scholarly journals TP10.1.2Evaluating the impact of the COVID-19 pandemic on the presentation and management of UGI cancer at a district general hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Mohamed Aly ◽  
Tanmoy Mukerjee ◽  
Reya Singh ◽  
Douglas Whitelaw ◽  
Tanveer Adil ◽  
...  
Keyword(s):  
Cancer Patients ◽  
General Hospital ◽  
District General Hospital ◽  
Service Availability ◽  
Supportive Treatment ◽  
Curative Intent ◽  
Treatment Pathways ◽  
Surgical Services ◽  
Mode Of Presentation ◽  
The Impact

Abstract Introduction It has been predicted that the COVID-19 pandemic would disrupt the delivery of UK cancer treatment pathways. This study aims to assess the mode of presentation and type of management offered to oesophagogastric (OG) and hepatopancreaticobiliary (HPB) cancer patients at a busy district general hospital during the pandemic. Methods Confirmed OG and HPB cancer patients were identified in the local MDT database. Patients were identified between 01/03/2020 - 30/09/2020 (pandemic), and 01/03/2019 - 30/09/2019 (pre-pandemic). Mode of presentation and management was identified and compared. Results In 2019, 42 and 15 patients were diagnosed with OG and HPB cancers, compared to 25 and 19 patients in 2020, respectively. 26 (46%) patients were referred via 2ww pathway in 2019, compared to 29 (66%) in 2020. The number of cancers referred routinely or emergently were 28 (49%) and 2 (4%) in 2019, compared to 2 (5%) and 9 (20%) in 2020, respectively (p < 0.0001). Patients suitable for curative treatment were 16 (28%) and 7 (16%), in 2019 and 2020, respectively. Palliative or supportive treatment was offered to 26 (46%) and 14 (25%) patients in 2019, compared to 21 (48%) and 10 (23%) patients in 2020, respectively. Conclusion 2ww referrals were similar to 2019, while routine referrals reduced significantly. A marked, but not significant, reduction in patients suitable for curative intent is noted, perhaps due to delay in presentation despite the continuation of cancer surgical services. Further work on creating “COVID-free” pathways and increasing awareness of service availability would improve detectability of curable disease.

scholarly journals 822 Lessons Learnt During the COVID-19 Pandemic on Emergency Surgical Admissions in A District General Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Ahn ◽  
N Khan ◽  
N Desai ◽  
M Abdu ◽  
L Hiddema ◽  
...  
Keyword(s):  
General Hospital ◽  
Public Health Intervention ◽  
District General Hospital ◽  
Lifestyle Changes ◽  
Severe Respiratory Distress ◽  
Surgical Services ◽  
Record Data ◽  
Efficacious Vaccine ◽  
Severe Respiratory Distress Syndrome ◽  
The Impact

Abstract Introduction Coronavirus disease (COVID-19) is an acute severe respiratory distress syndrome which resulted in an unprecedented impact on NHS service provision. We aimed to assess the impact of COVID-19 on general surgical services in a district general hospital. Method Electronic health care record data was retrospectively collected from 6th of April to 6th of May for both 2019 and 2020. Results Despite fewer referrals and admissions in 2020 (133 vs 177 admissions in 2019), there were more failed discharges (29 vs 17 in 2019) and higher associated costs. Higher numbers of biliary related pathologies and pancreatitis (50 in 2020 vs 25 in 2019), and fewer complaints of non-specific abdominal pain (10 in 2020 vs 22 in 2019) were observed. The use of outpatient investigations decreased by approximately 40% in 2020; however, utilisation of inpatient investigations was comparable. Conclusions Better utilisation of outpatient investigations and virtual clinic services may surmount pressures from further peaks of COVID-19. The increase in biliary related cases and pancreatitis may be consequent upon lifestyle changes during lockdown. This merits further investigation and if appropriate, public health intervention. In the absence of an efficacious vaccine, further research would be essential to streamline general surgical services based on clinical risk stratification.

scholarly journals EP.WE.268Impact of COVID-19 on surgical services in a District General Hospital in the UK: benefits versus drawbacks

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Islam El-Abbassy ◽  
Hesham El-Hakim ◽  
Mei Kei Wong ◽  
Robert McIntyre
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Surgical Service ◽  
Remote Consultation ◽  
Face To Face ◽  
Surgical Services ◽  
Number Of Patients ◽  
Service Activity ◽  
The Uk ◽  
The Impact

