Abstract Aims National surgical guidance during the Covid-19 pandemic cautioned against surgical intervention with subsequent unsurprising falls in emergency activity. Our unit, in contrast to national guidance, treated patients normally but with enhanced quality measures and without withholding surgery where indicated; key measures introduced included two-consultant operating, early consultant decision-making and daily consultant ward rounds to facilitate early discharge. This study outcomes from these locally developed guidelines. Methods All emergency laparotomies are entered contemporaneously on to the NELA database. Activity and outcomes from two time periods, from before and after the advent of Covid-19 (March 2019–2020 vs. March 2020–2021) were compared. Results Emergency laparotomy activity increased from 154 cases to 192 cases (24%). There were no pre-operative differences in frailty scores, ASA, pre-operative predicted mortality (7.4% vs. 6.9%) or predicted morbidity between the two periods. Although 2% of patients developed Covid-19 infection, there was no increase in crude mortality (9% to 8%) or post-operative complications. The proportion of patients who went to critical care after surgery fell though post-operative length of stay also fell (mean 18.8 days vs. 12 days). Conclusions With local guidelines and enhanced consultant-delivered care, emergency surgery was increased during the Covid pandemic without increased complications. This may reflect the marked reduction in activity in neighbouring hospitals and additional capacity due to falls in elective activity. Given the reduction in emergency surgery nationally, it is likely that guidance which cautioned against surgery has led to patients unnecessarily missing out on operative treatment with subsequent poorer outcomes and greater mortality.
目的2019冠状病毒病大流行期间的国家外科指南警告不要进行手术干预，以免随后急诊活动不出所料地下降。与国家指南相反，我们的单位对患者进行正常治疗，但采用了增强的质量措施，并在必要时不保留手术;引入的主要措施包括双会诊医师操作、早期会诊医师决策和每日会诊医师查房，以促进早日出院。这项研究的结果来自这些地方制定的指导方针。方法将所有急诊剖腹手术同时录入NELA数据库。比较了Covid-19出现之前和之后两个时间段(2019年3月- 2020年与2020年3月- 2021年)的活动和结果。结果急诊剖腹手术由154例增加到192例(24%)。术前虚弱评分、ASA、术前预测死亡率(7.4% vs. 6.9%)或预测发病率在两期之间没有差异。虽然有2%的患者发生了Covid-19感染，但粗死亡率(9%至8%)或术后并发症没有增加。术后进入重症监护的患者比例下降，但术后住院时间也有所下降(平均18.8天比12天)。结论:有了当地指南和加强的咨询医生提供的护理，Covid大流行期间急诊手术增加了，但并发症没有增加。这可能反映出邻近医院的活动明显减少，以及由于选择性活动减少而增加的能力。鉴于急诊手术在全国范围内的减少，警告不要进行手术的指导可能导致患者不必要地错过手术治疗，从而导致较差的结果和更高的死亡率。
{"title":"SP11.3 Impact of Covid on emergency laparotomy activity","authors":"M. Kronberga, A. Saha","doi":"10.1093/bjs/znac247.122","DOIUrl":"https://doi.org/10.1093/bjs/znac247.122","url":null,"abstract":"Abstract Aims National surgical guidance during the Covid-19 pandemic cautioned against surgical intervention with subsequent unsurprising falls in emergency activity. Our unit, in contrast to national guidance, treated patients normally but with enhanced quality measures and without withholding surgery where indicated; key measures introduced included two-consultant operating, early consultant decision-making and daily consultant ward rounds to facilitate early discharge. This study outcomes from these locally developed guidelines. Methods All emergency laparotomies are entered contemporaneously on to the NELA database. Activity and outcomes from two time periods, from before and after the advent of Covid-19 (March 2019–2020 vs. March 2020–2021) were compared. Results Emergency laparotomy activity increased from 154 cases to 192 cases (24%). There were no pre-operative differences in frailty scores, ASA, pre-operative predicted mortality (7.4% vs. 6.9%) or predicted morbidity between the two periods. Although 2% of patients developed Covid-19 infection, there was no increase in crude mortality (9% to 8%) or post-operative complications. The proportion of patients who went to critical care after surgery fell though post-operative length of stay also fell (mean 18.8 days vs. 12 days). Conclusions With local guidelines and enhanced consultant-delivered care, emergency surgery was increased during the Covid pandemic without increased complications. This may reflect the marked reduction in activity in neighbouring hospitals and additional capacity due to falls in elective activity. Given the reduction in emergency surgery nationally, it is likely that guidance which cautioned against surgery has led to patients unnecessarily missing out on operative treatment with subsequent poorer outcomes and greater mortality.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83795192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Dholoo, A. Shabana, Abigail Burrows, Jonathon Horsnell
