1703 The Walking Thread – What Happens to Fistula-In-Ano Patients Who Are Lost to Follow Up? A Service Improvement Study

Abstract Aim 1/3 of idiopathic cryptoglandular abscesses can result in fistula-in-ano. Current practice is to incise and drain primary abscesses and safety net for patients to return as necessary. Known fistula patients will be appointed for Examination Under Anaesthetic at 6-12 weeks.Is this best management or do they become “elective emergencies”? Method We performed a retrospective audit of management of fistula-in-ano over 4 years. We used a precollected data set of Cryptoglandular abscesses, excluding inflammatory, radiation or malignant causes and collected data for patients lost to follow up, including presentation, fistula diagnosed at first or subsequent attendance, number of operations, number of attendances and seton placement. Results 512 patients were operated on for cryptoglandular abscess causing fistula-in-ano between 2013 and 2017. 10% (N = 50) were lost to follow up. 32 had documented follow up plans, that were not fulfilled (eg elective theatre not booked). Of these, 18 were elective attendances, 14 emergency. 24 of the 32 had a Seton sited prior to being lost to follow up Conclusions The various presentations (emergency, elective, clinic or day surgery) and long waiting lists mean many of these patients are presenting as emergencies still awaiting follow up. Many are lost to follow-up, with Setons in situ. We propose a fortnightly hot-clinic system, registrar led to assess and manage these patients. This would provide an elective clinic to allow single point of access to fistula-in-ano patients ensuring prompt follow up and reduction in unnecessary EUA, as well as improving senior colorectal trainees exposure to perianal disease and its management.

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SP1.1.4The Walking Thread – What happens to fistula-in-ano patients who are lost to follow up? A Service Improvement Study

British Journal of Surgery ◽

10.1093/bjs/znab361.001 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Ellen Murgitroyd ◽

Blair Wilson ◽

Darja Kremel ◽

David Anderson

Keyword(s):

Current Practice ◽

Single Point ◽

Perianal Abscess ◽

Service Improvement ◽

Fistula In Ano ◽

Best Management ◽

Retrospective Audit ◽

Lost To Follow Up

Abstract Aims Management of perianal abscess and resultant fistula-in-ano remains controversial. Studies suggest that 1/3 of idiopathic cryptoglandular abscesses can result in fistula-in-ano. Our current practice is to incise and drain primary abscesses and for patients to return as necessary. Known fistula patients will be appointed for Examination Under Anaesthetic (EUA) at 6-12 weeks. Does this result in best management or do they become “elective emergencies”? Methods A retrospective audit of management of fistula-in-ano over 4 years was conducted, utilising precollected data of Cryptoglandular abscesses, excluding inflammatory, radiation or malignant causes. Patients lost to follow up were analysed including presentation, fistula diagnosed at first or subsequent attendance, number of operations, number of attendances and seton placement. Results 512 patients underwent operations for cryptoglandular abscess causing fistula-in-ano between 2013 and 2017. 10% (N = 50) were lost to follow up despite documented follow up plans for 32. Of these, 18 were elective attendances, 14 emergency. 24 of the 32 had a Seton sited prior to being lost to follow up. Conclusions The various presentations (emergency, elective, clinic) and waiting lists mean these patients are presenting as emergencies whilst awaiting follow-up. Many are simply lost to follow up, with Setons in-situ. We propose a fortnightly hot-clinic system, run by second on-call registrars to assess and manage these patients. This would provide an elective clinic to allow single point of access to fistula-in-ano patients ensuring prompt follow-up and reduction in unnecessary EUA, as well as improving senior colorectal trainees exposure to perianal disease and its management.

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Challenges to primary healthcare services in the management of non-communicable diseases in marginalised populations on the Thailand–Myanmar border: a pilot survey

Tropical Doctor ◽

10.1177/0049475518786853 ◽

2018 ◽

Vol 48 (4) ◽

pp. 273-277 ◽

Cited By ~ 3

Author(s):

Makoto Saito ◽

Arunrot Keereevijit ◽

Thi Dar San ◽

Yin Yin Thein ◽

Mary Ellen Gilder ◽

...

