scholarly journals EP.TH.625Consenting for a Bedside Procedure: A Prospective Observational Analysis of Consenting Practice in the Surgical Emergency Admissions Unit of a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shashwat Mishra ◽  
Heather Davis ◽  
Charannya Balakumar ◽  
Ashish Shrestha
Keyword(s):  
General Hospital ◽  
Clinical Care ◽  
District General Hospital ◽  
Case Law ◽  
Incision And Drainage ◽  
Emergency Admissions ◽  
Surgical Emergency ◽  
Operation Note ◽  
Risk And Benefit

Abstract Aims Consent is necessary to enable patient autonomy and essential to providing good clinical care. Recent case law has grown around consent and practice guidance has evolved. This was a prospective, observational study consisting of two cycles. It investigated the quality of consent for bedside incision and drainage (I&D) procedures performed in the surgical emergency admissions unit (SEAU) at a district general hospital compared with GMC guidance. Methods A prospective analysis of consent documentation was performed from August to September 2020. Data was gathered for quality of consent including risk and benefit discussions, local anaesthetic used, operation note documentation and procedure discussion. We communicated these results at a departmental level, increased awareness of available consent forms and placed them in more accessible locations. Data to see the benefit of these interventions were gathered from November 2020 to January 2021. Results In cycle one, of 20 cases (n = 20), 5.0% had written consent documentation, and 75.0% had verbal consent documentation. 20.0% of cases had no consent documented. Following interventions, of 14 cases (n = 14), 57.1% of cases had written consent documentation, and 7.14% had verbal consent documentation. 35.0% of cases had no consent documented. Conclusion This study highlighted a deviation from GMC guidance. Interventions have shown to increase the proportion of cases with written consent. Overall cases with no written evidence of consent remain high and further work is required to increase compliance. We aim to refine the interventions we have implemented in order to promote the highest quality of consent documentation.

scholarly journals 1470 Consenting for a Bedside Procedure: A Prospective Observational Analysis of Consenting Practice in the Surgical Emergency Admissions Unit of a District General Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H Davis ◽  
S Mishra ◽  
C Balakumar ◽  
A Shrestha
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Incision And Drainage ◽  
Emergency Admissions ◽  
Surgical Emergency ◽  
Improve Compliance ◽  
Operation Note ◽  
A Prospective Study ◽  
Risk And Benefit

Abstract Aim Consent is necessary to enable patient autonomy, and it is vital that it is voluntary, informed and, where possible, the patient has valid mental capacity to give consent. Recent case law has grown around consent and practice guidance has evolved. This was a prospective observational study investigating the quality of consenting practice for incision and drainage procedures performed within the surgical emergency admissions unit (SEAU) at a district general hospital. Method A prospective study was conducted on consent documentation for a study period from August to September 2020, for patients undergoing bedside incision and drainage (I&D) procedures within the SEAU. Documentation was reviewed and data collected for quality of consent. Further data into the quality of this documentation was also collected; including legibility, risk and benefit discussions, local anaesthetic used, operation note documentation and discussion of the procedure. This was compared against GMC standards. Results Of 20 cases (n = 20), 1 case had written consent and 15 cases had verbal consent documented. 4 cases had no documentation of consent. No cases had benefit documentation, and 4 out of the 20 cases had risks documented. 4 cases had documentation of procedure discussion. 13 cases had an operation note included. Conclusions This study highlights a deviation from recommended practice, and results have been communicated at a departmental level. Recommendations have been offered in an attempt to improve compliance, including the display of posters in the SEAU. We shall re-audit practice within the coming months after these changes have been implemented.

scholarly journals AB0903-HPR DURATION OF TELEPHONE CONSULTATIONS AMONGST RHEUMATOLOGY PRACTITIONERS IN A DISTRICT GENERAL HOSPITAL - ADAPTING TO REMOTE CONSULTATION IN A COVID-19 PANDEMIC

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1474.1-1474
Author(s):  
L. Parker ◽  
F. Coldstream
Keyword(s):  
General Hospital ◽  
Controlled Trial ◽  
Clinical Care ◽  
District General Hospital ◽  
British Society ◽  
Nice Guideline ◽  
Face To Face ◽  
Co Morbidity ◽  
Randomised Controlled ◽  
Remote Consultations

