scholarly journals 1394 Operation Notes Performa: The Way to Optimise Hand Trauma Service

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Labib ◽  
S Oniska ◽  
L Karran ◽  
J Moledina
Keyword(s):  
Reoperation Rate ◽  
British Society ◽  
Shared Decision ◽  
Hand Trauma ◽  
Retrospective Evaluation ◽  
University Hospitals ◽  
Trauma Service ◽  
Hand Fracture ◽  
Operation Note ◽  
Operating Surgeon

Abstract Aim To assess the effect of the introduction of British Society for Surgery of the Hand (BSSH) guided operation note Performa on the hand trauma service in St. George’s University Hospitals. Method First cycle was done in October 2019. This included retrospective evaluation of accuracy of documentation for closed hand fracture audit. Reassessment was done in September 2020 after introduction of surgical Performa guided by the latest BSSH guidelines. Results 27 patients have been included in the first cycle compared with 81 patients in the second cycle. While 82% of first cycle patients underwent operation, only 40% of second cycle patients were treated surgically. Overall documentation has improved by a mean of 40% in all parameters. This includes documentation of discussion of shared decision making regarding conservative and surgical management, documentation of level of competency of the operating surgeon and mobilisation advice given to patients before their first appointment with a hand therapist. This led to improvement in overall patient outcome including rate of infection falling from 14% to 1% and reoperation rate from 23% to 1%. Conclusions Op notes Performa is a useful tool in the armamentarium of hand trauma management. It helps junior trainees to memorise critical information to document especially in the ones usually missed like detailed post-operative advice.

scholarly journals 923 Accuracy of Assessment in Hand Trauma; Pre COVID-19 Face to Face Assessment Compared to Virtual Assessment During COVID-19 Lockdown

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Westley ◽  
H Creasy ◽  
R Mistry
Keyword(s):  
Telephone Call ◽  
Initial Assessment ◽  
Accurate Assessment ◽  
Hand Trauma ◽  
Face To Face ◽  
Queen Victoria ◽  
Set Up ◽  
Operation Note ◽  
Similar Accuracy ◽  
Virtual Clinic

Abstract Introduction The Queen Victoria Hospital (QVH) was designated a cancer and trauma hub during the COVID-19 pandemic. With this, a new virtual hand trauma clinic was set up. We assess accuracy of assessment within this virtual set-up with comparison to pre COVID-19 face-to-face assessment. Method Two weeks of clinic sessions during and pre lockdown were analysed. Initial assessment was compared with the patient's operation note. Results In the pre COVID-19 two-week period 129 face-to-face appointments were analysed. Of 99 patients that required surgery 77 (78%) had an accurate assessment. 6 were overestimated, 12 were underestimated. 189 patients were seen over two weeks during lockdown via telephone or video call. Accuracy of assessment increased with seniority of the clinician. Of 126 patients that required an operation 109 (87%) had an accurate assessment; all structures injured were correctly predicted. 12 were overestimated, 5 had their injury underestimated. Conclusions The new virtual clinic allowed patients to be remotely assessed during lockdown, reducing footfall and unnecessary journeys. We found that virtual clinic assessments are accurate, and no patient underwent an unnecessary procedure. Using a telephone call plus photo gave similar accuracy as a video call. Virtual assessment was more accurate than face-to-face assessment.

Brucellosis: a retrospective evaluation of 99 cases and review of brucellosis treatment

2008 ◽  
Vol 38 (1) ◽  
pp. 59-62 ◽  
Author(s):  
Neşe Demirtürk ◽  
Tuna Demirdal ◽  
Nurettin Erben ◽  
Serap Demir ◽  
Zerrin Asci ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Combination Therapy ◽  
Clinical Sign ◽  
Epidural Abscess ◽  
Retrospective Evaluation ◽  
University Hospitals ◽  
Serological Tests ◽  
Frequent Symptom ◽  
Clinical Presentations

This retrospective study was performed in two university hospitals between January 2002 and 2006. Ninety-nine brucellosis patients were included in the study. These patients were classified as acute (91), chronic (4) and relapse (4) according to their clinical presentations and serological tests. Brucella bacteria were isolated in the blood of 17 (17.2%) cases. The most frequent symptom and clinical sign was fever. The osteoarticular complications were found in 17 patients (17.2%). Four of them were complicated with epidural abscess the same time. Two (2.2%) had meningitis, two (2.2%) had epididymoorchitis, three (3.3%) had skin rashes and one (1.1%) had hepatitis. Three of the acute brucellosis patients were pregnant. Rifampin and doxycycline combination therapy had been administered to most of the patients with acute and relapse brucellosis. However, complicated and chronic brucellosis cases were given different treatment combinations. This study reviews brucellosis therapy choices.

scholarly journals EP.WE.105Hand trauma during COVID pandemic: a tertiary trauma centre experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Amir Ghareib ◽  
Sylwia Oniska ◽  
Laura Karran ◽  
Jamil Moledina
Keyword(s):  
High Volume ◽  
Trauma Centre ◽  
Active Movement ◽  
Trauma Patients ◽  
University Hospitals ◽  
Hand Fractures ◽  
Good Movement ◽  
Hand Fracture ◽  
June July