Abstract Introduction Pre-Operative Assessment (POA) is an integral part of surgery. It is essential for pre-operative investigations including bloods and COVID-19 swabbing. There was concern within the Breast-Unit that patients may be having unnecessary blood-tests as part of their POA. This was likely due to POA not having one unified resource to refer to. Guidance suggests POA uses the patient's American Association of Anaesthesiologist's (ASA) grade, type of surgery they are undergoing and additional conditions for determining pre-operative investigations. Methods This QIP consisted of 2 cycles. During cycle-1 data was audited against national guidance to see which blood tests were performed unnecessarily. After developing a universal-guidance poster and teaching sessions, a second cycle was performed. Cycle-2 assessed whether there was a reduction in unnecessary blood tests being performed. Results During cycle-1, 216 pre-operative blood tests were undertaken. Of these only 99 were required. Therefore 54% of the tests were unnecessary. This equates to £690.77 over 2-months and if extrapolated £4144.62 spent, unnecessarily per-year. This represents a significant cost to the trust and puts needless pressure onto the laboratory. During cycle-2, after our intervention, there were 57 fewer tests and 40 fewer, incorrect blood tests. Our intervention therefore resulted in a £183.46 saving, which over a year equates to £1110.76 saved. Conclusion The potential benefits of improving POA include financial savings, patient autonomy, increased appointment availability and reduced pressure on the laboratory. In these unprecedented times, trying to tackle the COVID-19 backlog; we advise all departments to ensure that clear guidance exists.
术前评估(pre - op Assessment, POA)是外科手术的重要组成部分。这对于包括血液和COVID-19拭子在内的术前调查至关重要。乳房科担心，作为POA的一部分，患者可能会进行不必要的血液检查。这可能是由于POA没有一个统一的资源可以参考。指南建议POA使用患者的美国麻醉医师协会(ASA)分级，他们正在进行的手术类型和其他条件来确定术前调查。方法该QIP为2个周期。在周期1期间，根据国家指南审核了数据，以确定哪些血液检查是不必要的。在制定了通用指导海报和教学会议之后，进行了第二轮活动。第2周期评估是否减少了进行不必要的血液检查。结果第1周期共进行术前血液检查216例。其中只有99个是必需的。因此，54%的测试是不必要的。这相当于在两个月内花费690.77英镑，如果以此类推，每年不必要的花费为4144.62英镑。这代表了信任的重大成本，并给实验室带来了不必要的压力。在第二个周期，经过我们的干预，测试减少了57次，错误的血液测试减少了40次。因此，我们的干预导致节省了183.46英镑，一年下来相当于节省了1110.76英镑。结论改进POA的潜在好处包括节省资金、患者自主权、增加预约和减轻实验室压力。在这个前所未有的时期，努力解决COVID-19积压;我们建议所有部门确保有明确的指导方针。
{"title":"WE6.2 The true cost of pre-operative investigations","authors":"F. Dholoo, A. Shabana, Abigail Burrows, Jonathon Horsnell","doi":"10.1093/bjs/znac248.145","DOIUrl":"https://doi.org/10.1093/bjs/znac248.145","url":null,"abstract":"Abstract Introduction Pre-Operative Assessment (POA) is an integral part of surgery. It is essential for pre-operative investigations including bloods and COVID-19 swabbing. There was concern within the Breast-Unit that patients may be having unnecessary blood-tests as part of their POA. This was likely due to POA not having one unified resource to refer to. Guidance suggests POA uses the patient's American Association of Anaesthesiologist's (ASA) grade, type of surgery they are undergoing and additional conditions for determining pre-operative investigations. Methods This QIP consisted of 2 cycles. During cycle-1 data was audited against national guidance to see which blood tests were performed unnecessarily. After developing a universal-guidance poster and teaching sessions, a second cycle was performed. Cycle-2 assessed whether there was a reduction in unnecessary blood tests being performed. Results During cycle-1, 216 pre-operative blood tests were undertaken. Of these only 99 were required. Therefore 54% of the tests were unnecessary. This equates to £690.77 over 2-months and if extrapolated £4144.62 spent, unnecessarily per-year. This represents a significant cost to the trust and puts needless pressure onto the laboratory. During cycle-2, after our intervention, there were 57 fewer tests and 40 fewer, incorrect blood tests. Our intervention therefore resulted in a £183.46 saving, which over a year equates to £1110.76 saved. Conclusion The potential benefits of improving POA include financial savings, patient autonomy, increased appointment availability and reduced pressure on the laboratory. In these unprecedented times, trying to tackle the COVID-19 backlog; we advise all departments to ensure that clear guidance exists.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72803606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bridgid Ferriter, B. Julius, Sinead Burke, Natasha Slattery, S. Tormey, A. Merrigan
