TP9.2.25No beds! Developing ambulatory surgical care in a District General Hospital

Abstract Aims Referrals to acute surgery are increasing by 10% a year with no increase in inpatient bed numbers. Our aims are to improve the patient experience with early review and provide early decision making preventing admission to hospital. In August 2019 we launched our ambulatory surgical service, in order to measure the impact we have reviewed every patient that has come through the service from its inception. Methods The service is manned by two dedicated surgical fellows based in an ambulatory unit with dedicated early morning USS slots available. To compare old with new we collated presentations into categories, for example ‘Right upper quadrant pain’ and compared the number of patients ‘ambulated’ to the average length of stay for patients with these presentations before ambulatory care. Results From August to October a total of 180 patients were ambulated via the new service. Using the comparison described this equated to approximately 423.05 ‘bed days’ saved the three-month initial period. Discharge times were spread throughout the day rather than ‘peaking’ with emergency team handover indicating an improved experience this has been backed up by qualitative reports from patients and families. Conclusion The introduction of the ambulatory service has improved the general surgical on-call experience at our hospital both for patients and clinicians alike, whilst decreasing surgical bed occupation. Utilising existing resources we have improved the patient experience, enabled quicker decision making and taken pressure away from the on-call.

Download Full-text

A Retrospective 05 Years Analysis of Operated Surgical Patients in Bangladesh Level II Hospital, UNMIL

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v9i1.18720 ◽

2014 ◽

Vol 9 (1) ◽

pp. 14-18

Author(s):

MB Uddin ◽

MU Ahmed ◽

MA Haque ◽

MD Hussain ◽

SME Hossain

Keyword(s):

Surgical Care ◽

Armed Forces ◽

Published Data ◽

Optimal Outcome ◽

Level Ii ◽

Number Of Patients ◽

Minor Surgery ◽

Surgical Conditions ◽

Logistic Support ◽

The Impact

Introduction: There is a paucity of published data on the type of surgical conditions that affect the UN personnel of different countries setup and the spectrum of surgical operations performed for these patients. Such information are necessary for assessing the impact of surgical conditions, both elective and emergency, on the health of UN peacekeepers from different races and nationalities and for setting priority to improve the surgical care. Objectives: To ascertain highest possible standard of surgical care to be ensured in an international arena for optimal outcome. Materials and methods: Five years retrospective study was carried out in Bangladesh level II hospital (BANMED), UNMIL located at Suakoko district of Liberia from April 2007 to April 2012 comprising of all major and minor surgical cases with different types of dressings done. Results: A total 83 major, 567 minor and 3924 dressings were done. The majority of operations were emergency cases of which 73.49% were of major and 78.30% were minor surgery. While 26.50% of major and 21.69% of minor surgery were elective cases. All were male patients in cases of major operations and 93.29% for minor cases as most of the peacekeepers were male personnel. The most frequent cases were acute appendicitis, inguinal hernia and polytrauma cases. Highest number of patients was 28 (33.73%) from 26-30 years age group. There were 3 minor postoperative complications with nil mortality rates. Conclusion: The surgical unit of a level-II hospital has to work in an adverse situation of a conflict area with various limitations. So it is very important to provide highest possible standard of surgical care to be ensured in terms of staff, equipments, logistic support and with a motivated surgical team in an international arena for optimal outcome. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18720 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 14-19

Download Full-text

The impact of COVID-19 on elective and trauma spine service in a district general hospital

Bone & Joint Open ◽

10.1302/2633-1462.16.bjo-2020-0059.r1 ◽

2020 ◽

Vol 1 (6) ◽

pp. 281-286

Author(s):

Wajiha Zahra ◽

Monil Karia ◽

Daniel Rolton

Keyword(s):

General Hospital ◽

District General Hospital ◽

Acute Hospital ◽

Retrospective Data ◽

Spine Trauma ◽

Clinical Criteria ◽

Time Period ◽

Number Of Patients ◽

Acute Hospital Admission ◽

The Impact

Aims The aim of this paper is to describe the impact of COVID-19 on spine surgery services in a district general hospital in England in order to understand the spinal service provisions that may be required during a pandemic. Methods A prospective cohort study was undertaken between 17 March 2020 and 30 April 2020 and compared with retrospective data from same time period in 2019. We compared the number of patients requiring acute hospital admission or orthopaedic referrals and indications of referrals from our admission sheets and obtained operative data from our theatre software. Results Between 17 March to 30 April 2020, there were 48 acute spine referrals as compared to 68 acute referrals during the same time period last year. In the 2019 period, 69% (47/68) of cases referred to the on-call team presented with back pain, radiculopathy or myelopathy compared to 43% (21/48) in the 2020 period. Almost 20% (14/68) of spine referrals consisted of spine trauma as compared to 35% (17/48) this year. There were no confirmed cases of cauda equine last year during this time. Overall, 150 spine cases were carried out during this time period last year, and 261 spine elective cases were cancelled since 17 March 2020. Recommendations We recommend following steps can be helpful to deal with similar situations or new pandemics in future: 24 hours on-call spine service during the pandemic. Clinical criteria in place to prioritize urgent spinal cases. Pre-screening spine patients before elective operating. Start of separate specialist trauma list for patients needing urgent surgeries. Conclusion This paper highlights the impact of COVID-19 pandemic in a district general hospital of England. We demonstrate a decrease in hospital attendances of spine pathologies, despite an increase in emergency spine operations. Cite this article: Bone Joint Open 2020;1-6:281–286.

