satisfaction, and stress recognition. The highest positive responses were found for the safety climate domain. In terms of negative responses, it was observed to be highest in the preparation of the unit management domain. However, there was no significant association between any domains with age group, gender, or working experience. In conclusion, the perception of the nurses toward patient safety attitude might be influenced by the managerial style, geographical work setting, and different job scopes. The leaders in a healthcare facility or service delivery should consider focusing on a strategy to ensure adequate management support for the medical personnel that might influence their attitude to patient safety culture in the future.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Aims To understand barriers of implementing a near-miss reporting and sharing of lessons as part of patient safety II culture. Staff must be encouraged to report less serious incidents and near misses as well as more serious errors if lessons are to be learned and patient safety enhanced.1 A key task in the enhancement of patient safety involves the ability to learn from error.2 The intention is that any staff member, irrespective of role, grade, seniority, or experience, can call 'Stop the Line' if they see that required safety procedures and checks are not being followed. All members of staff are encouraged to 'Stop the Line' if they notice a series of steps/process that could potentially cause harm to a patient. The event/incident that is stopped is referred to as a 'near miss'. Methods Stop the line piloted in specific clinical area in our trust (Paediatrics unit, surgical ward, neurosurgical theatres). This project was commenced on 1st November 2020. But due to Covid 19 clinical workload pressure it was paused from April 2021, I took over the project last September 2021. -Despite the project being piloted since last year, still considerable number of staff not fully understanding the project and what are near misses and small numbers of near misses reported throughout following months. -A survey formulated and distributed to health staff across the trust to explore their knowledge of near misses and the barriers for lack of reporting. Results The survey designed and published to the staff through global email. Survey structured of four segments including the Department and Job position, Knowledge about the project, definition of a near miss event and how to report a near miss, questions to check situations classifications as near misses or not and questions regarding their perception of barriers for reporting near misses. -Total 60 Respondents from different departments and roles: -Respondents included variant range of roles in the health care system including Consultants, Support workers, Junior doctors, Staff Nurses, Head of Outpatient Services, Healthcare assistants, ward clerks, Pharmacist, Digital Communications Managers, Project officers, members from Patient Safety & Improvement, Resuscitation officers. 90% of respondents reported knowledge of near miss definition, and similar proportion acknowledges that near misses should be reported (87%) (figure 1). -Approximately two thirds of staff respondents were knowledgeable how to report near misses (63%) compared to 37% who did not (figure 1). -Among variable scenarios 73-88% of respondents could identify the near miss events. -Main suggested barriers to reporting near miss events were time constraints, lack of awareness of importance of near misses reporting and fear of reporting on colleagues involved in the event. Conclusion There is a gap between staff intent to record a near miss occurrence and actual event reporting which could be either due to low incidence of near misses in the health organization or simply because of under reporting. (Figure Presented).
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Background and aims: Universal screening appears to be the most cost-effective strategy to reach the HCV elimination planned byWHO for 2030. All HCV patients have currently access to treatment. In France HCV screening is based on identification of Risk Factor. The aim of the present studywas to test universal screening strategy in all hospitalized patients. Method: From November 2019 to November 2021, we conduct a prospective, longitudinal monocentric study screening all consent patients for HCV regardless identification of Risk Factor. All HCV Ab positive was followed by HCV RNA screening. All replicating patients were proposed to be treated according to the other pathologies for which the patients were hospitalized. The study was authorized by CPP Toulouse. Because of occurrence COVID 19 pandemics, conducting this studywe identify several limitations leading to the prolongation of inclusion time and to develop adaptive measures such as oral consent. Results: As of September 30, 2021 results are shown in this figure: (Figure Presented) HCV Ab + patients seemed older;however this difference is not statistically different. Large part of patients (2/3) were unware of the HCV status. 