Abstract Background Trends in healthcare have caused a shift in training towards more competency based programmes. The COVID-19 pandemic has reduced time available for direct exposure and clinical learning, necessitating incorporation of simulation in training. The objectives of this study were to develop, pilot and evaluate a four week simulation based surgical teaching programme. Methods Interns pursuing a career in surgery joined a near-peer surgical training programme delivered by NCHDs. A survey established a baseline competency. Four skills workshops were delivered. Outcomes were measured using data from pre and post course surveys as well as a surgical skills competition. Results Of the 12 trainees, 71% had scrubbed in theatre before. 50% were already confident to scrub independently, increased to 75% post training. 28% were confident gowning/gloving, increased to 75% post training. 28% were confident to place a simple suture in theatre, this did not increase despite training. 42% were confident performing an instrument tie, increased to 75% post training. 14% were confident hand tying knots, this increased to 62%. 14% of participants were comfortable performing excisional biopsy in theatre, increased to 62% post training. Preparation and administration of local anaestetic could be performed confidently by 14% before training, this increased to 87%. On completion, a surgical skills competition showed that 100% were able to satisfactorily perform basic skills. Conclusions Near-peer delivery of surgical training has enhanced the basic surgical skills of interns. Similar programmes in other sites would ensure that interns have the skills required to safely care for surgical patients.
{"title":"TU5.10 Development of a Novel Near-peer Surgical Simulation-based Teaching Programme for Intern Doctors","authors":"Bridgid Ferriter, B. Julius, Sinead Burke, Natasha Slattery, S. Tormey, A. Merrigan","doi":"10.1093/bjs/znac248.053","DOIUrl":"https://doi.org/10.1093/bjs/znac248.053","url":null,"abstract":"Abstract Background Trends in healthcare have caused a shift in training towards more competency based programmes. The COVID-19 pandemic has reduced time available for direct exposure and clinical learning, necessitating incorporation of simulation in training. The objectives of this study were to develop, pilot and evaluate a four week simulation based surgical teaching programme. Methods Interns pursuing a career in surgery joined a near-peer surgical training programme delivered by NCHDs. A survey established a baseline competency. Four skills workshops were delivered. Outcomes were measured using data from pre and post course surveys as well as a surgical skills competition. Results Of the 12 trainees, 71% had scrubbed in theatre before. 50% were already confident to scrub independently, increased to 75% post training. 28% were confident gowning/gloving, increased to 75% post training. 28% were confident to place a simple suture in theatre, this did not increase despite training. 42% were confident performing an instrument tie, increased to 75% post training. 14% were confident hand tying knots, this increased to 62%. 14% of participants were comfortable performing excisional biopsy in theatre, increased to 62% post training. Preparation and administration of local anaestetic could be performed confidently by 14% before training, this increased to 87%. On completion, a surgical skills competition showed that 100% were able to satisfactorily perform basic skills. Conclusions Near-peer delivery of surgical training has enhanced the basic surgical skills of interns. Similar programmes in other sites would ensure that interns have the skills required to safely care for surgical patients.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79051723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Kumaran, Vishal Vijayaregu, B. Abdelqader, W. Chang, S. Sangal, R. Polson
