scholarly journals EP.TU.44Improving Access to Surgery: The F1 ‘Theatre Day’ Programme

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rebecca Nunn ◽  
Santhini Jeyarajah
Keyword(s):  
General Hospital ◽  
General Surgery ◽  
Elective Surgery ◽  
Working Hours ◽  
District General Hospital ◽  
Learning Opportunities ◽  
Learning Opportunity ◽  
Access To Surgery ◽  
Common Barriers

Abstract Aims To identify barriers in theatre attendance, facilitate access and maximise learning opportunities for surgical F1s (Foundation Year 1 Doctors) at a DGH (District General Hospital). Methods Between December 2019- December 2020, each F1 doctor was offered a day to spend in elective theatre during their General Surgery rotation (excluding emergency COVID rota periods). This was following feedback from the August- December 2019 cohort. Each ‘Theatre Day’ was scheduled during normal working hours when there was sufficient staff. Post-participation questionnaires were completed. Results Prior to implementation of the Programme, 3/8 F1s surveyed had not attended any elective surgery lists (1 had not attended theatre at all). All indicated that they would have been interested in attending a timetabled elective theatre day; 88% highlighted a ‘lack of staff’ and 63% indicated that ‘feeling guilty’ were barriers in attending theatre. 21 F1s were offered a ‘Theatre Day’: 17 agreed to participate and 16 completed post-participation questionnaires. Only 47% confirmed that they were considering a career in surgery prior to participation: all agreed that spending time in theatre was a useful learning opportunity and 94% agreed that the Programme should be continued. Conclusions Spending time in theatre appears to be valued as a useful learning opportunity for F1s, whether or not they are aspiring surgeons. Common barriers to self-organised theatre attendance appear to be an anticipated ‘lack of staff’ or feelings of ‘guilt’. A senior-led scheduling of one day in theatre should circumnavigate these barriers and ensure that access is available to all.

An Audit of Preoperative Blood Tests

2008 ◽  
Vol 18 (2) ◽  
pp. 56-59 ◽  
Author(s):  
Soni Putnis ◽  
Joe Nanuck ◽  
Dugal Heath
Keyword(s):  
General Hospital ◽  
General Surgery ◽  
Elective Surgery ◽  
Preoperative Assessment ◽  
Clinical Excellence ◽  
District General Hospital ◽  
National Guidelines ◽  
Nice Guidelines ◽  
Blood Tests ◽  
Retrospective Audit

Purpose Audit of the use of preoperative blood tests in elective general surgery in a district general hospital. Comparison is made with the National Institute for Health and Clinical Excellence (NICE) guidelines and recommendations. Methodology Retrospective audit of preoperative blood tests performed for elective general surgical patients in a district general hospital over a one month period. Findings Patients attending preoperative assessment for general surgery have blood tests performed in excess of the NICE guidelines. The most frequently requested test that is performed against NICE guidelines is a coagulation screen. This was requested in excess of the national guidelines in 17.8% of cases. Practical implications This audit highlights the overuse of preoperative blood tests and provides suggestions for improving efficiency and economics in the preoperative setting. Originality/value of paper There have been no published audits assessing the current practice against the 2003 NICE guidelines for the use of routine preoperative tests for elective surgery.

scholarly journals Introducing a reserve waiting list initiative for elective general surgery at a District General Hospital

2019 ◽  
Vol 8 (3) ◽  
pp. e000745 ◽  
Author(s):  
Vaki Antoniou ◽  
Olivia Burke ◽  
Roland Fernandes
Keyword(s):  
General Hospital ◽  
General Surgery ◽  
Fast Track ◽  
Operating Time ◽  
District General Hospital ◽  
Waiting List ◽  
Related Factors ◽  
Simple Protocol ◽  
Significant Burden ◽  
Training Opportunities