49 (39.5%) patients come from surgical departments, 38 (30.5%) from the medical department and 37 (30%) are followed in gastroenterology office. All HCV RNA+ patients have been evaluated for treatment. 8 are eradicated, 2 DAA therapy are still on going,1patient refuse treatment (89 years old), 5 patients suffer from HCC and treatmentwas delayed, 2 patients died during palliative management Conclusion: HCVAb prevalence recorded is significantly higher than that observed in the general population in France. However only 15.8% of hospitalized patients have been included. Motivation of all health care workers is essential. Final results of the study will be present at the meeting
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Objective: Healthcare teams often forget the possibility of pregnancy when fecund women present for non-obstetric problems. In this patient group, routine pregnancy tests are often omitted and related documentation is missing. This patient safety issue was further highlighted by an anecdotal story when a surgical procedure was performed and mid surgery a pregnancy was identified. Prior to our intervention, simple point of care testing was limited to the emergency department. At ward level, pregnancy tests could only be performed using blood serum. Also, the admission forms did not specifically ask to exclude a pregnancy. Design: We reviewed whether all female surgical admissions of childbearing age underwent pregnancy testing. A baseline audit highlighted the need to introduce point of care pregnancy kits on the surgical ward. The initial audit was presented to surgical and anaesthetic departments. In collaboration with management, funding was secured to provide pregnancy kits for the surgical wards and the admission protocol was changed accordingly. Method: The project was completed over a period of 19 months (delayed by Covid). The base-line data collection was from November to December 2019 with presentation of the results in December 2020. Introduction of pregnancy kits in April 2021 and follow-up data collection in May to June 2021. A total of 159 case notes were reviewed using the hospital patient information system named 'Portal'. In the baseline survey, 86 case notes were screened for pregnancy tests and whether the findings were documented. After the introduction of pregnancy kits, the survey was repeated involving 73 women. The mean age was 32 with a range from 17 to 52 years of age. Results: Results were obtained retrospectively using the Portal system to screen for pregnancy tests (urine/serum β-HCG), any radiation exposure and surgical intervention. In 2021, prior to intervention, 75% of fecund patients were exposed to radiation and 95% underwent surgery without pregnancy testing. In 2021 the rates dropped to 32% for radiation exposure and surgery without pregnancy testing to 27%. Overall pregnancy testing in fecund women for surgical admission improved to 60%. Conclusions: Omitting pregnancy tests and subsequent documentation could be due to time pressures in particular during same day admissions. The remaining 40% could be captured by using a computer-based admission protocol which prompts the health care staff to undertake a pregnancy test, but adds more complexity to an already busy surgical admission ward.
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Most of the time forefoot surgery requires the use of a tourniquet, and therefore, the surgery is usually performed with either a popliteal block or an ankle block. Surgical departments have traditionally relied on an anesthesiol-ogist to perform these procedures. The elective nature of the forefoot surgery and the lack of surgical anaesthetists due to the COVID-19 pandemic have become mandatory to find alternatives to continue performing these surgeries in order to avoid an increase of waiting lists. The foot and ankle wide-awake local anaesthesia with no tourniquet (WALANT) technique is an adaptation from the one used for hand surgery. This technique requires no sedation, no regional or general anaesthesia, and the patient is fully conscious during the operation. WALANT technique con-sists of administration of lidocaine and epinephrine for local anaesthesia and vasoconstriction. This technique allows the surgeon to perform the surgery with the patient fully awake and without a tourniquet. In addition, this gives the advantage to perform an intraoperative as-sessment of function. WALANT for foot and ankle surgery is a suitable, safe, and cheap technique. Taking into con-sideration the lack of anaesthetists, operating rooms, and hospital resources observed during SARS-CoV-2 epidemic, this technique represents an acceptable alternative to consider in order to be able to continue performing se-lected cases of foot and ankle surgery.
