scholarly journals P-OGC12 Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Alexander Bull ◽  
Philip Pucher ◽  
Nick Maynard ◽  
Tim Underwood ◽  
Jesper Lagergren ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Nasogastric Tube ◽  
Practice Variation ◽  
Radiological Assessment ◽  
Median Length ◽  
Electronic Survey ◽  
Conflicting Evidence ◽  
Clear Link ◽  
Low Volume ◽  
The Uk

Abstract Background Over 1,500 patients with oesophageal cancer undergo a resection in the UK each year. At surgery, patients commonly have a nasogastric tube (NGT) placed and may undergo a pyloric intervention. There is conflicting evidence on the use of both NGTs and pyloric interventions during oesophageal resections. We performed a national survey of oesophageal centres and assessed practice variation. Methods An electronic survey was distributed to all resection centres in England, Wales and Scotland. Variations in practice regarding NGTs and pyloric intervention were assessed, and compared to nationally reported centre volumes and length-of-stay data Results Most centres (31/39, 79%) responded to the survey. All centres reported routine NGT use. The majority of centres (19/31, 61%) did not perform pyloric interventions. When used, surgical pyloroplasty was the most frequent strategy (8/31, 26%). Routine post-operative radiological assessment was utilised in 9/31 (29%) of centres. Criteria for NGT removal and dietary progression was highly variable, with every centre reporting different protocols. There were no significant differences in practice between high and low volume centres. There were also no trends seen when comparing centres above vs at-or-below the median length-of-stay. The majority (68%) of centres were willing to take part in a trial assessing NGT use and pyloric interventions. Conclusions Pyloric intervention use varies widely, with no clear link to outcomes. NGT use remains standard practice despite evidence for safe omission. Surgeons require and recognise the need for a trial to assess requirement for NGTs and pyloric intervention after oesophageal resection.

FC11-06 - Female - only psychiatric intensive care unit (PICU): Prospective study of patient demographics and outcomes at elizabeth casson house, bristol, UK

2011 ◽  
Vol 26 (S2) ◽  
pp. 1875-1875 ◽  
Author(s):  
K. Gintalaite-Bieliauskiene ◽  
V. Tandon ◽  
V. Woochit
Keyword(s):  
Personality Disorder ◽  
Length Of Stay ◽  
Physical Aggression ◽  
Demographic Characteristics ◽  
Case Note ◽  
Median Length ◽  
Patient Demographics ◽  
Self Harm ◽  
Project Data ◽  
The Uk

IntroductionThere are above 170 PICUs identified in the UK. A modest body of research has emerged documenting characteristics of PICU populations. Comprehensive data describing patients admitted to PICUs remains incomplete. There is no data on Female only PICU population's characteristics.ObjectiveTo offer the first and the only project data country wide up to date on Female only PICU population. It describes socio-demographic characteristics, mental state and outcome of treatment for 49 patients admitted to the first Female PICU in NHS in UK in 2008MethodProspective case note analysisResults65% of patients were single, 73% were Caucasian and 26% had BME background. Most of patients were admitted from police stations and detained under S2 or S3 of the MHA. Most dominant diagnoses were Schizophrenia and Personality Disorder. 77% of admissions were due to physical aggression and severe self harm. Most patients had more than 5 previous admissions to Mental Health wards. Half of the patients received intramuscular Rapid Tranquilization during the admission and 22% were placed in Enhanced Care Area. Median length of stay did not exceed recommended 8 weeks but some patients with the diagnosis of Personality Disorder experienced an excessive length of PICU stay. Most patients were transferred to open acute wards.ConclusionsPatients admitted to Female PICU were most likely to have major psychosis or personality disorder, admitted due to violence or self harming behavior, more likely to exceed recommended max length of stay if diagnosis of PD was given, BME group being represented.

