scholarly journals 1152 “A Hypoxic Dilemma”- Compliance with Oxygen Prescriptions on The Acute Surgical Take

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Shaladi ◽  
J Jesuthasan ◽  
G Martin ◽  
J Allu ◽  
A Shah
Keyword(s):  
High Risk ◽  
Oxygen Therapy ◽  
Clinical Deterioration ◽  
Surgical Patients ◽  
British Thoracic Society ◽  
High Risk Patients ◽  
Oxygen Administration ◽  
Target Values ◽  
Risk Patients ◽  
Initial Results

Abstract Aim British Thoracic Society Guidelines state that all patients admitted to hospital should have oxygen targets prescribed to promptly start oxygen therapy should clinical deterioration occur. We aimed to assess oxygen prescribing compliance for new surgical patients. Method We assessed prescription of oxygen in patients admitted on the surgical take, once weekly for 8 weeks looking at target values, route of administration, frequency and appropriate signing and dating. A re-audit was performed after presenting the initial results at a department meeting. Results 61 patients were included. Out of 61, 8 patients had COPD. Only 9 patients had adequate oxygen prescriptions with all the criteria completed. After re-audit, 50 surgical take patients’ drug charts were reviewed. 42 out of 50 patients had correctly completed oxygen prescriptions. Conclusions Correct oxygen administration in high-risk patients is vital in their management, particularly during clinical deterioration. A discernible improvement in prescriptions was noted in this study.

scholarly journals The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0257941
Author(s):  
Claudia de Souza Gutierrez ◽  
Katia Bottega ◽  
Stela Maris de Jezus Castro ◽  
Gabriela Leal Gravina ◽  
Eduardo Kohls Toralles ◽  
...  
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Clinical Deterioration ◽  
Surgical Patients ◽  
Predictive Tool ◽  
Postoperative Death ◽  
High Risk Patients ◽  
Death Probability ◽  
Risk Patients ◽  
The Impact

Background Practical use of risk predictive tools and the assessment of their impact on outcome reduction is still a challenge. This pragmatic study of quality improvement (QI) describes the preoperative adoption of a customised postoperative death probability model (SAMPE model) and the evaluation of the impact of a Postoperative Anaesthetic Care Unit (PACU) pathway on the clinical deterioration of high-risk surgical patients. Methods A prospective cohort of 2,533 surgical patients compared with 2,820 historical controls after the adoption of a quality improvement (QI) intervention. We carried out quick postoperative high-risk pathways at PACU when the probability of postoperative death exceeded 5%. As outcome measures, we used the number of rapid response team (RRT) calls within 7 and 30 postoperative days, in-hospital mortality, and non-planned Intensive Care Unit (ICU) admission. Results Not only did the QI succeed in the implementation of a customised risk stratification model, but it also diminished the postoperative deterioration evaluated by RRT calls on very high-risk patients within 30 postoperative days (from 23% before to 14% after the intervention, p = 0.05). We achieved no survival benefits or reduction of non-planned ICU. The small group of high-risk patients (13% of the total) accounted for the highest proportion of RRT calls and postoperative death. Conclusion Employing a risk predictive tool to guide immediate postoperative care may influence postoperative deterioration. It encouraged the design of pragmatic trials focused on feasible, low-technology, and long-term interventions that can be adapted to diverse health systems, especially those that demand more accurate decision making and ask for full engagement in the control of postoperative morbi-mortality.

Deep Vein Thrombosis Prophylaxis: Audit of Practice in General Surgical Patients in a Teaching Hospital

2000 ◽  
Vol 15 (2) ◽  
pp. 71-74 ◽  
Author(s):  
O. Agu ◽  
A. Handa ◽  
G Hamilton ◽  
D. M. Baker
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Teaching Hospital ◽  
Surgical Patients ◽  
Thrombosis Prophylaxis ◽  
High Risk Patients ◽  
Vein Thrombosis ◽  
Dvt Prophylaxis ◽  
Risk Patients ◽  
Deep Vein

Objective: To audit the prescription and implementation of deep vein thrombosis (DVT) prophylaxis in general surgical patients in a teaching hospital. Methods: All inpatients on three general surgical wards were audited for adequacy of prescription and implementation prophylaxis (audit A). A repeat audit 3 months later (audit B) closed the loop. The groups were compared using the chi-square test. Results: In audit A 50 patients participated. Prophylaxis was correctly prescribed in 36 (72%) and implemented in 30 (60%) patients. Eighteen patients at moderate or high risk (45%) received inadequate prophylaxis. Emergency admission, pre-operative stay and inadequate risk assignment were associated with poor implementation of protocol. In audit B 51 patients participated. Prescription was appropriate in 45 (88%) and implementation in 40 (78%) patients (p< 0.05). Eleven patients at moderate or high risk received inadequate prophylaxis. Seven of 11 high-risk patients in audit A (64%) received adequate prophylaxis, in contrast to all high-risk patients in audit B. The decision not to administer prophylaxis was deemed appropriate in 5 of 15 (30%) in audit A compared with 6 of 10 (60%) in audit B. Conclusion: Increased awareness, adequate risk assessment, updating of protocols and consistent reminders to staff and patients may improve implementation of DVT prophylaxis.