Cancelled operations represent a significant burden on the National Health Service in terms of theatre efficiency, financial implications and lost training opportunities. Moreover, they carry considerable physical and psychological effects to patients and their relatives. Evidence has shown that up to 93% of cancelled operations are due to patient-related factors. An analysis at our District General Hospital revealed that approximately 18 operations are cancelled on the day of surgery each month. This equates to 27 hours of allocated operating time valued by the trust as £67 500, not being used effectively. This retrospective quality improvement report aims to reduce unused theatre time due to cancelled elective operations in general surgery theatres—thereby improving theatre efficiency and patient care. To ascertain the baseline number of cancelled operations, an initial review of theatre cases was undertaken. Further review was then completed after implementation of two improvements—a short notice surgical waiting list and fast track pre-assessment clinics. The results showed that implementation of the reserve surgical waiting list reduced unused operating time by an average of 2.25 hours per month. By further adding in the fast track preassessment clinic, these figures increased to an average of 11.5 hours over the next 3 months. This precipitated a reutilisation of otherwise wasted theatre time. Economic impact of this time amounts around £28 750 a month, after implementation of both improvements. Simple protocol changes can lead to large improvements in the efficient running of theatres. The resultant change has improved patient satisfaction, led to greater training opportunities and improved theatre efficiency. Extrapolation of our results show better usage of previously underused theatre time, to the equivalent worth of £345 000. Further implementation of these improvements in other surgical specialities and hospitals would be beneficial.

COVID-19: Adapting to change, general surgery at a district general hospital in the United Kingdom

2019 ◽  
Vol 30 (10) ◽  
pp. 301-308
Author(s):  
Sonia Ike ◽  
Chijioke Ikechi ◽  
Jaideep Rait ◽  
Ankur Shah
Keyword(s):  
United Kingdom ◽  
General Hospital ◽  
General Surgery ◽  
Major Change ◽  
Holistic Approach ◽  
District General Hospital ◽  
Viral Spread ◽  
The United Kingdom ◽  
Staff Wellbeing ◽  
Surgery Department

The Coronavirus pandemic has caused major change across the world and in the National Health Service. In order to cope and help limit contagion, numerous institutions recognised the need to adjust clinical practice quickly yet safely. In this paper, we aim to describe the changes implemented in a general surgery department at a district general hospital in the United Kingdom. Across the surgical specialties, frameworks, protocols and guidelines have been established locally and nationally. The aerosol generating procedures involved in general surgery required us to alter our daily activities. Modifications to patient management were necessary to try and reduce viral spread. Staff wellbeing was heavily promoted in order to help maintain the frontline workforce. A holistic approach was required.

Cancellation of elective surgery – any improvement after ten years?

2006 ◽  
Vol 88 (1) ◽  
pp. 28-30 ◽  
Author(s):  
XL Griffin ◽  
DR Griffin ◽  
AR Berry ◽  
DC Hunter
Keyword(s):  
Resource Management ◽  
General Hospital ◽  
Elective Surgery ◽  
District General Hospital ◽  
Waiting List ◽  
Admission Process

Cancellation of elective operations represents a waste of resources and a poor standard of service to patients who may already have spent several months on a waiting list. The purpose of this study was to determine the extent of the problem in a typical district general hospital, how it has changed over a period of ten years and whether alterations in resource management in the admission process have led to improvements in service.

Is weekend surgery a risk factor for post-tonsillectomy haemorrhage?

2016 ◽  
Vol 130 (8) ◽  
pp. 763-767 ◽  
Author(s):  
A Patel ◽  
N Foden ◽  
A Rachmanidou
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
General Hospital ◽  
General Surgery ◽  
District General Hospital ◽  
Low Risk ◽  
Morbidity And Mortality ◽  
The Uk