Abstract Aims The COVID-19 pandemic has led to a change in working practices in the diagnosis and management of colorectal cancer. Guidelines emerged which recommended changing anastomotic practice in favour of forming a defunctioning stoma or end stoma in patients who would have previously had an anastomosis. This study aimed to identify whether these changes have resulted in an increase in patients requiring a stoma and its potential impact. Methods All patients diagnosed with colorectal cancer in the authors’ tertiary surgical unit in three 4-month intervals were included. These corresponded to before the pandemic (March–June 2019), during the UK's first wave of COVID-19 (March–June 2020), and during the second wave (December 2020–March 2021). The incidence of stomas was compared between groups. Results In patients undergoing elective surgery the incidence of stomas was 13% pre-pandemic. However, this tripled to 39% during the first wave and increased to 54% in the second wave. Similar trends were seen in patients undergoing emergency surgery with 36% having stomas before the pandemic which rose to 50% during both the waves. Conclusion A change in stoma practice was observed with patients having a stoma when they would usually have had an anastomosis only. As COVID-19 continues to have a severe effect on planned surgery in the UK, patients requiring stoma reversal adds to the backlog. As the huge task of clearing the backlog begins, surgical teams must be provided with appropriate resources, professional and mental health support.
{"title":"TU3.5 Increasing stoma requirements during the COVID-19 pandemic","authors":"N. Kumaran, Vishal Vijayaregu, B. Abdelqader, W. Chang, S. Sangal, R. Polson","doi":"10.1093/bjs/znac248.029","DOIUrl":"https://doi.org/10.1093/bjs/znac248.029","url":null,"abstract":"Abstract Aims The COVID-19 pandemic has led to a change in working practices in the diagnosis and management of colorectal cancer. Guidelines emerged which recommended changing anastomotic practice in favour of forming a defunctioning stoma or end stoma in patients who would have previously had an anastomosis. This study aimed to identify whether these changes have resulted in an increase in patients requiring a stoma and its potential impact. Methods All patients diagnosed with colorectal cancer in the authors’ tertiary surgical unit in three 4-month intervals were included. These corresponded to before the pandemic (March–June 2019), during the UK's first wave of COVID-19 (March–June 2020), and during the second wave (December 2020–March 2021). The incidence of stomas was compared between groups. Results In patients undergoing elective surgery the incidence of stomas was 13% pre-pandemic. However, this tripled to 39% during the first wave and increased to 54% in the second wave. Similar trends were seen in patients undergoing emergency surgery with 36% having stomas before the pandemic which rose to 50% during both the waves. Conclusion A change in stoma practice was observed with patients having a stoma when they would usually have had an anastomosis only. As COVID-19 continues to have a severe effect on planned surgery in the UK, patients requiring stoma reversal adds to the backlog. As the huge task of clearing the backlog begins, surgical teams must be provided with appropriate resources, professional and mental health support.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"97 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80692313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anthony C. Rayner, Ahmed Mohamed, M. Mikhail, M. Gardiner
Abstract Aims Flexor tendon injuries are debilitating with rupture of repair leading to significant morbidity. The SARS-CoV-2 pandemic has led to a shift to out-of-theatre operating, with many flexor tendon repairs being performed on the same day as initial assessment in our outpatient department (OPD) procedure room. We aimed to compare the rupture rates before and after the start of the pandemic to assess the safety of this change in practice. Methods Patients who underwent repair of one or more flexor tendons were included from two six-month periods: July to December 2019 and April to September 2020. Patient records were reviewed to identify operation location, number of flexor tendons repaired per patient and rupture incidence. In the second period, patients whose operation was performed in theatre were excluded. Results 28 patients were included for the initial period with a total of 49 flexor tendons injured. All repairs were performed in theatre and 3 ruptures were recorded (6%). 17 patients underwent flexor tendon repair during the second period. 11 patients were operated on in the OPD with a total of 16 flexor tendons injured. 1 rupture was recorded (6%). Conclusions The rupture rate of OPD operating is comparable to that of the traditional theatre pathway. OPD operating also allowed us to circumvent theatre waiting lists and thus avoid costly delays to patient care. This project demonstrates maintained safety for patients and offers a platform for further research to confirm OPD operating as a viable and sustainable alternative for future practice.
