scholarly journals SP2.2.12Safety and Quality using GIRFT parameters; the use of hospital coded data as a quality measure

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Helen Fifer ◽  
Muhammad Ibrar Hussain ◽  
Tamsyn Grey ◽  
Arin Saha ◽  
Mark Peter
Keyword(s):  
Performance Metrics ◽  
Central Venous Access ◽  
Venous Access ◽  
Unplanned Readmission ◽  
Hospital Level ◽  
Governance System ◽  
Level Data ◽  
Mortality Review ◽  
General Surgeons ◽  
National Databases

Abstract Aim Several indicators measure performance of hospital departments. Despite keeping accurate personal logbooks, surgeons rarely interrogate hospital-level data though these are used nationally (such as on HES databases) to assess performance. This study assessed the accuracy of hospital-level data. Methods Patients who were recorded as having had a length of stay (LoS) of > 7 days, readmissions and patients who had a return to theatre were identified. A weekly ‘Safety and Quality (SnQ)’ governance meeting was established where consultant general surgeons assessed and analysed these data. Differences between hospital level data and outcomes after consultant review were compared. Results Over a six month study period, there were 306 patients (32 elective, 274 acute) who had a LoS of > 7 days. After review, just 33 patients (13%) had a prolonged LoS due to a complication whereas the majority were due to non-surgical reasons. There were 789 coded readmissions. Most coded readmissions were actually planned with 318 patients (43%) having an unplanned readmission. There were 47 recorded cases of a ‘return to theatre’ but after review, one-third (15 cases) were for planned central venous access and 22 cases were planned returns. Conclusions This responsive and accurate clinical governance system can assess performance beyond standard morbidity and mortality review. Hospital-level data often miss nuance; in this study, most coded readmissions were planned rather than unplanned and these discrepancies may reflect poorly on the department if entered onto national databases. Engagement with these data can help units improve outcomes and accuracy of their performance metrics.

Successful Long-Term Central Venous Access

1998 ◽  
Vol 2 (1) ◽  
pp. 38-40
Author(s):  
Franco Tesio ◽  
Hamurabi De Baz ◽  
Giacomo Panarello
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Central Venous

Upper Extremity Deep Venous Thrombosis in Cancer Patients with Venous Access Devices - Prophylaxis with a Low Molecular Weight Heparin (Fragmin)

1996 ◽  
Vol 75 (02) ◽  
pp. 251-253 ◽  
Author(s):  
Manuel Monreal ◽  
Antoni Alastrue ◽  
Miquel Rull ◽  
Xavier Mira ◽  
Jordi Muxart ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Upper Extremity ◽  
Statistical Significance ◽  
Central Venous Access ◽  
Venous Access ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
Central Venous ◽  
True Incidence ◽  
Venous Access Devices

SummaryCentral venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism.We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily for 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested.On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% Cl: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 ±145 vs 207 ±81 X 109/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.

Evaluation of Different Turbulence Models for the Characterization of Shear Stresses in the Central Venous Access for Hemodialysis

2020 ◽  
Author(s):  
Saulo Gonçalves ◽  
Matheus Costa ◽  
Thabata Lucas ◽  
Jonathas Haniel ◽  
Mário Silva ◽  
...  
Keyword(s):  
Central Venous Access ◽  
Turbulence Models ◽  
Venous Access ◽  
Shear Stresses ◽  
Central Venous

Prevention of Infection in Adults Receiving Intravenous Antibiotic Treatment via Indwelling Central Venous Access Devices

2019 ◽  
Vol 14 (1) ◽  
pp. 47-49
Author(s):  
Basant K. Puri ◽  
Anne Derham ◽  
Jean A. Monro
Keyword(s):  
Bloodstream Infection ◽  
Antibiotic Treatment ◽  
Central Venous Access ◽  
Case Series ◽  
Bloodstream Infections ◽  
Venous Access ◽  
Host Cells ◽  
Central Venous ◽  
Intravenous Antibiotic ◽  
Venous Access Devices

Background: The use of indwelling Central Venous Access Devices (CVADs) is associated with the development of bloodstream infections. When CVADs are used to administer systemic antibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developing Clostridium difficile infection. The overall bloodstream infection rate is estimated to be around 1.74 per 1000 Central Venous Catheter (CVC)-days. Objective: We hypothesised that daily oral administration of the anion-binding resin colestyramine (cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment via CVADs. Method: A small case series is described of adult patients who received regular intravenous antibiotic treatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; this represented a total of 357 CVC-days. In addition to following well-established strategies to prevent C. difficile infection, during the course of the intravenous antibiotic treatment the patients also received daily oral supplementation with 4 g colestyramine. Results: There were no untoward infectious events. In particular, none of the patients developed any symptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infection would have been expected. Conclusion: It is suggested that oral colestyramine supplementation may help prevent such infection through its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins are able to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibody responses to TcdA and TcdB have been shown to induce protection against C. difficile infection sequelae.

A Psychometric Validation of the Decisional Conflict Scale in Italian Cancer Patients Scheduled for Insertion of Central Venous Access Devices

2020 ◽  
Vol 40 (10) ◽  
pp. 5583-5592
Author(s):  
MARIA ROSARIA ESPOSITO ◽  
ASSUNTA GUILLARI ◽  
FRANCESCO GIANCAMILLI ◽  
TERESA REA ◽  
MICHELA PIREDDA ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Central Venous Access ◽  
Venous Access ◽  
Decisional Conflict ◽  
Psychometric Validation ◽  
Central Venous ◽  
Decisional Conflict Scale ◽  
Venous Access Devices ◽  
Conflict Scale
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