Hospital Volume is Not a Predictor of Outcomes after Gastrectomy for Neoplasm

2009 ◽  
Vol 75 (10) ◽  
pp. 932-936 ◽  
Author(s):  
Kevin M. Reavis ◽  
Marcelo W. Hinojosa ◽  
Brian R. Smith ◽  
James B. Wooldridge ◽  
Sindhu Krishnan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Gastric Surgery ◽  
National Database ◽  
Medical Centers ◽  
Outcome Relationship ◽  
Academic Medical ◽  
Low Volume ◽  
Poor Outcomes ◽  
The University

Studies have shown conflicting data with regard to the volume and outcome relationship for gastrectomy. Using the University HealthSystem Consortium national database, we examined the influence of the hospital's volume of gastrectomy on outcomes at academic centers between 2004 and 2008. Outcome measures, including length of stay, 30-day readmission, morbidity, and in-hospital mortality, were compared among high- (13 or greater), medium- (6 to 12), and low-volume (five or less) hospitals. There were 10 high- (n = 593 cases), 36 medium- (n = 1076 cases), and 75 low-volume (n = 500 cases) hospitals. There were no significant differences between high- and low-volume hospitals with regard to length of stay, overall complications, 30-day readmission rate, and in-hospital mortality (2.4 vs 4.4%, respectively, P = 0.06). Despite the small number of gastrectomies performed at the low-volume hospitals, these same hospitals performed a large number of other types of gastric surgery such as gastric bypass for the treatment of morbid obesity (102 cases/year). Within the context of academic medical centers, lower annual volume of gastrectomy for neoplasm is not a predictor of poor outcomes which may be explained by the gastric operative experience derived from other types of gastric surgery.

Impact of length of stay in psychiatric intensive care on the episode trajectory

2021 ◽  
Author(s):  
H. Thomas de Burgh ◽  
Jeremy McCabe ◽  
Kamal Gupta
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Extended Period ◽  
Post Discharge ◽  
Readmission Rates ◽  
Rapid Turnover ◽  
Complex Patients ◽  
Step Down ◽  
The Uk ◽  
Relationship Of

Background: Length of stay (LOS) on admission to psychiatric intensive care in the UK varies widely, with few studies examining the relationship of LOS to clinical outcomes. Data from two South London male PICUs delivering care with the contrasting philosophies of rapid turnover versus slower stepdown were investigated to determine if additional LOS correlated with clinical benefit.Method: Data on admissions to the PICUs were collected over six months and assessed for outliers and then for variance using Levene’s test. The variables were compared using independent samples t-tests. Pearson correlations were alsocalculated for the major variables.Results: Mean LOS was 8.4 days higher on PICU 1 (p = 0.026) and readmission rates to hospital 6 months post discharge were 27% higher on PICU 1 (p = 0.025). There were no strong correlations between LOS on either PICU and the other five variables examined.Conclusion: It was intuitive to expect better outcomes in the PICU with a slower turnover where complex patients could receive an extended period of re-evaluation of pharmacological treatments and engagement with services and could achieve a fuller recovery from the episode. However, this group had no reduction in LOS following step-down to the wards, readmission rates to PICU during in the index episode or re-hospitalisation six months following discharge. The PICU with a policy of rapid-turnover, concentrating on reducing acuity and risk and rapid step down, was equally effective on the measures evaluated.

scholarly journals Laparoscopic splenectomy: how minimal can we make it?

2022 ◽  
Author(s):  
Adetokunbo Fadipe ◽  
David Wilkinson ◽  
Robert Peters ◽  
Catherine Doherty ◽  
Nick Lansdale
Keyword(s):  
Length Of Stay ◽  
Laparoscopic Splenectomy ◽  
Operative Time ◽  
Hereditary Spherocytosis ◽  
Surgical Trauma ◽  
Cell Disease ◽  
Median Length ◽  
Post Operative Pain ◽  
Age At Surgery ◽  
Splenic Size

Abstract Aims Laparoscopic splenectomy (LS) is routinely performed in children, however, a large spleen in a small child can pose significant operative challenges. We instigated a highly standardised surgical and anaesthetic approach to LS to minimise surgical trauma and enhance recovery. The aim of this study was to assess the outcomes of this programme. Methods Prospective study of all LS’s performed 2018–2021. Surgical approach was via one 10 mm and three 5 mm ports. Early hilar control was accomplished with Hem-o-loks. Splenic retrieval via the 10 mm incision used finger morcellation within an Espiner EcoSac. Anaesthesia utilised a standardised regime of agents and bupivacaine was infiltrated to the splenic bed and wound sites. Post-operative opiates were minimised. Data are presented as median [IQR]. Results Twenty consecutive children were included. Indications for LS were hereditary spherocytosis (n = 12), sickle cell disease (n = 6), beta-thalassaemia (n = 1) and splenic haemangiomatosis (n = 1). Age at surgery was 101 months [75–117] and weight 30 kg [21–37]. Splenic size was 13.4 cm [12–14.4]. Operative time was 178 min [156–185]. There were no open conversions and no significant intra or post-operative bleeding. One patient developed pancreatitis. Median post-operative pain score was 1 [1–3]. Median length of stay was 2 days [2–3]. Conclusion LS is feasible, safe and efficient in smaller children with large spleens. This standardised programme of anaesthesia and surgery based around a core team reliably results in few complications, good analgesia and short length of stay.