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Background/aims: Many hospitalized patients have a life-limiting condition. It is not known how many patients this concerns and if these patients receive palliative care. This study aimed to investigate how many patients with a probable limited life expectancy were hospitalized and if a palliative care team (PCT) was involved or whether involvement was considered desirable. Methods: A flashmob study was conducted in Dutch hospitals on the 16th of April 2021 at all wards, except the pediatric and obstetric wards, emergency departments and day care departments. For all hospitalized patients, nurses and doctors independently answered the surprise question (SQ) “Would you be surprised if this patient died within the next 12 months?” as well as treatment limitations and palliative care team (PCT) involvement. Results: In 48 hospitals, surveys were completed for 8789 patients. Patients were admitted to surgical wards in 33% and to general medicine wards in 67%. The SQ was negatively answered in 35% by doctors and in 32% by nurses for the total population. Among patients admitted for a malignancy, non-malignant disease or COVID-19 doctors answered the SQ negatively in 49%, 32% and 33% respectively. Life expectancy was estimated to be less than three months in 7.3% for the total population. Treatment limitations were recorded in 39.5% of the total population. The PCT was involved in 2.2% and involvement was desirable in 2.1%, increasing to 15.1% and 12.9% when life expectancy was estimated as less than three months. Conclusions: In more than one-third of hospitalized patients, the SQ was answered negatively, suggesting a limited life expectancy and possible palliative care needs. PCT involvement was considered of added value by healthcare professionals in 4.3% of the whole population. Further studies should focus on exploration of palliative care needs of hospitalized patients and possible benefits of timely implementation of specialized palliative care.
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Background: Coronavirus are a family of viruses that can cause respiratory illnesses in human. Special features of Coronavirus is the 'crown like spikes' seen on the surface of the virus. Currently, the entire world are aware of the new strains of the coronavirus that was first reported in Wuhan, China in December 2019 named COVID-19. COVID- 19 pandemic has disrupted the transfusion services in Malaysia in terms of blood collection and potential transfusion needs in total. The pandemic has also caused plausible impact on blood utilization in Hospital Tengku Ampuan Rahimah, Klang, which also the only collection centre in the State of Selangor. Aims: We quantified the impact of COVID-19 on blood utilization in year 2019 until the emerging of COVID-19 pandemic, stratified by most utilized blood products and enumerated blood utilization by different departments. We then specifically analysed the blood utilization in hospitalized COVID-19 patients. Methods: This retrospective cross-sectional study was conducted at Transfusion Medicine Department, Hospital Tengku Ampuan Rahimah Klang from January 2019 to December 2021. Data on transfusion records from Quality Assurance database were collected, summarized and analysed. Overall blood utilization were computed on yearly basis, comparison of blood utilization among respective departments, different type of blood product utilized and overall trend of transfusion in COVID-19 patients were estimated. Results: For the past 3 years, a total of 82,056 units of blood product were utilized. 32,271 units in year 2019, 30,172 units in year 2020, and 19,613 units were used in year 2021. There was a significant reduction in blood utilization after the emerging of COVID-19 pandemic at about 6.50% in 2020 and 39.22% in 2021 compared to year 2019. The most utilized blood product during last 3 years were red cells ranging from 10,516-17,882 units, followed by random platelets 3376-6041 units, and fresh frozen plasma 3739-4662 units. However, there were no significant statistical impact of COVID-19 pandemic observed in utilization of different types of blood product. Average reduction in blood utilization in the year 2020 and 2021 compared to year 2019 in Emergency Department were (44.0%). We have observed a reduction in blood utilization for surgical-based departments, namely Orthopaedic Department (25.9%) and General Surgical Department (22.6%). During the early phase of pandemic in year 2020, the trend of COVID-19 cases was still on the rise and escalated in year 2021 and that was consistent with our findings for hospitalized COVID-19 patients as the red cells transfused in 2020 was only 908 units but in 2021 was 3120 units were transfused which comprised of 8.3% and 29.7% of total red cells utilization. Summary/Conclusions: Following notification of Hospital Tengku Ampuan Rahimah as a State referral and COVID-19 Hybrid Hospital, there was an influx of COVID-19 patients and re-direction of other cases to nearby facilities. Declined blood utilization during COVID 19 pandemic was associated with postponements of elective surgical procedures, reduction in trauma cases due to Movement Control Order and judicious transfusion in COVID-19 patients. An ongoing effective pandemic response and efforts made by various departments had good impact in rationale use of blood products at Hospital Tengku Ampuan Rahimah, Klang.
