EP.FRI.461 Management of acutely ill surgical patients NICE guidance CG50: a complete audit cycle

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shrinivas Kalaskar ◽  
Mathew Bonomoully
Keyword(s):  
General Surgery ◽  
Surgical Patients ◽  
Initial Assessment ◽  
Audit Tool ◽  
Trigger System ◽  
Nice Guidelines ◽  
Suboptimal Care ◽  
Nice Guidance ◽  
Audit Cycle ◽  
Time Of Admission

Abstract Aim NICE CG50 guidelines are a response to evidence suggesting patients who are, or become, acutely unwell may receive suboptimal care. The guidelines suggest: After previously unsuccessful audits a fourth re-audit was designed to re-assess compliance with the CG 50 guidelines. Method After implementing previous recommendations like, keeping a poster of recommendations in the handover room and making these guidelines as part of surgical induction, a re-audit was planned. A prospective random sample of 40 patients admitted during the general surgery was taken. Using the audit tool the following parameters were recorded for each patient in the sample: Results The compliance was 100% for patients who have had their physiological observations recorded at the time of admission or initial assessment, the percentage of patients monitored using a physiological track and trigger system, and the percentage whose physiological observations were monitored at least every 12 hours. The compliance was 95% for the percentage of patients with a clear written monitoring plan. Conclusions Following the interventions detailed above, there is now 95 to 100% compliance with NICE guidelines in the documentation.

scholarly journals SP2.1.10Prescription of regular medications to surgical patients within 24 hours of admission:Is it being done?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Anil Rai ◽  
Rhea Singh ◽  
Katherine Brown
Keyword(s):  
Retrospective Analysis ◽  
General Surgery ◽  
Family Members ◽  
Time Limit ◽  
Surgical Patients ◽  
Age Group ◽  
History Taking ◽  
Medication History ◽  
Time Of Admission ◽  
Careful History

Abstract Aim Prescription of necessary regular medications to patients within 24 hours of admission to the hospital is vital for better healthcare. Our aim was to analyse whether regular medications were prescribed to all general surgical patients within that time limit, to find the rationale behind the shortcomings and to suggest a more efficient way to overcome them. Materials and Methods A retrospective analysis of 186 surgical patients in the month of February 2020 who stayed in the hospital for more than 24 hours in General Surgery (167) and Urology (19) were analysed. Out of these, 100 were females and 86 males with the maximum in age group of 31-60 years (80) and 75 patients were more than 6o years. 11 groups of medications were analysed. Findings Conclusion More attention needs to be paid towards prescribing medications at the earliest. This could be improved by careful history taking and prescribing medications at the time of admission itself; GP to include all the medication history while referring a patient, liaising with pharmacist and family members for confirming the patients’ medications and providing portable bedside computers for doctors while they are seeing patients.

scholarly journals Clinical Utility of Peri-Operative C-Reactive Protein Testing in General Surgery

2008 ◽  
Vol 90 (4) ◽  
pp. 317-321 ◽  
Author(s):  
Duncan S Cole ◽  
Andrew Watts ◽  
David Scott-Coombes ◽  
Tony Avades
Keyword(s):  
General Surgery ◽  
Surgical Patients ◽  
Response To Treatment ◽  
Clinical Indication ◽  
C Reactive Protein ◽  
Nice Guidelines ◽  
Reactive Protein ◽  
Co Morbidity ◽  
Diagnosis Of Infection ◽  
Monitoring Response

INTRODUCTION C-reactive protein (CRP) is an acute-phase protein used clinically to diagnose infectious and inflammatory disease and monitor response to treatment. CRP measurement in the peri-operative period was audited and patterns of change analysed for elective general surgical patients. PATIENTS AND METHODS General surgical patients (201) admitted for elective general surgery over a 3-month period were considered for the study. CRP results pre- and postoperatively were recorded, and data on co-morbid conditions and surgical procedure were noted. RESULTS CRP was requested pre-operatively on 84% of patients. A high CRP was more likely to be found in patients with co-morbidity. Postoperatively, CRP was requested during the first 3 days on 69% of patients. CRP peaked at postoperative days two or three, and then fell. In patients who had a high pre-operative CRP, the peak CRP was higher and occurred later, than those who had a normal pre-operative CRP. CONCLUSIONS CRP requesting pre-operatively is common, but is not recommended in NICE guidelines. Postoperatively, CRP levels rise; as a result, its use as a tool to screen for infection is limited. CRP has a role in diagnosis of infection after the first three postoperative days and in monitoring response to treatment. Therefore, routine use of CRP measurements pre-operatively and in the first 2 or 3 days post-operatively is not recommended. A peri-operative CRP should only be requested if there is a clear clinical indication.

