scholarly journals 467 Impact of the Coronavirus Pandemic on Acute Surgical Patients’ Discharge Summaries

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Ooi ◽  
I B Stimson ◽  
G Williams
Keyword(s):  
Intensive Care ◽  
Data Collection ◽  
Healthcare Systems ◽  
Surgical Patients ◽  
Time Constraints ◽  
Single Centre ◽  
Effective Discharge ◽  
Delayed Discharge ◽  
Assessment Unit ◽  
Discharge Summaries

Abstract Background The emergence of the Coronavirus pandemic has placed increased demands on the NHS workforce, especially in medical and intensive care units. The subsequent redistribution of surgical house officers to accommodate this in a single centre has possibly negatively impacted on the effective discharge notification of acute surgical patients. Methods: Discharge summaries of all patients discharged from a Surgical Assessment Unit were collected and analysed, to identify the date of completion and grade of responsible clinician. Data collection was carried out over three weeks before the initiation of lockdown measures and continued for a further three weeks during the peak of the Coronavirus pandemic with a three-week interventional period in between. Results In the initial audit, 36.2% of the 246 patients had delayed discharge summaries with an average of 7 days to complete. On re-evaluation, 45.3% of the 223 patients had delayed discharge summaries, with an average of 12 days to complete. A survey conducted post-re-audit identified that the most common reason for this was due to time constraints. Conclusions The reallocation of surgical staff has affected communication between primary and secondary care. Given the potential repercussions of these delays, healthcare systems should be made aware of this consequence, especially in preparation for any future resurgences.

scholarly journals Impact of the COVID-19 pandemic on acute surgical patients’ discharge summaries – Experience of Wales worst-hit COVID-19 hospital

2021 ◽  
pp. 251604352110093
Author(s):  
Rucira Ooi ◽  
Imogen Bambrough Stimson ◽  
Gethin Williams
Keyword(s):  
Intensive Care ◽  
Data Collection ◽  
Healthcare Systems ◽  
Surgical Patients ◽  
Time Constraints ◽  
Single Centre ◽  
Effective Discharge ◽  
Delayed Discharge ◽  
Assessment Unit ◽  
Discharge Summaries

Background The emergence of the COVID-19 pandemic has placed increased demands on the NHS workforce, especially in medical and intensive care units. The subsequent redistribution of surgical house officers to accommodate this in a single-centre NHS hospital has possibly negatively impacted on the effective discharge notification of acute surgical patients. Methods Discharge summaries of all patients directly discharged from a Surgical Assessment Unit were collected on the day of discharge and analysed to identify the date of completion and staff grade of the responsible clinician. Data collection was carried out before the initiation of lockdown measures and continued for a further three weeks during the peak of the COVID-19 pandemic with an interventional period in between. A poster was created and displayed in areas where discharge software could be accessed. Results In the initial audit, 36.2% of the 246 patients had delayed discharge summaries with an average of 7 days to complete. On re-evaluation, 45.3% of the 223 patients had delayed discharge summaries, taking an average of 12 days to complete. A survey conducted post-re-audit identified that the most common reason for delayed discharge summaries was due to time constraints associated with the increased workload. Conclusion The reallocation of surgical staff in response to the COVID-19 pandemic has affected communication between primary and secondary care, with a rise in delayed discharge letters of acute surgical patients. Given the potential repercussions of these delays, healthcare systems should be aware of this consequence of the pandemic, especially in preparation for any resurgences.

scholarly journals Effect of covid-19 pandemic on in-hospital mortality

2021 ◽  
Vol 8 (6) ◽  
pp. 389-393
Author(s):  
Ramazan Ünal ◽  
Ramazan Güven ◽  
Dilek Atik ◽  
Ahmet Erdur ◽  
Ertuğrul Ak ◽  
...  
Keyword(s):  
Intensive Care ◽  
Hospital Mortality ◽  
Descriptive Study ◽  
Mortality Rates ◽  
Healthcare Systems ◽  
Patient Admission ◽  
Single Centre ◽  
Cross Sectional ◽  
Causes Of Mortality ◽  
Respiratory Causes