Download Full-text

937 Is the Dog Still Man's Best Friend?

British Journal of Surgery ◽

10.1093/bjs/znab134.335 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Ashraf ◽

M Waseem

Keyword(s):

Average Length ◽

Financial Burden ◽

District General Hospital ◽

The Elderly ◽

Operative Management ◽

Search Term ◽

Patient Demographics ◽

Best Friend ◽

Average Length Of Stay ◽

The Impact

Abstract Introduction It is colloquially known that dogs are man’s best friend. However, animal attacks cause a large number of injuries and deaths worldwide, with 70% of injuries being caused by pets. This study highlights the impact of dog related injuries. Method Data was collected retrospectively over 1 year in a small district general hospital. The search term “dog” was used to find patients who had attended A&E or fracture clinic. This data was analysed for patient demographics, injury type and severity, management, and cost to the NHS. Results The majority (77%) of patients were female and elderly, with the modal age group being 70-79. Of the 38% of patients requiring admission, average length of stay was 6.7 days. Fractures made up the majority of injuries (56%) and 17% of patients required operative management. A further 2% suffered from post-operative complications. The average cost to the NHS was £1,695 per patient. Conclusions Dog related injuries disproportionately affected women and the elderly, with a large portion requiring operative management. Some patients developed further complications. As well as health burden there was also a financial burden associated with these injuries. These health and financial detriments are not often considered when deciding on pet ownership.

Download Full-text

579 The Impact of Coronavirus 2 (SARS-CoV-2) in Emergency Surgery. Our experience at the General Surgery Department in Queen Elizabeth Hospital, London

British Journal of Surgery ◽

10.1093/bjs/znab134.069 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Chatzikonstantinou ◽

M David ◽

A Pouncey ◽

F Aljarad ◽

P Sorelli

Keyword(s):

General Surgery ◽

Emergency Surgery ◽

Surgical Care ◽

Emergency Operation ◽

Queen Elizabeth Hospital ◽

Local Data ◽

Number Of Patients ◽

Few Data ◽

Surgery Department ◽

The Impact

Abstract Background The outbreak of the COVID-19 has had global impact on elective and emergency surgical care. So far, we possess few data to understand the effect of the CoViD-19 on emergency surgery. Aim To compare the total number of patients who were referred, admitted, and had an emergency operation under General Surgery (GS) between March and May 2020, to the same period between 2016-19. Method Retrospective analysis of prospectively collected local data from surgical take lists and operative data obtained from the hospital’s Business Intelligence Team. Results A 22.4% reduction was seen in the referrals per day 15.18+/-2.45 vs. 11.77 +/- 4.54 (2016-9 vs. 2020, mean+/-SD) and a 36% reduction in admissions per day 7.40 +/-1.07 vs. 4.69+/- 2.03 (2016-9 vs. 2020, mean+/-SD). A 55% reduction in the total number of emergency operations during the CoViD-19 outbreak was observed 87 (total, 2020) vs. 194+/-35.96 (mean+/-SD, 2016-19). Conclusions CoViD-19 had a significant impact on the number of patients presenting to GS. Interestingly, an even greater reduction in operative treatment was also observed. This may reflect reduction in theatre availability or use of a higher threshold for conservative treatment.

Download Full-text

Impact of COVID-19 on Cleft Surgical Care

FACE ◽

10.1177/2732501621996009 ◽

2021 ◽

pp. 273250162199600

Author(s):

Andrew M. Ferry ◽

Han Zhuang Beh ◽

Rami P. Dibbs ◽

Lesley W. Davies ◽

Amy S. Xue ◽

...

