scholarly journals EP.FRI.175 Outcomes from the introduction of routine Geriatrician review for General Surgical patients over 65 years old undergoing Emergency Laparotomy at a large District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Amira Shamsiddinova ◽  
Joanne Kiang ◽  
James Jegard ◽  
Abhijit Bajracharya ◽  
Rebecca Himpson ◽  
...  
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Service Development ◽  
Emergency Laparotomy ◽  
Medical Needs ◽  
Team Working ◽  
Surgical Critical Care ◽  
Expected Mortality ◽  
Service Data ◽  
National Emergency

Abstract Aims The National Emergency Laparotomy Audit (NELA) results show that only 28.8% of all patients over 65years having emergency laparotomy had Geriatrician input. Advancing age predisposes to more complex medical needs due to a higher prevalence of co-morbidities, polypharmacy, cognitive impairment, and physiological frailty. Introduction of perioperative geriatrician input has been demonstrated to significantly reduce post-operatively mortality (national average 9.5%, rising to 20-40% in older age). We introduced a Geriatrician led liaison team with the initial aim to reduce 30-day mortality in older patients undergoing emergency laparotomy. Methods Prospective database was maintained of all eligible patients reviewed by the new service. Data on Rockwood Clinical Frailty Score (CFS), NELA risk prediction score, length of stay, mortality and complications were analysed. In this service development pilot we specifically assessed age and frailty demographics, expected mortality, and actual mortality in the cohort. Results All NELA patients 65 and over were reviewed by the service between September and December 2020, 35 in total. Median age 77 years; Median CFS 3 (range 2-6); Median NELA mortality risk 12% (range 0.9%-55.8%). Inpatient mortality was 2.9% and 30-day mortality 2.9% during this study period, compared to 18% in the previous year.  Conclusion Our pilot study demonstrates that development of an embedded Geriatrician liaison service for patients undergoing emergency laparotomy is achievable in a district general hospital. Consistent with other larger scale studies we demonstrated significant mortality reduction in older adults undergoing emergency laparotomy with the new service offering enhanced inter-disciplinary Surgical, Critical Care and Geriatrician team-working.

scholarly journals National emergency laparotomy audit in a district general hospital

2018 ◽  
Vol 55 ◽  
pp. S52
Author(s):  
G. Hui Chin Lim ◽  
K. McLauglin ◽  
D. Elahmin ◽  
M. Babiker ◽  
I. Hamad ◽  
...  
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Emergency Laparotomy ◽  
National Emergency

scholarly journals The use of pre-operative computed tomography in the assessment of the acute abdomen

2012 ◽  
Vol 94 (2) ◽  
pp. 102-107 ◽  
Author(s):  
J Weir-McCall ◽  
A Shaw ◽  
A Arya ◽  
A Knight ◽  
DC Howlett
Keyword(s):  
Computed Tomography ◽  
Diagnostic Accuracy ◽  
General Hospital ◽  
Acute Abdomen ◽  
District General Hospital ◽  
Operative Intervention ◽  
Emergency Laparotomy ◽  
Senior Consultant ◽  
Original Report

INTRODUCTION While there are a lot of data on the accuracy of computed tomography (CT) in diagnosing specific causes of an acute abdomen, there is very little information on the accuracy of CT in the acute general surgical admissions workload. We look at the diagnostic accuracy of CT in patients presenting with an acute abdomen who ultimately required a laparotomy. METHODS Patients who underwent an emergency laparotomy between 2008 and 2010 at Eastbourne District General Hospital with pre-operative CT on the same admission were included in the study. The CT report was compared with the laparotomy and histology findings and, where a discrepancy existed, the original imaging was reviewed by a senior consultant blinded to the original report and laparotomy findings. RESULTS A total of 196 emergency laparotomies were performed over the 2–year period, with 112 patients undergoing pre-operative CT. Fifteen patients were excluded from the study due to missing notes. In the remaining 97 patients, 80 CT reports correlated with the final operative diagnosis, giving a diagnostic accuracy of 82%. Of these, the on-call registrar was the initial reporter in 37 scans, with a diagnostic accuracy of 78%. On review of the CT by a second consultant, this increased to 90 correlations, yielding an accuracy of 93%. Delay between CT and the operation did not significantly alter diagnostic accuracy, nor was there any statistically significant reduction in accuracy in reports issued by on-call registrars. CONCLUSIONS On first reporting, CT misses 18% of diagnoses that ultimately require operative intervention. Reducing the threshold for obtaining a second consultant radiologist review significantly improves the diagnostic accuracy to 93%.

scholarly journals 670 Documentation and Communication of National Emergency Laparotomy Audit (NELA) Mortality and Morbidity Scoring with Patients Prior To Consenting: Are We Following the Best Practice?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Barghash ◽  
J Rehman ◽  
F Salimi ◽  
M Mansour
Keyword(s):  
Best Practice ◽  
District General Hospital ◽  
Management Plan ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
Retrospective Audit ◽  
Risk Of Mortality ◽  
The Uk ◽  
National Emergency ◽  
Management Alternatives