Abstract Introduction St. George’s University Hospitals NHS Foundation Trust is a tertiary trauma centre. We receive a high volume of hand referrals from all over the south West London region. Closed hand fractures represent a significant number of our referrals. COVID-19 has put more burden in all health service endangering poor management of these trauma patients. Aim To assess management of close hand trauma patients during COVID pandemic. Methods Retrospective evaluation of closed hand fracture referrals during June, July, and August 2020. Clinical documentations, operative details and follow up visit notes have been reviewed. Results 106 patients have been included. 47 patients treated surgically with 81% of them were in need for metalwork insertion. Most of operations were done within 8 days. Number of hospital visits was variable with a mean of six days for adult and two days for children. Patient who was in need for hand therapy have been seen within the first 8 days of their surgery. At three months follow up, only three cases had infection. Only one case had osteomyelitis and the other two case had infected metalwork. Most of the patents reported good movement in ASSH Total Active Movement of Hand score (TAM) at the end of the three months. Conclusion Despite COVID 19 pandemic our service managed to achieve acceptable results in dealing with these cases. Yet, securing a reasonable number of operating sessions and clinic appointments remains a challenge.

scholarly journals Improvement in hand trauma service at a regional plastics surgery unit in merseyside (BSSH Guidelines)

2018 ◽  
Vol 55 ◽  
pp. S97
Author(s):  
B. Adjei ◽  
H. Alfeky ◽  
M. Nair ◽  
C. Kelsey ◽  
D. Bell
Keyword(s):  
Hand Trauma ◽  
Trauma Service

SP7.2.6 Where is the nerve? Review of operation note documentation practice for inguinal hernia repair

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Barnaby Farquharson ◽  
Vernon Sivarajah ◽  
Shareef Mahdi ◽  
Henry Bergman ◽  
Santhini Jeyarajah
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Subgroup Analysis ◽  
District General Hospital ◽  
Intraoperative Management ◽  
Baseline Characteristics ◽  
Operation Note ◽  
Genital Branch ◽  
Operating Surgeon

Abstract Introduction Careful identification and management of inguinal nerves during inguinal hernia repair is important to avoid iatrogenic injury. Documentation of this practice informs postoperative clinical management. We set out to investigate how often surgeons identify inguinal nerves and document findings and management in operation notes. Methods Retrospective review of operation notes at single District General Hospital (DGH). Operation notes analysed for documentation of identification and intraoperative management (preservation vs sacrifice) of the inguinal nerves: iliohypogastric, ilioinguinal and genital branch of genitofemoral nerve. Data including baseline characteristics of each patient, hernia characteristics, and primary operating surgeon ascertained for subgroup analysis. Results A total of 100 patients were included in the analysis. Identification of any of the inguinal nerves (generic - “nerve”) was documented in 17% of operation notes. Documentation of named individual nerves in operation notes was limited. No documentation of intraoperative management of inguinal nerves found in 83% of operation notes. Preservation of the inguinal nerves (generic - “nerve”) was recorded in 8% and sacrifice recorded in 9% of cases. Subgroup analysis revealed similar incidence of documentation of identification and management of inguinal nerves across grades of primary surgeon, with overall incidence low for all grades. Conclusion This study has revealed a lack of appreciation of the importance of documentation of identification and intraoperative management of inguinal nerves in operation notes. Further consideration of the potential implications of poor documentation would be beneficial to improve standards.

474 Increasing the Availability of Operation Notes at Hand Surgery Follow-Up Through the Use of Electronic Operation Notes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
P Macneal ◽  
S Brar ◽  
S Dassanayake ◽  
K Jones ◽  
A Ghareib ◽  
...  
Keyword(s):  
Clinical Audit ◽  
Hand Surgery ◽  
Adult Patients ◽  
Hand Trauma ◽  
Prospective Audit ◽  
Operative Care ◽  
Before And After ◽  
Operation Note ◽  
Paper Format

Abstract Introduction The availability of operation notes is crucial to provide high-quality post-operative care. This clinical audit evaluates the availability of operation notes at post-operative follow-up, in a Tertiary Hand Unit, before and after implementation of electronic operation notes. Method This was a prospective audit analysing the availability of operation notes at the first post-operative hand surgery appointment. The initial data collection was over a 6-week period (July – August 2019). Following this, a standardised electronic operation note template was created in line with BSSH Hand Trauma Guidelines and RCS Good Surgical Practice. Six months later, a re-audit was conducted over a 4-week period (March 2020). Results The initial audit included 104 adult patients, with operation notes available for 64% (n = 67) of patients, and 94% (n = 63) of those were in paper format. Following implementation of electronic operation notes, the re-audit included 53 adult patients. For these patients, 96% (n = 51) of their operation notes were available, and 96% (n = 49) of the operation notes were electronic. Conclusions These findings demonstrate that electronic operation notes greatly increased the availability of operation notes at follow-up This innovation has significant implications for upholding well-coordinated continuity of care for patients undergoing surgery.

