scholarly journals EP.FRI.60 A complete audit cycle into the paediatric negative appendicectomy rate for children presenting to A&E with suspected appendicitis at a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hanna Maroof ◽  
Khalid Khalifa ◽  
Ahmed Bakr ◽  
Isran Shah ◽  
Mona Abuelgasim ◽  
...  
Keyword(s):  
Care Pathway ◽  
Compliance Rate ◽  
Ct Scanning ◽  
District General Hospital ◽  
Local Policy ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Cost Impact ◽  
Audit Cycle ◽  
Negative Appendicectomy

Abstract Aim Determine compliance rate with a local policy implemented in 2017, and whether interventions from audit cycle 1 were successful. The policy stated that all children aged 6-18 with acute abdominal pain must initially be reviewed by the ED registrar/consultant and have a documented Alvarado score.  Method A closed loop audit on adherence to the 2017 policy and negative appendicectomy rate in children aged 6 to 18, with suspected appendicitis. The data were collected and analysed. Areas for improvement were discussed at the M&M meeting, alongside methods to achieve these improvements. Results The study included 67 patients aged 6-18 who underwent an appendicectomy in 2019. The study found that the Alvarado score had only 14.29% specificity. There was poor adherence to the 2017 protocol as only 36% had a documented Alvarado score and 55% had a senior ED review. Audit cycle 1 recommended improvement of ultrasound quality and increased use of CT scanning to reduce the negative appendicectomy rate. We found that only 2 patients had a CT. The negative appendicectomy rate in patients with and without an ultrasound remained at 8%, indicating no quality improvement. Nevertheless, our primary outcome showed that negative appendicectomy rates reduced from 28% to 11%. Conclusion These results demonstrate negligible impact of ultrasound and Alvarado scores. Good history-taking and clinical examination skills are key in reducing the negative appendicectomy rate. A specific ambulatory care pathway for children with suspected appendicitis has been implemented to lower inpatient stays and cost impact of unnecessary laparoscopies. 

scholarly journals 307 Improving Compliance with Standard of Care Guidelines for Suspected Cauda Equina Syndrome Across A District General Hospital Network

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
D Richardson ◽  
F Greenway ◽  
A Mostofi ◽  
E Pereira
Keyword(s):  
Cauda Equina Syndrome ◽  
Guideline Implementation ◽  
Cauda Equina ◽  
Clinical Information ◽  
Standard Of Care ◽  
District General Hospital ◽  
Service Improvement ◽  
Local Policy ◽  
National Guidelines ◽  
Care Guidelines

Abstract Introduction Cauda equina syndrome (CES) is a spinal emergency that cannot be reliably detected through clinical examination alone and as a result requires prompt MR imaging to provide a diagnosis. This audit examined compliance to standard of care following service improvements in line with the updated SBNS/BASS national guidelines for CES. Method A retrospective analysis of 200 patients referred to neurosurgery for suspected CES: 100 pre- and 100 post-service improvement SBNS guideline implementation. The online neurosurgical database was reviewed, cases assessed for completeness of referral information (including appropriate exam and pre-referral MRI) with patient demographics, referring hospital and outcome also recorded. Results Prior to the SBNS guidelines only 19 patients received MRI prior to referral, 70% of all referrals were incomplete or contained erroneous clinical information. Post-service improvements there was a 68% increase of pre-referral MRI (32 cases), and an improvement in quality of clinical information with only 19% of referrals providing insufficient or unreliable information. Conclusions Through relatively simple changes to local policy, patient care flow and education of emergency department clinicians we have significantly improved pre-referral MRI rates as well as overall referral quality across the whole DGH network.

scholarly journals Accuracy of identification of negative appendicectomy by clinical coding at a district general hospital

2014 ◽  
Vol 12 ◽  
pp. S92-S93
Author(s):  
Jaison Patel ◽  
James Rich ◽  
Sam Bostock ◽  
Andrew Webster ◽  
Szymon Musiol ◽  
...  
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Clinical Coding ◽  
Negative Appendicectomy

SP9.1.5 Compliance with the NELA pathway at a District General Hospital. Reducing time to theatre by limiting CT-associated delay - A prospective closed loop audit

