scholarly journals Impact of COVID-19 on surgical services in a District General Hospital in the United Kingdom: benefits versus drawbacks

2021 ◽  
Vol 8 (2) ◽  
pp. 440
Author(s):  
Islam H. El-Abbassy ◽  
Hesham El-Hakim ◽  
Mei Kei Wong ◽  
Robert McIntyre
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Remote Consultation ◽  
Face To Face ◽  
Surgical Services ◽  
The United Kingdom ◽  
Number Of Patients ◽  
Service Activity ◽  
The Uk ◽  
The Impact

Background: COVID-19 outbreak led to significant changes in health services worldwide. This study aimed to assess the impact of this outbreak on the surgical services in a small District General Hospital and to highlight any benefits that we can take forward.Methods: Data were collected retrospectively comparing the surgical service activity during the two months (April and May 2020) around the peak of COVID-19 first wave in the UK and the similar two-month period the year before when activity was at its usual pre-COVID level. A short questionnaire on the use and satisfaction of remote consultation was circulated to all hospital consultants.Results: The total number of patients presenting to the emergency department in all specialities almost halved during the COVID-19 crisis. The number of emergency surgical admissions decreased. All elective lists were cancelled and more patients were managed conservatively. In April and May 2020, 156 patients had outpatient surgical consultations. Only 14 of them were face-to-face, whereas the rest were done either by telephone or video calls. This is compared to 472 patients who had face-to-face consultations in April and May 2019. The results of the questionnaire showed that over 90% of the consultants felt telemedicine consultations were satisfactory and that they would have an important role in the future.Conclusions: COVID-19 had serious impacts on surgical services regarding cancellation of elective lists and prolongation of waiting time. Despite these drawbacks, the increased confidence with telemedicine services was a significant benefit. 

scholarly journals EP.WE.268Impact of COVID-19 on surgical services in a District General Hospital in the UK: benefits versus drawbacks

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Islam El-Abbassy ◽  
Hesham El-Hakim ◽  
Mei Kei Wong ◽  
Robert McIntyre
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Surgical Service ◽  
Remote Consultation ◽  
Face To Face ◽  
Surgical Services ◽  
Number Of Patients ◽  
Service Activity ◽  
The Uk ◽  
The Impact

Abstract Background COVID-19 outbreak led to significant changes in health services worldwide. This study aims to assess the impact of this outbreak on the surgical services in a small District General Hospital and to highlight any benefits that we can take forward. Methods Data were collected retrospectively comparing the surgical service activity during the two months (April and May 2020) around the peak of COVID-19 first wave in the UK and the similar two-month period the year before when activity was at its usual pre-COVID level. A short questionnaire on the use and satisfaction of remote consultation was circulated to all hospital consultants. Results The total number of patients presenting to the emergency department in all specialities almost halved during the COVID-19 crisis. The number of emergency surgical admissions decreased. All elective lists were cancelled and more patients were managed conservatively. In April and May 2020, 156 patients had outpatient surgical consultations. Only 14 of them were face-to-face, whereas the rest were done either by telephone or video calls. This is compared to 472 patients who had face-to-face consultations in April and May 2019. The results of the questionnaire showed that over 90% of the consultants felt telemedicine consultations were satisfactory and that they would have an important role in the future. Conclusion COVID-19 had serious impacts on surgical services regarding cancellation of elective lists and prolongation of waiting time. Despite these drawbacks, the increased confidence with telemedicine services was a significant benefit.

scholarly journals 822 Lessons Learnt During the COVID-19 Pandemic on Emergency Surgical Admissions in A District General Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Ahn ◽  
N Khan ◽  
N Desai ◽  
M Abdu ◽  
L Hiddema ◽  
...  
Keyword(s):  
General Hospital ◽  
Public Health Intervention ◽  
District General Hospital ◽  
Lifestyle Changes ◽  
Severe Respiratory Distress ◽  
Surgical Services ◽  
Record Data ◽  
Efficacious Vaccine ◽  
Severe Respiratory Distress Syndrome ◽  
The Impact