Referral patterns for catheter-directed thrombolysis for iliofemoral deep venous thrombosis

2021 ◽  
pp. 026835552097728
Author(s):  
Kirtan D Patel ◽  
Alison YY Tang ◽  
Ashik DJ Zala ◽  
Rakesh Patel ◽  
Kishan R Parmar ◽  
...  
Keyword(s):  
Lower Limb ◽  
Management Option ◽  
Venous Anatomy ◽  
Nice Guidelines ◽  
Patient Demographics ◽  
Radiology Reports ◽  
Catheter Directed Thrombolysis ◽  
Nice Guidance ◽  
Icd 10 ◽  
Venous Thromboses

Objectives Post thrombotic syndrome (PTS) is a serious complication of deep venous thromboses (DVTs). PTS occurs more frequently and severely following iliofemoral DVT compared to distal DVTs. Catheter directed thrombolysis (CDT) of iliofemoral DVTs may reduce PTS incidence and severity. We aimed to determine the rate of iliofemoral DVT within our institution, their subsequent management, and compliance with NICE guidelines. Methods Retrospective review of all DVTs diagnosed over a 3-year period was conducted. Cases of iliofemoral DVT were identified using ICD-10 codes from patient notes, and radiology reports of Duplex scans. Further details were retrieved, such as patient demographics and referrals to vascular services. NICE guidance was applied to determine if patients would have been suitable for CDT. A survey was sent to clinicians within medicine to identify awareness of CDT and local guidelines for iliofemoral DVT management. Results 225 patients with lower limb DVTs were identified. Of these, 96 were radiographically confirmed as iliofemoral DVTs. The median age was 77. 67.7% of iliofemoral DVTs affected the left leg. Right leg DVTs made up 30.2% and 2.1% were bilateral DVTs. Of the 96 iliofemoral DVTs, 21 were deemed eligible for CDT. Only 3 patients (14.3%) were referred to vascular services, and 3 received thrombolysis. From our survey, 95.5% of respondents suggested anticoagulation alone as management for iliofemoral DVT. Only one respondent recommended referral to vascular services. There was a knowledge deficiency regarding venous anatomy, including superficial versus deep veins. Conclusions CDT and other mechanochemical procedures have been shown to improve outcomes of patients post-iliofemoral DVT, however a lack of awareness regarding CDT as a management option results in under-referral to vascular services. We suggest closer relations between vascular services and their “tributary” DVT clinics, development of guidelines and robust care pathways in the management of iliofemoral DVT.

scholarly journals 828 Is Isolation Before Elective Surgery the Way Forward During The COVID-19 Pandemic?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S James ◽  
G Lafaurie ◽  
R Hafeez
Keyword(s):  
High Risk ◽  
General Surgery ◽  
Elective Surgery ◽  
Patient’S Satisfaction ◽  
Anonymous Questionnaire ◽  
Nice Guidance ◽  
Main Factors ◽  
Mode Of Transport ◽  
Isolation Period ◽  
The Way

Abstract Introduction The COVID-19 pandemic is here to last, and services must adapt to enable elective surgery to continue. Surgery involves high-risk aerosol generating procedures, potentially harmful to staff and patients. The current NICE guidance is for the patient to self-isolate for 72 hours prior to surgery. A question persists: Is 72-hour isolation the way forward in elective general surgery? Method In a DGH centre, using an anonymous questionnaire, we prospectively collected data on isolation for 36 elective general surgery patients during the 72h isolation period. The data was analysed to assess the concordance with isolation as well as patient's satisfaction with the process. Results 75% of patients were concordant with 72 hours of isolation pre-operatively. This was an increase from 35% when compared to patients questioned during the 14 day isolation period. The main factors contributing to isolation breech were visitors to the house and the mode of transport used to attend hospital. Conclusions The protocol is now for a COVID swab 72 hours pre-operatively followed by isolation until the operation. Our results show that still significant breaches in isolation remain and patients welfare is adversely affected during that period. Further research and consideration is needed to optimise the COVID isolation protocol.

NICE gets tooled up

2001 ◽  
Vol 6 (4) ◽  
pp. 231-232 ◽  
Author(s):  
Valerie Beattie ◽  
Brian Hockley
Keyword(s):  
Essential Element ◽  
Clinical Governance ◽  
Audit Process ◽  
Nice Guidelines ◽  
Practical Support ◽  
Nice Guidance ◽  
Multi Level ◽  
Minimum Dataset

To date over 20 guidelines or technology appraisals have been issued. At first, it seemed implicit that these guidelines would be subject to the audit process and that NICE would provide guidance and practical support for undertaking this activity. NICE have now issued a template for the audit of NICE guidelines based on a multi‐level approach. While audit of NICE guidance is an essential element of the whole clinical governance agenda, the burden of work that this could introduce to Trusts may be unsustainable. Suggests possible alternatives to auditing NICE guidance and proposes the use of a minimum dataset and full exploitation of electronic means of data harvesting.

Surgical audit: are we not closing the loop?