Keyword(s):

Primary Healthcare ◽

Low Cost ◽

Healthcare Services ◽

Communicable Diseases ◽

Retention Rates ◽

Non Communicable Diseases ◽

Pilot Survey ◽

Retrospective Audit ◽

Lost To Follow Up

Non-communicable diseases (NCDs) are emerging rapidly. This manuscript reports on a pilot survey of NCDs at a primary healthcare level in a marginalised migrant population on the Thailand–Myanmar border in the face of declining rates of malaria. A retrospective audit of routine clinic (2004–2016) and NCD patient survey data (2014–2016) was conducted. The length of follow-up was assessed by Kaplan–Meier analysis. From July 2014 to July 2016, 238 migrant patients were on the NCD register. Hypertension (n = 80) and diabetes mellitus (n = 51) were the most common diagnoses. After the first consultation, 41% (95% confidence interval = 35–47%) were lost to follow-up by 30 days. NCD retention rates were low: 50% of registered patients were lost to follow-up by 80 (95% CI = 49–132) days. After this survey, a novel low-cost insurance scheme for the migrant community has been launched in this area. Development of new schemes involving patients, healthcare providers and funding support are required for improved and sustainable NCD care for marginalised populations.

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P007 Service evaluation of the nurse-led telephone advice line in the wake of COVID-19: a report of audit and staff satisfaction

Rheumatology ◽

10.1093/rheumatology/keab247.006 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Julia Day ◽

Janet Ball ◽

Jayne Down ◽

Raj Sengupta

Keyword(s):

Service Use ◽

Single Point ◽

Working Hours ◽

Work Load ◽

Service Evaluation ◽

Service Improvement ◽

Staff Satisfaction ◽

Telephone Advice ◽

Staff Workload

Abstract Background/Aims The Rheumatology nurse advice line (NAL) at the Royal National Hospital for Rheumatic Diseases (RNHRD, Bath) provides a vital service for direct patient access to specialist advice via a designated voicemail system. Increasing numbers and difficulty connecting call returns have increased staff workload, reduced efficiency and impacted on staff satisfaction. An audit was therefore undertaken to evaluate service use and efficiency, paired with formal assessment of staff satisfaction in order to identify areas for improvement. Methods The total number of monthly calls through the NAL during 2020 were counted. A subset of consecutive calls were audited in detail, documenting temporal parameters in relation to the call being logged, returned and concluded. The number of clinicians and attempts required to contact the patient was noted. An anonymised staff satisfaction questionnaire was completed by NAL nurses and administrators. Data was analysed using Excel. Results An average 653 calls per month (range 340-894) came through the NAL between January and September 2020. 97 consecutive patient contacts were audited from August 2020. Multiple attempts were required to successfully return the call in 19.6% of cases (n = 19/97). Of those, 68.4% (n = 13/19) of calls needed ≥ 2 nurses to contact the patient. In general, the first attempt to return the call was prompt (average 7.6 hours, range 0.1-27.7). However, the time to conclude the call from the patient’s first call log ranged from 0.1 - 142.6 hours (average 12.7 hours) with increased time associated with difficulties contacting the patient or when further advice was required from a Rheumatology doctor (18.5%, n = 18/97). Staff surveys revealed 67% of staff felt that the NAL is a good service to offer patients. However, 67% of staff did not feel the NAL in its current format was easy to manage. Specific comments included that the lack of rota'd responsibility, unpredictable workload and time inefficiencies were barriers to managing the service. Conclusion From this data, we conclude that patient calls are returned promptly, but utilising a system of voicemail and unscheduled call returns is inefficient and contributes to staff dissatisfaction. This data has driven change for service improvement. To improve efficiency, calls will be answered live by an administrator during working hours and patients given a call-back time. A doctor will be named as a single point of contact for the nurses to seek additional advice and a nurse rota will designate responsibility for NAL calls to reduce work-load uncertainty. Follow up service evaluation will include staff and patient satisfaction questionnaires, and repeat audit, with consideration of ways to support frequent service users. Disclosure J. Day: None. J. Ball: None. J. Down: None. R. Sengupta: None. V. Flower: None.

