scholarly journals Vascular Surgery within General Surgery: An Analysis of Workload 1989–2005

2007 ◽  
Vol 89 (7) ◽  
pp. 682-684 ◽  
Author(s):  
SQ Ashraf ◽  
A Bajwa ◽  
TR Magee ◽  
RB Galland
Keyword(s):  
Primary Care ◽  
Vascular Surgery ◽  
General Hospital ◽  
General Surgery ◽  
Varicose Vein ◽  
Primary Care Trust ◽  
District General Hospital ◽  
Considerable Debate ◽  
General Surgeons ◽  
Surgical Unit

INTRODUCTION There is considerable debate as to whether vascular surgery should be a subspecialty separate from general surgery. This study examines the changing relationship between general and vascular surgery in a district general surgical unit over 16 years. PATIENTS AND METHODS A detailed survey of referrals, admissions and operations to one unit was carried out over 3 months in 003. This was compared with similar surveys in 1989, 1990 and 1995. In addition a 3-month audit of operations performed was carried out in 2005 following a decision by the Primary Care Trust (PCT) to reduce varicose vein referrals. RESULTS There was a significant increase in the number of varicose vein and arterial referrals 1989–2003 (P = 0.0001 and P < 0.0001, respectively). This was reflected in increased number of vascular admissions (P < 0.0001). In 1989, 14% of the arterial cases were admitted as emergencies. This figure rose to 52% in 2003 (P < 0.0001). There was a significant increase in the number of arterial operations performed between 1989 and 1995; however, from 1995 to 2003 this number fell P < 0.0001). The number of varicose vein procedures increased significantly 1989–2003 (P < 0.0001), with a significant fall after the PCT decision (P < 0.0001). However, the number of operations carried out in 2005 increased slightly with the proportion of general surgical cases, mostly hernia repairs and laparoscopic cholecystectomies, increasing. CONCLUSIONS With increasing specialisation comes the risk that reduction in any aspect of a particular specialty may result in that unit becoming unsustainable. In vascular surgery this will inevitably lead to centralisation of services. In a large district general hospital having two general surgeons with a vascular interest, the general surgical component has maintained the workload of the unit following reduction in varicose vein referrals.

scholarly journals Reduction in Varicose Vein Services: Impact on Operative Training

2007 ◽  
Vol 89 (8) ◽  
pp. 789-791 ◽  
Author(s):  
A Bajwa ◽  
TR Magee ◽  
RB Galland
Keyword(s):  
Varicose Vein ◽  
Primary Care Trust ◽  
District General Hospital ◽  
Work Load ◽  
Middle Grade ◽  
Case Load ◽  
Before And After ◽  
Local Primary Care ◽  
The Impact ◽  
Surgical Unit

INTRODUCTION This study examines the impact of rationing varicose vein operations on operative training on a general surgical unit with a vascular interest. PATIENTS AND METHODS Log-books of middle-grade surgeons were analysed for 3-month periods before and after a decision by the local Primary Care Trust to ration varicose vein referrals. Number, intermediate equivalents and type of operations were recorded, whether they were general or vascular cases and whether the trainee had carried out or assisted with the operation. RESULTS There was a slight fall in the total number of operations in which the middle-grade surgeons were involved (208 to 186). There was a significant increase in general surgical cases with the fall in number of varicose vein operations (P < 0.0001).The fall in case-load and work-load operative training in vascular surgery was compensated by an increase in general surgical cases (P = 0.0003). This was largely due to increased number of hernia repairs (P = 0.0035). CONCLUSIONS From the point of operative training, a vascular unit in a district general hospital would not be sustainable following withdrawal of varicose vein services. However, this can be off-set by increasing general surgical case-load to fill the gap created.

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.

