Current process and outcomes of the surgical management of LUTS due to benign prostatic enlargement: how consistent are we? - results from the multi-institutional audit of surgical management of BPE (AuSuM BPE) in the United Kingdom.

OBJECTIVE: In view of changing landscape of surgical treatment for LUTS secondary to BPE, this audit was undertaken to assess key aspects of the processes and outcomes of the current interventional treatments for BPE, across different units in the UK. MATERIALS AND METHOD: A multi-institutional snapshot audit was conducted for patients undergoing interventions for LUTS/BPE over 8-week period. Using Delphi process two-part proforma was designed to capture data. RESULTS: 529 patients were included across 20 NHS trusts in England and Wales. Median age was 73 years. Indications for surgery were acute retention (47%) and LUTS (45%). 80% of patients had prior medical therapy. TURP formed the commonest procedure. 27% patients had <23 hour hospital stay. Immediate (21%) and delayed (18%) complications were Clavien-Dindo <2 category. High proportion of patients reported residual symptoms. Type and indication of surgery were significant predictor of complications, length of stay and failure of TWOC outcomes, on multivariate analyses. There were variations in departmental processes, 50% centres used PROMs. CONCLUSION: Monopolar TURP still remains the commonest intervention for BPE. Most departments are adopting newer technologies. The audit identified opportunities for development of consistent, effective and patient centric practices as well as need for large-scale focused studies.

Automated electronic discharge summary for patients undergoing acute scrotal exploration: does it improve accuracy and quality?

BACKGROUND: The acute scrotum is a common emergency presentation, and the priority is to exclude testicular torsion, which typically requires scrotal exploration. The accuracy of electronic discharge summaries (EDSs) for patients undergoing acute scrotal exploration has previously been shown to be poor. OBJECTIVE: The objective of this study was to assess accuracy of EDS in patients undergoing acute scrotal exploration in a tertiary paediatric hospital. This study aimed to determine if a new EDS system, whereby the operative procedure is automatically transcribed into the EDS, improves the information within the EDS. METHODS: Retrospective review of the EDS for all patients undergoing acute scrotal exploration between 1st April 2014 and 31st March 2016 was carried out. During this period, a new EDS system, whereby the operative procedure is automatically transcribed to the EDS, was introduced on 20th June 2015. The old system (1st April 2014 to 19th June 2015) was compared with the new system (20th August 2015 to 31st March 2016). RESULTS: A total of 181 patients were included. A diagnosis was not documented in 25 (14%) and was inconsistent with the operation notes in 56 (31%). An operative procedure was not documented at all in 13 (7%) and was inconsistent with the operation notes in 43 (24%). The laterality of pain was not documented and/or incorrect in 11 (6%). The new system in which the operative procedure is automatically transcribed to the EDS resulted in an improvement of diagnoses (78% vs 96%; p = 0.0022; old vs new) and procedures (95% vs 100%; p = 0.0218; old vs new) being documented but not the accuracy. CONCLUSION: The EDS prepared for patients undergoing acute scrotal exploration frequently exhibit inaccuracies; a system that automatically transcribes the operative procedure into the EDS results in modest improvement.