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S1124 Reasons for Lost to Follow-Up in Patients With Advanced Hepatic Fibrosis After Completion of Hepatitis C Treatment in a Midwest Urban Safety Net Hospital: A Sampling-Based Approach

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000706544.65061.dc ◽

2020 ◽

Vol 115 (1) ◽

pp. S566-S566

Author(s):

Subhan Ahmad ◽

Andrew M. Ford ◽

Imad Asaad

Keyword(s):

Hepatitis C ◽

Hepatic Fibrosis ◽

Safety Net ◽

Hepatitis C Treatment ◽

Safety Net Hospital ◽

Urban Safety ◽

Lost To Follow Up

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2542. ID-Psych Addiction Rounds: A New Model to Address Opioid Use Disorder For Patients on the Infectious Disease Consult Service

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2220 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S883-S883

Author(s):

William West ◽

Benjamin Eckhardt ◽

Gabriel M Cohen

Keyword(s):

Substance Use ◽

Clinical Characteristics ◽

Safety Net ◽

Opioid Use Disorder ◽

Opioid Epidemic ◽

Opioid Use ◽

Consult Service ◽

Case Conferences ◽

Lost To Follow Up

Abstract Background ID physicians often treat the infectious sequelae of opioid use disorder (OUD) and are uniquely poised to link hospitalized patients to substance use resources. In a large safety net hospital, we launched a multi-disciplinary initiative to ensure that patients on the ID consult service with OUD were always offered medication-assisted treatment (MAT). We used infections as “sentinel” events to identify patients with OUD and described the clinical characteristics of the high-risk patient population jointly consulted by ID and Psychiatry teams. This healthcare workforce initiative aimed to expand the role of ID providers in the opioid epidemic and decrease barriers to buprenorphine prescribing. Methods Every 2 weeks, ID fellows identified patients on their consult lists with infectious complications of OUD. Focused discussions were then held with the Psychiatry service and discussion of each patient continued at subsequent case conferences with attention paid to re-engaging those lost to follow-up. We performed chart abstraction of demographic and clinical characteristics as part of a quality improvement initiative. Results From October 2018 to March 2019, 23 patients were discussed at 10 case conferences with input from attendings, fellows, housestaff, social workers, and representatives from a novel Primary Care Safety Net program. The average patient age was 43 (range 24–50). Patients were predominantly male (65%), heroin users (90%) with high rates of HIV (22%) and untreated HCV (40%). ID-related infections included endocarditis (39%), osteomyelitis (31%), skin and soft-tissue infections (17%) and spinal abscesses (17%). The median time for a patient to be presented at an ID-Psych Addiction Rounds was 7 days (IQR 4.5–11.5). The mean length of hospitalization was 30 days (range 2–112). MAT was initiated in 75% of patients (41% buprenorphine; 59% methadone). The 30-day lost to follow-up rate was exceedingly high, with 80% of post-hospital appointments being missed. Conclusion ID physicians can effectively link hospitalized patients with OUD to substance use resources. A multi-disciplinary approach is key to addressing the opioid epidemic. Future work should explore how to create effective post-hospital transitions to decrease those lost to follow-up. Disclosures All authors: No reported disclosures.

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The management of chronic non-arthritic scapholunate dissociation: a systematic review

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417734990 ◽

2017 ◽

Vol 43 (4) ◽

pp. 394-401 ◽

Cited By ~ 5

Author(s):

Zafar Naqui ◽

Wee Sim Khor ◽

Anuj Mishra ◽

Vivien Lees ◽

Lindsay Muir

Keyword(s):

Systematic Review ◽

Comparative Studies ◽

Final Analysis ◽

Scapholunate Dissociation ◽

Level Of Evidence ◽

Data Set ◽

Best Management ◽

Patient Consent ◽

Natural History Studies

A systematic review was conducted to identify the best management for chronic scapholunate dissociation. EMBASE, MEDLINE, and CENTRAL were searched from 1965–2016. A narrative synthesis was performed. One thousand, one hundred and ninety-one citations were identified, of which 17 had final analysis. In all interventions, the pain score at 2 years reduced from 6.0 to 2.8 with similar effect from capsulodesis and tenodesis techniques. Overall there was an 18% loss of flexion arc. Radial to ulnar arc improved in capsulodesis (+19%; n = 45) and worsened in tenodesis (−6%; n = 45). Grip strength was better in capsulodesis (+31%; n = 64 versus + 11%; n = 56). There was insufficient evidence to link radiological outcome with clinical outcome. Rates of complications (20%) and CRPS (3.8%) were high, with implications for patient consent. Due to heterogeneity in data collection, the lack of comparative studies and short-term follow-up, no conclusion regarding the superiority of a single technique was possible. Longer term comparative studies are required, as are natural history studies. A minimum data set has been advised. Level of evidence: II

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