scholarly journals 1373 Semi-Elective Trauma Patients Pathway and Medical Clerking Proforma, Closed Loop Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Altell ◽  
E Massa ◽  
M Edwards
Keyword(s):  
Trauma Care ◽  
Closed Loop ◽  
Surgical Intervention ◽  
Clinical Governance ◽  
Lower Limbs ◽  
Trauma Patients ◽  
Patient Records ◽  
Orthopaedic Department ◽  
Near Misses ◽  
Audit Cycle

Abstract Introduction Semi-elective Trauma care is a service provided by the Trauma and Orthopaedic department for patients who sustain fractures to the upper and lower limbs requiring surgical intervention, are still ambulatory and can be cared for safely at home until the date of operation. Aim To assess patients’ referral pathway and clerking documentation against the Standards for the Clinical Structure and Content of Patient Records, published by the RCSEng. Method We performed a closed loop audit on the clerking documentation and the referral pathway for these patients. We collected data retrospectively for three months, assessing the clerking documentation against the guidelines. The data was analysed and presented at our Clinical Governance meeting. We then implemented the Semi-Elective Trauma Pathway and the Medical Clerking Proforma. Afterwards, data was collected prospectively to complete the audit cycle. Results A sum of 181 patient were included. Before the use of our changes, only 36% of patients had a complete clerking documentation, with two cases of near misses, and no comprehensive referral pathway for these patients. Post implementation of the Pathway and the Clerking Proforma, 88% of patients had complete clerking documentation, no near misses and 95% of them went properly through the pathway we introduced. Conclusions These patients present an important part of any trauma list. This Audit shows that having a comprehensive referral pathway and a clerking proforma will make sure that patients will have full medical history taken and are ready for the operation on the day of surgery and decrease the number of near misses.

scholarly journals Effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047439
Author(s):  
Rayan Jafnan Alharbi ◽  
Virginia Lewis ◽  
Sumina Shrestha ◽  
Charne Miller
Keyword(s):  
Systematic Review ◽  
Trauma Care ◽  
Data Extraction ◽  
Meta Analysis ◽  
Trauma System ◽  
Secondary Data ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Trauma Systems ◽  
Stages Of Development

IntroductionThe introduction of trauma systems that began in the 1970s resulted in improved trauma care and a decreased rate of morbidity and mortality of trauma patients. Worldwide, little is known about the effectiveness of trauma care system at different stages of development, from establishing a trauma centre, to implementing a trauma system and as trauma systems mature. The objective of this study is to extract and analyse data from research that evaluates mortality rates according to different stages of trauma system development globally.Methods and analysisThe proposed review will comply with the checklist of the ‘Preferred reporting items for systematic review and meta-analysis’. In this review, only peer-reviewed articles written in English, human-related studies and published between January 2000 and December 2020 will be included. Articles will be retrieved from MEDLINE, EMBASE and CINAHL. Additional articles will be identified from other sources such as references of included articles and author lists. Two independent authors will assess the eligibility of studies as well as critically appraise and assess the methodological quality of all included studies using the Cochrane Risk of Bias for Non-randomised Studies of Interventions tool. Two independent authors will extract the data to minimise errors and bias during the process of data extraction using an extraction tool developed by the authors. For analysis calculation, effect sizes will be expressed as risk ratios or ORs for dichotomous data or weighted (or standardised) mean differences and 95% CIs for continuous data in this systematic review.Ethics and disseminationThis systematic review will use secondary data only, therefore, research ethics approval is not required. The results from this study will be submitted to a peer-review journal for publication and we will present our findings at national and international conferences.PROSPERO registration numberCRD42019142842.

Repairing the injured bronchus in blunt chest trauma – A case series

Trauma ◽  
2021 ◽  
pp. 146040862098811
Author(s):  
Anith Nadzira Riduan ◽  
Narasimman Sathiamurthy ◽  
Benedict Dharmaraj ◽  
Diong Nguk Chai ◽  
Narendran Balasubbiah
Keyword(s):  
Blunt Trauma ◽  
Chest Trauma ◽  
Surgical Intervention ◽  
Case Series ◽  
Trauma Patients ◽  
Lung Collapse ◽  
Comprehensive Management ◽  
Lung Capacity ◽  
Management Algorithm ◽  
Operative Outcomes