2018 ◽  
Vol 31 (8) ◽  
pp. 966-972 ◽  
Author(s):  
Declan Dunne ◽  
Nikhil Lal ◽  
Nagarajan Pranesh ◽  
Michael Spry ◽  
Christopher Mcfaul ◽  
...  
Keyword(s):  
No Value ◽  
General Surgery ◽  
Clinical Medicine ◽  
Multi Centre Study ◽  
Content Type ◽  
Closing The Loop ◽  
Audit Cycle ◽  
Surgical Audit ◽  
Audit Activity ◽  
Clinical Audits

PurposeA clinical audit is a key component of the clinical governance framework. The rate of audit completion in general surgery has not been investigated. The purpose of this paper is to assess the rates of audit activity and completion and explore the barriers to successful audit completion.Design/methodology/approachThis was a multi-centre study evaluating current surgical audit practice. A standardised audit proforma was designed. All clinical audits in general surgery during a two-year period were identified and retrospectively reviewed. Data held by the audit departments were collated, and individual audit teams were contacted to verify the data accuracy. Audit teams failing to complete the full audit cycle with a re-audit were asked to explain the underlying reasons behind this.FindingsOf the six trusts approached, two refused to participate, and one failed to initiate the project. A total of 39 audits were registered across three surgical directorates. Only 15 out of 39 audits completed at least one audit cycle, with 4 deemed of no value to re-audit. Only seven audits were completed to re-audit. Achieving a publication or a presentation was the most cited reason for not completing the audit loop.Originality/valueThis study demonstrates that the poor rates of audit completion rate found in other areas of clinical medicine pervade general surgery. Improved completion of an audit is essential and strategies to achieve this are urgently needed.

scholarly journals Clinical profile and outcome of pediatric surgical patients in a rural tertiary centre

2021 ◽  
Author(s):  
Sunil Pathak ◽  
R. V. Mhapsekar ◽  
Neeraj Gupta ◽  
Karthik Surabhi ◽  
Shruchi Bhargava ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Clinical Profile ◽  
Surgical Patients ◽  
Curative Therapy ◽  
Tertiary Centre ◽  
Number Of Patients ◽  
Important Means ◽  
Surgical Conditions ◽  
Time Of Admission ◽  
Surgical Condition

Background: Pediatric surgery is a sub-speciality involving the surgery of foetuses, infants, children and adolescents. Congenital malformations, trauma and childhood cancers are their three major concerns requiring the focus of their attention. Rural pediatric population in India still remains devoid of such facilities. Little is factually known about the burden of surgical disease globally. Surgical treatment is an essential component of basic medical care and an important means of providing preventive and curative therapy. Pediatrician has a significant role in caring for surgical patients. There is a need to know the spectrum of diseases that warrant admission into the pediatric surgical units. Current study was conducted to find out the clinical profile and immediate outcome of the various pediatric surgical conditions. Methods: This prospective observational study was conducted at Vadodara. All the patients 0-18 years, with surgical condition were enrolled in the study. Patients were followed from the time of admission to discharge.  All the clinical data from admission to discharge were recorded and analyzed.Results: Total 127 (3%) patients were enrolled in the study. Males were 93 (73.2%). One to 5 years 45 (35.4%) was the largest age group folowed by infants 23 (18.1%). Largest number of patients were from Gastro Intestinal Condition 52 (40.9%) and congenital causes forms 83 (65.35%) of admissions. Commonest congenital anomaly was inguinal hernia 23 (27.7%). Complications were recorded in 46 (36.22%) patients. The average duration of stay was 7.7 days. The 124 patients were discharged successfully.Conclusions: Surgical conditions are important part of pediatric and neonatal care. Management of congenital surgical condition is important to decrease infant and under five mortality and other comorbidities as well.

scholarly journals 1229 Standardising Consent for General Surgical Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Mamun ◽  
E Charles
Keyword(s):  
Informed Consent ◽  
Hernia Repair ◽  
General Surgery ◽  
Case Note ◽  
Surgical Patients ◽  
Standards Of Care ◽  
Retrospective Case ◽  
Incision And Drainage ◽  
Consent Forms ◽  
Surgical Practice

Abstract Aim Informed consent requires all material risks to be discussed, as per Montgomery vs Lanarkshire 2015. This audit was based on the latest RCS England guidelines on consenting patients. We aimed to assess our adherence and to introduce standardised procedure-specific consent stickers to ensure the highest standards of care, which were reproducible. Method We undertook two retrospective case note reviews of patients undergoing emergency and elective general surgery procedures from 01/01-15/06 and 01/10-30/11 in 2020. RCS Good Surgical Practice 3.5.1 “Consent” details the standards for this audit. We included patients undergoing appendicectomy, cholecystectomy, incision and drainage and hernia repair (inguinal, umbilical, and incisional). We did not audit laparotomy due to variability in procedural risks precluding a specific sticker and we excluded patients unable to give consent. Results Our initial audit of 82 patients highlighted the variability between practitioners in the material risk discussion. Different patients undergoing the same procedures were being consented differently with significant omissions. We designed procedure specific-consent stickers to be used when consenting to address this imbalance and made these stickers available on surgical wards. A re-audit of 50 patients showed increase from 41% to 88% in documentation of material risks. While only 34% of the audited consent forms featured the stickers, those forms that did have the stickers on had 100% material risk documentation. Conclusions We saw an improvement in material risk discussion by implementing procedure-specific consent stickers. This supports the growing need for standardising consent across General Surgery to reduce variability. We will next aim to design laparotomy stickers.

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