scholarly journals 729 Effect Of COVID-19 On Orthopaedic Trauma Admissions in A London District General Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
U Zahoor ◽  
C Malik ◽  
H Raja ◽  
S Ramaraju ◽  
K Sri-Ram
Keyword(s):  
General Hospital ◽  
Healthcare Delivery ◽  
High Volume ◽  
District General Hospital ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Electronic Patient Records ◽  
Patient Demographics ◽  
Trauma Service ◽  
Time Of Admission

Abstract Introduction The coronavirus pandemic (COVID-19) has presented orthopaedic services with new challenges across all aspects of healthcare delivery. This study explores the effect of the COVID-19 lockdown on trauma admissions at a London District General Hospital. Method Data was collected retrospectively from electronic patient records during the lockdown period (16th March -30thApril 2020) and compared to the same dates in 2019. Patient age, date and time of admission, operation and anaesthesia timings and length of stay (LOS) were analysed. Results Fewer trauma patients were admitted in 2020 (108 vs. 65). Additionally, there was a patient demographics shift, with mean age increasing from 55.6 years to 64.1 years (p = 0.038). Falls remained the leading cause of injury, although the proportion dropped from 75% to 62%. Anaesthesia duration was longer in 2020 (136 vs 83 minutes, p < 0.00001). Similarly, there was a 13.6% increase in median operation length. Finally, although LOS was similar, admission-operation was greatly reduced in 2020 (1.22 days vs 4.74, p < 0.0000001). Conclusions Orthopaedic trauma care remains a vital service, particularly in high-volume hospitals. By understanding the effects of the lockdown on trauma admissions, healthcare managers can more effectively plan for future changes in non-emergent trauma service delivery as we move towards easing lockdown restrictions.

scholarly journals 1075 Paediatric Injuries Pre And During COVID-19 Requiring an Operative Intervention: The District General Hospital Experience

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Howard ◽  
S Arshad ◽  
R Kabariti ◽  
R Roach
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Operative Intervention ◽  
Parental Supervision ◽  
Trauma Patients ◽  
Summer Period ◽  
Patient Demographics ◽  
Retrospective Audit ◽  
Reduced Rate ◽  
Type Of Injury

Abstract Aim To assess the effect of lockdown and the following summer period on paediatric trauma patients who required an operative intervention in a district general hospital. Method A single centre retrospective audit was performed on all paediatric patients <16 years requiring an operative intervention. Two study periods were assessed – pre-COVID (22/03/2019- 30/09/2019) and during the COVID-19 pandemic and subsequent summer period (26/03/2020 – 26/09/2020). Data were collected on patient demographics, type of injury sustained, and intervention performed. Results During the COVID-19 pandemic 119 operations were performed, compared to 238 operations performed before the pandemic. Distal radius fractures were the most common injury both during and before the pandemic. However, during the pandemic there was a higher incidence of both hand injuries and lower limb lacerations. The most common type of operation both before and during the pandemic was manipulation under anaesthetic, but there was an increased incidence of washouts performed during the pandemic. Conclusions Despite extensive restructuring of services due to COVID-19, 119 operations were performed during the pandemic. However, this is 119 fewer operations than the same period of the previous year. The reduced rate of operations could be a consequence of increased parental supervision, and less outdoor activity during the pandemic period, but further research is necessary.

The new neck of femur fracture target: experience in a district general hospital

2014 ◽  
Vol 27 (1) ◽  
pp. 36-43 ◽  
Author(s):  
Edward Britton ◽  
William Nash
Keyword(s):  
Hip Fracture ◽  
General Hospital ◽  
Best Practice ◽  
District General Hospital ◽  
Significant Rise ◽  
Trauma Patients ◽  
Neck Of Femur ◽  
Content Type ◽  
Trauma Service ◽  
Service Staff

Purpose – The hip fracture “best practice tariff” (BPT) came into effect in April 2010. It advocated two key improvements: surgery within 36hrs of arrival in the emergency department; and multi-disciplinary care directed by ortho-geriatrician from admission to discharge. The aim of this paper is to look at the 36 hours to operation target and its implications for orthopaedic department trauma service staff in a busy district general hospital, and to evaluate the measures implemented to meet the target. Design/methodology/approach – Trauma-list data, collected from a theatre management system, was compared with trauma patients placed on elective and emergency lists, before and after designated daily trauma lists were implemented. Findings – After a designated daily trauma list was introduced, a significant rise (from 56 per cent to 85 per cent) became evident in the proportion of patients operated on within 36hrs, between November 2010 to February 2011, while hip fracture cases managed on the elective list fell from 24 per cent to 17 per cent. Practical implications – Despite adding a half-day trauma list, the trauma service has insufficient capacity to achieve the new BPT for all hip fracture patients in the hospital. Therefore, there is a significant knock-on effect for managing patient overspill on elective services. Will the significant changes in service provision designed to achieve this BPT be cost effective? Originality/value – This paper aims to answer how busy department staff address an issue that professionals in every English hospital are facing.

