scholarly journals EP.TH.386Management of acute gallstone-related complications at Great Western Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rute Castelhano ◽  
Jessica Bartlett ◽  
Harry Wooler ◽  
Ahmed Mahmoud ◽  
Aris Theofilis ◽  
...  
Keyword(s):  
Service Provision ◽  
National Average ◽  
Observational Analysis ◽  
Surgical Department ◽  
Related Disease ◽  
Western Hospital ◽  
Number Of Patients ◽  
The Impact ◽  
Current Guidelines ◽  
Reason For Admission

Abstract Aim Gallstone-related disease accounts for a third of the admissions to the Surgical Department. In June 2019, an audit was undertaken at Great Western Hospital assessing the number of patients who underwent cholecystectomy, following initial diagnosis, in accordance to current guidelines. The results demonstrated a very low number of patients had cholecystectomy, within the targeted timeframe, which led to the implementation of a dedicated operative “hot gallbladder” list weekly. In June 2020, we re-audit the service to evaluate the impact of the change implemented. Methods A retrospective observational analysis of patients admitted to the Hospital in June 2020 with gallstone-related disease. Data was collected using the Surgical on-call lists, these were analysed and patients selected according to the reason for admission. Only gallstone related issues were considered in this analysis. Finally, via Medway, the time from admission to surgery was assessed. Results Despite the disruption in service provision due to COVID-19, the implementation of the “hot gallbladder” list led to a 10.7% increase in timely cholecystectomies, bringing the overall compliance to 14%. There was also a significant reduction in biliary related re-admissions, from 58% to 37%. Despite 47.3% of patients were still awaiting surgery, the waiting list was reduced by 5.2% in only 1 year. Conclusions This study demonstrated that the implementation of the “hot gallbladder” list has improved the compliance with the current guidelines. The change has brought us in line with the national average of 15%, as estimated by RCSEng, therefore demonstrating the efficacy of the weekly list.

scholarly journals 963 Management of Acute Gallstone-Related Complications at Great Western Hospital (GWH): Re-Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Castelhano ◽  
J Bartlett ◽  
H Wooler ◽  
A Theofilis ◽  
A Mahmoud ◽  
...  
Keyword(s):  
Service Provision ◽  
Clinical Audit ◽  
Time Frame ◽  
Surgical Department ◽  
Related Disease ◽  
Western Hospital ◽  
Number Of Patients ◽  
The Impact ◽  
Current Guidelines ◽  
Reason For Admission

Abstract Aim Gallstone related disease accounts for a third of the admissions to the Surgical Department. In June 2019, a clinical audit was undertaken at Great Western Hospital assessing the number of patients who underwent cholecystectomy, following initial diagnosis, in accordance to current guidelines. The results demonstrated a very low number of patients had cholecystectomy, within the targeted time frame, which led to the implementation of a dedicated operative “hot gallbladder” list weekly. In June 2020, we re-audit the service to evaluate the impact of the change implemented. Method A retrospective observational analysis of patients admitted to the Hospital in June 2020 with gallstone related disease. Data was collected using the Surgical on-call lists, these were analysed and patients selected according to the reason for admission, only gallstone related issues were considered in this analysis. Finally, via Medway, the time from admission to surgery was assessed. Results Despite the disruption in service provision due to COVID-19, the implementation of the “hot gallbladder” list led to a 10.7% increase in timely cholecystectomies, bringing the overall compliance to 14%. There was also a significant reduction in biliary relate re-admissions, from 58% to 37%. Despite 47.3% of patients were still awaiting surgery, the waiting list was reduced by 5.2% in only 1 year. Conclusions This study demonstrated that the implementation of the “hot gallbladder” list has improved the compliance with the current guidelines. The change has brought us in line with the national average of 15%, as estimated by RCSEng, therefore demonstrating the efficacy of the weekly list.

scholarly journals The Impact of the Covid-19 Pandemic with Hidradenitis suppurativa Being Treated with Adalimumab: Evidence from Real-World Data

2020 ◽  
Vol 5 (4) ◽  
Author(s):  
Turkmen M
Keyword(s):  
Real World ◽  
Hidradenitis Suppurativa ◽  
Real World Data ◽  
Observational Analysis ◽  
World Data ◽  
Related Disease ◽  
Number Of Patients ◽  
Adalimumab Therapy ◽  
Study Population ◽  
The Impact

Background: There is uncertainty concerning the outcome of coronavirus disease-19 (COVID-19) infections in patients who are receiving adalimumab for hidradenitis suppurativa (HS) treatment. Objectives: This study aims to investigate the effect of adalimumab in HS patients during COVID 19 outbreak. Methods: We performed a retrospective observational analysis of the moderate-to-severe HS patients under adalimumab therapy, with reporting the number of patients hospitalized or who died from COVID 19 infection between 13 March 2020 and 31 July 2020. Results: Eighty nine patients who continued their therapy during pandemic were evaluated retrospectively. There were no cases of death from COVID-related disease in our study population or patients hospitalized for COVID-related disease. Conclusions: We suggest continuing the treatment of ADA in HS patients, under COVID-19 pandemic.

