An Analysis of Complaints in Two Large Tertiary University Teaching Hospital ENT Departments: A Two-Year Retrospective Review

Introduction. Complaints relating to patient care are known to correlate with surgical complication rates and malpractice lawsuits. In a continually evolving health service and on-going financial pressures, identifying current complaint themes could drive future improvements in healthcare delivery. Objective. The aim of this paper is to review and analyse complaints received by the ENT department of two large teaching hospitals in London in order to determine current trends and mitigate future challenges. Method. All complaints registered with the Patient Advice and Liaison Service (PALS) from the ENT Department at our institution were collected between June 2016 and August 2018. Demographic information was collated and complaints were analysed and interpreted as per a standardised coding taxonomy. Results. A total of 242 complaints were collected. Most (91.7%) were logged by patients themselves with a mean age of 48.3 (range 3–98 years). The majority were directed at the administrative team (52%) followed by management (23.5%) and then clinicians (16.9%). Administrative issues were the most common (50.1%) followed by clinical (25.1%) and relationship/communication (24.7%). The bulk of complaints focused on delays in access to services and treatment in the form of cancellations and long appointment waiting times (37%). Conclusion. There has been a significant shift in complaints themes from clinical issues to administrative issues. This may reflect increasing financial and staffing pressures in the NHS. Complaints analysis is key in quality improvement and a cross-specialty integrated filing system in concordance with the recently proposed taxonomy would ease future collection and analysis of data.

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Evaluation of Complications and Costs During Overlapping Transsphenoidal Surgery in the Treatment of Pituitary Adenoma

Neurosurgery ◽

10.1093/neuros/nyy269 ◽

2018 ◽

Vol 84 (5) ◽

pp. 1104-1111 ◽

Cited By ~ 9

Author(s):

Michael Karsy ◽

Christian A Bowers ◽

Jonathan Scoville ◽

Bornali Kundu ◽

Mohammed A Azab ◽

...

Keyword(s):

Pituitary Adenoma ◽

Pituitary Adenomas ◽

Improve Patient Safety ◽

Surgical Complication ◽

Tumor Resection ◽

Healthcare Delivery ◽

Complication Rates ◽

Tumor Type ◽

Presenting Symptoms ◽

Transsphenoidal Resection

Abstract BACKGROUND Pituitary adenomas are among the most common primary brain tumors. Recently, overlapping surgery has been curbed in many institutions because of the suggestion there might be more significant adverse events, despite several studies showing that complication rates are equivalent. OBJECTIVE To assess complications and costs associated with overlapping surgery during the transsphenoidal resection of pituitary adenomas. METHODS A single-center, retrospective cohort study was performed to evaluate the cases of patients who underwent a transsphenoidal approach for pituitary tumor resection. Patient, surgical, complication, and cost (value-driven outcome) variables were analyzed. RESULTS A total of 629 patients (302 nonoverlapping, 327 overlapping cases) were identified. No significant differences in age (P = .6), sex (P = .5), tumor type (P = .5), or prior rates of pituitary adenoma resection (P = .5) were seen. Similar presenting symptoms were observed in the 2 groups, and follow-up length was comparable (P = .3). No differences in tumor sizes (P = .5), operative time (P = .4), fat/fascia use (P = .4), or cerebrospinal fluid diversion (P = .8) were seen between groups. The gross total resection rate was not significantly different (P = .9), and no difference in recurrence rate was seen (P = .4). A comparable complication rate was seen between groups (P = .6). No differences in total or subtotal costs were seen either. CONCLUSION The results of this study offer additional evidence that overlapping surgery does not result in worsened complications, lengthened surgery, or increased patient cost for patients undergoing transsphenoidal resection of pituitary adenomas. Thus, studies and policy aiming to improve patient safety and cost should focus on optimizing other aspects of healthcare delivery.