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Introduction: The 2018 GIRFT report and 2019 NICE renal and ureteric stone guidelines recommended regional, fixed-site lithotripsy units to provide elective and emergency extracorporeal shockwave lithotripsy (ESWL) for urinary tract calculus <20 mm. In our region, Trusts were serviced by a mobile lithotripter, which was unable to provide adequate emergency treatment, as such a new fixedsite regional service was developed. Methods: The ongoing pandemic resulted in many challenges in the service development, including a reduction in urological operating by 25% during the COVID-19 pandemic, with additional loss of capacity as only patients ASA 2 or below was able to be treated in peripheral centres. A new pathway was introduced aiming to reduce admissions to surgical wards, instead moving directly to treatment and pain relief at home, in line with the 2019 NHS long-term plan. After 6 weeks of treating local patients, the service was opened to Trusts across the region to enable equal access for all patients' for both emergency and elective ESWL. Results: In the first 6 months, 144 local stones were treated with ESWL (38 ureteric and 106 renal), of which 118 (81.9%) were successfully cleared, with the NICE guidelines quoting success rates between 72.4% and 83.8%. Across that period, this would have required 40 additional operating sessions (160 operative hours) to treat these stones ureteroscopically. With ureteroscopy £2347 more expensive than ESWL to get stone clearance (Constanti et al. BJUI 2020;125: 457-466), the treatment cost saving in the first 6 months is £281,666. In addition, 53 stones were treated as an emergency from the region, with a stone clearance rate of 81% and 53% treated within 48 hours. Conclusion: The new ESWL service has resulted in regional stone treatments with success rates in line with published data, in addition to providing economic and operative capacity benefits during a global pandemic.
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Rationale: With increasing experience, and widespread application of LDLT worldwide, experienced LDLT centers now accept right or left lobe donors with complex bilio-vascular anatomy. Though there are a few reports from high volume centers that this may not have an impact on graft or recipient outcome, the true impact in terms of vascular and biliary complications in the recipient and the donor is not well studied. Moreover, accepting these donors may also have an impact on donor morbidity, with possible higher incidence of biliary, vascular complications, re-explorations etc. The true implication would probably be identified if we were to not only analyze the absolute incidence, but also the incidence compared to a cohort of donors and recipients with standard vascular and biliary anatomy. This can probably done only in a multicenter study, where there are different donor acceptance criteria, and probably slightly variant surgical techniques. Aims: Primary objective -This study aims to determine the differences in incidence of bilio-vascular complications and morbidity in recipients of LDLT receiving grafts from donors with complex bilio-vascular anatomy, compared to those receiving grafts with single artery, portal vein, bile duct. Secondary objectives -To determine whether presence of complex bilio-vascular anatomy has an impact on donor complications, and adds to donor morbidity. To determine whether number (of graft artery/PV/ducts), type (according to classification of bilio-vascular donor anatomy), or type of anastomoses (using loupes vs. microscope for artery and bile duct, plasty with straight extension vs. Y graft in PV, duct to duct vs. Roux for multiple ducts etc.) determine incidence of complications. To determine whether complications have an impact on long term graft and patient outcomes. Update: While the two centers Medanta-The Medicity, India, and Asan Medical Center, South Korea have already started accumulating data on the subject in the designed form, we are awaiting Ethical Committee approval for the multicenter study. This has been delayed given the COVID pandemic. We have already received applications from 4 other centers: Icahn School of Medicine at Mount Sinai, RMTI, NY, USA, National Medical Research Center of transplantology and Artificial Organs named after V.I. Shumakov/ Surgical Department #2 (Liver Transplantation), National Medical Research Center of transplantology and Artificial Organs named after V.I. Shumakov/ Surgical Department #2 (Liver Transplantation), and University of Unimore, Modena, Italy. We will accept these other centers for the study as soon as we have IRB Approval.