Objective: This study aimed to examine the effect of the pandemic on hospital mortality and patient admission in four months since March 2020 when the Ministry of Health announced the first confirmed COVID-19 case in Turkey and the first wave occurred. Material-Method: This research is a single-centre, retrospective, cross-sectional descriptive study. It covers the periods between March 01 and Jun 30 of 2018, 2019, and 2020. Results: Between 2018-2020, 897522, 972799, and 395438 patients were admitted to our Hospital, respectively. It was observed that the number of admissions decreased by 55-60% in 2020 compared to the previous years (p=0.001). Moreover, 205318 (22.9%) of the admissions in 2018, 229278 (23.6%) of the admissions in 2019, and 1127293 (32%) of the admissions in 2020 were emergency room (ER) admissions. Especially in 2020, there was a significant increase in the overall in-hospital (p=0.001) and ER (p=0.001 mortality rates compared to previous years. In-hospital mortality was found to be higher, especially in patients with suspected COVID-19 (p=0.001). It was found that the number of deaths due to respiratory causes was significantly increased in 2020 compared to the previous years (p=0.001). Conclusion: The COVID-19 pandemic has led to significant changes in mortality rates and causes of mortality compared to previous years. Although the pandemic has affected all healthcare systems, ER and intensive care units (ICU) are seriously affected.

scholarly journals Paediatric admissions to a district general hospital adult intensive care unit over a six year period: A single centre retrospective case series, with review of practitioner confidence and competence in paediatric critical care

2021 ◽  
pp. 175114372110121
Author(s):  
Stephen A Spencer ◽  
Joanna S Gumley ◽  
Marcin Pachucki
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Case Series ◽  
Critically Ill Children ◽  
Single Centre ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Paediatric Critical Care ◽  
Doctors And Nurses

Background Critically ill children presenting to district general hospitals (DGH) are admitted to adult intensive care units (AICUs) for stabilisation prior to transfer to paediatric intensive care units (PICUs). Current training in PICU for adult intensive care physicians is only three months. This single centre retrospective case series examines the case mix of children presenting to a DGH AICU and a multidisciplinary survey assesses confidence and previous experience, highlighting continued training needs for DGH AICU staff. Methods all paediatric admissions to AICU and paediatric retrievals were reviewed over a 6-year period (2014-2019). Cases were identified from the Electronic Patient Record (EPR) and from data provided by the regional paediatric retrieval service. A questionnaire survey was sent to AICU doctors and nurses to assess confidence and competence in paediatric critical care. Results Between 2014-2019, 284 children were managed by AICU. In total 35% of cases were <1 y, 48% of cases were <2 y and 64% of cases were <5 y, and 166/284 (58%) children were retrieved. Retrieval reduced with increasing age (OR 0.49 [0.40-0.60], p < 0.0001). The survey had an 82% response rate, and highlighted that only 13% of AICU nurses and 50% of doctors had received prior PICU training. Conclusion At least one critically unwell child presents to the AICU each week. Assessment, stabilisation and management of critically unwell children are vital skills for DGH AICU staff, but confidence and competence are lacking. Formalised strategies are required to develop and maintain paediatric competencies for AICU doctors and nurses.

scholarly journals Increased blood culture contamination rate during COVID-19 outbreak in intensive care unit: A brief report from a single-centre

2021 ◽  
pp. 175114372110121
Author(s):  
Emanuele Russo ◽  
Giuliano Bolondi ◽  
Emiliano Gamberini ◽  
Domenico Pietro Santonastaso ◽  
Alessandro Circelli ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Contamination Rate ◽  
Single Centre

scholarly journals 379 The Critical Care Experience of Irish Surgical Non-Consultant Hospital Doctors, Are We Equipped to Assist During the Covid-19 Outbreak and Beyond?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Burke ◽  
P Balfe
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Healthcare Systems ◽  
Care Environment ◽  
Care Experience ◽  
Electronic Survey ◽  
Surgical Trainees ◽  
Hospital Doctors ◽  
Basic Course ◽  
Further Development

Abstract Introduction The ongoing COVID-19 pandemic has presented unforeseen threats and stresses to healthcare systems around the world, most notably in the ability to provide critical care. Aim To assess surgical NCHD experience in providing critical care and working in an intensive care environment. Method An electronic survey was distributed amongst surgical trainees and then amongst individual surgical departments. Ten questions were included in the survey assessing the NCHD’s experience with aspects of critical care. Results 39 respondents including 16 specialist registrars, 3 senior registrars, 11 registrars and 9 senior house officers. 18% of respondents had previous experience in anaesthetics or intensive care. 23% self-reported being competent in performing endotracheal intubation. 15% self-reported being competent in the use of CPAP and BiPaP, 5% did not know what these were. 20% self-reported being competent in the use of AIRVO. 15% self-reported being competent in placing central and arterial lines. 15% self-reported being competent in starting and adjusting inotropes/vasopressors. 49% reported completing a CCRISP or BASIC course. 85% felt that a rotation in anaesthesia should be a routine part of surgical training. Conclusions Whilst there is critical care experience amongst the surgical NCHD cohort there remains room for further development.