Introduction Traumatic bronchial injury (TBI) is uncommon, difficult to diagnose and often missed. The incidence of TBI among blunt trauma patients is estimated to be around 0.5–2%. Bronchoplastic surgery is indicated in most cases to repair the tracheobronchial airway and preserve lung capacity. There is limited existing literature addressing the management of this condition in view of its rarity. The comprehensive management and outcomes of these patients are discussed. Methods The case notes of all patients who presented with persistent lung collapse due to trauma since July 2017 were reviewed retrospectively. Those patients requiring surgical intervention were included in the review. The mode of injury, clinical, radiological and bronchoscopy findings, concurrent injuries, type of surgery, length of stay (LOS) and operative outcomes were reviewed. Results Out of 11 patients who presented with persistent lung collapse post-blunt trauma, four (36%) were found to have structural bronchial disruption. All of them underwent successful repair of the injured bronchus, without the need of a pneumonectomy. The other seven patients were successfully treated conservatively. Conclusion The repair of the injured bronchus is essential in improving respiratory function and to prevent a pneumonectomy. Routine bronchoscopic evaluation should be performed for all suspected airway injuries as recommended in our management algorithm. Delayed presentations should not hinder urgent referral to thoracic centers for tracheobronchial reconstruction.

scholarly journals 291 Pre-Operative Venepuncture: An Audit of The Trauma and Orthopaedic Department at The Royal Sussex County Hospital, Brighton

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Harris ◽  
T Antonio ◽  
A Hagiga ◽  
D Crone
Keyword(s):  
Major Trauma ◽  
Elective Surgery ◽  
Financial Burden ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Inclusion Criteria ◽  
Blood Testing ◽  
Orthopaedic Department ◽  
Minor Surgery ◽  
Routine Coagulation

Abstract Background NICE recommends that patients undergoing intermediate or minor elective surgery do not need routine coagulation or transfusion blood testing unless they are ASA 3+ or taking anticoagulation mediation, where testing may be considered. Currently there is no guidance for trauma patients. Method We identified all patients that underwent intermediate or minor trauma and orthopaedic surgery within a three-month period from December 2019- February 2020 at the RSCH. We excluded major trauma patients, patients taking anticoagulants and patients with complex admission or past medical history. Computer records were used to identify pre-operative investigations and admission history. Results 843 patients met our inclusion criteria. In total, 92 clotting studies and 200 transfusion samples were taken preoperatively. The majority of tests were for patients undergoing ankle 130/292 (45%) or Tibia/Fibula 54/292 (18%) procedures. This equates to approximately 1168 blood tests per year. Based on the lab cost of £15.97 for a transfusion sample and £18 for a coagulation sample, this is a cost of approximately £19,616 each year on blood testing that is not indicated. Discussion We hope that by presenting these results we will help reduce the unnecessary time and financial burden of routine venipuncture in departments undertaking intermediate and minor surgery.

scholarly journals Profile of lumbar spine conditions requiring surgical intervention in the Orthopaedic Department at a specialist public hospital in Kwa-Zulu Natal

2018 ◽  
Author(s):  
◽  
Jens Hillermann
Keyword(s):  
South Africa ◽  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Surgical Management ◽  
Public Hospital ◽  
Surgical Intervention ◽  
Lumbar Spine Surgery ◽  
Low Back ◽  
Orthopaedic Department