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Aim: Literature is suggesting significant perioperative mortality and morbidity associated with COVID-19. Therefore, the Royal College of Surgeons (RCS) has produced guidance detailing additional considerations in consenting for surgery whilst COVID-19 is prevalent within society. Section 3A of this document emphasizes the need to discuss the risk of contracting COVID-19 while patients are in hospital. We conducted a multi-cycle closed-loop audit to examine the adherence to this guidance. Method: We completed four audit cycles, each comprising data collection and educational intervention to disseminate the guidance. Data was obtained from consent forms for patients who had consented to both emergency and elective surgery over a two-month period at a large NHS Trust in London. The intervention consisted of teaching sessions, regular emails to the general surgical department, and posters displayed in common areas. Results: Consent forms from 139 patients were reviewed over the four cycles (n=38, 41, 28, and 32). The proportion of patients consented for the risk of contracting COVID-19 during the perioperative period rose serially between the cycles (37%, 61%, 71%, and 85% respectively), and was significantly increased between the first and last cycle (p , 0.01, two-sided Z-test). The interventions proved most effective for senior house officers who improved from consenting 8% initially to 100% on completion of the audit. Conclusions: We demonstrate the marked effectiveness of simple interventions combined with serial auditing to disseminate this message. The same practice may help improve consenting practice at other centres whilst COVID-19 is prevalent in society.
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Background and aim: During the COVID pandemic the daily practice of endoscopic services has deeply changed. The risk of viral transmission to healthcare professionals and patients has strongly influenced the patient triage before endoscopy, the setting of the waiting rooms, the hygienic protocols for the endoscopic suites and the instruments, the use of the personal protective devices. Since government restrictions, the need to limit the access to hospitals only for urgent or oncological treatments, either for ambulatory procedures or for admissions to wards, has postponed many elective exams. Aim of the study was to assess how the EUS procedures have changed as compared to 2019 in an endoscopy unit of a provincial capital hospital in Lombardy (Italy). Materials and methods: We retrospectively compared our EUS procedures in the COVID period (March 2020 - February 2021) to those in the pre-COVID period (March 2019 - February 2020). less than the previous 12 months (-17.7%);this decrease concerned (-20.3%) than the inpatients (-15.6%). In detail we identified 3 four-month phases with a different trend. In the first one (March 2020–June 2020) we performed 88 exams;during March 2019 - June 2019 they had been 145 (-39.3%). In the second phase our procedures did not decrease (160 from July 2020 to October 2020, 151 from July 2019 to October 2019). In the third phase (November 2020 - February 2021) the procedures were 123, while from November 2019 to February 2020 they had been 155 (-20.6%). As regards the final EUS diagnosis, in the COVID period 25.2% of cases resulted neoplastic diseases, whereas in the 12-months before malignancy was detected in 23.4% of Conclusions: The drop rate in our EUS activity was parallel to the COVID incidence in Lombardy, that showed a first peak (with up to 6000 new cases / day) from March 2020 to May 2020, a following low-incidence plateau (with <1000 cases / day) from June 2020 to September 2020, and a successive second peak (with >10000 cases / day) from October 2020 to February 2021. This tendency could reflect either the outpatients’ low propensity to schedule exams in the riskiest periods, or the transformation of some internal medicine or surgical wards in COVID divisions when the need for such admissions was greater. Despite this decreased overall EUS activity, in the COVID period the oncological EUS procedures have been relatively guaranteed.
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Background: Delays from the COVID-19 pandemic led to increased surgical wait times. With ongoing bed pressures, we must safely maximize surgical volumes. We prospectively evaluated the feasibility and safety of bariatric surgery without inpatient hospital admission. Methods: We identified patients whose elective bariatric surgery we felt could be safely scheduled without inpatient admission to a surgical ward. Patients recovered in an 'overnight stay' perioperative area. Selection criteria excluded patients with revisional surgery, BMI≥55, insulin-dependent diabetes, or therapeutic anticoagulation. Data were collected on consecutive patients scheduled without admission between April and June 2021. Seven-day emergency department (ED) visits and readmissions were used to establish the safety of this intervention. Results: Of 47 patients scheduled for surgery without admission, 42 (89.4%) underwent Roux-en- Y gastric bypasses and 5 (10.6%) sleeve gastrectomies. Patients stayed between 16 and 23 hours, with a mean and median of just over 20 hours. Only 2 (4.3%) patients required admission to the surgical ward, but both were discharged on postoperative day 1 (POD1). Only 2(4.3%) patients had ED visits within 7 days postoperatively, and neither required admission. There were no complications, reoperations, or deaths. A control group of bariatric surgery patients with planned hospital admission per usual care is being analyzed for comparison. Conclusions: We demonstrated that bariatric surgery can be performed without inpatient hospital admission in select patients. We anticipate our controls will further confirm the safety of this endeavor. Optimizing resource utilization is crucial now, as hospitals recover from the pandemic and prepare for potential future waves.