scholarly journals Decreasing hospital burden of COVID-19 during the first wave in Regione Lombardia: an emergency measures context

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Grosso Francesca Maria ◽  
Presanis Anne Margaret ◽  
Kunzmann Kevin ◽  
Jackson Chris ◽  
Corbella Alice ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Median Length ◽  
Calendar Time ◽  
Fatality Risk ◽  
Lengths Of Stay ◽  
Hospital Beds ◽  
Hospital Patients ◽  
Poor Outcomes ◽  
Emergency Measures

Abstract Background The aim of this study is to quantify the hospital burden of COVID-19 during the first wave and how it changed over calendar time; to interpret the results in light of the emergency measures introduced to manage the strain on secondary healthcare. Methods This is a cohort study of hospitalised confirmed cases of COVID-19 admitted from February–June 2020 and followed up till 17th July 2020, analysed using a mixture multi-state model. All hospital patients with confirmed COVID-19 disease in Regione Lombardia were involved, admitted from February–June 2020, with non-missing hospital of admission and non-missing admission date. Results The cohort consists of 40,550 patients hospitalised during the first wave. These patients had a median age of 69 (interquartile range 56–80) and were more likely to be men (60%) than women (40%). The hospital-fatality risk, averaged over all pathways through hospital, was 27.5% (95% CI 27.1–28.0%); and steadily decreased from 34.6% (32.5–36.6%) in February to 7.6% (6.3–10.6%) in June. Among surviving patients, median length of stay in hospital was 11.8 (11.6–12.3) days, compared to 8.1 (7.8–8.5) days in non-survivors. Averaged over final outcomes, median length of stay in hospital decreased from 21.4 (20.5–22.8) days in February to 5.2 (4.7–5.8) days in June. Conclusions The hospital burden, in terms of both risks of poor outcomes and lengths of stay in hospital, has been demonstrated to have decreased over the months of the first wave, perhaps reflecting improved treatment and management of COVID-19 cases, as well as reduced burden as the first wave waned. The quantified burden allows for planning of hospital beds needed for current and future waves of SARS-CoV-2 i.

Abstract 322: Optimizing Cardiac Catheterization Laboratory Utilization

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
William E Lawson ◽  
Lisa Wilbert ◽  
Lisa Sokoloff ◽  
Allen Jeremias ◽  
Anil Mani
Keyword(s):  
Length Of Stay ◽  
Limited Resource ◽  
Median Number ◽  
Skewed Distribution ◽  
Median Length ◽  
Case Volume ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Cardiac Catheterizations ◽  
Effective Use

Background: Optimizing efficient utilization of the catheterization lab is an important concern. Inefficient use of this limited resource increases costs and can compromise patient care. At times of high hospital and specialty care unit census, cath lab throughput is also limited by the availability of recovery beds which may further compromise efficient throughput. At SBUH the cardiac cath lab is staffed from 0630-2300 daily Monday-Friday with an on-call team to provide 7 x 24 hour coverage for STEMI’s. Lab usage was evaluated to determine if this was an efficient and effective use of this limited resource. Methods: All cardiac catheterizations during the period of 10/1/12-12/31/12 were reviewed. The distribution of daily cases, mean and median hours to catheterization by day of the week and median length of stay (ALOS) were determined. Elective outpatient, inpatient, and emergent cases were included. Results: There were a total of 997 cases during this quarter. Average weekday case volume ranged from 13-17 cases/day with the greatest average number of cases performed on Mondays (24% of the weeks cases). Median hours to the cath lab averaged 4.2 hours with the greatest delay on Mondays (5.4 hrs) and Fridays (5.7 hrs). The median number of hours to the cath lab was 31.3 hours with the greatest delay on Fridays (38.5 hrs) and gradually decreasing times from Monday through Thursday with the lowest time delay being on Thursdays (18.9 hrs). The median length of stay averaged 1.11 days, with Mondays patients averaging the longest stays at 1.26 days. There were 45 emergent STEMI cases (5% of the total) during the reviewed period. Conclusions: The marked disparity in mean and median hours reflects a skewed distribution, with many inpatients delayed in going to the CCL. Both median and mean hours were prolonged on Mondays and Fridays along with median length of stay. Further drill down suggested hand-offs, inter-hospital transfer delays, high bed occupancy, and high patient volume contributed to delays on these days. Operator availability, procedure variance, and case mix also contributed to distortions in scheduling and the effective use of lab time. Mid week, Wednesday, was the most efficient day. Block scheduling has since been implemented to better accomodate operators and procedure types within the current staffing constraints. Also as a result of this analysis fewer outpatients are being scheduled on Mondays, changes have been made in ACS protocols, hand-offs, rounding and transfers, and opening the cath lab on a weekend day for inpatients is planned.