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahrukh Ahmad ◽  
Nazhatul Hasbullah ◽  
Siddhartha Handa ◽  
Panna Patel
Keyword(s):  
Patient Outcomes ◽  
Closed Loop ◽  
Ct Scanning ◽  
District General Hospital ◽  
Electronic Records ◽  
Emergency Laparotomy ◽  
Out Of Hours ◽  
Included Patient ◽  
Ct Protocol ◽  
Reduced Time

Abstract Aim NELA recommends rapid request, conduct and reporting of CT to reduce the delay in time to theatre and thus ultimately improving patient outcomes. Our aim was to identify and reduce delays with regards to CT scanning and reporting. Methods Our Local Laparotomy Pathway standard recommends that CT scans be performed within one hour of being requested and reported within one hour of being performed. NELA data and electronic records were reviewed over a 3 month period (January 2020 to March 2020) - revealing that only 59% of pre-laparotomy CTs done (n = 17) complied with this standard. A dedicated “CT Emergency Laparotomy” protocol was introduced, which assigned the scan as top priority for both radiographers and radiologists. After making this change, data was prospectively collected to see if there was reduced time from CT request to report. Results Compliance with the pathway standard for the three month period from October 2020 to January 2021 increased to 81% (n = 21). Reasons for non-compliance included patient instability, awaiting renal profile; and COVID-related deep cleaning between patients. Out of hours, CT reporting was outsourced, which led to even quicker reporting – with multiple scans being both performed and reported within one hour of the request. Of the 16 patients that fit the criteria for urgent laparotomy, 87.5% (14 patients) were operated on within 6 hours of initial intention to operate. Conclusion Our re-audit showed that after the introduction of a dedicated laparotomy CT protocol, there was reduced time to CT report and ultimately reduced delay to Laparotomy.

EP.FRI.615 Assessing the reliability of the Adult Appendicitis Score in managing patients with suspected acute appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Carry Zheng ◽  
Shiela Lee ◽  
Steven Brown ◽  
Venkat Kanakala
Keyword(s):  
Acute Appendicitis ◽  
Risk Group ◽  
Pathological Finding ◽  
High Risk Group ◽  
Histological Diagnosis ◽  
Suspected Appendicitis ◽  
Tertiary Centre ◽  
Negative Appendicectomy ◽  
Age Range ◽  
Suspected Acute Appendicitis

Abstract Aims To evaluate the effectiveness of using a clinical prediction tool in the management of suspected acute appendicitis Methods Retrospective data was collected on patients undergoing appendicectomy at a single tertiary centre from November 2019 to June 2020. Inclusion criteria were all patients aged 18 and above undergoing diagnostic laparoscopy for suspected appendicitis. Exclusion criteria were all patients that had a pathological finding other than appendicitis at laparoscopy. The pre operative AAS score at first presentation was calculated and patients grouped into low(0-10), intermediate(11-15), and high(16 and above) risk. These groups were then compared to the histological findings. Results A total of 74 patients were included, 44 male and 30 female. The age range was from 18 to 83, with a median age of 36. Of 10 patients in the low risk group, 4 (40%) had appendicitis on histology. 36 out of 40 (90%) patients in the intermediate risk group had appendicitis and 100% of the 24 patients in the high risk group. Pearson’s coefficient showed a significant correlation between the AAS risk (low, intermediate, and high) and the histological diagnosis of appendicitis (r = 0.48, p = 0.000016). Conclusions Our study did show a positive correlation between the AAS risk stratification and histological diagnosis. Based on our findings we would recommend the adoption of this score in assessing patients with suspected acute appendicitis and minimising the negative appendicectomy rate.

scholarly journals Clinico-pathological and etiological evaluation of acute appendicitis and assessment of significance of laboratory and ultrasonography examination as an ancillary aid to clinical diagnosis

2019 ◽  
Vol 6 (6) ◽  
pp. 1954
Author(s):  
Sailendra Nath Paul ◽  
Dilip Kumar Das
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Clinical Symptoms ◽  
Lower Abdominal Pain ◽  
Complication Rates ◽  
Alvarado Score ◽  
Negative Appendicectomy ◽  
Operative Findings

