EP.TU.482A closed loop audit on patient nutrition in a general surgical ward

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Wafaa Ramadan ◽  
Muhammad Rafaih Iqbal ◽  
Sarah-Jane Walton
Keyword(s):  
Hospital Stay ◽  
Surgical Procedure ◽  
Closed Loop ◽  
Ward Round ◽  
Surgical Patients ◽  
Surgical Ward ◽  
Communication Gap ◽  
The Way

Abstract Aim Nutrition is an important aspect in the patient’s road to recovery after any surgical procedure. Often there is a communication gap which is not beneficial for the patient. The aim of this audit was to evaluate the communication regarding patient nutrition requirements. Method All consecutive patients on a General surgical morning ward round were included. Four communication points were reviewed: Data was collected prospectively on a predesigned proforma. Results First Cycle: Second Cycle: Conclusion Nutrition in surgical patients is very important. It is proven that patients on ERAS programme have fewer complications, more rapid return to function and shorter hospital stay. Emphasis and education about the importance of nutrition is the way forward.

scholarly journals TP9.2.27A closed loop audit looking at the use of a checklist in surgical ward rounds to improve ward round documentation. Can we improve patient safety?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Christopher Liao ◽  
Emma Sheaff ◽  
Harry Wilkins
Keyword(s):  
Closed Loop ◽  
Improve Patient Safety ◽  
Clinical Care ◽  
Ward Round ◽  
Clinical Notes ◽  
Legal Documents ◽  
Surgical Ward ◽  
Ward Rounds

Abstract Aims To assess if surgical ward rounds would improve through the use of a peri-operative ward round checklist in the clinical notes. Method We performed a closed loop audit with a different novel ward round checklist in each audit, the second made from improving the first, based on feedback. We looked at checklist utilisation, and the quality of documentation in notes. We compared the quality of documentation in notes with the checklist, to notes without the checklist. The data was then collated and analysed. Standards from the Royal College of Physicians’ “Ward Rounds in Medicine”. Results In the first audit, our sample was 68, in the second, our sample was 64. With the use of a checklist (M = 67%, SD = 22%) ward round documentation was significantly better than without the checklist (M = 26%, SD = 10%), t(64)=8.85, p<.00001. Ward documentation was especially improved regarding fluid balance, analgesia, and assessing physiotherapy needs. The second version of the checklist (M = 56%, SD = 28%) was used significantly more than the first checklist (M = 13%, SD = 22%), t(75)=7.59, p<.00001. Conclusions With the growing role of clinical notes as legal documents, handover tools, and pillars of care planning, and the move to use electronic patient record systems, improving the quality of documentation is imperative. This study shows that a systematic checklist significantly improves ward round documentation, and so can improve clinical care. We will follow-up this study with a third audit, focusing on patient satisfaction and determining reduction in harm caused to patients with a ward round checklist.

scholarly journals 642 A Closed Loop Audit Looking at The Use of a Checklist in Surgical Ward Rounds to Improve Documentation. Can We Improve Patient Safety?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Christopher Liao ◽  
Emma Sheaff ◽  
Harry Wilkins
Keyword(s):  
Patient Safety ◽  
Closed Loop ◽  
Improve Patient Safety ◽  
Clinical Care ◽  
Ward Round ◽  
Clinical Notes ◽  
Surgical Ward ◽  
Legal Document ◽  
Ward Rounds

