EP.FRI.5 Defining measurable data points for Emergency Surgical care

Aims Service provision and assessing the impact of future innovations can best be assessed by accurate data collection. Methods We have devised a simple dataset and implemented prospective data collection detailing patient referral source and outcome (consecutive days from 19.08.20 to 06.01.21) of Acute Surgical admissions. Results 2706 patient episodes. Conclusions These baseline figures demonstrate referral source and outcomes. Traditional Emergency Department referrals via the Surgical Registrar result in a noticeable difference in admission rates compared with novel pathways such as ASU Direct which allows admission from ED without discussion. These data are essential to facilitate proper evaluation of service delivery, the impact of novel pathways and would allow units to compare / combine results.

676 Paediatric Circumcisions- Compliance with RCS Standards

Introduction Variation in regional paediatric circumcision rates suggested some circumcisions were being performed unnecessarily. In 2016, the Royal College of Surgeons (RCS) released a clinical commissioning guide on foreskin conditions to standardise the indications for circumcision. We retrospectively audited the foreskin procedure practice at our urology department and its adherence to RCS clinical commissioning guidance. Method We assessed electronic health records for all paediatric patients (<17 years) having undergone a foreskin procedure from 1st Jan 2018 to 1st Jan 2019. Records were assessed for referral source, trial of medical treatment (steroid cream), indication, operative management carried out, daycase or inpatient cases, and histological analysis. Results 198 patients (mean age 8.7, range 2-16) underwent foreskin procedures in the set time frame. 98.9% were referred from GP surgery, and the remainder directly from A&E. 29.8% had documented trials of steroid creams prior to surgery. 51.5% of procedures were performed for ‘non-retractile foreskin’ and 11.6% for pathological phimosis. 87.4% of patients underwent circumcision and 11.1% had freeing of adhesions. All of procedures were performed as day-case. Histology was sent for 17.3% of circumcisions, with non-specific inflammation being the most common finding (46.7%), followed by lichen sclerosus (40%). Conclusions In our series large number of foreskin procedures were carried out over a 12-month period with a minority for the only absolute indication of pathological phimosis We have introduced stringent guidelines in the department since this audit, which will prevent circumcision in children who may otherwise avoid surgery.

531 An Admission Proforma to Improve Clerking Documentation in the ENT Department During the Covid-19 Pandemic: A Full Cycle Audit

Aim Good Surgical Practice states that surgeons must ensure that accurate, comprehensive, legible and contemporaneous records are maintained for all their interactions with patients. It is therefore critical that the clerking document, as the initial record of an admission, meets this standard. During the Covid-19 pandemic, an emergency rota meant that cross-covering of ENT at junior level was increasingly required in our hospital. Understandably, these trainees were less familiar with admitting ENT patients and of departmental standards. Our aim was to evaluate the quality of clerking documentation in our department during this period and investigate whether a standardised admission proforma could improve this. Method Clerking documents for all patients admitted in April 2020 were checked for completion of venous thromboembolism (VTE) risk assessment and inclusion of ten key pieces of information as outlined by the Surgical Tool for Auditing Records score. As was standard at this time, all clerking documentation had been completed on blank hospital continuation paper. A departmental admission proforma was introduced before admissions in June 2020 were then assessed identically. Results Improvement was noted in all measured parameters with no adverse effects. There was particular improvement in documentation of referral source (28% to 97%), consultant in charge (35% to 90%), name/grade/bleep (25% to 94%) and VTE risk assessment (14% to 78%). Trainee response was positive. Conclusions A simple admission proforma can markedly improve the standard of clerking documentation and therefore increase patient safety during a turbulent time. We would encourage other departments to consider developing their own.

Variations by ethnicity in referral and treatment pathways for IAPT service users in South London

Background The Improving Access to Psychological Therapies (IAPT) programme aims to provide equitable access to therapy for common mental disorders. In the UK, inequalities by ethnicity exist in accessing and receiving mental health treatment. However, limited research examines IAPT pathways to understand whether and at which points such inequalities may arise. Methods This study examined variation by ethnicity in (i) source of referral to IAPT services, (ii) receipt of assessment session, (iii) receipt of at least one treatment session. Routine data were collected on service user characteristics, referral source, assessment and treatment receipt from 85 800 individuals referred to South London and Maudsley NHS Foundation Trust IAPT services between 1st January 2013 and 31st December 2016. Multinomial and logistic regression analysis was used to assess associations between ethnicity and referral source, assessment and treatment receipt. Missing ethnicity data (18.5%) were imputed using census data and reported alongside a complete case analysis. Results Compared to the White British group, Black African, Asian and Mixed ethnic groups were less likely to self-refer to IAPT services. Black Caribbean, Black Other and White Other groups are more likely to be referred through community services. Almost all racial and minority ethnic groups were less likely to receive an assessment compared to the White British group, and of those who were assessed, all racial and ethnic minority groups were less likely to be treated. Conclusions Racial and ethnic minority service users appear to experience barriers to IAPT care at different pathway stages. Services should address potential cultural, practical and structural barriers.

Length of stay in a home treatment team

AimsThe aims were to establish the mean length of stay (LOS) in the Wandsworth home treatment team (HTT), and to identify which variables were associated with LOS. We hypothesised that the variables that are routinely collected via the electronic record system were associated with the LOS.BackgroundPsychiatric HTT's have been set up in all NHS trusts in England. These 24-hour community health services exist to assess and manage patients during a crisis, who would otherwise be admitted to an acute psychiatric ward. HTT's also allow inpatients to be discharged sooner, as their treatment can continue in the community. Currently, research into predictors of LOS in HTT's is limited.Researchers have been exploring whether LOS in psychiatric inpatients can be predicted, but no consistent pattern has emerged. This suggests that LOS is mainly determined by the local service organisation, and the individual circumstances of the patients.MethodRoutinely collected data about all patients under the care of the Wandsworth HTT during the financial year 2018/2019 were used. Only the first admission per individual was considered. Admissions lasting less than 2 days, or more than 42 days were excluded. This is on the basis that those with a very short LOS had not consented to being treated at home, and those with a very long LOS were due to administrative errors. This resulted in a total of 664 admissions being included in the study. The available data for analysis included age, gender, diagnosis, HoNOS cluster, ethnicity, nationality, religion, marital status, referral source, employment status, accommodation status, and accommodation type. The data were analysed in SPSS version 25 using ANOVA, independent samples T-test, and Pearson's correlation.ResultThe mean LOS in the Wandsworth HTT was 14.28 days (standard deviation: 8.57). LOS was positively skewed, with a median LOS of 13 days, but 46.5% of admissions had a LOS longer than this. None of the variables (age, gender, diagnosis, HoNOS cluster, ethnicity, nationality, religion, marital status, referral source, employment status, accommodation status, and accommodation type) had a significant association with LOS, but there was a trend for referral source and accommodation type.ConclusionThe results from this study suggest that LOS cannot be consistently predicted in the Wandsworth HTT from the routinely collected variables, and that it is the specific circumstances of individual patients that determine their LOS.There was no external funding for this study.