496 The Use of Virtual Trauma Clinics (VTC) In the Assessment of Acute Hand Trauma; A Service Evaluation

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Creasy ◽  
S Westley ◽  
R Shah ◽  
R Mistry
Keyword(s):  
Service Evaluation ◽  
Definitive Treatment ◽  
Hand Trauma ◽  
Referral Centre ◽  
Tertiary Referral Centre ◽  
Prospective Data ◽  
Time To Surgery ◽  
Trauma Service ◽  
The Impact ◽  
Definitive Management

Abstract As a UK tertiary referral centre for hand trauma the current COVID outbreak has led to the reconfiguration of trauma services. We evaluate the impact of our newly introduced VTC on our hand trauma service, comparing a cohort of patients who were managed pre-COVID, with our current revised pathway. We carried out a service evaluation of all those patients processed by the VTC over 14 days in April 2020 (n = 184). We collected prospective data on timing of referral to assessment and surgery. This data was compared to a matched period in April 2019 (n = 162). Post VTC there has been a significant reduction in time to clerking and time to surgery (p = < 0.001), with 98.1% being clerked within 1 day of referral. Post VTC 12.9% of patients were discharged directly from VTC, all other patients had definitive treatment in a single trip. VTC has shown a clear benefit to patients with definitive management provided in a single trip in all cases. Whilst we have been able to clerk patients earlier any improvement in time to surgery depends on theatre staffing and availability, which differed in the two cohorts and certainly will as we move forward into normal services.

scholarly journals 99 Perfecting the Proforma – A Full-Cycle Audit on The Quality of Documentation of The Hand Trauma Proforma At the Regional Plastic Surgery Department

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Noshirwani ◽  
B Phillips ◽  
M Hosain ◽  
K Drewniak ◽  
V Parekh ◽  
...  
Keyword(s):  
High Standard ◽  
Free Text ◽  
Hand Trauma ◽  
Record Keeping ◽  
The United Kingdom ◽  
Written Descriptions ◽  
Operation Note ◽  
Surgery Department

Abstract Aim We aimed to assess the quality of record-keeping of the departments hand trauma proforma, identify areas of improvement, and to implement and assess the quality of an updated proforma. Method Data from 101 parameters was collected for 20 patients undergoing surgery for an upper limb injury in November 2019. An updated proforma was implemented and a further 20 patients were analysed in February 2020. All fields were compared between two audit cycles and comments were collected. Results The overall completion rate increased. Documentation of the responsible consultant increased to 100%, along with an increase in documenting of hobbies and injury mechanism. X-ray findings (55% to 85%) and antibiotic plan (35% to 80%) increased. Implementation of a free text box resulted in written descriptions of injury to compliment sketches. In the operation note, documentation of anaesthetic type used increased, along with tourniquet use and time. There was clearer documentation of the injury, findings, and procedure, with greater use of diagrams to illustrate the repair. There was a drop in the recording of post-op plans (100% to 85%), post-op antibiotics (90% to 75%), and follow-up plan (95% to 60%). Clinicians commented to increase the size of the free-text box and hand diagram on the operative page to facilitate easier drawings. Conclusions The Hand Trauma Proforma has made good progress from its original version but requires further adjustments to ensure complete data input. It sets a high standard for data collection and presents itself as a useful tool for units across the United Kingdom.

scholarly journals Operation Note Transformation: The Application of Lean Six Sigma to Improve the Process of Documenting the Operation Note in a Private Hospital Setting

2021 ◽  
Vol 18 (22) ◽  
pp. 12217
Author(s):  
Nicola Wolfe ◽  
Seán Paul Teeling ◽  
Marie Ward ◽  
Martin McNamara ◽  
Liby Koshy
Keyword(s):  
Six Sigma ◽  
Private Hospital ◽  
Hospital Setting ◽  
Lean Six Sigma ◽  
Transitions Of Care ◽  
Operative Care ◽  
Project Site ◽  
Operation Note ◽  
Operating Surgeon

Clinical documentation is a key safety and quality risk, particularly at transitions of care where there is a higher risk of information being miscommunicated or lost. A surgical operation note (ON) is an essential medicolegal document to ensure continuity of patient care between the surgical operating team and other colleagues, which should be completed immediately following surgery. Incomplete operating surgeon documentation of the ON, in a legible and timely manner, impacts the quality of information available to nurses to deliver post-operative care. In the project site, a private hospital in Dublin, Ireland, the accuracy of completion of the ON across all surgical specialties was 20%. This project sought to improve the accuracy, legibility, and completeness of the ON in the Operating Room. A multidisciplinary team of staff utilised the Lean Six Sigma (LSS) methodology, specifically the Define/Measure/Analyse/Design/Verify (DMADV) framework, to design a new digital process application for documenting the ON. Post-introduction of the new design, 100% of the ONs were completed digitally with a corresponding cost saving of EUR 10,000 annually. The time to complete the ON was reduced by 30% due to the designed digital platform and mandatory fields, ensuring 100% of the document is legible. As a result, this project significantly improved the quality and timely production of the ON within a digital solution. The success of the newly designed ON process demonstrates the effectiveness of the DMADV in establishing a co-designed, value-adding process for post-operative surgical notes.

Sign in / Sign up

Export Citation Format

Share Document