AbstractBackground:Tonsillectomy is a common, low-risk procedure. Post-tonsillectomy haemorrhage remains the most serious complication. Recent nationwide studies in the UK have identified an increased morbidity and mortality for both high-risk and low-risk elective general surgery performed at the weekend.Methods:Data for tonsillectomies performed at a district general hospital over a three-year period were retrospectively reviewed. The same group of surgeons performed elective tonsillectomies on both weekends and weekdays. All patients who developed a post-tonsillectomy haemorrhage were identified and the day of original operation was noted.Results:Between 2010 and 2013, 2208 (94.00 per cent) elective tonsillectomies were performed on a weekday and 141 (6.00 per cent) were performed on the weekend. Post-tonsillectomy haemorrhages occurred in 104 patients (4.71 per cent) who underwent their procedure on a weekday and in 10 patients (7.09 per cent) who had their surgery at the weekend (p = 0.20).Conclusion:There is no difference in the rate of post-tonsillectomy haemorrhage for procedures performed on a weekday or weekend.

scholarly journals Universal SHO and SpR shift rotas adversely influence SHO operative experience

2006 ◽  
Vol 88 (7) ◽  
pp. 244-246 ◽  
Author(s):  
C Beaton ◽  
MR Stephens ◽  
AN Hopper ◽  
WG Lewis
Keyword(s):  
General Hospital ◽  
Shift Work ◽  
Clinical Experience ◽  
Surgical Training ◽  
General Surgery ◽  
District General Hospital ◽  
European Working ◽  
Training Post ◽  
Operative Experience ◽  
Working Time Directive

The European Working Time Directive (EWTD) will reduce the clinical experience obtained by surgeons prior to attaining consultant status from 21,000 surgical hours to 7,640 hours, 1 with shift work obligatory for compliance. We have shown previously that the operative experience of SHOs in general surgery is on the wane in our own hospital, varies with subspecialty interest 2 and has witnessed further erosion by the introduction of the EWTD. 3 The aim of this study was to assess the influence of an all tier shift rota on the emergency and elective operative experience of SHOs in a category 1 general surgical training post working in a large district general hospital serving a population of 600,000.

scholarly journals Laser depilation as adjuvant therapy in prevention of recurrence of pilonidal sinus disease: initial experience of a district general hospital in the UK

2020 ◽  
Vol 102 (9) ◽  
pp. 685-688
Author(s):  
ASD Liyanage ◽  
Y Woods ◽  
MA Javed ◽  
C Deftly ◽  
H Shaban ◽  
...  
Keyword(s):  
General Hospital ◽  
Recurrence Rate ◽  
Elective Surgery ◽  
Pilonidal Disease ◽  
Hospital Setting ◽  
Final Analysis ◽  
District General Hospital ◽  
Disease Recurrence ◽  
Pilonidal Sinus Disease ◽  
The Uk

Introduction Pilonidal disease is a chronic condition involving the sacrococcygeal area. It can have a significant impact on quality of life, social activities and occupation. Surgery is the mainstay of treatment. However, laser depilation has been proposed as an adjunct to surgery and has shown improved results in some studies. We present our experience of laser depilation in the treatment of pilonidal disease in a district general hospital setting in the UK. Materials and methods A prospectively maintained database of all consecutive patients who received laser depilation after elective surgery for pilonidal disease was analysed. Patients were offered a minimum of two sessions of laser depilation. The primary outcome measure was disease recurrence. Evidence of new symptoms or signs of pilonidal disease after one year from the latest surgical intervention was defined as recurrent disease. Data are presented as medians with interquartile ranges. Results A total of 64 patients underwent laser depilation after elective surgery between 1 June 2013 and 1 June 2018; 57 were eligible for final analysis. Sixty-five per cent of patients received six or more sessions of laser treatment. There were no short- or long-term complications related to laser depilation. Patients who had more than two sessions of laser depilation showed an improved recurrence rate. Overall, recurrence rate in our series was 12% at a median follow-up of 172 weeks. Conclusion Laser depilation is a safe and effective adjunct to surgery in minimising the recurrence of pilonidal disease. Patients with primary pilonidal disease and those who are undergoing minimally invasive surgery may also benefit from adjuvant laser depilation. Further high-quality control trials are required to assess its efficacy and safety.