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Knowledge and Utilization of Health Informatics among Medical Doctors in Ahmadu Bello University Teaching Hospital, Shika-Zaria

International Journal of Informatics and Communication Technology (IJ-ICT) ◽

10.11591/ijict.v10i3.pp171-181 ◽

2021 ◽

Vol 10 (3) ◽

pp. 171

Author(s):

Jamila Mohammed Dahiru

Keyword(s):

Health Care ◽

Health Informatics ◽

Care Delivery ◽

Healthcare Delivery ◽

University Teaching ◽

Teaching Hospitals ◽

Survey Method ◽

Medical Doctors ◽

Sources Of Information ◽

Record System

The strategic visions in the health care system now underpin application of Information Communication Technology for effective care delivery. Recognising the potentials of ICT for Health, the Nigerian government as part of its policy derive towards achieving effective health care delivery by the year 2020, adopted use of ICT for effective healthcare delivery. Part of the target was establishment of ICT/Health informatics units in teaching hospitals in the country. This study assessed level of knowledge and utilization of health informatics among medical doctors in Ahmadu Bello University, Shika-Zaria. Premised on the Unified Theory of Acceptance and Use of Technology, this study adopted descriptive survey method and structured questionnaire as its instrument of data collection. Findings revealed that 91.4% (n=201) of the 220 sampled medical doctors in ABUTH are aware of health informatics and that 68.2% (n=150) have knowledge of how to use it. The most prominent areas of health informatics among the medical doctors are ‘Management Information System’, ‘Electronic Health Record System’ and ‘Electronic Medical Record’. However, only 58.6% (n=129) of the medical doctors in BUTH Shika- Zaria are actually utilizing health informatics. Internet (n=133, 60.5%) and interpersonal sources (n= 71, 32.3%) were found to be the major sources of information of knowledge and utilization of health informatics among the medical doctors. The study therefore recommends that ABUTH, Shika-Zaria should put in place more mechanism for creating awareness on use of health informatics varieties and a strong need for time-series research to examine future development in respect to knowledge and utilization of health informatics in Nigerian health institutions.

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The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve

Journal of Neurosurgery Spine ◽

10.3171/2019.7.spine19656 ◽

2020 ◽

Vol 32 (2) ◽

pp. 207-220 ◽

Cited By ~ 4

Author(s):

Darryl Lau ◽

Vedat Deviren ◽

Christopher P. Ames

Keyword(s):

Blood Loss ◽

Operative Time ◽

Surgical Complication ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Neurological Deficits ◽

Complication Rates ◽

Years Of Experience ◽

Surgeon Experience ◽

Operative Measures

OBJECTIVEPosterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD.METHODSA retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss.RESULTSA total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss.CONCLUSIONSSurgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon’s experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.

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Complications and Revisions After Spine Surgery in Patients With Skeletal Dysplasia: Have We Improved?

Global Spine Journal ◽

10.1177/2192568221994786 ◽

2021 ◽

pp. 219256822199478

Author(s):

Karim Shafi ◽

Francis Lovecchio ◽

Maria Sava ◽

Michael Steinhaus ◽

Andre Samuel ◽

...

Keyword(s):