Purpose: Low Back Pain (LBP) is a leading cause of activity limitation and absence from work globally, and the treatment is often complicated and multifactorial. There is little documentation about the types of conditions requiring lumbar spine surgery in the public health care sector in South Africa (SA). The aim of this study was to develop a profile of lumbar spine conditions requiring surgical intervention in the Orthopaedic Department at a specialist public hospital in KwaZulu-Natal (KZN). Methods: This study utilised a descriptive, retrospective, clinical audit design. A total of 112 patient files meeting the study inclusion criteria were analysed and data was extracted and recorded on a data template. Permission to conduct the study was obtained from the KZN Department of Health, the Manager of the King Dinizulu Hospital and ethical approval was obtained from the Institutional Research Ethics committee. The data was analysed using the Statistical Package for the Social Sciences (SPSS) (IBM Corporation). The data was described using means, standard deviations, percentages and count. Inferential statistical analysis was utilised to draw conclusions about populations from sample data. Chi-square and Fischer’s Exact test were used to compare categorical data with a statistical significance of p value ≤0.05. Results: The mean age of the patients was 41.7 years of age (range 3-76 years of age), with more females (55.4%, n = 62) than males (44.6%, n = 50) requiring surgery. More than half of the patients were Black Africans (55.4%, n = 62), with the majority (58%, n = 65) of all the patients being unemployed. Mechanical low back pain (MLBP) was the condition most often requiring surgical intervention (41.1%, n = 46) with lumbar stenosis being the most common diagnosis (17%, n = 19). This was followed by infective spondylitis (33.9%, n = 38). Frankel grading for neurological deficit was most often reported in patients with non-mechanical or infective causes of low back pain. Infective co-morbidity was (39.3%, n = 44) with 19.6% (n = 22) patients suffering from both tuberculosis (TB) and human immunodeficiency virus (HIV), 14.3% (n = 16) from TB alone and 5.4% (n = 6) with HIV/Acquired immunodeficiency syndrome alone. Most patients (91.1%, n = 102) received pre-surgical management consisting of medication either alone or in combination with other therapies such as physiotherapy, back braces, crutches and dietary intervention. The most common surgical procedure utilised was posterior spinal fusion (PSF) (43.8%, n = 49) either alone or in combination with other surgical procedures such as: decompression, biopsy and abscess drainage. This procedure alone was the favoured for non-mechanical LBP (NMLBP) (12.5%, n = 14), while PSF in combination with decompression was favoured the treatment for LBP of infective origin (15.2%, n = 17). Post-surgical management included medication (96.4%, n = 108) and physiotherapy (17%, n = 19); these were administered either individually or in combination. There were only six post- surgical complications; two were metal ware failure and four were infections. Of the four post- surgical infections, all of the patients had HIV/AIDS as a co-morbid condition. The trends suggest that the MLBP patients were predominantly older i.e. 40-69 years (82.6%, n = 38) and from the Indian race group (25.9%, n = 29). This was in contrast to the other types of LBP which predominately affected younger populations (i.e. 10-39 years) and Blacks. There were no differences in gender distribution for both MLBP and NMLBP. However, with LBP of infective origin, females were twice as much affected than males. Conclusion: The profile of lumbar spine conditions requiring surgical intervention at a public hospital is varied and there is a high prevalence of surgery for mechanical and infective cases of lumbar spine pain. Effective management of these conditions may reduce morbidity. Future studies should investigate the economic impact of lumbar spine surgery on health expenditure in South Africa.

scholarly journals Effect of Under Triage on Early Mortality After Major Pediatric Trauma: A Registry-based Propensity Score Matching Analysis

2020 ◽  
Author(s):  
François-Xavier Ageron ◽  
Jordan Porteaud ◽  
Jean-Noël Evain ◽  
Anne Millet ◽  
Jules Greze ◽  
...  
Keyword(s):  
Propensity Score ◽  
Trauma Care ◽  
Pediatric Population ◽  
Pediatric Trauma ◽  
Trauma System ◽  
Early Death ◽  
Risk Difference ◽  
Early Mortality ◽  
Trauma Patients ◽  
Risk Of Death

Abstract Backgroundlittle is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24 hour-mortality after major pediatric trauma in a regional trauma systemMethodsThis cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24 hour-mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. ResultsA total of 1 143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 hours. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference: 6.0 [95% CI 1.3-10.7]) and Ps matching analyses (risk difference: 3.1 [95% CI 0.8-5.4]).ConclusionsIn a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.

717 The Introduction of a Discharge Letter Proforma For Hip Fracture Patients Improves Compliance with VTE Prophylaxis Prescription on Discharge: A Closed Loop Audit

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C Williamson ◽  
C Brennan
Keyword(s):  
Hip Fracture ◽  
Marked Improvement ◽  
Closed Loop ◽  
Low Molecular Weight ◽  
Local Policy ◽  
Vte Prophylaxis ◽  
Discharge Letter ◽  
Lower Limb Surgery ◽  
Audit Cycle ◽  
Appropriate Prescription

Abstract Introduction Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in inpatients; with those undergoing lower limb surgery at particularly high risk. NICE recommends that Low Molecular Weight Heparin (LMWH) or Fondaparinux should be used for VTE prophylaxis for one month following hip fracture. Our local policy is to prescribe Dalteparin for 30 days following surgery. Method A closed loop audit of VTE prophylaxis on discharge for 193 patients with hip fractures was performed. The first audit cycle established whether VTE prophylaxis was being prescribed in line with departmental policy. Following this, a template discharge letter was introduced which included a prompt for appropriate prescription of VTE prophylaxis. Results Initially, data for 93 consecutive patients was collected. It was found that 13% had not received VTE prophylaxis in line with guidelines. Of these, six patients had no documented contraindication or alternative prophylaxis prescribed. Results were disseminated locally. After introduction of the template discharge letter, data for 100 consecutive patients was collected. Re-audit showed a marked improvement in adherence to local policy with 95% of patients now receiving appropriate VTE prophylaxis on discharge. Conclusions Introduction of a template discharge letter prompts the documentation of contraindications to prophylaxis and improves compliance with local policy.