Abstract Introduction Ward rounds are essential in assessing and planning patient care, but they are often subject to variable quality and structure. A ward round checklist could improve documentation and patient safety. Method We performed a closed-loop audit with a different novel ward round checklist in each audit, the second made from improving the first, based on feedback. We looked at checklist utilisation, and the quality of documentation in notes. We compared the quality of documentation in notes with the checklist, to notes without the checklist. The data was then collated and analysed. Standards from the Royal College of Physicians’ “Ward Rounds in Medicine”. Results In the first audit, our sample was 68, in the second, it was 64. With the use of a checklist (M = 67%, SD = 22%) documentation was significantly better than without (M = 26%, SD = 10%), t(64)=8.85, p<.00001. Ward documentation was especially improved regarding fluid balance, analgesia, and assessing physiotherapy needs. The second version of the checklist (M = 56%, SD = 28%) was used significantly more than the first checklist (M = 13%, SD = 22%), t(75)=7.59, p<.00001. Conclusions With the growing role of clinical notes as a legal document, a tool for handover, and a pillar of care planning, improving the quality of the documentation is imperative. This study shows that a systematic checklist significantly improves ward round documentation, which has already established in an improvement in clinical care. We hope to follow-up this study with a third audit, focusing on patient satisfaction and determining reduction in harm caused to patients with a ward round checklist.

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

scholarly journals Objective Quantification of In-Hospital Patient Mobilization after Cardiac Surgery Using Accelerometers: Selection, Use, and Analysis

Sensors ◽  
2021 ◽  
Vol 21 (6) ◽  
pp. 1979
Author(s):  
Frank R. Halfwerk ◽  
Jeroen H. L. van Haaren ◽  
Randy Klaassen ◽  
Robby W. van Delden ◽  
Peter H. Veltink ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Hospital Stay ◽  
Intensive Care Unit Stay ◽  
Heart Surgery ◽  
Mixed Model ◽  
Postoperative Recovery ◽  
Time In Bed ◽  
Surgical Ward

Cardiac surgery patients infrequently mobilize during their hospital stay. It is unclear for patients why mobilization is important, and exact progress of mobilization activities is not available. The aim of this study was to select and evaluate accelerometers for objective qualification of in-hospital mobilization after cardiac surgery. Six static and dynamic patient activities were defined to measure patient mobilization during the postoperative hospital stay. Device requirements were formulated, and the available devices reviewed. A triaxial accelerometer (AX3, Axivity) was selected for a clinical pilot in a heart surgery ward and placed on both the upper arm and upper leg. An artificial neural network algorithm was applied to classify lying in bed, sitting in a chair, standing, walking, cycling on an exercise bike, and walking the stairs. The primary endpoint was the daily amount of each activity performed between 7 a.m. and 11 p.m. The secondary endpoints were length of intensive care unit stay and surgical ward stay. A subgroup analysis for male and female patients was planned. In total, 29 patients were classified after cardiac surgery with an intensive care unit stay of 1 (1 to 2) night and surgical ward stay of 5 (3 to 6) nights. Patients spent 41 (20 to 62) min less time in bed for each consecutive hospital day, as determined by a mixed-model analysis (p < 0.001). Standing, walking, and walking the stairs increased during the hospital stay. No differences between men (n = 22) and women (n = 7) were observed for all endpoints in this study. The approach presented in this study is applicable for measuring all six activities and for monitoring postoperative recovery of cardiac surgery patients. A next step is to provide feedback to patients and healthcare professionals, to speed up recovery.

scholarly journals Awareness and concern towards anesthesia among patients undergoing surgical procedure: A cross-sectional study at pre-anesthetic clinic of a Teaching Hospital

2019 ◽  
Vol 8 (2) ◽  
pp. 76-80
Author(s):  
Sushila Lama Moktan ◽  
Ujma Shrestha ◽  
Mona Sharma ◽  
Manan Karki
Keyword(s):  
Questionnaire Survey ◽  
Surgical Procedure ◽  
Educational Status ◽  
Cross Sectional Study ◽  
Demographic Characteristics ◽  
Surgical Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Poor Knowledge ◽  
The Past

Background: With the advent of anesthesia, surgery is no longer a race against the clock and surgeons. Many studies in the past have demonstrated limited knowledge among patients about various aspects of anesthesia.Objectives: To assess the awareness and concern of elective surgical patients towards anesthesia.Methodology: A cross-sectional questionnaire survey was conducted over two months’ period in adult patients of age eighteen years and above. Two hundred surgical patients accessing services at the pre-anesthesia check-up clinic were interviewed using 12 questions assessing demographic characteristics, educational status and their knowledge about anesthesia.Results: Out of 200 patients, only 32% knew that anesthesiologists provide anesthesia. It was found that 63% didn’t have any knowledge about the types of anesthesia. The most common fear among the participants about anesthesia was the fear of pain during surgery.Conclusion: The study showed poor knowledge of patients regarding anesthesia.

