EP.FRI.362 Improving Prescribing and Minimising Delay in Administration of Potassium Replacement Therapies: Surgical Audit on Management of Hypokalaemia in Emergency Surgical Unit at a District General Hospital in UK

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ji Young Park ◽  
Dinh Van Chi Mai ◽  
George Tenovici
Keyword(s):  
Length Of Stay ◽  
Potassium Level ◽  
Group Analysis ◽  
District General Hospital ◽  
Surgical Patients ◽  
Current Guideline ◽  
Potassium Replacement ◽  
Surgical Audit ◽  
Surgical Unit ◽  
Local Guideline

Abstract Aims Surgical patients are prone to hypokalaemia due to gastrointestinal losses1. Hypokalaemia prolongs ileus2 and thus prompt management is essential. No current guideline on hypokalaemia focuses on surgical patients. We aimed to identify the prevalence of hypokalaemia in emergency surgical patients as well as measure timeliness and appropriateness of replacement. Methods We retrospectively reviewed adult emergency surgical admissions exceeding 48 hours between 05/05/2020 and 15/07/2020.  A sub-group analysis assessed the timing of intravenous replacement and duration taken to normalise potassium (3.5 mmol/L). We used another NHS trust’s guideline3 as standard for appropriate potassium replacement.  Results Of 110 surgical admissions, 26 cases were hypokalaemic. Of these, 15 had initially normal potassium level. Three cases were likely iatrogenic secondary to inappropriate fluid prescribing. Mean potassium in the hypokalaemic group was 3.2 mmol/L (80.8% mild vs. 19.2% moderate). Mean length of stay was 11.3 days for hypokalaemia versus 6.54 days in normokalaemic cases. Mean duration of hypokalaemia was 2.13±1.45 days. Potassium replacement was prescribed correctly in only 50% of cases (23% not prescribed; 25% insufficient; 2% incorrect) and of these correct prescriptions, 46% were not actually administered. When intravenous replacement was given, there was a mean 3.55-hour delay between lab result and administration.  Conclusion The majority of hypokalaemic cases developed during admission. Only 27% of these patients had correct potassium replacement in terms of both prescription and administration. Consequently, we have created a local guideline for hypokalaemia in surgical patients to standardise both prevention and management.

scholarly journals Hip Fractures in Centenarians: Has Care Improved in the National Hip Fracture Database Era?

2017 ◽  
Vol 8 (3) ◽  
pp. 161-165 ◽  
Author(s):  
Alastair G. Dick ◽  
Dominic Davenport ◽  
Mohit Bansal ◽  
Therese S. Burch ◽  
Max R. Edwards
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
District General Hospital ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Retrospective Case ◽  
Time To Surgery ◽  
Surgery Mortality ◽  
Hospital Acquired

Introduction: The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications. Methods: A retrospective case note study of all centenarians managed for a hip fracture over a 7-year period at a London district general hospital. Results: We report on 22 centenarians sustaining 23 hip fractures between 2008 and 2015. Twenty-one fractures were managed operatively. For patients managed operatively, in-hospital, 30-day, 3-month, 6-month, 1-year, 2-year, 3-year, and 5-year cumulative mortalities were 30%, 30%, 39%, 50%, 77%, 86%, 95%, and 100%, respectively. In-hospital mortality was 100% for those managed nonoperatively. Mean time to surgery was 1.6 days (range: 0.7-6.3 days). Mean length of stay on the acute orthopedic ward was 23 days (range: 2-51 days). Seventy-one percent had a postoperative complication most commonly a hospital-acquired pneumonia or urinary tract infection. Conclusion: Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.

SP3.2.10 Establishing an Emergency Surgical Ambulatory Care (ESAC) pathway for acute laparoscopic cholecystectomies: a single centre experience from a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Neil Donald ◽  
Lavanya Varatharajan ◽  
Kumaran Ratnasingham ◽  
Shashi Irukulla
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Ambulatory Care ◽  
Operating Time ◽  
District General Hospital ◽  
Gallstone Pancreatitis ◽  
Early Laparoscopic Cholecystectomy ◽  
Patient Demographics ◽  
Day Range ◽  
Cost Efficiencies