scholarly journals The effect of the COVID pandemic lockdown measures on surgical emergencies: experience and lessons learned from a Greek tertiary hospital

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Emmanouil Pikoulis ◽  
Nikolaos Koliakos ◽  
Dimitrios Papaconstantinou ◽  
Nikolaos Pararas ◽  
Andreas Pikoulis ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Hospital Admissions ◽  
Motor Vehicle ◽  
Perianal Abscess ◽  
Lessons Learned ◽  
University Hospital ◽  
Tertiary Referral Center ◽  
Surgical Department ◽  
Number Of Patients ◽  
The Impact

Abstract Background The COVID-19 pandemic caused a rise in healthcare demands leading to significant restructuring of hospital emergency departments worldwide. The aim of the present study is twofold: firstly, to discern any differences in regard to reason for surgical emergency department (SED) attendance and hospital admission during the pandemic and pre-pandemic eras in Greece, and secondly, to assess the impact of the lockdown measures implemented during the pandemic on SED patient attendance. Methods Since the beginning of the COVID-19 pandemic in Greece (1 March 2020) and up to 15 December 2020, the charts of all adult patients arriving at the SED of the third surgical department of the “Attikon” University Hospital (a tertiary referral center for surgical and COVID-19 cases) were retrospectively reviewed and broken down in four periods reflecting two nationwide lockdown (period A 1/3/2020 to 30/4/2020 and period D 16/10/2020 to 15/12/2020) and two interim (period B 1/5/2020 to 15/6/2020 and period C 15/9/2020 to 30/10/2020) periods. Demographic and clinical data were compared to those obtained from the same time periods of the year 2019. Results The total number of patients attending the SED decreased by 35.9% during the pandemic (from 2839 total patients in 2019 to 1819 in 2020). During the first lockdown, there was statistically significant reduction of motor vehicle accidents (p=0.04) and torso injuries (p=0.01). Contrarily, the rate of head injuries (p<0.001) and abdominal pain (p=0.04) were significantly increased. The same effect was observed regarding the rate of hospital admissions (p=0.002), although in terms of absolute numbers, admissions remained unchanged. During the second lockdown, there was a reduction in the number of perianal abscess cases (p=0.04) and hernia-related problems (p=0.001). An increase in the rate of fall injuries was also demonstrable (p=0.02). Overall, application of the lockdown led to a significant decrease in minor (p<0.001) and torso (p=0.001) injuries. Conclusion The burden of the new COVID-19 disease has left a noticeable imprint in the function of emergency departments worldwide. In Greece, SED attendance was significantly reduced during the pandemic, an effect that was even more pronounced during the lockdown implementation; nevertheless, the overall rate of hospital admissions remained the same, denoting that patient care was not altered.

scholarly journals The impact of the COVID-19 pandemic on cardiology services

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001359 ◽  
Author(s):  
Omar Fersia ◽  
Sue Bryant ◽  
Rachael Nicholson ◽  
Karen McMeeken ◽  
Carolyn Brown ◽  
...  
Keyword(s):  
Performance Indicators ◽  
Service Provision ◽  
Recovery Phase ◽  
Community Services ◽  
Outpatient Clinics ◽  
Clinical Activity ◽  
Single Centre ◽  
Number Of Patients ◽  
The Uk ◽  
The Impact

ObjectiveThe COVID-19 pandemic resulted in prioritisation of National Health Service (NHS) resources to cope with the surge in infected patients. However, there have been no studies in the UK looking at the effect of the COVID-19 work pattern on the provision of cardiology services. We aimed to assess the impact of the pandemic on cardiology services and clinical activity.MethodsWe analysed key performance indicators in cardiology services in a single centre in the UK in the periods prior to and during lockdown to assess reduction or changes in service provision.ResultsThere has been a greater than 50% drop in the number of patients presenting to cardiology and those diagnosed with myocardial infarction. All areas of cardiology service provision sustained significant reductions, which included outpatient clinics, investigations, procedures and cardiology community services such as heart failure and cardiac rehabilitation.ConclusionsAs ischaemic heart disease continues to be the leading cause of death nationally and globally, cardiology services need to prepare for a significant increase in workload in the recovery phase and develop new pathways to urgently help those adversely affected by the changes in service provision.

Impact of a structured quality management program on survival of patients with advanced (AOC) and relapsed ovarian cancer (ROC) treated in a dedicated tertiary gynecologic-oncology (GO) center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17048-e17048
Author(s):  
Philipp Harter ◽  
Florian Heitz ◽  
Beyhan Ataseven ◽  
Sonia Prader ◽  
Stefanie Schneider ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Quality Assurance ◽  
Quality Management ◽  
Gynecologic Oncology ◽  
Management Program ◽  
Quality Assurance Program ◽  
Primary Therapy ◽  
Surgical Department ◽  
Number Of Patients ◽  
The Impact

