scholarly journals The effect of COVID-19 on the trauma burden, theatre efficiency and training opportunities in a district general hospital

2020 ◽  
Vol 1 (8) ◽  
pp. 494-499
Author(s):  
Monil Karia ◽  
Vatsal Gupta ◽  
Wajiha Zahra ◽  
Joeseph Dixon ◽  
Edward Tayton
Keyword(s):  
Hip Fracture ◽  
General Hospital ◽  
District General Hospital ◽  
Turnaround Time ◽  
Service Planning ◽  
Surgical Time ◽  
Significant Difference ◽  
Training Opportunities ◽  
And Training ◽  
Anaesthetic Time

Aims The aim of this study is to determine the effects of the UK lockdown during the COVID-19 pandemic on the orthopaedic admissions, operations, training opportunities, and theatre efficiency in a large district general hospital. Methods The number of patients referred to the orthopaedic team between 1 April 2020 and 30 April 2020 were collected. Other data collected included patient demographics, number of admissions, number and type of operations performed, and seniority of primary surgeon. Theatre time was collected consisting of anaesthetic time, surgical time, time to leave theatre, and turnaround time. Data were compared to the same period in 2019. Results There was a significant increase in median age of admitted patients during lockdown (70.5 (interquartile range (IQR) 46.25 to 84) vs 57 (IQR 27 to 79.75); p = 0.017) with a 26% decrease in referrals from 303 to 224 patients and 37% decrease in admissions from 177 to 112 patients, with a significantly higher proportion of hip fracture admissions (33% (n = 37) vs 19% (n = 34); p = 0.011). Paediatric admissions decreased by 72% from 32 to nine patients making up 8% of admissions during lockdown compared to 18.1% the preceding year (p = 0.002) with 66.7% reduction in paediatric operations, from 18 to 6. There was a significant increase in median turnaround time (13 minutes (IQR 12 to 33) vs 60 minutes (IQR 41 to 71); p < 0.001) although there was no significant difference in the anaesthetic time or surgical time. There was a 38% (61 vs 38) decrease in trainee-led operations. Discussion The lockdown resulted in large decreases in referrals and admissions. Despite this, hip fracture admissions were unaffected and should remain a priority for trauma service planning in future lockdowns. As plans to resume normal elective and trauma services begin, hospitals should focus on minimising theatre turnaround time to maximize theatre efficiency while prioritizing training opportunities. Clinical relevance Lockdown has resulted in decreases in the trauma burden although hip fractures remain unaffected requiring priority Theatre turnaround times and training opportunities are affected and should be optimised prior to the resumption of normal services. Cite this article: Bone Joint Open 2020;1-8:494–499.

scholarly journals The workload of stroke thrombolysis: A prospective study in a district general hospital setting

2011 ◽  
Vol 10 (1) ◽  
pp. 10-12
Author(s):  
Seán J Slaght ◽  
◽  
Nic U Weir ◽  
Joanna K Lovett ◽  
◽  
...  
Keyword(s):  
Prospective Study ◽  
General Hospital ◽  
Hospital Setting ◽  
District General Hospital ◽  
Service Planning ◽  
Stroke Severity ◽  
Southampton General Hospital ◽  
Stroke Thrombolysis ◽  
Few Data ◽  
A Prospective Study

Many hospitals are still setting up acute stroke thrombolysis services, often delayed by fears over workload. However, there are few data on how many patients require urgent assessment before one is treated. We prospectively studied all referrals to the 24-hour stroke thrombolysis service, February 2009 – January 2010, in Southampton General Hospital. 128 patients were referred to the thrombolysis team and 20 received thrombolysis. The most common reasons for treatment exclusion were: stroke severity (37%), time from onset (26%) or CT findings (15%). Approximately six patients required urgent assessment by the thrombolysis team for every one treated. These data are crucial to inform service planning.

P09 ‘there’s no place like home’: reducing paediatric discharge steps

2018 ◽  
Vol 103 (2) ◽  
pp. e1.13-e1
Author(s):  
Barbour Emma ◽  
Collins Catherine ◽  
Mclister Niamh
Keyword(s):  
Data Collection ◽  
General Hospital ◽  
District General Hospital ◽  
Turnaround Time ◽  
List Type ◽  
Discharge Process ◽  
Paediatric Ward ◽  
Two Phase ◽  
Maximum Time ◽  
Ward Level

AimTo determine the efficiency of dispensing paediatric discharges at dispensary vs ward level.MethodA data collection form was designed for use during a two-phase audit. During the first week of data collection, the turnaround time of dispensing discharges in the dispensary was collected. In the second week, the turnaround time of dispensing discharges at ward level on the paediatric ward was recorded.The dispensary standard of a 60 min turnaround for medium priority discharges1 was used for both weeks. Medical, surgical and ENT prescriptions were all included in the audit.ResultsInformation relating to 23 discharges was collected during week one at dispensary level. In week 2, 21 discharges were assessed.When assessing the minimum and maximum time taken from when a patient was informed of their discharge to medications being given, there was a reduction of 98 min when completed at ward level for minimum time and 75 min for the maximum time.The average turnaround time for dispensing prescriptions was 94 min at dispensary level and 26 min at ward level. Only 57% of discharges completed in the dispensary met the standard turnaround time of 60 min compared to 100% completed at ward level. Discharge prescription turnaround time was decreased by 72% when completed at ward level.In total sixteen discharge steps were identified using the traditional dispensary based method for discharges. These ranged from the patient being told they can go home on the ward round to the prescription being written and sent to pharmacy, and finally returned to the ward for transfer to the patient.The process of dispensing discharges at ward level enabled a reduction of 50% of the sixteen steps, subsequently expediting the discharge process.ConclusionWhen discharges were completed at ward level standards were met 100% of the time and a reduction in eight discharge steps was accomplished. Thus highlighting that a ward level dispensing service is necessary on the paediatric ward in this District General Hospital.ReferenceWallace K. Prescription Tracker System (PTS). Patient services District General Hospital2014.