Background:The Covid-19 pandemic has resulted in a rapid adoption of remote consultations in order to limit face to face clinical contact wherever appropriate, as recommended by the British Society for Rheumatology. The same clinic templates which existed for face-to-face encounters have been retrospectively adapted, without consideration of any potential difference in duration of consultations. Rheumatology practitioners from a variety of clinical backgrounds work alongside the rheumatology consultants, providing clinical care to patients with both inflammatory arthritis and connective tissue disease.Objectives:To record the duration of all scheduled telephone consultations carried out by advances rheumatology practitioners in a 4-week period.Methods:All scheduled telephone clinic encounters over a 4-week period were timed and the duration recorded in a spreadsheet. Data was collected in real time by all 8 rheumatology advanced practitioners working within the rheumatology department of a district general hospital, following each clinic episode.Results:Data was recorded from a total of 337 clinic appointments. Of these, 317 (94%) were booked as routine, 3 (0.9%) as urgent, 4 (1.2%) were expedited following an advice line contact, and 13 (3.9%) no data was recorded. 28 (8%) of the patients did not answer when contacted. 80 (24%) clinic appointments lasted 15 minutes or less, 186 (55%) lasted 16 - 30 minutes, 37 (11%) lasted 31 - 45 minutes, and 6 (2%) lasted 46 - 60 minutes. The average duration was 22 minutes.Conclusion:Within this department, remote consultations appear to have a similar duration when compared against the traditional clinic template for a fully face-to-face clinic, with some encounters lasting significantly longer than the planned duration. This would appear to differ to telephone consultations used in other settings, such as general practice where the duration is reportedly shorter1. This may be representative of the additional complexity and co-morbidity of a typical rheumatology patient, or due to the multi-faceted nature of a rheumatology follow-up appointment2. Although remote consultations are effective in limiting risk of exposure to Covid-19, they may not offer a quicker or more efficient service compared with the face-to-face model. Further study in this field is required to evaluate this widely adopted new pattern of working.References:[1]Pinnock H, Bawden R, Proctor S, Wolfe S, Scullion J, Price D, Sheikh A. Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial. BMJ. 2003 Mar 1;326(7387):477-9. doi: 10.1136/bmj.326.7387.477. PMID: 12609944; PMCID: PMC150181.[2]National Institute for Health and Care Excellence (NICE) (2018) rheumatoid arthritis in adults: management (NICE Guideline NG100). Available at https://www.nice.org.uk/guidance/ng100 [Accessed 05 January 2021].Disclosure of Interests:None declared

scholarly journals The Quality of Life Chronic Renal Failure (CRF) Patients in Hemodialysis Unit at District General Hospital Pringsewu Regency Lampung Province in 2018

2018 ◽  
Vol 68 ◽  
pp. 01009
Author(s):  
Virna Widora Saputri ◽  
Rico Januar Sitorus ◽  
H. M. Zulkarnain
Keyword(s):  
Quality Of Life ◽  
Family Support ◽  
General Hospital ◽  
Emotional Health ◽  
Sampling Technique ◽  
District General Hospital ◽  
Cross Sectional ◽  
Hemodialysis Unit ◽  
The Mean

The purpose of this study was to determine the factors that affect the quality of life of CRF patients in Hemodialysis Unit at Pringsewu District General Hospital. This study was conducted from February to May 2018 with cross sectional study design. The sampling technique using total sampling technique. Measurement of quality of life using KDQOL-SFTM version 1.3. The results found that quality of life scores were quite low in some domains and subscales. The mean of total score was 55.70 ± 21.30 with mean of Physical Health Composite (PHC) = 38.85 ± 9.26 and mean of Mental Health Composite (MHC) = 36.13 ± 7.08. Regarding the targeted area of ESRD, the scale of renal disease burden and occupational status scale resulted in the lowest score. The sleep quality scale score was 56.18 ± 20.72. Only 61 patients responded to questions of sexual activity with a score of 55.53 ± 27.44 on the scale of sexual function. In the 36-item health survey, the mean total score was 45.90 ± 21.95. The lowest score represented the limitations of roles caused by physical and emotional health problems. The result of statistical test showed that the variables significantly related to the quality of life of CRF patients were age, income, duration of hemodialysis and family support. Thus, family support was the variable that had the greatest impact on determining the quality of life of CRF patients. The CRF patients who lacked family support were 4.6 times more likely to lead poorer life compared to CRF patients who received good family support after being controlled by age, income, duration of hemodialysis, gender, working status, and diabetes mellitus variables.

scholarly journals Quality of e-discharge summaries at a district general hospital