Abstract Introduction Coronavirus disease (COVID-19) is an acute severe respiratory distress syndrome which resulted in an unprecedented impact on NHS service provision. We aimed to assess the impact of COVID-19 on general surgical services in a district general hospital. Method Electronic health care record data was retrospectively collected from 6th of April to 6th of May for both 2019 and 2020. Results Despite fewer referrals and admissions in 2020 (133 vs 177 admissions in 2019), there were more failed discharges (29 vs 17 in 2019) and higher associated costs. Higher numbers of biliary related pathologies and pancreatitis (50 in 2020 vs 25 in 2019), and fewer complaints of non-specific abdominal pain (10 in 2020 vs 22 in 2019) were observed. The use of outpatient investigations decreased by approximately 40% in 2020; however, utilisation of inpatient investigations was comparable. Conclusions Better utilisation of outpatient investigations and virtual clinic services may surmount pressures from further peaks of COVID-19. The increase in biliary related cases and pancreatitis may be consequent upon lifestyle changes during lockdown. This merits further investigation and if appropriate, public health intervention. In the absence of an efficacious vaccine, further research would be essential to streamline general surgical services based on clinical risk stratification.

scholarly journals Day case laparoscopic cholecystectomy: Identifying patients for a ‘COVID-Cold’ isolated day-case unit during the pandemic

2021 ◽  
pp. 175045892097741
Author(s):  
Zoe Hinchcliffe ◽  
Imran Mohamed ◽  
Anil Lala
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Hospital ◽  
Univariate Analysis ◽  
District General Hospital ◽  
Day Case ◽  
Patient Factors ◽  
Surgical Services ◽  
North Wales ◽  
Selection For ◽  
The Uk

Background The UK practice of laparoscopic cholecystectomy has reduced during the COVID-19 pandemic due to cancellation of non-urgent operations. Isolated day-case units have been recommended as ‘COVID-cold’ operating sites to resume surgical procedures. This study aims to identify patients suitable for day case laparoscopic cholecystectomy (DCLC) at isolated units by investigating patient factors and unexpected admission. Method Retrospective analysis of 327 patients undergoing DCLC between January and December 2018 at Ysbyty Gwynedd (District General Hospital; YG) and Llandudno General Hospital (isolated unit; LLGH), North Wales, UK. Results The results showed that 100% of DCLCs in LLGH were successful; 71.4% of elective DCLCs were successful at YG. Increasing age ( p = 0.004), BMI ( p = 0.01), ASA Score ( p = 0.006), previous ERCP ( p = 0.05), imaging suggesting cholecystitis ( p = 0.003) and thick-walled gallbladder ( p = 0.04) were significantly associated with failed DCLC on univariate analysis. Factors retaining significance (OR, 95% CI) after multiple regression include BMI (1.82, 1.05–3.16; p = 0.034), imaging suggesting cholecystitis (4.42, 1.72–11.38; p = 0.002) and previous ERCP (5.25, 1.53–18.00; p = 0.008). Postoperative complications are comparable in BMI <35kg/m2 and 35–39.9kg/m2. Conclusions Current patient selection for isolated day unit is effective in ensuring safe discharge and could be further developed with greater consideration for patients with BMI 35–39.9kg/m2. As surgical services return, this helps identify patients suitable for laparoscopic cholecystectomy at isolated COVID-free day units.

scholarly journals The impact of COVID-19 on elective and trauma spine service in a district general hospital

2020 ◽  
Vol 1 (6) ◽  
pp. 281-286
Author(s):  
Wajiha Zahra ◽  
Monil Karia ◽  
Daniel Rolton
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Acute Hospital ◽  
Retrospective Data ◽  
Spine Trauma ◽  
Clinical Criteria ◽  
Time Period ◽  
Number Of Patients ◽  
Acute Hospital Admission ◽  
The Impact