scholarly journals COVID-19 in Geriatric Age Group - A Review

2020 ◽  
Vol 52 (04) ◽  
pp. 81-87
Author(s):  
Alisha Rewari ◽  
Keyword(s):  
High Risk ◽  
Clinical Deterioration ◽  
Age Group ◽  
Comorbid Conditions ◽  
Global Crisis ◽  
High Risk Patients ◽  
Risk Patients ◽  
Group A ◽  
Specific Cluster

Coronavirus pandemic is an unprecedented global crisis that has affected the entire mankind. The elderlies are a specific cluster of high-risk patients for developing COVID-19 infection with rapid clinical deterioration. Frailty and comorbid conditions in the geriatric age group may be associated with mortality, considering the diversity of results in the existing literature. The present document has been drafted to review the available literature and evidences on this infection in geriatric age group which is particularly vulnerable to this disease and its fatal manifestations.

scholarly journals Noninvasive ventilation versus conventional oxygen therapy after extubation failure in high-risk patients in an intensive care unit: a pragmatic clinical trial

2021 ◽  
Vol 33 (3) ◽  
Author(s):  
Alberto Belenguer-Muncharaz ◽  
Maria-Lidón Mateu-Campos ◽  
Bárbara Vidal-Tegedor ◽  
María- Desamparados Ferrándiz-Sellés ◽  
Maria-Luisa Micó-Gómez ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Noninvasive Ventilation ◽  
Oxygen Therapy ◽  
Extubation Failure ◽  
Pragmatic Clinical Trial ◽  
High Risk Patients ◽  
Risk Patients

A multidisciplinary perioperative medicine clinic to improve high-risk patient outcomes: A service evaluation audit

2021 ◽  
pp. 0310057X2110171
Author(s):  
Aidan I Fullbrook ◽  
Elizabeth P Redman ◽  
Kerry Michaels ◽  
Lisa R Woods ◽  
Aruntha Moorthy ◽  
...  
Keyword(s):  
Intensive Care ◽  
High Risk ◽  
Perioperative Medicine ◽  
Surgical Patients ◽  
Perioperative Outcomes ◽  
Surgical Patient ◽  
High Risk Patients ◽  
Medicine Clinic ◽  
Risk Patients ◽  
High Risk Surgical Patient

Various perioperative interventions have been demonstrated to improve outcomes for high-risk patients undergoing surgery. This audit assessed the impact of introducing a multidisciplinary perioperative medicine clinic on postoperative outcomes and resource usage amongst high-risk patients. Between January 2019 and March 2020, our institution piloted a Comprehensive High-Risk Surgical Patient Clinic. Surgical patients were eligible for referral when exhibiting criteria known to increase perioperative risk. The patient’s decision whether to proceed with surgery was recorded; for those proceeding with surgery, perioperative outcomes and bed occupancy were recorded and compared against a similar surgical population identified as high-risk at our institution in 2017. Of 23 Comprehensive High-Risk Surgical Patient Clinic referrals, 11 did not proceed with the original planned surgery. Comprehensive High-Risk Surgical patients undergoing original planned surgery, as compared to high-risk patients from 2017, experienced reduced unplanned intensive care unit admission (8% versus 19%, respectively), 30-day mortality (0% versus 13%) and 30-day re-admission to hospital (0% versus 20%); had shorter postoperative lengths of stay (median (range) 8 (7–14) days versus 10.5 (5–28)) and spent more days alive outside of hospital at 30 days (median (range) 18 (0–25) versus 21 (16–23)). Cumulatively, the Comprehensive High-Risk Surgical patient cohort compared to the 2017 cohort (both n=23) occupied fewer postoperative intensive care (total 13 versus 24) and hospital bed-days (total 106 versus 212). The results of our Comprehensive High-Risk Surgical Patient pilot project audit suggest improved individual outcomes for high-risk patients proceeding with surgery. In addition, the results support potential resource savings through more appropriate patient selection.

scholarly journals Emergency Cholecystectomy Versus Percutaneous Cholecystostomy for Treatment of Acute Cholecystitis in High-Risk Surgical Patients

2019 ◽  
Vol 103 (11-12) ◽  
pp. 534-541
Author(s):  
Cevher Akarsu ◽  
Ahmet Cem Dural ◽  
Aysun Erbahceci Salik ◽  
Mustafa Gokhan Unsal ◽  
Osman Kones ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Length Of Hospital Stay ◽  
Treatment Method ◽  
Surgical Patients ◽  
Percutaneous Cholecystostomy ◽  
High Risk Patients ◽  
Severity Scores ◽  
Risk Patients