Orthopaedic assessment unit: a service model for the delivery of orthopaedic trauma care in a major trauma centre during the global pandemic (COVID-19)

2021 ◽  
Vol 103 (3) ◽  
pp. 167-172
Author(s):  
JW Lim ◽  
H Rehman ◽  
S Gaba ◽  
H Sargeant ◽  
IM Stevenson ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Trauma Care ◽  
Statistical Significance ◽  
High Standard ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Service Model ◽  
Global Pandemic ◽  
Major Trauma Centre ◽  
Assessment Unit

Introduction We describe a new service model, the Orthopaedic Assessment Unit (OAU), designed to provide care for trauma patients during the COVID-19 pandemic. Patients without COVID-19 symptoms and isolated musculoskeletal injuries were redirected to the OAU. Methods We prospectively reviewed patients throughput during the peak of the global pandemic (7 May 2020 to 7 June 2020) and compared with our historic service provision (7 May 2019 to 7 June 2019). The Mann–Whitney and Fisher Exact tests were used to test the statistical significance of data. Results A total of 1,147 patients were seen, with peak attendances between 11am and 2pm; 96% of all referrals were seen within 4h. The majority of patients were seen by orthopaedic registrars (52%) and nurse practitioners (44%). The majority of patients suffered from sprains and strains (39%), followed by fractures (22%) and wounds (20%); 73% of patients were discharged on the same day, 15% given follow up, 8% underwent surgery and 3% were admitted but did not undergo surgery. Our volume of trauma admissions and theatre cases decreased by 22% and 17%, respectively (p=0.058; 0.139). There was a significant reduction of virtual fracture clinic referrals after reconfiguration of services (p<0.001). Conclusions Rapid implementation of a specialist OAU during a pandemic can provide early definitive trauma care while exceeding national waiting time standards. The fall in trauma attendances was lower than anticipated. The retention of orthopaedic staff in the department to staff the unit and maintain a high standard of care is imperative.

The Value of Abdominal and Pelvic CT Scan in Trauma Patients With Low Injury Severity Score and High Glasgow Coma Scale

2021 ◽  
pp. 000313482110474
Author(s):  
Tarik Wasfie ◽  
Daniel Rivera ◽  
Mursal Naisan ◽  
Shelby Zaremba ◽  
Mikayla Depuydt ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Glasgow Coma Scale ◽  
Physical Examination ◽  
Injury Severity ◽  
Surgical Intervention ◽  
Trauma Patients ◽  
Ct Findings ◽  
Group A ◽  
Fast Exam ◽  
Group B

Introduction Computed tomography scans became the mainstay of emergency department (ED) evaluation of trauma patients including those with a high Glasgow Coma Scale (GCS) and a low Injury Severity Score (ISS). We elected to find the value of abdominal and pelvic CT in patients with negative physical examination and Focused Assessment of Sonography for Trauma (FAST) on arrival to the ED. Methods This study is a retrospective analysis of 901 consecutive patients from 2017 to 2019 who presented to the ED with level 2 and 3 activation criteria. Each patient received a physical examination, CT abdomen and pelvis, and FAST exam. Data were collected on external factor including GCS, ISS, age, sex, comorbidities, anticoagulation use, and surgical intervention. The patients were divided into 2 groups, Group A and B. Group A consisted of patients with a negative physical exam, FAST, and CT result. Group B included patients with a negative physical exam and FAST exam with positive CT findings. Statistical analysis was done using a Student’s t-test and chi-square test for significance value of P < .05. Institutional Review Board approval was obtained for this study. Results A total of 901 patients were analyzed which included 489 (54.3%) male and 412 (45.7%) female with a mean age of 56.2 (SD = 22.62) years. Out of the 901 patients, 461 patients received a physical, FAST, and CT exam. Group A consisted of 442 (95.9%) patients and Group B had 19 (4.1%) patients. Both groups were similar in GCS and ISS scoring with no significance difference in age, sex, comorbidities, and anticoagulation use. There was a significant difference in the ICU and hospital mean length of stay when CT scan was positive [2 (SD = 4.23) days vs. .6 (SD = 1.33) days with P < .0001 and 4.57 (SD ± 4.17) days vs. 2.5 (SD = 2.00) days with P < .0001, respectively]. The CT findings of the 19 patients in group B consisted of 6 incidentalomas, 5 vertebral compression fractures, 4 pelvic bone fractures, 1 minor liver contusion, 1 non-specific bowel thickening, 1 non-displaced rib fracture, and 1 case of small amount of free fluid in the pelvis. None of the CT findings required surgical intervention. Conclusion Computed tomography of the abdomen and pelvis in trauma patients with high GCS and low ISS with initial negative physical and FAST examination did not provide additional critical information.

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