scholarly journals Introducing a reserve waiting list initiative for elective general surgery at a District General Hospital

2019 ◽  
Vol 8 (3) ◽  
pp. e000745 ◽  
Author(s):  
Vaki Antoniou ◽  
Olivia Burke ◽  
Roland Fernandes
Keyword(s):  
General Hospital ◽  
General Surgery ◽  
Fast Track ◽  
Operating Time ◽  
District General Hospital ◽  
Waiting List ◽  
Related Factors ◽  
Simple Protocol ◽  
Significant Burden ◽  
Training Opportunities

Cancelled operations represent a significant burden on the National Health Service in terms of theatre efficiency, financial implications and lost training opportunities. Moreover, they carry considerable physical and psychological effects to patients and their relatives. Evidence has shown that up to 93% of cancelled operations are due to patient-related factors. An analysis at our District General Hospital revealed that approximately 18 operations are cancelled on the day of surgery each month. This equates to 27 hours of allocated operating time valued by the trust as £67 500, not being used effectively. This retrospective quality improvement report aims to reduce unused theatre time due to cancelled elective operations in general surgery theatres—thereby improving theatre efficiency and patient care. To ascertain the baseline number of cancelled operations, an initial review of theatre cases was undertaken. Further review was then completed after implementation of two improvements—a short notice surgical waiting list and fast track pre-assessment clinics. The results showed that implementation of the reserve surgical waiting list reduced unused operating time by an average of 2.25 hours per month. By further adding in the fast track preassessment clinic, these figures increased to an average of 11.5 hours over the next 3 months. This precipitated a reutilisation of otherwise wasted theatre time. Economic impact of this time amounts around £28 750 a month, after implementation of both improvements. Simple protocol changes can lead to large improvements in the efficient running of theatres. The resultant change has improved patient satisfaction, led to greater training opportunities and improved theatre efficiency. Extrapolation of our results show better usage of previously underused theatre time, to the equivalent worth of £345 000. Further implementation of these improvements in other surgical specialities and hospitals would be beneficial.

scholarly journals Managing supracondylar fractures of the distal humerus in children in a district general hospital

2013 ◽  
Vol 95 (8) ◽  
pp. 582-585 ◽  
Author(s):  
M Pullagura ◽  
S Odak ◽  
R Pratt
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
General Hospital ◽  
Open Reduction ◽  
District General Hospital ◽  
Distal Humerus ◽  
Timing Of Surgery ◽  
Postoperative Outcomes ◽  
Supracondylar Fractures ◽  
Significant Difference

Introduction Controversy exists regarding the timing of surgery in children with displaced supracondylar fractures of the humerus. Methods We reviewed retrospectively the postoperative outcomes and complications in these children managed in a district general hospital. Results There were 81 children with displaced supracondylar fractures (64 Gartland type III and 17 type IIA). Of these, 46 children were treated within 6 hours of presentation and 35 were treated later. The rate of open reduction was higher in children treated early (23%) than in late cases (11%). There was no significant difference in the postoperative outcomes and complications between the groups. Conclusions In children with a supracondylar fracture, the timing of surgical treatment (before or after six hours from presentation to hospital) had no effect on postoperative complications and outcomes.

scholarly journals The Consequences of Toxic Shock Syndrome in an 18-Month-Old Boy with 20% Scalds

1996 ◽  
Vol 89 (2) ◽  
pp. 115P-116P ◽  
Author(s):  
T C Davis ◽  
N K Griffin
Keyword(s):  
Young Children ◽  
General Hospital ◽  
Toxic Shock Syndrome ◽  
Early Recognition ◽  
Hospital Setting ◽  
District General Hospital ◽  
Toxic Shock ◽  
Early Therapy ◽  
And Training

Toxic shock syndrome may complicate burns and scalds in young children1,2. However, it can occur in the district general hospital setting, where early recognition of the prodromal features to facilitate early therapy will depend on the knowledge and training of paediatricians and casualty staff.

scholarly journals Knowledge and Performance Ability of Defibrillator among General Hospital Nurses

2021 ◽  
Vol 21 (3) ◽  
pp. 110-116
Author(s):  
Jin Chae ◽  
Jeong Yun Park
Keyword(s):  
General Hospital ◽  
American Heart ◽  
Heart Association ◽  
Self Report ◽  
Hospital Nurses ◽  
Significant Difference ◽  
The Mean ◽  
Performance Ability ◽  
And Performance ◽  
And Training

Background: The purpose of this study was to investigate nurses' knowledge and performance ability of Defibrillator.Methods: The participants in this study were 121 nurses who have been working in a general hospital located in G region. The measuring tools of this study were developed on the basis of guidelines from American Heart Association and Korea Association of Cardiopulmonary Resuscitation. The knowledge of defibrillator was measured by self-report questionnaire, and the performance ability of defibrillator was measured by observation of the participants. The period of collected date was from May 15 to June 15 in 2016. The collected data were analyzed by using SPSS 19.0 program.Results: The mean score about knowledge of defibrillator was 2.79±2.42. The mean score about performing ability of defibrillation was 6.44±3.39. The knowledge of defibrillator was a significant difference with age, working area, working carrier, experience of using defibrillator. The performance ability of defibrillator was a significant difference with age, working area, working carrier, experience of using defibrillator. There was a significant positive correlation between knowledge and performance ability of defibrillator.Conclusions: The finding suggests developing the knowledge and the performance ability of defibrillator on going refresher courses and training programs, including the related nursing practice guidelines to improve the knowledge and performance ability of defibrillator.

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