2019 ◽  
Vol 6 (Suppl 1) ◽  
pp. 52-52
Author(s):  
Mohummad S Goonoo ◽  
Ismail Al-Talib ◽  
Nidal Hammoud ◽  
Pankaj Chaturvedi
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Discharge Summaries

scholarly journals EP.TH.640Outcomes in Elective and Emergency Laparoscopic Cholecystectomies in a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ahmed Nur ◽  
Aditya Agrawal
Keyword(s):  
General Hospital ◽  
Bile Leak ◽  
District General Hospital ◽  
Perioperative Outcomes ◽  
Electronic Patient Records ◽  
Incision And Drainage ◽  
Retrospective Audit ◽  
Operative Findings ◽  
Time Of Operation ◽  
Base Data

Abstract Aims To evaluate early perioperative outcomes following emergency and elective laparoscopic cholecystectomies in a district general hospital against the national average. Methods A retrospective audit was carried out on consecutive Laparoscopic Cholecystectomies performed between January 2020 and June 2018. All indications were included. Demographics and base data included; age, gender, ASA grade, type of surgery (Emergency/Elective), number of symptomatic days preoperatively, preoperative bloods, preoperative ERCP, operative findings, postoperative complications and length of stay. Data was gathered from physical and electronic patient records. Results 166 laparoscopic cholecystectomies were included in the audit. Of the 166 included patients, 48 were male and 118 were female. Mean age at time of operation was 53.4 years. 106 of the laparoscopic cholecystectomies were carried out as Elective cases and 60 were performed as Emergencies. 100% of cases were performed laparoscopically, with 3 cases requiring conversion to open intraoperatively. Postoperatively, 5 patients had post-op pneumonia. There were 3 documented cases of bile leak with 1 patient requiring ERCP as a result. There were 2 cases of wound infection requiring re-admission. Other documented complications included; umbilical port sit abscess requiring incision and drainage, collection in the gallbladder fossa, small bowel injury and a post-op drop in Haemoglobin requiring transfusion. Conclusions Outcomes in this cohort of patients undergoing laparoscopic cholecystectomies are comparable to national data. The focus of further evaluation from this cohort should be to compare outcomes between Emergency and Elective Laparoscopic Cholecystectomies, with Emergency cases further stratified according to the number of symptomatic days preoperatively.

scholarly journals Inovasi Pelayanan Kesehatan Di Rumah Sakit Umum Daerah Kota Pariaman

2020 ◽  
Vol 8 (2) ◽  
pp. 167
Author(s):  
Bobi Rizki Ananda ◽  
Roni Ekha Putera ◽  
Ria Ariany
Keyword(s):  
Qualitative Research ◽  
Data Collection ◽  
General Hospital ◽  
Health Sector ◽  
District General Hospital ◽  
Quality Of Services ◽  
Community Satisfaction ◽  
Satisfaction Index ◽  
The City

TThis study aims to explain service innovations in the health sector that have been carried out by the Pariaman District General Hospital so that the services provided to the community are better. So far what has happened in the city is the presence of bad services performed by various existing hospitals in the regions so that there are people who complain about these health services. This study uses qualitative research methods with data collection techniques through interviews, observation and documentation. The informants came from the hospital and the community who performed the service. The results of this study indicate that the Pariaman Regional General Hospital has been innovating as a form of effort of the Pariaman Regional General Hospital in facilitating matters of service to the community, with the existence of innovations in the Pariaman Regional General Hospital since 2018, the quality of services has increased, things this is proven by the Community Satisfaction Index (IKM) in 2018 which is outstanding value. Penelitian ini bertujuan untuk menjelaskan inovasi–inovasi pelayanan di bidang kesehatan yang telah dilakukan oleh Rumah Sakit Umum Daerah Pariaman sehingga pelayanan yang diberikan kepada masyarakat menjadi lebih baik. Selama ini yang terjadi di masyarakat adalah terdapatnya pelayanan buruk yang dilakukan oleh berbagai rumah sakit yang ada di daerah. Sehingga dengan demikian ada masyarakat yang mengeluhkan pelayanan kesehatan tersebut. Penelitian ini menggunakan metode penelitian kualitatif dengan Teknik pengumpulan data melalui wawancara, observasi dan dokumentasi. Informan berasal dari pihak rumah sakit dan masyarakat yang melakukan layanan. Adapun hasil dari penelitian ini menunjukkan bahwa Rumah Sakit Umum Daerah Pariaman telah melakukan inovasi sebagai bentuk upaya Rumah Sakit Umum Daerah Pariaman dalam mempermudah urusan pelayanan kepada masyarakat. Dengan adanya inovasi di Rumah Sakit Umum Daerah Pariaman tersebut semenjak tahun 2018, kualitas pelayanan semakin meningkat, hal ini dibuktikan dengan Indek Kepuasan Masyarakat (IKM) pada tahun 2018 yang bernilai sangat baik. 