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Aim: Gallstone-related disease accounts for a third of the admissions to the Surgical Department. In June 2019, an audit was undertaken at Great Western Hospital assessing the number of patients who underwent cholecystectomy, following initial diagnosis, in accordance to current guidelines. The results demonstrated a very low number of patients had cholecystectomy, within the targeted timeframe, which led to the implementation of a dedicated operative “hot gallbladder” list weekly. In June 2020, we re-audit the service to evaluate the impact of the change implemented. Methods: A retrospective observational analysis of patients admitted to the Hospital in June 2020 with gallstone-related disease. Data was collected using the Surgical on-call lists, these were analysed and patients selected according to the reason for admission. Only gallstone related issues were considered in this analysis. Finally, via Medway, the time from admission to surgery was assessed. Results: Despite the disruption in service provision due to COVID-19, the implementation of the “hot gallbladder” list led to a 10.7% increase in timely cholecystectomies, bringing the overall compliance to 14%. There was also a significant reduction in biliary related re-admissions, from 58% to 37%. Despite 47.3% of patients were still awaiting surgery, the waiting list was reduced by 5.2% in only 1 year. Conclusions: This study demonstrated that the implementation of the “hot gallbladder” list has improved the compliance with the current guidelines. The change has brought us in line with the national average of 15%, as estimated by RCSEng, therefore demonstrating the efficacy of the weekly list.
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Aims: Treatment Escalation Plan (TEP) is essential for recognition of patients' ceiling for care in the event of clinical deterioration. It should be clearly documented to ensure continuity of care, especially during Covid-19 pandemic. This audit aims to evaluate and improve the TEP filling rate for general surgical patients. Methods: A prospective data collection was performed for one week in July 2020 in general surgical wards. Data on patients' gender, age, presence of DNACPR form and date of TEP completion were collected from patients' clinical notes. Data was analysed using SPSS statistic software. Educational posters were displayed in the ward and presentation was done to emphasise the importance of TEP documentation. Second audit cycle was done in August 2020 to assess for improvement in TEP filling rate. Results: In the first cycle, 60 patients were included with a mean age of 60. Only 11.7% patients had TEP form filled in with a mean delay of 2.7 days since admission. In the second cycle, 57 patients were included with a mean age of 66. 28.1% patients had TEP form documented with a mean delay of 1.7 days. This has shown a 140% improvement in completion rate of TEP form and 59% reduction in the delay in TEP documentation. Conclusions: TEP is essential to ensure that patients received optimal care when their condition deteriorate. Simple intervention such as educational posters will help to improve the TEP completion rate. However, continuous auditing is required to ensure improvement in TEP documentation for surgical patients.
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Aims: Studies have shown that new medical graduates feel unprepared for their role as clinicians. Courses and teachings have been cancelled due to COVID-19. Our aim was to assess demand for surgical teaching and provide a new surgical course delivered virtually to fill this gap. Methods: FY1 doctors from a large teaching hospital were invited to fill in a questionnaire to assess their preparedness for surgical specialties and subsequent appetite for near-peer teaching. The findings were used to create a virtual surgical teaching course. A post-course questionnaire was distributed to assess the success of the course. Results: Fifteen FY1 doctors completed the questionnaire. 73% (11) felt they had not had sufficient teaching on surgical specialties during medical school. 93% (14) felt they did not have sufficient teaching on managing surgical patients in foundation training. None felt 'very confident' managing patients peri-operatively. None felt 'very confident' managing surgical complications. 66.7% (10) and 53.3% (8) said they had not had any teaching from SHOs or SpRs respectively. Of those who had, 66.7% (4) and 85.7% (6) found it 'very useful'. 100% (15) said they would be interested in surgical teaching delivered by CSTs. Twelve FY1 doctors completed the post-course feedback. 83% (10) found the course 'extremely useful' and relevant to their surgical ward based jobs. Conclusion: FY1s are not confident in managing surgical patients on the wards. There is a demand for surgical teaching for FY1s. Virtual lunch-time teaching is an effective way to encourage and continue surgical teaching throughout the pandemic.