scholarly journals Reaching the summit of discharge summaries: a quality improvement project

2021 ◽  
Vol 10 (1) ◽  
pp. e001142
Author(s):  
Richard Thomas Richmond ◽  
Isobel Joy McFadzean ◽  
Pramodh Vallabhaneni
Keyword(s):  
Quality Improvement ◽  
Health And Safety ◽  
Improve Patient Care ◽  
Discharge Summary ◽  
Shop Floor ◽  
Junior Doctors ◽  
Improvement Project ◽  
Step Model ◽  
Assessment Unit ◽  
Discharge Summaries

BackgroundDischarge summaries need to be completed in a timely manner, to improve communication between primary and secondary care, and evidence suggests that delays in discharge summary completion can lead to patient harm.Following a hospital health and safety review due to the sheer backlog of notes in the doctor’s room and wards, urgent action had to be undertaken to improve the discharge summary completion process at our hospital’s paediatric assessment unit. It was felt that the process would best be carried out within a quality improvement (QI) project.MethodsKotter’s ‘eight-step model for change’ was implemented in this QI project with the aim to clear the existing backlog of pending discharge summaries and improve the timeliness of discharge summary completion from the hospital’s paediatric assessment unit. A minimum target of 10% improvement in the completion rate of discharge summaries was set as the primary goal of the project.ResultsFollowing the implementation of the QI processes, we were able to clear the backlog of discharge summaries within 9 months. We improved completion within 24 hours, from <10% to 84%, within 2 months. The success of our project lies in the sustainability of the change process; to date we have consistently achieved the target completion rates since the inception of the project. As a result of the project, we were able to modify the junior doctor rota to remove discharge summary duty slots and bolster workforce on the shop floor. This is still evident in November 2020, with consistently improved discharge summary rates.ConclusionQI projects when conducted successfully can be used to improve patient care, as well as reduce administrative burden on junior doctors. Our QI project is an example of how Kotter’s eight-step model for change can be applied to clinical practice.

scholarly journals Profile of Intensive Care Unit admission and Outcomes of Medical and Surgical patients at A Tertiary Government Hospital: A 5 Year Trend Analysis

2018 ◽  
Vol 29 (2) ◽  
pp. 59-62
Author(s):  
Shakera Ahmed ◽  
Omar Faruque Yusuf ◽  
AKM Shamsul Alam ◽  
Anisul Awal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Ventilatory Support ◽  
Surgical Patients ◽  
College Hospital ◽  
Medical College ◽  
Advanced Airway ◽  
Medical Discipline ◽  
Record Review

Background: The intensive care unit (ICU) is that part of the hospital where critically ill patients that require advanced airway, respiratory and haemodynamic supports are usually admitted. Intensive care unit admissions which aim at achieving an outcome better than if the patients were admitted into other parts of the hospital however come at a huge cost to the hospital, the personnel and patients’ relations.Objective: To audit the 5 year bed occupancy rate and outcome of medicine and surgical patients admitted into the ICU of the Chittagong Medical College Hospital, Chittagong, Bangladesh.Design: A 5 years retrospective study (Record review) from January 2012 to December 2016. Method: Data were extracted from the ICU records of the patient and analyzed.Results: During this study period, the frequency of admission into ICU was significantly more (p<0.001) from medical discipline (55.20%) than surgical disciplines (44.80%). The incidence of survival was significantly lower (p<0.001) from medical discipline (37.68%), than from surgical disciplines (49.05%). Occurrence of total ventilatory support provided in all disciplines was 60.32% and it was significantly higher for the surgical patients. Overall mortality rate was 57.23%.Conclusion: During prioritizing the patients for ICU admission surgical cases should get preference. It is primarily necessary to optimize patient to doctor ratio and patient to nurse ratio and providing the service by critical care physicians (“intensivists”) to reduce the mortality rate of ICU.Bangladesh J Medicine Jul 2018; 29(2) : 59-62

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