Background: Timely diagnosis and intervention of acute appendicitis reduces morbidity and mortality associated with the disease condition. The study aimed to evaluate the etiology of acute appendicitis, to analyze the sensitivity of modified Alvarado scoring system and radiology in the diagnosis of acute appendicitis and to correlate the observations of laboratory tests, operative findings with the histopathological report of specimen of appendix.Methods: This was a prospective study done on 100 patients with clinical symptoms of acute right lower abdominal pain suggestive of appendicular origin during the period from February 2015 to January 2016 in the department of surgery thorough clinical assessment, laboratory investigations, ultrasound findings as were done for all patients. After confirming the diagnosis of AA the patients had operative intervention and specimens were sent for histopathological study.Results: Male preponderance was seen in the study. Majority of them belongs to 21 to 30 years age group (50%). Faecolith was the most common etiological factor observed (58%). Abdominal pain (100%) was the most common clinical symptom. Alvarado score had sensitivity of 95.74% and specificity of 66.67% in diagnosing AA. In correlation to histopathological findings, ultrasonography findings showed 100% positive visualization rate in all 71 cases. Elevated ESR (94%) had high diagnostic accuracy as confirmed by HPE finding (96.81%) which is statistically significant (p<0.000).Conclusions: Alvarado scoring system, elevated ESR levels and USG findings of the appendix can be considered as adjuncts to clinically diagnose the AA, to improve the diagnostic accuracy thereby consequently the rate of negative appendicectomy can be reduced and thus decreases the complication rates.

717 The Introduction of a Discharge Letter Proforma For Hip Fracture Patients Improves Compliance with VTE Prophylaxis Prescription on Discharge: A Closed Loop Audit

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C Williamson ◽  
C Brennan
Keyword(s):  
Hip Fracture ◽  
Marked Improvement ◽  
Closed Loop ◽  
Low Molecular Weight ◽  
Local Policy ◽  
Vte Prophylaxis ◽  
Discharge Letter ◽  
Lower Limb Surgery ◽  
Audit Cycle ◽  
Appropriate Prescription

Abstract Introduction Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in inpatients; with those undergoing lower limb surgery at particularly high risk. NICE recommends that Low Molecular Weight Heparin (LMWH) or Fondaparinux should be used for VTE prophylaxis for one month following hip fracture. Our local policy is to prescribe Dalteparin for 30 days following surgery. Method A closed loop audit of VTE prophylaxis on discharge for 193 patients with hip fractures was performed. The first audit cycle established whether VTE prophylaxis was being prescribed in line with departmental policy. Following this, a template discharge letter was introduced which included a prompt for appropriate prescription of VTE prophylaxis. Results Initially, data for 93 consecutive patients was collected. It was found that 13% had not received VTE prophylaxis in line with guidelines. Of these, six patients had no documented contraindication or alternative prophylaxis prescribed. Results were disseminated locally. After introduction of the template discharge letter, data for 100 consecutive patients was collected. Re-audit showed a marked improvement in adherence to local policy with 95% of patients now receiving appropriate VTE prophylaxis on discharge. Conclusions Introduction of a template discharge letter prompts the documentation of contraindications to prophylaxis and improves compliance with local policy.

sTREM-1 assessment as a diagnostic biomarker for suspected acute appendicitis in children

2019 ◽  
Author(s):  
Tal Taraboulos Klein ◽  
Elkana Kohn ◽  
Baruch Klin ◽  
Tomer Ziv-Baran ◽  
Eran Kozer ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Complete Blood Count ◽  
Surrogate Marker ◽  
Serum Levels ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Reactive Protein ◽  
Significant Difference ◽  
History Of ◽  
Suspected Acute Appendicitis

Abstract Background The typical history of acute appendicitis is observed in less than 60% of cases. Therefore, searching for a surrogate marker is mandatory. Our goal was to determine whether the soluble triggering receptor expressed on myeloid cells (sTREM-1) is an efficient biomarker for acute appendicitis. Methods sTREM-1 serum levels were measured in addition to carrying out routine diagnostic tests (urine dipstick, complete blood count and C- reactive protein) in children admitted to the Emergency Department with suspected appendicitis. Statistical analysis was performed in order to examine whether sTREM-1 was a significant predictor of appendicitis. Results Fifty three of 134 children enrolled in the study were diagnosed with appendicitis. There was no significant difference in serum sTREM-1 levels (p=0.111) between children with or without appendicitis. Leukocytes, neutrophils and CRP were significantly elevated in the appendicitis group (p<0.001). The appendix diameter was significantly larger and the Alvarado score significantly higher in the appendicitis group (p<0.001). Conclusion serum sTREM-1 is not a good marker for acute appendicitis. Customary tests in addition to a proper patient history and physical examination are still the most effective methods to diagnose acute appendicitis.