Abstract Aims Early laparoscopic cholecystectomy is the gold standard for acute cholecystitis and gallstone pancreatitis. In order to deliver this service, a local Emergency Surgical Ambulatory Care (ESAC) pathway with a dedicated ESAC theatre list was established. The aim of this audit was to determine whether ESAC was associated with (1) improved length of stay and (2) cost efficiencies. Methods Consecutive patients who underwent an emergency laparoscopic cholecystectomy between October 2018 to October 2019 were identified. Data related to patient demographics, operating time, complications length of stay (LOS), reason for inpatient stay and re-admissions were collected. A dedicated ESAC service was introduced in July 2020. Outcomes were re-audited (July – December 2020). Results Prior to the introduction of ESAC, 142 patients (42% male, mean age 51 years (range 14 -82 years)) underwent an acute cholecystectomy, of which 13% were discharged on the same day. Median pre-operative LOS was 2 days (range 0-12 days) and median post-operative LOS was 1 day (range 1-16 days). Following the introduction of ESAC, 78 patients (32% male, mean age 49 years (range 22 – 89 years)) underwent an acute cholecystectomy, of which 76% were discharged on the same day and 90% within 1 day. Median pre-operative LOS was 0 days (range 0 to 7 days) and median post-operative LOS was 0 days (range 0-16 days). Conclusions Our results show that the introduction of a dedicated ESAC pathway improved both pre- and post-operative LOS. This subsequently saves approximately £80,000 per annum in hospital bed days.

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.

MON-P193: Malnutrition has Negative Effects on Postoperative Complications, Length of Stay and Readmissions at Surgical Patients

2017 ◽  
Vol 36 ◽  
pp. S249-S250 ◽  
Author(s):  
P. Sarkut ◽  
S. Kilicturgay ◽  
E.S. Kerim ◽  
O. Sütcüoglu ◽  
G. Dundar ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Surgical Patients ◽  
Negative Effects

scholarly journals Shortening Postoperative Stay after Parathyroidectomy - A District General Hospital Experience

2019 ◽  
Vol 24 (03) ◽  
pp. e313-e318
Author(s):  
Sidhartha Sinha ◽  
Matthew Fok ◽  
Ijaz Ahmad ◽  
Mustafa Al-Sheikh ◽  
Christopher Backhouse
Keyword(s):  
Patient Education ◽  
Length Of Stay ◽  
District General Hospital ◽  
Unplanned Readmission ◽  
Short Stay ◽  
Retrospective Audit ◽  
Parathyroid Adenomas ◽  
Biochemical Cure ◽  
Postoperative Length ◽  
Preoperative Patient

Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure. Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP). Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015. Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas.The length of stay decreased from a median of 3 days (range 2–9 days; mean 3.32) preprotocol to a median of 2 days (range 2–3 days; mean 2.16) postprotocol (p < 0.0001) with no difference in the 30-day unplanned readmission rate (4.8 versus 2.9%; p = 0.999). Conclusions The postoperative length of stay after parathyroidectomy for PHP can be safely reduced through patient education and by rationalizing postoperative calcium management without adversely affecting outcomes.

Comparing Surgical Efficiency in Independent Practice Association HMOS and Traditional Insurance Programs

1993 ◽  
Vol 6 (2) ◽  
pp. 99-108
Author(s):  
Robert C. Bradbury ◽  
Joseph H. Golec ◽  
Frank E. Stearns
Keyword(s):  
Length Of Stay ◽  
Resource Use ◽  
Severity Of Illness ◽  
Multiple Regression Model ◽  
Surgical Patients ◽  
Independent Practice ◽  
Positive Coefficient ◽  
Beta Coefficient ◽  
Independent Practice Association ◽  
Total Charges

This study examines the effect of Independent Practice Association (IPA) HMO membership on hospital total charges, ancillary charges and length of stay (LOS) for surgical patients. Intrahospital comparisons of IPA and traditional insurance patients are made after adjusting for surgical procedure, admission severity of illness, age, sex and year of admission. Our multiple regression model indicates that IPA patients undergoing 12 frequently occurring surgical procedures have lower resource use. Eight (80%) of the 10 study hospitals exhibit a negative IPA beta coefficient for total charges, ancillary charges and LOS. Five (50%) hospitals have statistically significant (p <0.05) negative coefficients for total charges, while one (10%) hospital has a significant positive coefficient. IPA patients exhibit adjusted total charges that are 6% lower than traditional insurance, ancillary charges that are 4.3% lower, and LOS that is 10% shorter.

scholarly journals Team-based extubation protocol in cardiac surgical patients reduces ventilation time and reduces length of stay in the ICU

Critical Care ◽  
2015 ◽  
Vol 19 (Suppl 1) ◽  
pp. P195
Author(s):  
JM Taculod ◽  
MJ Dajac ◽  
A Rosario ◽  
J Gammad ◽  
S Mahaju ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Surgical Patients ◽  
Ventilation Time