Keyword(s):

Cleft Lip ◽

Alveolar Bone ◽

Surgical Care ◽

The United States ◽

Surgical Volume ◽

Case Volume ◽

Volume Number ◽

Number Of Patients ◽

Alveolar Bone Grafting ◽

The Impact

Background: Coronavirus disease 2019 (COVID-19) has greatly impacted pediatric healthcare facilities throughout the United States due to widespread case rescheduling and the implementation of supplementary COVID-19 perioperative protocols. To our knowledge, no studies have investigated the impact of COVID-19 on case volume, surgical timing, or operational aspects of cleft surgical procedures. The aim of this study is to investigate the impact that COVID-19 has had on cleft surgical care at our institution. Methods: A retrospective study comparing cleft surgical care in 2019 (the pre-pandemic cohort) and 2020 (the COVID-19 cohort) was designed. All patients who underwent a cleft surgical procedure from April 1st to August 31st in 2019 and 2020 were included for analysis. Procedures were stratified into 4 groups: primary cleft lip repairs, primary cleft palate repairs, alveolar bone grafting procedures, and revisional/secondary repair procedures. Variables investigated in this study included: surgical volume, number of patients receiving timely surgery, causes for untimely surgery, number of combined cases, number of delayed cases, delay time, time under anesthesia, and procedure length. Results: A total of 191 cleft surgeries, 102 in 2019 and 89 in 2020, were identified during the study period. We observed no statistically significant differences in cleft surgical volume and other investigated variables across all surgical subgroups from 2019 to 2020. Conclusion: Cleft surgical care was largely unaffected by COVID-19 despite high rates of case rescheduling and the addition of supplementary perioperative safety protocols. More studies are needed to assess the impact of COVID-19 on cleft surgical care at other cleft centers and to investigate the long-term outcomes of these patients.

Download Full-text

EP.WE.726A snapshot audit of cholecystectomy for gallstone pancreatitis during the first wave of COVID-19

British Journal of Surgery ◽

10.1093/bjs/znab308.087 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Bryony David ◽

Sony Aiynattu ◽

Katie Jones ◽

Antonio Gallucci

Keyword(s):

Length Of Stay ◽

Average Length ◽

Surgical Care ◽

Index Admission ◽

Gallstone Pancreatitis ◽

Data Set ◽

Time To Surgery ◽

Number Of Patients ◽

And Gender ◽

Acute Gallstone Pancreatitis

Abstract Aims COVID-19 has caused difficulties in providing efficient surgical care. We aimed to audit cholecystectomy provision for gallstone pancreatitis from January 2019 to June 2020. We audited time from admission with gallstone pancreatitis to cholecystectomy in pre-COVID and COVID cohorts in order to assess the effect of the first wave of the pandemic on service provision. Methods Patients with confirmed gallstone pancreatitis plus their age and gender were included using information software Cerner. We analysed length of stay, time to surgery and number of patients planned for surgery. We also looked at readmissions whilst awaiting surgery. Patients with previous cholecystectomies or deemed not fit for surgery were excluded. Results 68 patients were included; 42 admitted from Jan 2019 to Feb 2020 (non-COVID group) and 26 from March 2020 to June 2020 (COVID 19 group). Average length of stay was 11.8 days for non-COVID group and 8.8 days for COVID group. Average time to surgery for non-COVID group was 47.4 days. 25 patients underwent surgery. Average time to surgery was 56.7 days and 9 patients received surgery, in the COVID group. In this group, 3 patients had index admission surgery compared to 15 in the non-COVID group. Conclusions Albeit small, our data set shows a longer wait to surgery in the COVID group with fewer operations performed at index admission, compared to the non-COVID group. Future surgical services will require careful planning to ensure that urgent cholecystectomies continue to be performed in acute gallstone pancreatitis.

Download Full-text

EP.FRI.271 The impact of Surgical Assessment Unit on emergency and ambulatory surgical care in a district general hospital

British Journal of Surgery ◽

10.1093/bjs/znab312.050 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Aloka Suwanna Danwaththa Liyanage ◽

Philip Apter ◽

Gemma Causer ◽

Krishnan Gokul ◽

Paul Ainsworth

Keyword(s):

Care Delivery ◽

Surgical Care ◽

District General Hospital ◽

Direct Access ◽

Post Discharge ◽

Similar Time ◽

Assessment Unit ◽

Audit Period ◽

The Impact

Abstract Aims There has been a paradigm shift in the delivery of emergency and ambulatory surgical care necessitated by paucity of beds, improved expedited diagnostics and delayed transit in Emergency departments. The objective of a surgical assessment unit (SAU) is to reduce the number of semi-urgent admissions, provide direct access to urgent surgical admissions bypassing the ED, expeditious assessment by senior clinicians and to reduce the number of OPD follow up. In our setting, the SAU came into existence on all 5 working days at 12-hour daily schedule and its impact was evaluated retrospectively. Methods Prospectively maintained data base over a 2-month period was examined. Pre and post SAU figures were compared to judge any quantitative improvement in surgical services. Results During the audit period of 2 months there were 156 emergency patients and 190 ward attenders for follow up care. Majority of these patients were assessed within 4 hours and discharged or ambulated. Numbers being admitted overnight purely to facilitate investigations showed a decrease of 44.6% post SAU establishment. There was a reduction in post discharge outpatients appointments when compared to a similar time period pre SAU (14% difference). Conclusion The SAU, although initially conceived and designed purely to cope with increased admissions and to minimise breaching of emergency department targets, has shown quantitative and qualitative improvement in emergency and ambulatory surgical care delivery.