Abstract Background COVID-19 outbreak led to significant changes in health services worldwide. This study aims to assess the impact of this outbreak on the surgical services in a small District General Hospital and to highlight any benefits that we can take forward. Methods Data were collected retrospectively comparing the surgical service activity during the two months (April and May 2020) around the peak of COVID-19 first wave in the UK and the similar two-month period the year before when activity was at its usual pre-COVID level. A short questionnaire on the use and satisfaction of remote consultation was circulated to all hospital consultants. Results The total number of patients presenting to the emergency department in all specialities almost halved during the COVID-19 crisis. The number of emergency surgical admissions decreased. All elective lists were cancelled and more patients were managed conservatively. In April and May 2020, 156 patients had outpatient surgical consultations. Only 14 of them were face-to-face, whereas the rest were done either by telephone or video calls. This is compared to 472 patients who had face-to-face consultations in April and May 2019. The results of the questionnaire showed that over 90% of the consultants felt telemedicine consultations were satisfactory and that they would have an important role in the future. Conclusion COVID-19 had serious impacts on surgical services regarding cancellation of elective lists and prolongation of waiting time. Despite these drawbacks, the increased confidence with telemedicine services was a significant benefit.

scholarly journals Impact of COVID-19 on surgical services in a District General Hospital in the United Kingdom: benefits versus drawbacks

2021 ◽  
Vol 8 (2) ◽  
pp. 440
Author(s):  
Islam H. El-Abbassy ◽  
Hesham El-Hakim ◽  
Mei Kei Wong ◽  
Robert McIntyre
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Remote Consultation ◽  
Face To Face ◽  
Surgical Services ◽  
The United Kingdom ◽  
Number Of Patients ◽  
Service Activity ◽  
The Uk ◽  
The Impact

Background: COVID-19 outbreak led to significant changes in health services worldwide. This study aimed to assess the impact of this outbreak on the surgical services in a small District General Hospital and to highlight any benefits that we can take forward.Methods: Data were collected retrospectively comparing the surgical service activity during the two months (April and May 2020) around the peak of COVID-19 first wave in the UK and the similar two-month period the year before when activity was at its usual pre-COVID level. A short questionnaire on the use and satisfaction of remote consultation was circulated to all hospital consultants.Results: The total number of patients presenting to the emergency department in all specialities almost halved during the COVID-19 crisis. The number of emergency surgical admissions decreased. All elective lists were cancelled and more patients were managed conservatively. In April and May 2020, 156 patients had outpatient surgical consultations. Only 14 of them were face-to-face, whereas the rest were done either by telephone or video calls. This is compared to 472 patients who had face-to-face consultations in April and May 2019. The results of the questionnaire showed that over 90% of the consultants felt telemedicine consultations were satisfactory and that they would have an important role in the future.Conclusions: COVID-19 had serious impacts on surgical services regarding cancellation of elective lists and prolongation of waiting time. Despite these drawbacks, the increased confidence with telemedicine services was a significant benefit. 

scholarly journals 668 The Consequences to Emergency Surgery During COVID19 Pandemic in a UK District General Hospital in The North East of England

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Evans ◽  
C Ng
Keyword(s):  
Surgical Treatment ◽  
General Hospital ◽  
Emergency Surgery ◽  
Early Identification ◽  
District General Hospital ◽  
Public Confidence ◽  
Surgical Services ◽  
North East ◽  
The North ◽  
Initial Reduction

Abstract Aim COVID19 pandemic has significantly affected surgical services. We aim to review its effects on our theatre output and risk of encountering COVID 19 cases. Method Serial record of operations performed locally were reviewed from start of UK COVID19 pandemic lockdown on 23rd March 2020 to 13th July 2020 after it was lifted. A weekly average by month of operations and the percentage of COVID19 cases diagnosed within 30 days of the procedure were noted. Results 733 operations performed through this period. In March, 33 operations/week performed, 88.4% emergency and 7% diagnosed with COVID19. April, 31 operations /week performed, 95.9% emergency and 10.6% diagnosed with COVID19. May 46 operations /week performed, 94.5% emergency and 3.3% diagnosed with COVID19. June 56 operations /week, 80.9% emergency and less than 0.01% diagnosed with COVID19. By July 80 operations/week, 59.4% emergency and none diagnosed with COVID 19. Since testing capacity increased, only 6 of the 27 operated were diagnosed with COVID19. Conclusions There was initial reduction to non-emergency workload. However, this has gradually shifted as protocols are in place improve public confidence to return for surgical treatment. Mandatory admission testing allows early identification and remains essential for planning of services and protecting the workforce.

scholarly journals Day case laparoscopic cholecystectomy: Identifying patients for a ‘COVID-Cold’ isolated day-case unit during the pandemic

2021 ◽  
pp. 175045892097741
Author(s):  
Zoe Hinchcliffe ◽  
Imran Mohamed ◽  
Anil Lala
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Hospital ◽  
Univariate Analysis ◽  
District General Hospital ◽  
Day Case ◽  
Patient Factors ◽  
Surgical Services ◽  
North Wales ◽  
Selection For ◽  
The Uk