Aims The aim of this paper is to describe the impact of COVID-19 on spine surgery services in a district general hospital in England in order to understand the spinal service provisions that may be required during a pandemic. Methods A prospective cohort study was undertaken between 17 March 2020 and 30 April 2020 and compared with retrospective data from same time period in 2019. We compared the number of patients requiring acute hospital admission or orthopaedic referrals and indications of referrals from our admission sheets and obtained operative data from our theatre software. Results Between 17 March to 30 April 2020, there were 48 acute spine referrals as compared to 68 acute referrals during the same time period last year. In the 2019 period, 69% (47/68) of cases referred to the on-call team presented with back pain, radiculopathy or myelopathy compared to 43% (21/48) in the 2020 period. Almost 20% (14/68) of spine referrals consisted of spine trauma as compared to 35% (17/48) this year. There were no confirmed cases of cauda equine last year during this time. Overall, 150 spine cases were carried out during this time period last year, and 261 spine elective cases were cancelled since 17 March 2020. Recommendations We recommend following steps can be helpful to deal with similar situations or new pandemics in future: 24 hours on-call spine service during the pandemic. Clinical criteria in place to prioritize urgent spinal cases. Pre-screening spine patients before elective operating. Start of separate specialist trauma list for patients needing urgent surgeries. Conclusion This paper highlights the impact of COVID-19 pandemic in a district general hospital of England. We demonstrate a decrease in hospital attendances of spine pathologies, despite an increase in emergency spine operations. Cite this article: Bone Joint Open 2020;1-6:281–286.

scholarly journals Safe implementation of index telephone clinic appointments for patients with suspected lower gastrointestinal cancer with concurrent financial and environmental benefits.

2021 ◽  
Author(s):  
Kasun Wanigasooriya ◽  
Diwakar Sarma ◽  
Peter Woods ◽  
Paul O'Connor ◽  
Adrian Matthews ◽  
...  
Keyword(s):  
Waiting Times ◽  
District General Hospital ◽  
Environmental Benefits ◽  
Electronic Patient Records ◽  
Curative Intent ◽  
Detection Rates ◽  
Face To Face ◽  
The United Kingdom ◽  
Financial Benefits ◽  
The Impact

Aims: The COVID-19 pandemic led to hospitals in the United Kingdom substituting face-to-face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the impact of virtual two-week wait (2-ww) lower gastrointestinal (LGI) consultations on stakeholders at a district general hospital in England. Methods: Patients undergoing index outpatient 2-ww LGI clinic assessment between 01/06/2019-31/10/2019 (FtF group) and 01/06/2020-31/10/2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets (WTT) was assessed. Environmental and financial impact analyses were performed. Results: In total, 1531 patients were analysed (median age=70, male=852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone; the remainder were seen FtF (n=774, 50.6%). Ninety two (6%, VC=44, FtF=48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC); of these, 46 (71.9%, VC=26, FtF=20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p<0.001). The cancer detection rates (p=0.749), treatments received (p=0.785) and median time to index treatment for CRC patients (p=0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p<0.001). VC appointments saved patients a total of 9288 miles, 0.7 metric tonnes of CO2 emissions and £7482.97. Taxpayers saved £80,242.00 from VCs. No adverse events or complaints were reported in the VC group. Conclusion: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits for stakeholders.

scholarly journals 1274 Impact of Covid 19 on Urgent Suspicion of GI Cancer Referral in a District General Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Barman ◽  
H J Ng ◽  
S Teo ◽  
E M Blaney ◽  
O Mansfield
Keyword(s):  
Cancer Detection ◽  
Detection Rate ◽  
District General Hospital ◽  
Cancer Detection Rate ◽  
P Value ◽  
High Grade ◽  
Consistent Finding ◽  
Number Of Patients ◽  
The Uk ◽  
The Impact

