Performance Measurement and Optimal Care for Surgical Patients

2014 ◽  
Vol 259 (5) ◽  
pp. 850-851 ◽  
Author(s):  
Frank G. Opelka
Keyword(s):  
Performance Measurement ◽  
Surgical Patients ◽  
Optimal Care

scholarly journals EP.TU.156Frailty in the Emergency General Surgical Cohort, could we being doing more?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ross Hunter
Keyword(s):  
Multidisciplinary Approach ◽  
Length Of Hospital Stay ◽  
District General Hospital ◽  
National Standards ◽  
Surgical Patients ◽  
Specialist Care ◽  
Optimal Care ◽  
Clinical Frailty Scale ◽  
Physiological Capacity ◽  
External Stimuli

Abstract Aims Frailty, a state of diminished diminished physiological capacity to deal with external stimuli, is being seen ever increasingly in the aging emergency general surgical cohort. Length of hospital stay, morbidity and mortality are shown in the literature to dramatically increase in the frail population. Outcomes in this cohort are shown to improve significantly with specialist frailty input from geriatricians, physiotherapy and occupational therapy teams. The authors aimed to assess the burden of frailty in emergency surgical admissions in a District General Hospital, and the frailty specialist care these patients received. Methods A snapshot survey of all acute surgical admissions during a single 24 hour period was performed. Frailty was defined as a Rockwood Clinical Frailty Scale score of 5 or above. The management of these patients was then compared to national standards and recommendations made on how the treatment of the clinically frail could be improved upon. Results 73% of patients in the sampled cohort (19/26) were found to be clinically frail. Only 2 (10%) of these patients had been reviewed by the frailty specialist teams within the hospital. Following implementation of recommendations, namely an improved referral system, reminders within initial clerking paperwork and raising departmental awareness, specialist input was shown to increase threefold to 32% (10/31) within the same patient group. Conclusions A significant cohort of emergency general surgical patients are classified as clinically frail. Optimal care for these patients involves a multidisciplinary approach, the uptake of which can be increased significantly with intra-departmental education and increased awareness.

EP.TU.270Improving Treatment Escalation Plan (TEP) Completion Rate for General Surgical Patients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Eric Yuen Ing Yii ◽  
Alison Bradley
Keyword(s):  
Completion Rate ◽  
Surgical Patients ◽  
Filling Rate ◽  
Optimal Care ◽  
Continuous Auditing ◽  
Prospective Data ◽  
Clinical Notes ◽  
Mean Delay ◽  
Audit Cycle ◽  
Treatment Escalation

Abstract Aims Treatment Escalation Plan (TEP) is essential for recognition of patients’ ceiling for care in the event of clinical deterioration. It should be clearly documented to ensure continuity of care, especially during Covid-19 pandemic. This audit aims to evaluate and improve the TEP filling rate for general surgical patients. Methods A prospective data collection was performed for one week in July 2020 in general surgical wards. Data on patients’ gender, age, presence of DNACPR form and date of TEP completion were collected from patients’ clinical notes. Data was analysed using SPSS statistic software. Educational posters were displayed in the ward and presentation was done to emphasise the importance of TEP documentation. Second audit cycle was done in August 2020 to assess for improvement in TEP filling rate. Results In the first cycle, 60 patients were included with a mean age of 60. Only 11.7% patients had TEP form filled in with a mean delay of 2.7 days since admission. In the second cycle, 57 patients were included with a mean age of 66. 28.1% patients had TEP form documented with a mean delay of 1.7 days. This has shown a 140% improvement in completion rate of TEP form and 59% reduction in the delay in TEP documentation. Conclusions TEP is essential to ensure that patients received optimal care when their condition deteriorate. Simple intervention such as educational posters will help to improve the TEP completion rate. However, continuous auditing is required to ensure improvement in TEP documentation for surgical patients.

Quality management in the prophylaxis of venous thrombembolism - Results of a survey including 464 medical and surgical patients

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 123-130
Author(s):  
Klein-Weigel ◽  
Richter ◽  
Arendt ◽  
Gerdsen ◽  
Härtwig ◽  
...  
Keyword(s):  
Renal Function ◽  
High Risk ◽  
Quality Management ◽  
High Risk Group ◽  
Surgical Patients ◽  
Medical Patients ◽  
Risk Status ◽  
Vte Prophylaxis ◽  
Safety Concerns

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. Patients and methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). Conclusions: We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and “hot spots” quality management-audits proved to be valuable instruments.

Sign in / Sign up

Export Citation Format

Share Document