COVID-19: Adapting to change, general surgery at a district general hospital in the United Kingdom

2019 ◽  
Vol 30 (10) ◽  
pp. 301-308
Author(s):  
Sonia Ike ◽  
Chijioke Ikechi ◽  
Jaideep Rait ◽  
Ankur Shah
Keyword(s):  
United Kingdom ◽  
General Hospital ◽  
General Surgery ◽  
Major Change ◽  
Holistic Approach ◽  
District General Hospital ◽  
Viral Spread ◽  
The United Kingdom ◽  
Staff Wellbeing ◽  
Surgery Department

The Coronavirus pandemic has caused major change across the world and in the National Health Service. In order to cope and help limit contagion, numerous institutions recognised the need to adjust clinical practice quickly yet safely. In this paper, we aim to describe the changes implemented in a general surgery department at a district general hospital in the United Kingdom. Across the surgical specialties, frameworks, protocols and guidelines have been established locally and nationally. The aerosol generating procedures involved in general surgery required us to alter our daily activities. Modifications to patient management were necessary to try and reduce viral spread. Staff wellbeing was heavily promoted in order to help maintain the frontline workforce. A holistic approach was required.

Is weekend surgery a risk factor for post-tonsillectomy haemorrhage?

2016 ◽  
Vol 130 (8) ◽  
pp. 763-767 ◽  
Author(s):  
A Patel ◽  
N Foden ◽  
A Rachmanidou
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
General Hospital ◽  
General Surgery ◽  
District General Hospital ◽  
Low Risk ◽  
Morbidity And Mortality ◽  
The Uk

AbstractBackground:Tonsillectomy is a common, low-risk procedure. Post-tonsillectomy haemorrhage remains the most serious complication. Recent nationwide studies in the UK have identified an increased morbidity and mortality for both high-risk and low-risk elective general surgery performed at the weekend.Methods:Data for tonsillectomies performed at a district general hospital over a three-year period were retrospectively reviewed. The same group of surgeons performed elective tonsillectomies on both weekends and weekdays. All patients who developed a post-tonsillectomy haemorrhage were identified and the day of original operation was noted.Results:Between 2010 and 2013, 2208 (94.00 per cent) elective tonsillectomies were performed on a weekday and 141 (6.00 per cent) were performed on the weekend. Post-tonsillectomy haemorrhages occurred in 104 patients (4.71 per cent) who underwent their procedure on a weekday and in 10 patients (7.09 per cent) who had their surgery at the weekend (p = 0.20).Conclusion:There is no difference in the rate of post-tonsillectomy haemorrhage for procedures performed on a weekday or weekend.

Primary care trust commissioning of varicose vein intervention – New guidance needed?

2013 ◽  
Vol 29 (8) ◽  
pp. 505-510 ◽  
Author(s):  
Kathryn Jane Griffin ◽  
Simon Cousins ◽  
Marc Aaron Bailey ◽  
David Berridge ◽  
David Julian Ashbridge Scott
Keyword(s):  
Primary Care ◽  
National Health Service ◽  
Health Service ◽  
Varicose Vein ◽  
Primary Care Trust ◽  
Freedom Of Information ◽  
Freedom Of Information Act ◽  
Current State ◽  
Endovenous Laser Therapy ◽  
Email Survey

Objectives In light of evidence of national variability in service commissioning of varicose vein intervention, our aim was to evaluate the current state of primary care trust commissioning for all forms of varicose vein intervention in England. We also sought to clarify the extent to which access to endovenous and surgical varicose vein services is being restricted. Methods Under the Freedom of Information Act (2001), a structured email survey was sent to 108 primary care trusts in England. Trusts were asked how many elective endovenous laser therapy and open procedures were commissioned from 2008 to 2011 and they were asked to submit their commissioning policy for analysis. The ‘qualifying criteria’ expressed in each policy were analysed by theme and geographical region. Results Of 108 surveys, 95 (88%) were completed and returned. Of these, 91 (96%) stated that varicose vein interventions were actively commissioned. Eighty-eight (97%) of primary care trusts that commissioned varicose vein interventions stated that access was restricted. Qualifying criteria varied considerably between regions. Conclusions Access to varicose vein intervention appears to be restricted, with national variation in commissioning across England. This might have an impact on patient care and surgical training. We propose that a national decision be made about which varicose vein patients should be offered funding for treatment on the National Health Service.

scholarly journals EP.TU.44Improving Access to Surgery: The F1 ‘Theatre Day’ Programme

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rebecca Nunn ◽  
Santhini Jeyarajah
Keyword(s):  
General Hospital ◽  
General Surgery ◽  
Elective Surgery ◽  
Working Hours ◽  
District General Hospital ◽  
Learning Opportunities ◽  
Learning Opportunity ◽  
Access To Surgery ◽  
Common Barriers