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Aim: Gallstone related disease accounts for a third of the admissions to the Surgical Department. In June 2019, a clinical audit was undertaken at Great Western Hospital assessing the number of patients who underwent cholecystectomy, following initial diagnosis, in accordance to current guidelines. The results demonstrated a very low number of patients had cholecystectomy, within the targeted time frame, which led to the implementation of a dedicated operative 'hot gallbladder' list weekly. In June 2020, we re-audit the service to evaluate the impact of the change implemented. Method: A retrospective observational analysis of patients admitted to the Hospital in June 2020 with gallstone related disease. Data was collected using the Surgical on-call lists, these were analysed and patients selected according to the reason for admission, only gallstone related issues were considered in this analysis. Finally, via Medway, the time from admission to surgery was assessed. Results: Despite the disruption in service provision due to COVID-19, the implementation of the 'hot gallbladder' list led to a 10.7% increase in timely cholecystectomies, bringing the overall compliance to 14%. There was also a significant reduction in biliary relate re-admissions, from 58% to 37%. Despite 47.3% of patients were still awaiting surgery, the waiting list was reduced by 5.2% in only 1 year. Conclusions: This study demonstrated that the implementation of the 'hot gallbladder' list has improved the compliance with the current guidelines. The change has brought us in line with the national average of 15%, as estimated by RCSEng, therefore demonstrating the efficacy of the weekly list.
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Aim: Good Surgical Practice (RCS England) and GMC guidelines inform a surgeon's practice in the consent process for an operation. Since the Covid-19 pandemic, many surgical departments have converted from face-to-face to telephonic consultations. The clinic letter is of increased importance given that it forms a key part of the medical record which the patient should receive to ensure sufficient time and information to make an informed decision. Method: Clinic letters of patients undergoing elective ENT surgery at our trust over a four-week period were examined in this retrospective audit of compliance with RCSEng and GMC guidelines. Additional data was collected on clinician grade and proportion of letters sent to patients. Patients rated satisfaction with consultation on a five-point Likert scale. Results: 135 eligible patients were included in our audit and the majority were listed by a consultant (57%). In all domains, consultant letters were more likely to be comprehensive as compared to registrars. Overall quality of clinic letters was highly variable regarding documentation of diagnosis (52%), surgical risks (50%), discussion of alternative or no treatment (30%) and registrar discussion with consultant (31%). There was also a stark difference between registrars and consultants sending patients copies of clinic letters (10% vs 47%). Only 10% of patients received a leaflet on their condition. 90% of patients were either satisfied or very satisfied with their clinic consultation. Conclusions: Refresher sessions on consent, updated template letters and increased provision of patient information leaflets will be introduced to the ENT department, and improvements monitored with further re-audit.
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Aim: Fasting before general anaesthetic aims to decrease the volume and acidity of stomach contents during surgery, which therefore reduces the risk of aspiration. This is a second cycle closed loop reaudit which had implemented Nil by mouth (NBM) guidelines during the first cycle as an intervention to improve knowledge. Preoperatively, adult patients should remain fasted for a minimum duration as below: • Solid food= 6 hours, • A cup of milky tea/ fizzy drink= 6 hours, • Clear fluids= 2 hours • Medications= 30 minutes During the second cycle interventions were included such as: teaching to junior doctors and nurses including specific teaching during induction of new surgical doctors and posters displaying the NBM guidelines were placed in surgical wards. These were carried out despite restrictions during the COVID-19 pandemic. Method: The same questionnaire was redistributed amongst staff members (nurses and HCA) throughout various surgical wards and junior doctors. Results were compared with the initial audit during this second cycle to assess whether any improvements had been made after implementation of interventions. Results: Total number of staff: • 56 (63 initial audit) • 82% - NBM for 6 hours for meals (37% initial audit), • 84% -NBM for 6 hours for drinks with particles (62% initial audit), • 91% - 2 hours as the cut off for clear fluids (58% initial audit), • 86% - 30 minutes as cut off for medications (55% initial audit). Conclusions: A significant improvement in knowledge and understanding of the NBM guidelines was demonstrated with all members of staff and practice was in accordance with NICE guidelines.