scholarly journals EP.TU.526Is a foundation interim year one post better for improving confidence in general surgery in a tertiary centre or a district general hospital?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jayan George ◽  
Alok Mathew ◽  
Edward Robinson ◽  
Edward Botsford ◽  
Rohan Ardley ◽  
...  
Keyword(s):  
General Hospital ◽  
General Surgery ◽  
District General Hospital ◽  
Hepatobiliary Disease ◽  
Surgical Patients ◽  
Microsoft Excel ◽  
Likert Scales ◽  
Google Docs ◽  
Confidence Levels ◽  
Tertiary Centre

Abstract Aims 1. Understand the confidence levels in caring for general surgical patients of current foundation year one (FY1) doctors in who have had foundation interim year one (FiY1) post in a tertiary centre (TC) and a district general hospital (DGH). 2. Determine whether there is a difference in the experience of the FiY1 post in a TC or DGH. Methods FY1s doctors were surveyed throughout August – December 2020. Nine questions used Likert scales (1 to 5: not at all confident to very confident) over some common general surgical themes. Data was initially inputted using Google Docs and analysed in Microsoft Excel. Results 20% (6/30) from a DGH and 80% (24/30) from a TC Confidence levels were higher for FY1s who had a FiY1 post in a TC as opposed to a DGH in dealing with acute general surgical patients, appendicitis and scrubbing in theatre. Confidence levels were the same in both a TC and DGH for FY1s in managing those with hepatobiliary disease, prescribing fluids for resuscitation and maintenance as well as speaking to a family when a patient is dying and speaking to a patient when their diagnosis is unknown. Conclusions FY1s who had a FiY1 post in a TC had better confidence levels in more areas as opposed to a DGH. The experience of the FiY1 post should be more standardised to ensure the growth of confidence across all areas identified in the survey.

scholarly journals EP.TU.521Does a foundation interim year one post improve confidence in general surgery in a district general hospital?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jayan George ◽  
Alok Mathew ◽  
Edward Robinson ◽  
Rohan Ardley
Keyword(s):  
Abdominal Pain ◽  
General Hospital ◽  
General Surgery ◽  
District General Hospital ◽  
Hepatobiliary Disease ◽  
Microsoft Excel ◽  
Likert Scales ◽  
Google Docs ◽  
Confidence Levels ◽  
Deteriorating Patient

Abstract Aims 1. Understand the confidence levels of current foundation year one (FY1) doctors. 2. Understand whether an interim foundation year one (FiY1) post improves confidence. Methods FY1s were surveyed throughout August – December 2020. Nine questions used Likert scales (1 to 5: not at all confident to very confident) over some common general surgical themes. Data was initially inputted using google docs and analysed in Microsoft Excel. Results 32.1% (9/28) of FY1s completed the survey. 33.3% (3/9) did not undertake a FiY1 post where 66.7% (7/9) did. Confidence levels were mostly the same between FY1s who had a FiY1 post and those that did not for dealing with patients with hepatobiliary disease, non-specific abdominal pain, appendicitis, speaking to a family when a patient is dying prescribing fluids for maintenance as well as resuscitation. Confidence levels were higher for FY1s who did not have a FiY1 post compared to those that did in managing the deteriorating patient. Confidence levels were lower for FY1s who did not have a FiY1 post compared to those that did in speaking to a patient when their diagnosis is unknown. Conclusions FY1s who have had a FiY1 post in a district general hospital have more confidence in most areas but not all. This data shows the value of the FiY1 post however work needs to be done to improve the experience to the role.

scholarly journals The use and Compliance of Thromboembolism Proforma in General Surgery in a Single District General Hospital

2017 ◽  
Vol 47 ◽  
pp. S39
Author(s):  
I. Leptidis ◽  
G. Bointas ◽  
F. Tsang ◽  
V. Pandey ◽  
J. Livingstone
Keyword(s):  
General Hospital ◽  
General Surgery ◽  
District General Hospital
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