Intrathecal baclofen pumps in the management of hypertonia in childhood: a UK and Ireland wide survey

2021 ◽  
pp. archdischild-2020-321487
Author(s):  
Rajib Lodh ◽  
Sam Amin ◽  
Amr Ammar ◽  
Lucy Bellis ◽  
Phillip Brink ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Patient Characteristics ◽  
Intrathecal Baclofen ◽  
Children And Young People ◽  
Electronic Survey ◽  
Non Invasive ◽  
Referral Criteria ◽  
National Guidance ◽  
Continuous Dose ◽  
The Uk

BackgroundIntrathecal baclofen (ITB) is a useful treatment for hypertonia where non-invasive treatments have been ineffective or poorly tolerated. There is an absence of national guidance on selection criteria and a lack of literature regarding patient characteristics and treatment details for children and young people (CYP) receiving ITB therapy in the UK and Ireland. We aimed to gather patient and treatment characteristics for CYP receiving ITB in the UK and Ireland.MethodsAn electronic survey was sent to all paediatric ITB centres in the UK and Ireland. Anonymised data were returned between December 2019 and April 2020. CYP >16 years and those awaiting ITB pump removal were excluded from the dataset.Results176 CYP were identified as receiving ITB therapy across the UK and Ireland. The majority of CYP with ITB pumps were non-ambulant (93%) with a diagnosis of cerebral palsy (79%). Median age of ITB insertion was 9 years; median current age was 14 years. 79% of CYP had significant spasticity, 55% had significant dystonia. The most commonly used ITB dosing modes were continuous (73%) and flexible (23%).ConclusionsITB pumps were most frequently used for non-ambulant CYP with cerebral palsy and existence of spasticity and/or dystonia in the UK and Ireland. Most CYP were receiving a continuous dose of ITB. There is significant variation in the number of paediatric ITB pumps across UK and Ireland. There is a need for development of nationally accepted paediatric referral criteria and clinical standards for ITB use.

scholarly journals P087: Procedural sedation in Canadian emergency departments a national survey of pharmacological agent selection and practice variation

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S87-S87
Author(s):  
E. Leci ◽  
K. Van Aarsen ◽  
A. Shah ◽  
J. W. Yan
Keyword(s):  
Practice Variation ◽  
Procedural Sedation ◽  
Pharmacologic Agent ◽  
Electronic Survey ◽  
Canadian Association ◽  
Institutional Influences ◽  
Agent Selection ◽  
Practice Variability ◽  
American Society ◽  
Question Survey

Introduction: Emergency department (ED) physicians strive to provide analgesia, amnesia and sedation for patients when performing painful procedures through the use of procedural sedation (PS). Examination of the literature suggests that the application of PS appears to be variable with institutional influences and clinician disagreement on pharmacology, airway management, and monitoring. The primary goal of this research project was to describe the variability of practice with respect to pharmacologic choices and clinical applications of PS among Canadian ED physicians. Methods: An electronic survey was distributed through the Canadian Association of Emergency Physicians (CAEP). Practicing physician members of CAEP were invited to complete the survey. The 20 question survey encompassed various aspects of PS including physician choices regarding PS indications and pharmacology. The primary outcome was the quantification of practice variability among ED physicians with respect to the above listed aspects of PS. The data was presented with simple descriptive statistics. Results: To date, 278 ED physicians responded to our survey (response rate 20.3%). Respondents were primarily academic hospital (53.2%) or community hospital based (38.2%). With emergency medicine training as: CCFP-EM (55.2%), FRCPC (30.1%), and CCFP (9.0%). There was relative agreement on the following interventions requiring PS: 98.4% applied PS for electrical cardioversion and 98.1% for brief (<10 mins) orthopedic manipulations. However, only 36.3% utilized PS for burn debridement in the ED. PS was utilized less frequently (78.1%) for prolonged (>10mins) orthopedic manipulations than brief manipulations. For all procedures aggregated, in hemodynamically stable patients with an American Society of Anesthesiology (ASA) score of 1, ED physicians utilized propofol 76.3% of the time. Additional agents were utilized at the following rates: fentanyl-propofol (7.6%), ketamine (7.6%), and fentanyl (4%). This inclination towards propofol alone appears to be consistent across modality of ER training, type of ER setting (rural vs academic), and volume of PS performed. Conclusion: This study demonstrates that Canadian ED physicians have a clear preference for propofol as a first line pharmacologic agent when administering PS in hemodynamically stable, ASA1 patients. Conversely, there appears to be more variation amongst ED physicians with respect to second line pharmaceutical choices for PS.