Abstract Aim Endoscopy services across United Kingdom were affected significantly since March 2020 due to Covid-19 pandemic. Services were reduced and were more selective. We aim to compare the impact on duration between referral to colonoscopy and the detection rate of pathology between February (pre- Covid) and August (Covid impacted) 2020. Method Data was analysed from a prospectively maintained database of patients referred for colonoscopy to Royal Alexandra Hospital, Scotland. Patients underwent colonoscopy in month of February and August 2020 were included. Bowel screening patients were excluded. Positive findings included diverticulosis, colitis, polyp and adenocarcinoma. P value of &lt; 0.05 was considered significant. Results Total number of patients included was 97 (55 in February, 42 in August). Median age was 61 and 69 years, respectively. Mean duration from referral to colonoscopy were 4 weeks in February and 7 weeks in August. qFIT test were found raised in 50.9% in February and 57.1% in August with positive findings of 47.3% in February and 66.7% in August. 46.4% in February and 16.7% in August had raised qFIT but normal findings (p &lt; 0.05). Two high grade dysplasia polyps and two adenocarcinomas were identified in February, none found in August. Conclusions Covid-19 pandemic has disrupted the endoscopic services prolonging the duration from referral to colonoscopy. qFIT test is more heavily relied to prioritise urgent colonoscopies resulting in more positive findings on colonoscopy. Cancer detection rate has reduced which is a consistent finding as the UK national endoscopy study. Massive efforts are needed to restore endoscopy services.

scholarly journals The impact of COVID-19 on elective and trauma spine service in a district general hospital

2020 ◽  
Vol 1 (6) ◽  
pp. 281-286
Author(s):  
Wajiha Zahra ◽  
Monil Karia ◽  
Daniel Rolton
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Acute Hospital ◽  
Retrospective Data ◽  
Spine Trauma ◽  
Clinical Criteria ◽  
Time Period ◽  
Number Of Patients ◽  
Acute Hospital Admission ◽  
The Impact

Aims The aim of this paper is to describe the impact of COVID-19 on spine surgery services in a district general hospital in England in order to understand the spinal service provisions that may be required during a pandemic. Methods A prospective cohort study was undertaken between 17 March 2020 and 30 April 2020 and compared with retrospective data from same time period in 2019. We compared the number of patients requiring acute hospital admission or orthopaedic referrals and indications of referrals from our admission sheets and obtained operative data from our theatre software. Results Between 17 March to 30 April 2020, there were 48 acute spine referrals as compared to 68 acute referrals during the same time period last year. In the 2019 period, 69% (47/68) of cases referred to the on-call team presented with back pain, radiculopathy or myelopathy compared to 43% (21/48) in the 2020 period. Almost 20% (14/68) of spine referrals consisted of spine trauma as compared to 35% (17/48) this year. There were no confirmed cases of cauda equine last year during this time. Overall, 150 spine cases were carried out during this time period last year, and 261 spine elective cases were cancelled since 17 March 2020. Recommendations We recommend following steps can be helpful to deal with similar situations or new pandemics in future: 24 hours on-call spine service during the pandemic. Clinical criteria in place to prioritize urgent spinal cases. Pre-screening spine patients before elective operating. Start of separate specialist trauma list for patients needing urgent surgeries. Conclusion This paper highlights the impact of COVID-19 pandemic in a district general hospital of England. We demonstrate a decrease in hospital attendances of spine pathologies, despite an increase in emergency spine operations. Cite this article: Bone Joint Open 2020;1-6:281–286.

scholarly journals TP10.1.2Evaluating the impact of the COVID-19 pandemic on the presentation and management of UGI cancer at a district general hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Mohamed Aly ◽  
Tanmoy Mukerjee ◽  
Reya Singh ◽  
Douglas Whitelaw ◽  
Tanveer Adil ◽  
...  
Keyword(s):  
Cancer Patients ◽  
General Hospital ◽  
District General Hospital ◽  
Service Availability ◽  
Supportive Treatment ◽  
Curative Intent ◽  
Treatment Pathways ◽  
Surgical Services ◽  
Mode Of Presentation ◽  
The Impact