Download Full-text

1274 Impact of Covid 19 on Urgent Suspicion of GI Cancer Referral in a District General Hospital

British Journal of Surgery ◽

10.1093/bjs/znab259.498 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S Barman ◽

H J Ng ◽

S Teo ◽

E M Blaney ◽

O Mansfield

Keyword(s):

Cancer Detection ◽

Detection Rate ◽

District General Hospital ◽

Cancer Detection Rate ◽

P Value ◽

High Grade ◽

Consistent Finding ◽

Number Of Patients ◽

The Uk ◽

The Impact

Abstract Aim Endoscopy services across United Kingdom were affected significantly since March 2020 due to Covid-19 pandemic. Services were reduced and were more selective. We aim to compare the impact on duration between referral to colonoscopy and the detection rate of pathology between February (pre- Covid) and August (Covid impacted) 2020. Method Data was analysed from a prospectively maintained database of patients referred for colonoscopy to Royal Alexandra Hospital, Scotland. Patients underwent colonoscopy in month of February and August 2020 were included. Bowel screening patients were excluded. Positive findings included diverticulosis, colitis, polyp and adenocarcinoma. P value of < 0.05 was considered significant. Results Total number of patients included was 97 (55 in February, 42 in August). Median age was 61 and 69 years, respectively. Mean duration from referral to colonoscopy were 4 weeks in February and 7 weeks in August. qFIT test were found raised in 50.9% in February and 57.1% in August with positive findings of 47.3% in February and 66.7% in August. 46.4% in February and 16.7% in August had raised qFIT but normal findings (p < 0.05). Two high grade dysplasia polyps and two adenocarcinomas were identified in February, none found in August. Conclusions Covid-19 pandemic has disrupted the endoscopic services prolonging the duration from referral to colonoscopy. qFIT test is more heavily relied to prioritise urgent colonoscopies resulting in more positive findings on colonoscopy. Cancer detection rate has reduced which is a consistent finding as the UK national endoscopy study. Massive efforts are needed to restore endoscopy services.

Download Full-text

The Impact of COVID-19 pandemic Lockdown on the utilization of acute surgical care, retrospective, multicenter analysis

10.21203/rs.3.rs-70079/v1 ◽

2020 ◽

Author(s):

Jaroslav Presl ◽

Martin Varga ◽

Christof Mittermaier ◽

Stefan Mitterwallner ◽

Michael Weitzendorfer ◽

...

Keyword(s):

General Surgery ◽

Average Length ◽

Surgical Care ◽

Length Of Hospital Stay ◽

Abdominal Wall Hernia ◽

Colon Surgery ◽

Emergency General Surgery ◽

Multicenter Analysis ◽

Medical Disciplines ◽

The Impact

Abstract Background: The emergency general surgery encompasses the care of critically ill patients, with a potentially high mortality if delayed. As some medical disciplines have reported a strong decrease of emergencies during the COVID-19 pandemic, remains the effect of the Lockdown on the general surgery emergencies unclear. Methods:This study is a retrospective, multicentre analysis of the general surgery emergency operations performed during the 2020 Lockdown and in the same period of 2019 in three centers covering the surgical care of the area Salzburg-North, Austria. Results: In total 165 emergency surgeries were performed in the study period of 2020 compared to 287 in Year 2019. This is a significant decrease of 122 (42.5%) emergency surgeries during the COVID-19 Lockdown (p=0.005). The average length of hospital stay in the 2019 was in median 4 days and was reduced to 3 days during the Lockdown. Appendectomy remained the most performed emergency surgery for the both periods but the operations count reduced to less than a half with 72 cases in 2019 and 33 cases in 2020 (p=0.118). Considering the ration of appendectomy vs all emergency surgeries, it represented 25 % in 2019 and 20% in 2020. The emergency colon surgery observed the strongest decrease of 75% from 17 cases in 2019 to 4 in 2020. In addition, the emergency abdominal wall hernia, cholecystectomies for acute cholecystitis, small surgeries and proctological emergencies recorded drops of 70%, 39%, 33% and 47% respectively. A strongest reduction in frequency of 6 of 13 main categories of emergency surgeries was reported from Center 1, which was the only COVID designed Center (“Hot” hospital) in the examined region.Conclusions:The emergency general surgery is an essential service that continues to run under any circumstances. Our data showed that the COVID-19 related restriction and the fear of being infected with COVID-19 in the hospital result in a significant decrease of the utilization of acute surgical care. Policies and modern alternatives are needed to ensure continued access to specialized services to prevent patients from harm.

Download Full-text