scholarly journals Comparison of Outcome Data for Shelter Dogs and Cats in the Czech Republic

Animals ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. 595
Author(s):  
Veronika Vojtkovská ◽  
Eva Voslářová ◽  
Vladimír Večerek
Keyword(s):  
Czech Republic ◽  
Length Of Stay ◽  
Outcome Data ◽  
Negative Effects ◽  
Median Length ◽  
The Czech Republic ◽  
Animal Protection ◽  
Shelter Dogs ◽  
The Subject

Animal protection, which also comprises the subject of abandoned and stray animals, has become a pressing and widely discussed topic. The aim of this study was to compare dogs and cats from two shelters in a selected region of the Czech Republic, based on factors that affect the length of stay. The following factors were analyzed: outcome, sex, age, and purebred status. A total of 419 cats and 2580 dogs housed in the monitored shelters from 2013 to 2016 were included in the analysis. The results show that dogs (n = 1343; 52.1%) are returned to their owners significantly more often (p < 0.001) than cats (n = 10; 2.4%). Dogs stayed in the shelter significantly (p < 0.001) less time than cats regardless of the outcome (the median length of stay of dogs were 3 days, while that of cats was 51 days). Also the length of stay in the shelter until adoption is shorter in dogs than in cats (dogs: median 27 days; cats: median 53 days). Median length of stay tended to increase with the increasing age in both species. Monitored age categories of dogs and cats differed significantly (p < 0.05) in their median length of stay (LOS) until adoption. We found that purebred status does not affect the length of stay in the shelter until adoption, either in dogs or in cats. Overall, our results suggest that dogs are preferred over cats in the Czech Republic. Shelter operators should take into account this aspect affecting animal adoption. By targeted efforts and education of public, it is possible to mitigate the negative effects of favoring a certain category of animals over others.

scholarly journals Competence in using the arthroscopy stack system: a national survey of orthopaedic trainees in the UK

2020 ◽  
Vol 102 (2) ◽  
pp. 149-152
Author(s):  
G Manoharan ◽  
N Sharma ◽  
P Gallacher
Keyword(s):  
Patient Safety ◽  
Training Programme ◽  
Electronic Survey ◽  
System A ◽  
Ensure Patient Safety ◽  
Set Up ◽  
Orthopaedic Training ◽  
The Uk ◽  
Almost All ◽  
Arthroscopic Procedures

Introduction Surgeons are required to have a sound knowledge regarding all operating theatre equipment they wish to use. This is important to ensure patient safety and theatre efficiency. Arthroscopy forms a significant part of all orthopaedic subspecialty practice. Proficiency in performing arthroscopic procedures is assessed during registrar training. The aim of this survey was to determine the competence of orthopaedic trainee registrars in setting up the arthroscopy stack system and managing intraoperative problems. Materials and methods Electronic survey forms were sent to all orthopaedic training programme directors in the UK to be forwarded to trainees in their deanery. The electronic survey contained 13 questions aimed at determining trainee experience and competence level with working with the arthroscopy stack system. Results A total of 138 responses were received from 14 deaneries in the UK. Almost all registrars had experienced intraoperative delays because of equipment malfunction that required addressing by more competent staff. However, 82% of respondents had not received any formal training for operating the arthroscopy stack system. Some 82% of registrars of ST7 grade or above, who had performed over 50 arthroscopic procedures and achieved a level 4 PBA competence, were unable to set up the stack system and successfully address these delays. Conclusions Inadequate training is delivered to orthopaedic registrars from both the training programme and arthroscopy-themed courses with regards to set-up and operation of the arthroscopy tower system. This training should be part of the curriculum to ensure patient safety and efficient theatre practice.

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