e17048 Background: Treatment of AOC needs interdisciplinary and specialized skills and structures. We report the impact of a dedicated quality management program over 2 decades from learning curve and specialization process started in 1998-2004 when the surgical department was separated from a general clinic of obstetrics and gynecology. The next period from 2005-2010 covers the data after implementation of the first step of our ovarian cancer quality assurance program. In 2011, a dedicated department of GO was founded. Additionally, we investigated the role of subsequent centralized versus decentralized treatment when patients relapsed after they had primary therapy at our institution. Methods: Descriptive analysis of our prospective tumor registry including all consecutive patients with primary diagnosis of AOC FIGO IIB-IV treated from 1998-2004, 2005-2010 and 2011-2017. All patients having started any therapy outside of our center were excluded. Results: The number of patients with untreated AOC increased from 10 to 147 per year from 1998 to 2017. In total, 1,663 pts were analyzed. The annual percentage of FIGO IV increased from 14% in 1998 to 54-61% in recent years (2013-2017). The complete resection rate of upfront surgery was 50%, 67%, and 69% in the periods 1997-2004, 2005-2010, and 2011-2017, respectively. Correspondingly, median PFS increased from 19 to 21 and 26 months (p < 0.001) and median OS increased from 33 to 42 and 56 months, respectively (p < 0.001). Altogether, 893 pts (53.7%) experienced a relapse. 490/893 pts (54.9% of all ROC pts) were treated again in our center, the remaining 45.1% were treated somewhere else. Median OS calculated from first relapse was 43 months for patients re-treated in our institution versus 32 months for others (p < 0.001). Conclusions: We demonstrate a correlation between specialization and improved outcome in AOC. Focusing and implementing a quality assurance program including structural evolution from a department of general obstetrics/gynecology to a department of GO led to an improvement although systemic primary treatment standards did not change during this period.

Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

2020 ◽  
pp. 1-6
Author(s):  
Paul Park ◽  
Victor Chang ◽  
Hsueh-Han Yeh ◽  
Jason M. Schwalb ◽  
David R. Nerenz ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Readmission Rate ◽  
Rating Scale ◽  
Short Term ◽  
Readmission Rates ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Before And After ◽  
The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

scholarly journals Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

Change in Service Provision Networks: The Case of Animal Welfare Services

2021 ◽  
pp. 0160323X2110092
Author(s):  
Laura A. Reese ◽  
Xiaomeng Li
Keyword(s):  
Service Provision ◽  
Survey Design ◽  
Participant Observation ◽  
Local Level ◽  
Major Change ◽  
Network Evolution ◽  
Political Factors ◽  
Before And After ◽  
Organizational Ties ◽  
The Impact

This research focuses on change within informal service provision networks, specifically examining the impact that changes within a key organization can have on the larger network. Employing a before and after survey design with a treatment at the midpoint and participant observation, it asks: What is the impact of a major change within one organization on the larger external network? What is the nature of the organizational ties? and, How do political factors exogenous to the network impact the network evolution process? The findings suggest that internal change within a focal actor can have ripple effects throughout the network increasing density. Public service provision at the local level can be enhanced through an increase in partnerships between the public and nonprofit sectors. However, network evolution can be limited by the larger political environment and lack of a coordinating role on the part of local government.

scholarly journals How Risky Is That Risk Sharing Agreement? Mean-Variance Tradeoffs and Unintended Consequences of Six Common Risk Sharing Agreements

2021 ◽  
Vol 6 (1) ◽  
pp. 238146832199040
Author(s):  
Gregory S. Zaric
Keyword(s):  
Risk Sharing ◽  
Financial Risk ◽  
Unintended Consequences ◽  
Drug Costs ◽  
New Drugs ◽  
Total Drug ◽  
Number Of Patients ◽  
Clinical Benefits ◽  
The Impact ◽  
Mean Variance

Background. Pharmaceutical risk sharing agreements (RSAs) are commonly used to manage uncertainties in costs and/or clinical benefits when new drugs are added to a formulary. However, existing mathematical models of RSAs ignore the impact of RSAs on clinical and financial risk. Methods. We develop a model in which the number of patients, total drug consumption per patient, and incremental health benefits per patient are uncertain at the time of the introduction of a new drug. We use the model to evaluate the impact of six common RSAs on total drug costs and total net monetary benefit (NMB). Results. We show that, relative to not having an RSA in place, each RSA reduces expected total drug costs and increases expected total NMB. Each RSA also improves two measures of risk by reducing the probability that total drug costs exceed any threshold and reducing the probability of obtaining negative NMB. However, the effects on variance in both NMB and total drug costs are mixed. In some cases, relative to not having an RSA in place, implementing an RSA can increase variability in total drug costs or total NMB. We also show that, for some RSAs, when their parameters are adjusted so that they have the same impact on expected total drug cost, they can be rank-ordered in terms of their impact on variance in drug costs. Conclusions. Although all RSAs reduce expected total drug costs and increase expected total NMB, some RSAs may actually have the undesirable effect of increasing risk. Payers and formulary managers should be aware of these mean-variance tradeoffs and the potentially unintended results of RSAs when designing and negotiating RSAs.

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value &lt; 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P &lt; 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P &lt; 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P &lt; 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

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