Spine Surgery ◽

Skeletal Dysplasia ◽

Spinal Surgery ◽

Cardiovascular Health ◽

Surgical Complication ◽

Case Series ◽

Neurologic Complication ◽

Complication Rates ◽

Retrospective Case ◽

Average Patient

Study Design: Retrospective case series. Objective: To report contemporary rates of complications and subsequent surgery after spinal surgery in patients with skeletal dysplasia. Methods: A case series of 25 consecutive patients who underwent spinal surgery between 2007 and 2017 were identified from a single institution’s skeletal dysplasia registry. Patient demographics, medical history, surgical indication, complications, and subsequent surgeries (revisions, extension to adjacent levels, or for pathology at a non-contiguous level) were collected. Charlson comorbidity indices were calculated as a composite measure of overall health. Results: Achondroplasia was the most common skeletal dysplasia (76%) followed by spondyloepiphyseal dysplasia (20%); 1 patient had diastrophic dysplasia (4%). Average patient age was 53.2 ± 14.7 years and most patients were in excellent cardiovascular health (88% Charlson Comorbidity Index 0-4). Mean follow up after the index procedure was 57.4 ± 39.2 months (range). Indications for surgery were mostly for neurologic symptoms. The most commonly performed surgery was a multilevel thoracolumbar decompression without fusion (57%). Complications included durotomy (36%), neurologic complication (12%), and infection requiring irrigation and debridement (8%). Nine patients (36%) underwent a subsequent surgery. Three patients (12%) underwent a procedure at a non-contiguous anatomic zone, 3 (12%) underwent a revision of the previous surgery, and another 3 (12%) required extension of their previous decompression or fusion. Conclusions: Surgical complication rates remain high after spine surgery in patients with skeletal dysplasia, likely attributable to inherent characteristics of the disease. Patients should be counseled on their risk for complication and subsequent surgery.

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Management of slides by departments of medical illustration and medical libraries in university teaching hospitals

Journal of Audiovisual Media in Medicine ◽

10.3109/17453059009055330 ◽

1990 ◽

Vol 13 (4) ◽

pp. 135-142 ◽

Cited By ~ 3

Author(s):

G. S. Sutcliffe

Keyword(s):

University Teaching ◽

Teaching Hospitals ◽

Medical Illustration ◽

Medical Libraries ◽

University Teaching Hospitals

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Comparison of Outcomes of Emergency Laparotomies Performed During Daytime Versus Nights and Weekends in Rwandan University Teaching Hospitals

World Journal of Surgery ◽

10.1007/s00268-021-06327-6 ◽

2021 ◽

Author(s):

Isaie Twahirwa ◽

Norbert Niyonshuti ◽

Clement Uwase ◽

Jennifer Rickard

Keyword(s):

University Teaching ◽

Teaching Hospitals ◽

University Teaching Hospitals

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Therapeutic Outcomes in AIDS-Associated Kaposi's Sarcoma Patients on Antiretroviral Therapy Treated with Chemotherapy at Two Tertiary Hospitals in Lusaka, Zambia

Current HIV Research ◽

10.2174/1570162x16666180711103610 ◽

2018 ◽

Vol 16 (3) ◽

pp. 231-236 ◽

Cited By ~ 6

Author(s):

Watson Mtonga ◽

Aaron Mujajati ◽

Derick Munkombwe ◽

Aubrey Kalungia ◽

Lungwani Tyson Muungo ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Kaposi's Sarcoma ◽

Kaposi’S Sarcoma ◽

Complete Response ◽

University Teaching ◽

Teaching Hospitals ◽

Recurrence Rates ◽

Therapeutic Outcomes ◽

Efficacious Treatment ◽

Study Participants

The incidence of HIV-associated Kaposi’s sarcoma (KS) remains high in Zambia in the antiretroviral therapy era. The most efficacious treatment regimen for KS has yet to be established. In both developed and developing countries, treatment regimens have had limited efficacy. Late presentation in Africa affects therapeutic outcomes. Objective: The aim of this study was to determine therapeutic outcomes of epidemic KS patients on combination antiretroviral therapy (cART) after completion of six cycles of Adriamycin, Bleomycin, and Vincristine (ABV) chemotherapy. Methods: This was a descriptive cross-sectional study. Study participants were drawn from a study database of confirmed incident KS patients seen at the Skin Clinic of the University Teaching Hospitals (UTH) during the period between August, 2015 and September, 2016. Results: Of the 38 successfully recruited study participants, a complete response was documented in 18 (47%) after 6 cycles of ABV whereas 20 (53%) experienced a partial response. KS recurrence was observed in 8 (44%) of the individuals that experienced an initial complete response. At the time of the study, clinical assessment revealed that KS lesions had completely regressed in 21 (55%) of all the patients. Conclusion: ABV chemotherapy appears ineffective in long-term resolution of epidemic KS patients on ART. Recurrence rates are high after chemotherapy in patients that experience initially favorable responses to treatment. There is a need to diagnose KS earlier, and to develop more efficacious treatment options in order to reduce recurrence rates for epidemic KS.

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