Our aim is to present our experience with laparoscopic cholecystectomy (LC) and percutaneous cholecystostomy (PC) in high-risk patients with acute cholecystitis (AC). The guidelines for AC are still debatable for high-risk patients. We aimed to emphasize the role of LC as a primary treatment method in patients with severe AC instead of a treatment after PC according to the Tokyo Guidelines (TG). AC patients with high surgical risk [American Society of Anesthesiologists (ASA) III-IV] who were admitted to our department between March 2008 and November 2014 were retrospectively evaluated. Disease severity in all patients was assessed according to the 2007 TG for AC. Patients were either treated by emergency LC (group LC) or PC (group PC). Demographic data, ASA scores, treatment methods, rates of conversion to open surgery, duration of drainage, length of hospital stay, and morbidity and mortality rates were compared among groups. Age, ASA score, and TG07 severity scores in the PC group were significantly higher than that in the LC group (P &lt; 0.001, P &lt; 0.001, and P &lt; 0.001, respectively). Sex distribution (P = 0.33), follow-up periods (P = 0.33), and morbidity (P = 0.86) were similar. In the patients with early surgical intervention, mortality was significantly lower (P &lt; 0.001). Length of hospital stay was significantly shorter in the LC group compared with the PC group (P &lt; 0.001). In high-risk surgical patients, PC can serve as an alternative treatment method because of its efficiency in the prevention of sepsis-related complications due to AC. However, LC still should be an option for severe AC with comparable short-term results.

Initial Results of a Thoracic Aortic Endovascular Program: Safer in High-Risk Patients

2009 ◽  
Vol 23 (4) ◽  
pp. 478-484 ◽  
Author(s):  
Chadwick W. Stouffer ◽  
M. Ashraf Mansour ◽  
Mickey M. Ott ◽  
Robert L. Hooker ◽  
Jill M. Gorsuch ◽  
...  
Keyword(s):  
High Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
Initial Results

scholarly journals The African Surgical OutcomeS-2 (ASOS-2) Pilot Trial, a mixed-methods implementation study

2019 ◽  
pp. 14-23
Author(s):  
L Du Toit ◽  
H-L Kluyts ◽  
V Gobin ◽  
CM Sani ◽  
E Zoumenou ◽  
...  
Keyword(s):  
High Risk ◽  
Data Collection ◽  
Surgical Outcomes ◽  
Pilot Trial ◽  
Surgical Patients ◽  
Implementation Study ◽  
Postoperative Surveillance ◽  
High Risk Patients ◽  
Risk Patients ◽  
Collection Strategies

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. The working hypothesis is that patients die as a result of failure to rescue following complications in the postoperative period. The African Surgical OutcomeS-2 (ASOS-2) Trial plans to test the efficacy of increased postoperative surveillance in high risk patients for decreasing perioperative morbidity and mortality. This pilot trial aimed i) to evaluate the adequacy of data produced by the data collection strategies of the ASOS-2 Trial, ii) to evaluate the fidelity of implementation of the increased postoperative surveillance intervention, and iii) to understand the acceptability, appropriateness and feasibility of the intervention and the trial processes. Methods: The ASOS-2 Pilot Trial was a mixed-methods (quantitative-qualitative) implementation study focusing on the intervention arm of the proposed ASOS-2 Trial. The intervention is increased postoperative surveillance for high-risk surgical patients. The intervention protocol was implemented at all sites for a seven-day period. A post pilot trial survey was used to collect data on the implementation outcomes. Results: 803 patients were recruited from 16 hospitals in eight African countries. The sampling and data collection strategies provided 98% complete data collection. Seventy-three percent of respondents believed that they truly provided increased postoperative surveillance to high risk patients. In reality 83/125 (66%) of high-risk patients received some form of increased postoperative surveillance. However, the individual components of the increased postoperative surveillance intervention were implemented in less than 50% of high-risk patients (excepting increasing nursing observations). The components most frequently unavailable were the ability to provide care in a higher care ward (32.1%) and assigning the patient to a bed in view of the nurses’ station (28.4%). Failure to comply with available components of the intervention ranged from 27.5% to 54.3%. The post pilot survey had a response rate of 30/40 (75%). In Likert scale questions about acceptability, appropriateness, and feasibility of the ASOS-2 intervention, 63% to 87% of respondents indicated agreement. Respondents reported barriers related to resources, trial processes, teamwork and communication as reasons for disagreement. Conclusions: The proposed ASOS-2 Trial appears to be appropriate, acceptable and feasible in Africa. This pilot trial provides support for the proposed ASOS-2 Trial. It emphasises the need for establishing trial site teams which address the needs of all stakeholders during the trial. A concerted effort must be made to help participating hospitals to increase compliance with all the components of the proposed intervention of ‘increased postoperative surveillance’ during the ASOS-2 Trial.

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