An All–Wales Audit of the Integrated Care Pathway for the Last Days of Life: Establishing the Audit Cycle

2007 ◽  
Vol 11 (1) ◽  
pp. 16-31
Author(s):  
Susan Closs ◽  
Ros Johnstone ◽  
Andrew Fowell
Keyword(s):  
Integrated Care ◽  
Response Rate ◽  
Care Pathway ◽  
Contributory Factor ◽  
Annual Review ◽  
General Hospitals ◽  
Ongoing Training ◽  
Audit Cycle ◽  
Integrated Care Pathway ◽  
Response Rate Data

Since 2000, the Integrated Care Pathway (ICP) for the last days of life has been implemented mainly in secondary care and to some extent in primary care throughout Wales. The use of the document was monitored centrally. Analysis and feedback of the variance sheets demonstrated that looking at the ICP variances in isolation had limitations. In response to suggestions made by colleagues working with the ICP for the last days of life throughout Wales, an all-Wales audit of the pathway was initiated. At the close of the baseline audit (31 August 2006), data were analysed from 24 sites, which included four (of 5) hospices, three (of 5) specialist inpatient units, eight (of 28) community sites, eight (of 9) district general hospitals and one nursing home. These sites submitted data on 201 deaths managed using the ICP for the last days of life and represent a 77% response rate. Data arriving up to one week after the deadline were subsequently entered onto the database resulting in a response rate of 80%. The response rate from a concomitant staff survey sent out to district nursing teams, community hospitals, wards in district general hospitals and hospices was 48%. The findings of the audit indicate that standards were met in 62% of cases. Variance recording and reporting are misunderstood resulting in 34% underreporting of variances or changes to the expected course of care as detailed in the ICP. Ongoing training and ‘refresher’ sessions are indicated for new and existing staff. The outcomes of the staff survey endorse the findings of the audit and call for more training, although the pathway is recognized as a contributory factor in improving the care of the dying patient. Re-audit six months later showed an overall outcome of the ICP standards being met in 81% of cases. This second audit establishes the annual audit cycle for the pathway that will continue to monitor quality of care and contribute to the annual review of the pathway.

scholarly journals Sensitivity of Alvarado Score among the Suspected Appendicitis Patients at a Tertiary Level Teaching Hospital

2020 ◽  
Vol 32 (1) ◽  
pp. 45-47
Author(s):  
Md Shamsuzzaman ◽  
Md Alamgir Hossain Sikder ◽  
Quazi Sabran Uddin Ahmed ◽  
Shyamol Chandra Banik ◽  
Kartick Chanda Shaha
Keyword(s):  
Iliac Fossa ◽  
Medical College Hospital ◽  
College Hospital ◽  
Alvarado Score ◽  
Predictive Values ◽  
Suspected Appendicitis ◽  
National Medical College ◽  
Medical College ◽  
National Medical ◽  
The Right

Introduction: The aim of this study was to screening the Sensitivity of Alvarado score among the hospitalized suspected appendicitis patients at Dhaka National Medical College Hospital for determine the diagnostic accuracy. Materials and Methods: It was an observational type of descriptive study, conducted in the Dhaka National Medical College Hospital, Dhaka, during the study period of July 2015 to December 2015. The study was approved by the institutional ethical committee. Results: Most of the appendicitis patients belonged to the between 21-30 years which was 64 (32%). Male appendicitis patients (52%) are more than the female patients (48%). Majority of the patients (69%) complains pain occurs in the Right iliac fossa. The sensitivity of Alvarado scores was 81.60%, specificity 74.58%, accuracy 79.35%, positive and negative predictive values were 87.18% and 65.67% respectively. Conclusion: Alvarado score has more specificity. Medicine Today 2020 Vol.32(1): 45-47

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