EP.FRI.857 Audit and quality improvement project; data entry into the NELA database from Royal Stoke university hospital

Aims During the period December-2018 to November-2019 a total of 84 cases were entered on the NELA website, corresponding to HES data suggesting 392 laparotomies. This suggests a possible case acquisition of 21% prompting us to look at our data acquisition in detail. Methods Interrogation of the NELA data from January–March 2020 was done from NELA website and hospital records. Results Analysis revealed that during this period 45 patients had laparotomy recorded whereas hospital database recorded 68 laparotomies. Of the 45 cases entered on the NELA database, only 1 patient had a complete data set entered. 22 cases had 87% data entry and 22 cases had <50% of the data fields completed. Firstly, we were not capturing all patients who underwent an emergency laparotomy and secondly our data entry for the patients we did report was incomplete. This led us to engage in a quality improvement project with following measures - Conclusions We re-assessed the case ascertainment and completeness of data collection in the period April 2020 – June 2020 and case ascertainment rate increased to 54% and all the entries were complete and locked.

657 A Retrospective Cost Analysis of Group and Save Samples Performed Prior To Vascular Procedures

Aim To assess if routine group and save is indicated prior to all vascular procedures. Method A retrospective review of all patients who were admitted to vascular ward between 1st to 30th June 2020 was performed using our hospital database. The following data was retrieved: admission diagnosis, preoperative haemoglobin, number, and type of vascular surgeries performed, number of G&S sent and total number requiring transfusion. Results Total 81 patients were admitted, all had a G&S on arrival with routine bloods. All preoperative patients need 2 G&S prior to surgery as per trust policy.69 patients underwent surgery.111G&S were processed.51 patients had 1 G&S on admission as they had a previous sample.28 patients had 2 G&S either because they had no previous records or had postoperative complications.2 patients required multiple transfusions so had >3 G&S each. 8 out of 81 patients needed peri-operative blood transfusion. 7 of them had undergone limb or toe amputations and 1 patient had ruptured AAA. The cost of single G&S sample is £30.8. Patients undergoing angioplasty, bypass, carotid endarterectomy (n = 46) did not require transfusion, but the expenditure incurred by performing g&s in these patients was £1570.8 Conclusions Peri-operative blood transfusion rates were 9.8%. Judicious use of G&S could have saved £1570.8 to the trust. Rationalising preoperative G&S policy would lead to substantial financial savings.

Relationship between emergency department and inpatient occupancy and the likelihood of an emergency admission: a retrospective hospital database study

BackgroundWe investigate whether admission from a consultant-led ED is associated with ED occupancy or crowding and inpatient (bed) occupancy.MethodsWe used general additive logistic regression to explore the relationship between the probability of an ED patient being admitted, ED crowding and inpatient occupancy levels. We adjust for patient, temporal and attendance characteristics using data from 13 English NHS Hospital Trusts in 2019. We define quintiles of occupancy in ED and for four types of inpatients: emergency, overnight elective, day case and maternity.ResultsCompared with periods of average occupancy in ED, a patient attending during a period of very high (upper quintile) occupancy was 3.3% less likely (relative risk (RR) 0.967, 95% CI 0.958 to 0.977) to be admitted, whereas a patient arriving at a time of low ED occupancy was 3.9% more likely (RR 1.039 95% CI 1.028 to 1.050) to be admitted. When the number of overnight elective, day-case and maternity inpatients reaches the upper quintile then the probability of admission from ED rises by 1.1% (RR 1.011 95% CI 1.001 to 1.021), 3.8% (RR 1.038 95% CI 1.025 to 1.051) and 1.0% (RR 1.010 95% CI 1.001 to 1.020), respectively. Compared with periods of average emergency inpatient occupancy, a patient attending during a period of very high emergency inpatient occupancy was 1.0% less likely (RR 0.990 95% CI 0.980 to 0.999) to be admitted and a patient arriving at a time of very low emergency inpatient occupancy was 0.8% less likely (RR 0.992 95% CI 0.958 to 0.977) to be admitted.ConclusionsAdmission thresholds are modestly associated with ED and inpatient occupancy when these reach extreme levels. Admission thresholds are higher when the number of emergency inpatients is particularly high. This may indicate that riskier discharge decisions are taken when beds are full. Admission thresholds are also high when pressures within the hospital are particularly low, suggesting the potential to safely reduce avoidable admissions.

The Epidemiology of COVID-19 and MS-Related Characteristics in a National Sample of People With MS in China

Few studies have focused on immune status and disease activity in MS patients during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study is to investigate immune status, COVID-19 infection, and attacks in MS patients during the pandemic. An online questionnaire about COVID-19 infection, MS attack, and MS treatment during the pandemic was administered to all 525 MS patients registered in our hospital database from January 1, 2011, to June 1, 2020. Only 384 responded, of which 361 patients could be included in the final analysis. During the pandemic, 42.1% of the 361 patients and 65.0% of the 234 patients on immunotherapies were exposed to teriflunomide. Compared to patients who didn't receive treatment, patients exposed to DMTs had significantly lower levels of neutrophils (P < 0.01) and immunoglobulin G (P < 0.01), and patients exposed to immunosuppressants had significantly lower levels of immunoglobulin G (P < 0.05). Over 80% of our patients followed effective protective measures and none of the 361 MS patients in our cohort contracted COVID-19. Patients whose treatment was disrupted had a significantly higher annualized relapse rate (ARR) during than before the pandemic (P < 0.01), while the ARR of patients with continuous treatment or without treatment remained unchanged. During the pandemic, the risk of MS attack due to treatment disruption possibly outweighs the risk of COVID-19 infection under preventive measures, and MS treatment maintenance might be necessary.