Abstract Aim Patients presenting as an emergency have a greater risk of dying than those admitted electively. The ability to stratify risk and calculate a percentage chance of death, not only gives the clinical team a common language to be able to formulate a management plan but also enables them to communicate this with patients and their families. This includes a full explanation of potential risks, benefits, a ceiling of care and management alternatives. In this project, we assessed if the NELA score has been properly calculated, documented prior to surgery for every emergency laparotomy patient and whether such patients were aware of NELA risk predictions prior to consenting. Method This was a retrospective audit based on the NELA guidelines of pre-operative risk stratification and the fifth report NELA recommendations. We assessed 50 case notes of patients who had laparotomies from January 2019 to April 2020 in a busy district general hospital in the UK. Results We noted that NELA risk prediction score was not utilised/documented in most of the patients with compliance of only 26%. We also found that, in the majority of notes, no NELA score discussion with the patient/family was documented, even with patients who had their NELA score calculated preoperatively. Compliance was only 14% in relation to this category. Conclusions A formal assessment of the risk of mortality and morbidity should be made explicit to each patient and should be recorded clearly in the consent form and medical record.

scholarly journals 1156 NELA – Time to Antibiotics

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Waterman ◽  
M Abdel-Dayem
Keyword(s):  
District General Hospital ◽  
Abdominal Sepsis ◽  
Emergency Laparotomy ◽  
Early Administration ◽  
Suspected Sepsis ◽  
Current Time ◽  
Clinical Notes ◽  
Retrospective Audit ◽  
Time To Antibiotics ◽  
National Emergency

Abstract Introduction Early administration of antibiotics is vital in patients that have intra-abdominal sepsis. The National Emergency Laparotomy Audit (NELA) 2019 found only 19% of patients with suspected sepsis received antibiotics in the first hour. The aim of this project was to audit the current time to antibiotics in patients who underwent an emergency laparotomy in our District General Hospital (DGH) in Wales. Method This was a retrospective audit of all patients that underwent an emergency laparotomy between January to July 2019. Data was collected from the NELA database and Clinical Notes. Results 33 patients underwent an emergency laparotomy, 2 patients were excluded leaving a total of 31 patients. 55% of patients received antibiotics prior to theatre. 61% of patients triggered the systemic inflammatory response syndrome (SIRS) criteria on admission but only 47% of these patients received antibiotics. Of those that received antibiotics only 16% had them prescribed within 1 hour of arriving to the hospital. 41% of patients waited over an hour from the antibiotics being prescribed to receiving them and 1 patient did not receive the antibiotics at all. Conclusions This project shows there are many areas for improvement. Although antibiotics maybe prescribed, clear communication with nursing staff is important, so that they can be given in a timely manner. It is also important simple measures, like working cannulas, do not prevent administration of antibiotics. Re-audit of these results is vital after education. Some patients may not require antibiotics – but missing those that do could cost lives!

scholarly journals Working Collaboratively: Outcomes of Geriatrician Input in Older Patients Undergoing Emergency Laparotomy in a District General Hospital

Cureus ◽  
2020 ◽  
Author(s):  
Kashuf A Khan ◽  
Thejasvi Subramanian ◽  
Megan Richters ◽  
Ayesha Mubarik ◽  
Abdalla Saad Abdalla Al-Zawi ◽  
...  
Keyword(s):  
General Hospital ◽  
Older Patients ◽  
District General Hospital ◽  
Emergency Laparotomy

scholarly journals Deliberate self-harm: service development in Kettering

1995 ◽  
Vol 19 (8) ◽  
pp. 475-477 ◽  
Author(s):  
Catherine Gordon ◽  
Andrew Blewett
Keyword(s):  
General Hospital ◽  
Service Provision ◽  
Public Health Problem ◽  
District General Hospital ◽  
Service Development ◽  
Paracetamol Poisoning ◽  
Deliberate Self Harm ◽  
Threefold Increase ◽  
Self Harm ◽  
Recent Trends

Services for deliberate self-harm patients in the general hospital are unsatisfactory in many respects. A survey of activity and quality in a district general hospital confirmed recent trends observed elsewhere and highlights areas in which service provision can be improved.High rates of deliberate self-harm (DSH) are a public health problem. A study in Oxford showed rising rates among young women during the late 1980s, and a threefold increase in the proportion due to paracetamol poisoning between 1976 and 1990 (Hawton & Fagg, 1992). A multicentre European study found a trend of increasing peak age, a declining female to male ratio, and unexplained differences between regions (Platt, 1992). In the year following DSH, 9% repeat (Hawton & Fagg, 1992); and suicide rates reach 1.1 to 1.3% of patients in the three years following an episode of DSH (Owens et al. 1991).

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