Prevalence of pressure ulcers in patients hospitalized in a surgical unit of a university hospital

2011 ◽  
Vol 5 (7) ◽  
pp. 1684
Author(s):  
Miguir Terezinha Vieccelli Donoso ◽  
Eline Lima Borges ◽  
Camila Patrícia Rennó Carazzato
Keyword(s):  
Nursing Care ◽  
Pressure Ulcers ◽  
Ethics Committee ◽  
Minas Gerais ◽  
Descriptive Statistics ◽  
University Hospital ◽  
Surgical Patients ◽  
Not At Risk ◽  
Transversal Study ◽  
Surgical Unit

ABSTRACTObjective: to identify the prevalence, staging, and risk for developing pressure ulcers (PU) of patients hospitalized in a surgical unit. Method: this is a transversal study, carried out with 20 surgical patients hospitalized in a university hospital in Minas Gerais, from both sexes, and older than 18 years. For the analysis the descriptive statistics – with distribution of frequency, minimum and maximum values, mean, standard deviation, and prevalence of PU – was used. The project was approved by the Universidade Federal de Minas Gerais Research Ethics Committee (process ETIC 150/05), Results: the prevalence of PU was 10%, 90% are not at risk for developing PU, two patients with PU presented 2 and 3 ulcers, respectively, classified as belonging to the stages I and II. Conclusion: considering the prevalence of PU, the need of an appropriate and individualized nursing care planning emerges, having as a reference each patient’s risk for developing this kind of ulcer. The need of adopting appropriate nursing practices has been realized, according to each patient’s risk score for developing PU. Descriptors: pressure ulcer; nursing; prevalence. RESUMOObjetivo: identificar a prevalência, o estadiamento e o risco de desenvolvimento de úlceras por pressão (UP) em pacientes internados em uma unidade cirúrgica, Método: estudo transversal, realizado com 20 pacientes cirúrgicos, internados em um hospital universitário de Minas Gerais, de ambos os sexos e com idade superior a 18 anos. Para análise utilizou-se estatística descritiva com a distribuição de freqüência, valores mínimos e máximos, mediana, desvio-padrão e prevalência de UP. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais com parecer ETIC 150/05, Resultados: a prevalência de UP foi de 10%, 90% eram sem risco para formação de UP, dois pacientes com UP apresentaram duas e três úlceras, respectivamente, classificadas em estágio I e II, Conclusão: diante da prevalência de UP, surge a necessidade de uma planificação de cuidados adequados e individualizada, tendo como referência o risco que cada paciente apresenta para o desenvolvimento dessa úlcera. Percebeu-se a necessidade de implementação de cuidados adequados, de acordo com o escore que cada paciente apresente para o desenvolvimento da UP. Descritores: úlcera por pressão; enfermagem; prevalência.RESUMENObjetivo: identificar la prevalencia, estadiamiento y el riesgo de desarrollo de úlceras por presión (UP) en pacientes internados en una unidad quirúrgica. Método: estudio transversal, realizado con 20 pacientes quirúrgicos, internados en un hospital universitario de Minas Gerais, de ambos sexos y con edad superior a 18 años. Para el análisis se utilizó la estadística descriptiva mediante la distribución de frecuencia, valores mínimos y máximos, mediana, desvío-estándar y prevalencia de UP. El proyecto se aprobó por el Comité de Ética en Pesquisa de la Universidad Federal de Minas Gerais con parecer/laudo ETIC 150/05. Resultados: la prevalencia de UP fue de 10%, 90% lo eran sin riesgo para formación de UP, dos pacientes con UP presentaron dos o tres úlceras, respectivamente, clasificadas en estadio I y II. Conclusión: cara a la prevalencia de UP, surge la necesidad de una planificación de cuidados y de forma individualizada, teniendo como referencia el riesgo que cada paciente presenta al desarrollo de esta úlcera. Se detectó la necesidad de implementación de cuidados adecuados, según el marcador que cada paciente presente al desarrollo de la UP. Descriptores: úlcera por presión; enfermería; prevalencia.

CHOLELITHIASIS: LENGTH‐OF‐STAY ANALYSIS IN TWO SERIES OF SURGICAL PATIENTS

1979 ◽  
Vol 2 (13) ◽  
pp. 691-693
Author(s):  
Anthony W. Ireland ◽  
Jane Harris ◽  
Jane Harris ◽  
Christopher G. Scarf ◽  
Christopher G. Scarf
Keyword(s):  
Length Of Stay ◽  
Surgical Patients
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