Surgical ward round quality and impact on variable patient outcomes

2013 ◽  
Vol 217 (3) ◽  
pp. S103 ◽  
Author(s):  
Philip Pucher ◽  
Rajesh Aggarwal ◽  
Ara W. Darzi
Keyword(s):  
Patient Outcomes ◽  
Ward Round ◽  
Surgical Ward

scholarly journals EP.WE.782Retrospective analysis of acute surgical admissions during COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shenbaga Rajamanikam ◽  
Suzzana Argyropoulos ◽  
Reza Arsalani Zadeh
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Surgical Procedures ◽  
Length Of Hospital Stay ◽  
Period Length ◽  
Surgical Patients ◽  
Surgical Team ◽  
Surgical Operations

Abstract Background COVID-19 pandemic has affected the number of surgical admissions and the number of emergency general surgical operations performed. COVID-19 pandemic has also led to changes in how some of the acute surgical patients were managed. Aim of the study was to compare acute surgical admissions and number of emergency general surgical procedures in this period. Material and Method We retrospectively analyzed acute surgical admissions during the pandemic from 20/3/20 to 19/4/20 and compared it with acute surgical admissions during pre-COVID-19 period from 1/11/2019 to 30/11/2019. Results During the COVID-19 pandemic 97 patients were assessed and admitted by the General surgical team, during the pre COVID-19 period 205 patients were assessed and admitted by the General surgical team. The number of acute surgical admissions during COVID-19 pandemic dropped by 53%. There were 46% less emergency surgeries performed during COVID 19 pandemic period. Length of stay during and before the COVID-19pandemic were 4.1 vs 4.4 days. Conclusion During the COVID-19 pandemic number of acute surgical admissions and the number of emergency surgeries were fewer than during pre COVID-19 pandemic. Length of hospital stay was less during COVID-19 pandemic.

scholarly journals Role of Ayurved in the Management of Wound Dehiscence - A Case Report

2021 ◽  
Vol 12 (2) ◽  
pp. 395-397
Author(s):  
Kiran Pundlikrao Mendhekar ◽  
Sanjay Babar ◽  
Ashwin Shete
Keyword(s):  
Case Report ◽  
Hospital Stay ◽  
Surgical Procedure ◽  
Fluid Collection ◽  
Fatal Outcome ◽  
Wound Dehiscence ◽  
Wound Management ◽  
Invasive Technique ◽  
Team Approach ◽  
Obese People

Wound dehiscence is the common problem which is faced by most of the surgeons in case of obese people. As we know, in case of post-operative wound management, avascularity and excessive adipose tissue lysis can lead to fluid collection which leads to gapping of sutured wound. This may also cause Dushta vrana i.e. secondary infection to the wound. Wound dehiscence in surgical field leads to most fatal outcome which can lead to cause local as well as systemic sepsis in the patient. Present case report reveals a treatment modality which involves multidisciplinary team approach such as management of wound as well as obesity by using Ayurvedic perspective. Whereas modern technique of resuturing the gapped wound exposes patient to another surgical procedure which is expensive and increases the hospital stay. The local and oral drugs formulations were proven effective in reducing excessive wound discharge as well as they stimulate the wound healing mechanism when administered in both local and systemic ways. The cost and benefit ratio was found high as there is no re-exposure to the surgical procedure and patient will get benefitted with non-invasive technique along with minimal expenses and hospital stay.

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