SP5.1.7 What did we miss? A 5 - year retrospective cohort study calculating the endoscopy miss rate for UGI cancers in a Scottish district general hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
M Rashid ◽  
D Clyde ◽  
P J Driscoll ◽  
H Jafferbhoy
Keyword(s):  
General Hospital ◽  
Meta Analysis ◽  
District General Hospital ◽  
Quality Standard ◽  
Health Records ◽  
Male Predominance ◽  
Patient Demographics ◽  
Reporting Tool ◽  
Age Range ◽  
Upper Gastrointestinal

Abstract Aims Despite the widespread use of endoscopy, upper gastrointestinal (UGI) cancers still present at an advanced stage. As survival is closely linked to stage and time of diagnosis, failure to detect subtle precancerous changes at endoscopy may compound poor prognoses. This study calculates the miss rate of UGI cancer over a 5-year period at a district general hospital. Methods All patients diagnosed with UGI cancer between January 2015 - December 2019 were identified from a prospectively collected cancer registry. Electronic health records and Unisoft GI reporting tool were used to identify patient demographics and previous UGI endoscopies. ‘Missed cancers’ were defined as patients who had a normal endoscopy within 3 years of their cancer diagnosis. Results The median age at diagnosis was 72.2 years (age range 24 - 98, n = 408) with a male predominance of 2:1 (66.6% male vs 33.4% female) in keeping with UK statistics. Within this 5 year study period, there were 22 missed cancers (5.4%, n = 408). A year by year break down shows miss rate in 2015 of 3% ( 3,n=100), 2016 of 4.2% (5,n=120), 2017 5.5% (5,n=91), 2018 6.4% (6,n=94) and most recently in 2019 3.2% (3,n=94). Conclusions In 2014, a meta-analysis by S.Menon et al recorded a miss rate of 11.3%. More recently published UK studies report miss rates between 6% - 7.3%, more in keeping with our local rate of 5.4%. Further assessment is required to assess whether the 2017 BSG and AUGIS UGI endoscopy quality standard statement will improve this rate.

scholarly journals EP.TH.640Outcomes in Elective and Emergency Laparoscopic Cholecystectomies in a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ahmed Nur ◽  
Aditya Agrawal
Keyword(s):  
General Hospital ◽  
Bile Leak ◽  
District General Hospital ◽  
Perioperative Outcomes ◽  
Electronic Patient Records ◽  
Incision And Drainage ◽  
Retrospective Audit ◽  
Operative Findings ◽  
Time Of Operation ◽  
Base Data

Abstract Aims To evaluate early perioperative outcomes following emergency and elective laparoscopic cholecystectomies in a district general hospital against the national average. Methods A retrospective audit was carried out on consecutive Laparoscopic Cholecystectomies performed between January 2020 and June 2018. All indications were included. Demographics and base data included; age, gender, ASA grade, type of surgery (Emergency/Elective), number of symptomatic days preoperatively, preoperative bloods, preoperative ERCP, operative findings, postoperative complications and length of stay. Data was gathered from physical and electronic patient records. Results 166 laparoscopic cholecystectomies were included in the audit. Of the 166 included patients, 48 were male and 118 were female. Mean age at time of operation was 53.4 years. 106 of the laparoscopic cholecystectomies were carried out as Elective cases and 60 were performed as Emergencies. 100% of cases were performed laparoscopically, with 3 cases requiring conversion to open intraoperatively. Postoperatively, 5 patients had post-op pneumonia. There were 3 documented cases of bile leak with 1 patient requiring ERCP as a result. There were 2 cases of wound infection requiring re-admission. Other documented complications included; umbilical port sit abscess requiring incision and drainage, collection in the gallbladder fossa, small bowel injury and a post-op drop in Haemoglobin requiring transfusion. Conclusions Outcomes in this cohort of patients undergoing laparoscopic cholecystectomies are comparable to national data. The focus of further evaluation from this cohort should be to compare outcomes between Emergency and Elective Laparoscopic Cholecystectomies, with Emergency cases further stratified according to the number of symptomatic days preoperatively.

scholarly journals 77 Lessons Learnt from Managing Orthopaedic Trauma During the First Wave of the COVID-19 Pandemic at a UK District General Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Patel ◽  
S Green ◽  
C Hennessy ◽  
F Adamu-Biu ◽  
Y Ghani ◽  
...  
Keyword(s):  
General Hospital ◽  
Patient Outcomes ◽  
Fast Track ◽  
Soft Tissue Injuries ◽  
District General Hospital ◽  
Electronic Records ◽  
Orthopaedic Trauma ◽  
Ordinal Logistic Regression Analysis ◽  
Operative Complications ◽  
Time Periods