Abstract Aims To identify barriers in theatre attendance, facilitate access and maximise learning opportunities for surgical F1s (Foundation Year 1 Doctors) at a DGH (District General Hospital). Methods Between December 2019- December 2020, each F1 doctor was offered a day to spend in elective theatre during their General Surgery rotation (excluding emergency COVID rota periods). This was following feedback from the August- December 2019 cohort. Each ‘Theatre Day’ was scheduled during normal working hours when there was sufficient staff. Post-participation questionnaires were completed. Results Prior to implementation of the Programme, 3/8 F1s surveyed had not attended any elective surgery lists (1 had not attended theatre at all). All indicated that they would have been interested in attending a timetabled elective theatre day; 88% highlighted a ‘lack of staff’ and 63% indicated that ‘feeling guilty’ were barriers in attending theatre. 21 F1s were offered a ‘Theatre Day’: 17 agreed to participate and 16 completed post-participation questionnaires. Only 47% confirmed that they were considering a career in surgery prior to participation: all agreed that spending time in theatre was a useful learning opportunity and 94% agreed that the Programme should be continued. Conclusions Spending time in theatre appears to be valued as a useful learning opportunity for F1s, whether or not they are aspiring surgeons. Common barriers to self-organised theatre attendance appear to be an anticipated ‘lack of staff’ or feelings of ‘guilt’. A senior-led scheduling of one day in theatre should circumnavigate these barriers and ensure that access is available to all.

scholarly journals Universal SHO and SpR shift rotas adversely influence SHO operative experience

2006 ◽  
Vol 88 (7) ◽  
pp. 244-246 ◽  
Author(s):  
C Beaton ◽  
MR Stephens ◽  
AN Hopper ◽  
WG Lewis
Keyword(s):  
General Hospital ◽  
Shift Work ◽  
Clinical Experience ◽  
Surgical Training ◽  
General Surgery ◽  
District General Hospital ◽  
European Working ◽  
Training Post ◽  
Operative Experience ◽  
Working Time Directive

The European Working Time Directive (EWTD) will reduce the clinical experience obtained by surgeons prior to attaining consultant status from 21,000 surgical hours to 7,640 hours, 1 with shift work obligatory for compliance. We have shown previously that the operative experience of SHOs in general surgery is on the wane in our own hospital, varies with subspecialty interest 2 and has witnessed further erosion by the introduction of the EWTD. 3 The aim of this study was to assess the influence of an all tier shift rota on the emergency and elective operative experience of SHOs in a category 1 general surgical training post working in a large district general hospital serving a population of 600,000.

scholarly journals Audit of Performance of Day Case Surgical Unit in A District General Hospital

2010 ◽  
Vol 8 (7) ◽  
pp. 532
Author(s):  
M.J. Akbar ◽  
S. Mehmood ◽  
N. Qayyum ◽  
O.E. Klimach
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Day Case ◽  
Surgical Unit

Iatrogenic Leg Ulcer after Subfascial Endoscopic Perforator Surger (SEPS)

1999 ◽  
Vol 14 (4) ◽  
pp. 167-168
Author(s):  
A. Huang ◽  
D. L. McWhinnie
Keyword(s):  
Case Report ◽  
Vascular Surgery ◽  
General Hospital ◽  
District General Hospital ◽  
Venous Ulcer ◽  
Leg Ulcer ◽  
Perforating Artery ◽  
Perforating Vein ◽  
Subfascial Endoscopic Perforator Surgery ◽  
Milton Keynes

Objective: To report a case of iatrogenic leg ulcer after subfascial endoscopic perforator surgery (SEPS). Design: Case report. Setting: Department of Vascular Surgery, Milton Keynes Hospital, a district general hospital. Patient, intervention and results: A 57-year-old woman underwent SEPS for a venous ulcer secondary to an incompetent perforating vein. Post-operatively she developed a new ulcer directly over the site of the divided perforator. The ulcer healed completely with conservative bandaging treatment after 4 months. Conclusion: We describe a complication of SEPS not previously reported. The perforating artery might have been divided inadvertently instead of the perforating vein. It is important to positively identify the perforating vein during SEPS before its division, especially in the presence of mixed arteriovenous disease.

Sign in / Sign up

Export Citation Format

Share Document