scholarly journals Reducing Prescribing Errors in Paediatric Patients by Assessment and Feedback Targeted at Prescribers

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Michael Eisenhut ◽  
Blanche Sun ◽  
Sarah Skinner
Keyword(s):  
General Hospital ◽  
Medical Errors ◽  
District General Hospital ◽  
Common Type ◽  
Prescribing Errors ◽  
Emergency Admissions ◽  
Wrong Dose ◽  
Written Assessment ◽  
Prescribing Medication ◽  
The Impact

Prescribing errors are the most common type of medical errors and can result in harm particularly in young children. Doctors were enrolled in a programme of written assessment in prescribing skills and individualized feedback. Pharmacists audited the impact. The setting was the paediatric wards and neonatal unit of a District General Hospital. 16 doctors were tested and received feedback. A total of 110 errors were identified in this test, out of a 51 were classified as major including wrong dose and frequency, and prescribing medication the patient had an allergy to. Audit of impact of this intervention revealed a reduction of errors from 47 to 21, and patients affected from 19 to 11 per 100 () emergency admissions compared to an audit before the intervention. An intervention combining a comprehensive multifaceted assessment and detailed feedback can lead to reduction of prescribing errors in paediatric trainees.

scholarly journals 684 The Standard of Emergency Operation Note Documentation at A District General Hospital Compared Against The Royal College of Surgeons of England (RCSEng) Standard

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Zuberi ◽  
Y Mushtaq ◽  
K Patel ◽  
J Joseph ◽  
R Gurprashad
Keyword(s):  
General Hospital ◽  
Royal College ◽  
Emergency Operation ◽  
District General Hospital ◽  
National Standard ◽  
Average Score ◽  
Estimated Blood Loss ◽  
Operation Note ◽  
The Impact ◽  
Current Guidelines

Abstract Introduction Meticulous operation note documentation is essential for seamless, safe continuity of care in postoperative surgical patients. This study evaluated the standard of emergency operation note documentation at a district general hospital, when compared to the Royal College of Surgeons of England (RCSEng) guidelines and assessed the impact of a new operation note proforma. Method A retrospective review of 50 emergency operation notes was conducted between December 2019 and March 2020 and compared to RCSEng guidelines. Initial findings were presented at a local clinical governance meeting and a new electronic operation note was introduced. A further 50 emergency operation notes using the new proforma were analysed between August 2020 and December 2020. Results RCSEng mentions 19 main points that all operation notes must include. A total of 100 operation notes were reviewed and each given a score out of 19. Intervention of the new proforma showed significant improvement to the average score (15.64 vs 17.94; p < 0.0001) when compared to RCSEng guidelines. In particular, there was significant improvement in the documentation of assistants involved in the procedure (58% vs 98%; p < 0.0001), estimated blood loss (2% vs 63%; p < 0.0001) and specific mention whether the operation was emergency or elective (20% vs 86%; p < 0.0001). Conclusions Implementation of the new proforma showed significant improvement in operation note documentation when compared to the RCSEng standard. Therefore, this study emphasises the need for surgeons to familiarise themselves with the current guidelines and highlights the importance of tailoring local operation note proformas to match this national standard closely.

The Chronically Mentally Ill in Community Facilities

1989 ◽  
Vol 154 (1) ◽  
pp. 77-82 ◽  
Author(s):  
C. J. Simpson ◽  
C. E. Hyde ◽  
E. B. Faragher
Keyword(s):  
Quality Of Life ◽  
General Hospital ◽  
Mentally Ill ◽  
District General Hospital ◽  
Group Homes ◽  
Chronically Mentally Ill ◽  
Community Facilities ◽  
Acute Wards

The quality of life of chronically mentally ill patients in acute wards in a district general hospital, a hostel ward and group homes was compared. Within the spectrum of care of these patients, the severity of psychopathology corresponded to their placement. Analysis, including adjustments for the influence of psychopathology, showed differences between the three types of facility. Although differences existed between all types of care, residents in group homes and the hostel ward shared more similarities in quality of life than those in the district general hospital. Problems of caring for the chronically mentally ill on acute wards are highlighted.

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