Abstract Background The Coronavirus disease (COVID-19) pandemic has contributed to over 900,000 deaths worldwide. Hospitals responded by expanding services to accommodate the forecasted rise in COVID-19-related admissions. We describe the effects these changes had on management of orthopaedic trauma and patient outcomes at a district general hospital in Southern England. Method Data were extrapolated retrospectively from two separate six-week periods in 2019 and 2020 (1st April - 13th May) using electronic records of patients referred to the orthopaedic team. Soft tissue injuries were included where a confirmed diagnosis was made with radiological evidence. Patients were excluded if no orthopaedic intervention was required. Data were compared between the two time periods. Results There were fewer attendances to hospital in 2020 compared with 2019 (178 vs 328), but time from presentation to surgery significantly increased in 2020 (2.94 days vs 4.91 days, p = 0.009). There were fewer operative complications in 2020 (36/145 vs 11/88, p < 0.001). However, ordinal logistic regression analysis found a significantly greater complication severity in 2020 including death (p = 0.039). Complication severity was unrelated to COVID-19 status. Conclusions Restructuring of orthopaedic services in response to the COVID-19 pandemic has been associated with significant delays to surgery and higher post-operative complication severity. Our results demonstrate the need for fast-track emergency operative orthopaedic services in UK district general hospitals whilst the COVID-19 pandemic continues.

scholarly journals Trauma surgery at a designated COVID-19-free site during the pandemic

2020 ◽  
Vol 1 (6) ◽  
pp. 302-308
Author(s):  
Gianluca Gonzi ◽  
Kathryn Rooney ◽  
Rhodri Gwyn ◽  
Kunal Roy ◽  
Matthew Horner ◽  
...  
Keyword(s):  
Trauma Surgery ◽  
Electronic Record ◽  
Health Board ◽  
Trauma Patients ◽  
Staff Members ◽  
Patient Demographics ◽  
Orthopaedic Patients ◽  
Trauma Service ◽  
Surgical Unit

Aims Elective operating was halted during the COVID-19 pandemic to increase the capacity to provide care to an unprecedented volume of critically unwell patients. During the pandemic, the orthopaedic department at the Aneurin Bevan University Health Board restructured the trauma service, relocating semi-urgent ambulatory trauma operating to the isolated clean elective centre (St. Woolos’ Hospital) from the main hospital receiving COVID-19 patients (Royal Gwent Hospital). This study presents our experience of providing semi-urgent trauma care in a COVID-19-free surgical unit as a safe way to treat trauma patients during the pandemic and a potential model for restarting an elective orthopaedic service. Methods All patients undergoing surgery during the COVID-19 pandemic at the orthopaedic surgical unit (OSU) in St. Woolos’ Hospital from 23 March 2020 to 24 April 2020 were included. All patients that were operated on had a telephone follow-up two weeks after surgery to assess if they had experienced COVID-19 symptoms or had been tested for COVID-19. The nature of admission, operative details, and patient demographics were obtained from the health board’s electronic record. Staff were assessed for sickness, self-isolation, and COVID-19 status. Results A total of 58 surgical procedures were undertaken at the OSU during the study period; 93% (n = 54) of patients completed the telephone follow-up. Open reduction and internal fixation of ankle and wrist fractures were the most common procedures. None of the patients nor members of their households had developed symptoms suggestive of COVID-19 or required testing. No staff members reported sick days or were advised by occupational health to undergo viral testing. Conclusion This study provides optimism that orthopaedic patients planned for surgery can be protected from COVID-19 nosocomial transmission at separate COVID-19-free sites. Cite this article: Bone Joint Open 2020;1-6:302–308.

scholarly journals Managing the open abdomen in a district general hospital

2014 ◽  
Vol 96 (3) ◽  
pp. 194-198 ◽  
Author(s):  
J De Siqueira ◽  
O Tawfiq ◽  
J Garner
Keyword(s):  
General Hospital ◽  
Open Abdomen ◽  
Hospital Setting ◽  
District General Hospital ◽  
Hospital Environment ◽  
Fascial Closure ◽  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Hospital Stays ◽  
The Uk

Introduction The need to manage an open abdomen is becoming more common in general surgical practice and a variety of methods of temporary abdominal closure (TAC) are available. The evidence for the efficacy of the various forms of TAC as well as the subsequent definitive fascial closure (DFC) rates and complications comes mainly from large trauma series in the US, which represent a different patient population to those in the UK in whom TAC is usually required. Methods All cases of open abdomen management in our hospital over a five-year period were reviewed to ascertain the methods of TAC used, our success in achieving DFC and the applicability of managing such cases in a district hospital environment. Results Nineteen patients underwent TAC, with two deaths (10.5%) and an overall DFC rate at hospital discharge of 12/17 (70.6%). The median lengths of critical care and hospital stays were 19.5 and 38.0 days respectively. Thirteen out of seventeen survivors had at least one significant complication. Conclusions The management of the open abdomen can be achieved safely in a district general hospital setting with acceptable outcomes for the non-trauma patients commonly seen in UK practice but it is a resource intensive and expensive undertaking.

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