Background The UK practice of laparoscopic cholecystectomy has reduced during the COVID-19 pandemic due to cancellation of non-urgent operations. Isolated day-case units have been recommended as ‘COVID-cold’ operating sites to resume surgical procedures. This study aims to identify patients suitable for day case laparoscopic cholecystectomy (DCLC) at isolated units by investigating patient factors and unexpected admission. Method Retrospective analysis of 327 patients undergoing DCLC between January and December 2018 at Ysbyty Gwynedd (District General Hospital; YG) and Llandudno General Hospital (isolated unit; LLGH), North Wales, UK. Results The results showed that 100% of DCLCs in LLGH were successful; 71.4% of elective DCLCs were successful at YG. Increasing age ( p = 0.004), BMI ( p = 0.01), ASA Score ( p = 0.006), previous ERCP ( p = 0.05), imaging suggesting cholecystitis ( p = 0.003) and thick-walled gallbladder ( p = 0.04) were significantly associated with failed DCLC on univariate analysis. Factors retaining significance (OR, 95% CI) after multiple regression include BMI (1.82, 1.05–3.16; p = 0.034), imaging suggesting cholecystitis (4.42, 1.72–11.38; p = 0.002) and previous ERCP (5.25, 1.53–18.00; p = 0.008). Postoperative complications are comparable in BMI <35kg/m2 and 35–39.9kg/m2. Conclusions Current patient selection for isolated day unit is effective in ensuring safe discharge and could be further developed with greater consideration for patients with BMI 35–39.9kg/m2. As surgical services return, this helps identify patients suitable for laparoscopic cholecystectomy at isolated COVID-free day units.

661 Improving Antibiotic Prescribing in a District General Hospital: A Closed Loop Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Z H Ng ◽  
T Kamran
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Educational Interventions ◽  
Correct Choice ◽  
Antibiotic Prescribing ◽  
Surgical Team ◽  
Abdominal Abscesses ◽  
Antibiotic Efficacy ◽  
The Impact ◽  
Local Antibiotic

Abstract Aim Broad-spectrum antibiotics are effective in decreasing wound infection and postoperative intra-abdominal abscesses for patients undergoing appendicectomy. Compliance with local hospital antibiotic guidelines is important in ensuring antibiotic efficacy and reducing potential for toxicity and antibiotic resistance. The aim was to assess the impact of educational interventions on the adherence to local antibiotic guidelines in patients undergoing appendicectomy at a Scottish district general hospital. Method Preoperative antibiotic prescribing in consecutive adult patients aged ≥ 16 years undergoing appendicectomy were audited against hospital guidelines over a four-month period between March 2019 and July 2019. We implemented change through antibiotic prescribing teaching for doctors in the surgical team and anaesthetic team. This change was subsequently evaluated through a re-audit over a three-month period between December 2019 and February 2020. Results The baseline audit demonstrated 68.8% (n = 11/16) compliance to local antibiotic guidelines among patients undergoing appendicectomy. The remaining patients had the correct choice of antibiotics, but gentamicin was prescribed in different doses. Gaps in prescriber awareness of antibiotic guidelines were identified. Following departmental teaching sessions regarding antibiotic prescribing and use of the gentamicin dosing calculator, the re-audit showed 93.8% (n = 15/16) compliance with local antibiotic guidelines among prescribers in the surgical team and anaesthesic team. Conclusions Education interventions were instrumental in improving adherence to antibiotic prescribing guidelines. This highlights the importance of regular audit and prescriber education in the promotion of antibiotic stewardship in hospitals.

Reducing the number of unnecessary laboratory tests within hospital through the use of educational interventions

2021 ◽  
pp. 000456322110406
Author(s):  
Michael Thurm ◽  
Helen Craggs ◽  
Merlin Watts ◽  
Anthony Brooks
Keyword(s):  
Cohort Study ◽  
Cost Saving ◽  
General Hospital ◽  
Laboratory Tests ◽  
Patient Management ◽  
District General Hospital ◽  
Educational Interventions ◽  
Blood Tests ◽  
Medical Teams ◽  
The Impact

Background The growing number of laboratory investigation requests is placing an increased burden upon NHS resources. Around a quarter of all tests are unnecessary repeats, and almost a third have no impact on patient management. Doctors recognise that tests should only be performed when clinically indicated, but a culture persists of undertaking unnecessary repeat investigations. Methods A cohort study was undertaken at a district general hospital to observe the impact of introducing educational interventions in the form of a poster and a series of educational lectures, encouraging clinicians to consider whether an investigation was clinically indicated. Data was collected from nine different sites across the hospital run by different medical teams regarding the number of tests undertaken and the impact on patient care. Results Data from over 13,000 tests and over 2000 patients was analysed from nine different sites across the hospital. There was a significant reduction (33%, p = 0.0001) in the number of blood tests performed. This reduction in testing saved £7006 over the course of 1 month, in addition to other benefits. There was a reduction in testing in eight out of the nine sites in which the study was undertaken, demonstrating good generalisability of results. There was no significant increase in length of admission or mortality. Conclusion Educational interventions to doctors have a significant and safe impact in reducing the number of unnecessary investigations, providing cost saving benefits to the NHS.

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