Abstract Introduction It has been predicted that the COVID-19 pandemic would disrupt the delivery of UK cancer treatment pathways. This study aims to assess the mode of presentation and type of management offered to oesophagogastric (OG) and hepatopancreaticobiliary (HPB) cancer patients at a busy district general hospital during the pandemic. Methods Confirmed OG and HPB cancer patients were identified in the local MDT database. Patients were identified between 01/03/2020 - 30/09/2020 (pandemic), and 01/03/2019 - 30/09/2019 (pre-pandemic). Mode of presentation and management was identified and compared. Results In 2019, 42 and 15 patients were diagnosed with OG and HPB cancers, compared to 25 and 19 patients in 2020, respectively. 26 (46%) patients were referred via 2ww pathway in 2019, compared to 29 (66%) in 2020. The number of cancers referred routinely or emergently were 28 (49%) and 2 (4%) in 2019, compared to 2 (5%) and 9 (20%) in 2020, respectively (p &lt; 0.0001). Patients suitable for curative treatment were 16 (28%) and 7 (16%), in 2019 and 2020, respectively. Palliative or supportive treatment was offered to 26 (46%) and 14 (25%) patients in 2019, compared to 21 (48%) and 10 (23%) patients in 2020, respectively. Conclusion 2ww referrals were similar to 2019, while routine referrals reduced significantly. A marked, but not significant, reduction in patients suitable for curative intent is noted, perhaps due to delay in presentation despite the continuation of cancer surgical services. Further work on creating “COVID-free” pathways and increasing awareness of service availability would improve detectability of curable disease.

scholarly journals EP.FRI.368Impact of Covid 19 on Urgent Suspicion of GI Cancer Referral in a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sowrav Barman ◽  
Hwei Jene Ng ◽  
Serene Teo ◽  
Eimear Blaney ◽  
Olivia Mansfield
Keyword(s):  
Cancer Detection ◽  
Detection Rate ◽  
District General Hospital ◽  
Cancer Detection Rate ◽  
P Value ◽  
High Grade ◽  
Consistent Finding ◽  
Number Of Patients ◽  
The Uk ◽  
The Impact

Abstract Aim Endoscopy services across United Kingdom were affected significantly since March 2020 due to Covid-19 pandemic. Services were reduced and were more selective. We aim to compare the impact on duration between referral to colonoscopy and the detection rate of pathology between February (pre- Covid) and August (Covid-impacted) 2020.    Methods Data was analysed from a prospectively maintained database of patients referred for colonoscopy to Royal Alexandra Hospital, Scotland. Patients underwent colonoscopy in month of February and August 2020 were included. Bowel screening patients were excluded. Positive findings included diverticulosis, colitis, polyp and adenocarcinoma. P value of &lt; 0.05 was considered significant. Results Total number of patients included was 97 (55 in February, 42 in August). Median age was 61 and 69 years respectively. Mean duration from referral to colonoscopy were 4 weeks in February and 7 weeks in August. qFIT test were found raised in 50.9% in February and 57.1% in August with positive findings of 47.3% in February and 66.7% in August. 46.4% in February and 16.7% in August had raised qFIT but normal findings (p &lt; 0.05). Two high grade dysplasia polyps and two adenocarcinomas were identified in February, none found in August.   Conclusion Covid-19 pandemic has disrupted the endoscopic services prolonging the duration from referral to colonoscopy. qFIT test is more heavily relied to prioritise urgent colonoscopies resulting in more positive findings on colonoscopy. Cancer detection rate has reduced which is a consistent finding as the UK national endoscopy study. Massive efforts are needed to restore endoscopy services. 

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