{"title":"EP-422 Operating in the outpatient department: the future of flexor tendon repair?","authors":"Anthony C. Rayner, Ahmed Mohamed, M. Mikhail, M. Gardiner","doi":"10.1093/bjs/znac245.105","DOIUrl":"https://doi.org/10.1093/bjs/znac245.105","url":null,"abstract":"Abstract Aims Flexor tendon injuries are debilitating with rupture of repair leading to significant morbidity. The SARS-CoV-2 pandemic has led to a shift to out-of-theatre operating, with many flexor tendon repairs being performed on the same day as initial assessment in our outpatient department (OPD) procedure room. We aimed to compare the rupture rates before and after the start of the pandemic to assess the safety of this change in practice. Methods Patients who underwent repair of one or more flexor tendons were included from two six-month periods: July to December 2019 and April to September 2020. Patient records were reviewed to identify operation location, number of flexor tendons repaired per patient and rupture incidence. In the second period, patients whose operation was performed in theatre were excluded. Results 28 patients were included for the initial period with a total of 49 flexor tendons injured. All repairs were performed in theatre and 3 ruptures were recorded (6%). 17 patients underwent flexor tendon repair during the second period. 11 patients were operated on in the OPD with a total of 16 flexor tendons injured. 1 rupture was recorded (6%). Conclusions The rupture rate of OPD operating is comparable to that of the traditional theatre pathway. OPD operating also allowed us to circumvent theatre waiting lists and thus avoid costly delays to patient care. This project demonstrates maintained safety for patients and offers a platform for further research to confirm OPD operating as a viable and sustainable alternative for future practice.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82748579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Leigh, Rita Deb, H. Sheth, D. Raje, N. Pore, F. Soggiu
Abstract Aim Virtual clinics were rapidly established during the COVID-19 pandemic to maintain outpatient surgical care. To evaluate their use, we analysed telephone clinic outcomes and their compliance with the NHS Referral to Treatment (RTT) guidelines. Method Data was collected for patients booked into Upper GI Surgery clinics between September – December 2020 (n = 622). This included details of referral, appointments (first to most recent), patient attendance, and clinic outcomes (active monitoring, offered surgery, discharge, other). We compared first appointment management decisions between telephone and face-to-face clinics. Results 317 patients had their first appointment via telephone; 179 patients were seen initially face-to-face. For first appointments, non-attendance rate was 9.8% (31/317) in telephone clinics versus 3.9% (7/181) in face-to-face clinics. At first appointment, 8.5% (27/317) of patients consulted via telephone were offered surgery compared to 20.1% (36/179) seen face-to-face. 22.4% (71/317) of telephone clinic patients were started on active monitoring at first appointment, compared to 31.3% (56/179) of patients assessed face-to-face. 31.3% (155/496) of all patients analysed were compliant with RTT guidelines – 57.4% initiated on active monitoring; 11.6% underwent surgery. Conclusion Patients are less likely to be listed for surgery after their first assessment if this was via telephone appointment compared to face-to-face. Delays in physical examination, and clinician and/or patient hesitancy may contribute to this; higher non-attendance rates would further postpone outcomes. However, telemedicine does allow effective active monitoring. To better evaluate telemedicine's efficacy in sustaining timely patient care, comparison of compliance with the RTT guidelines for cases managed solely face-to-face pre-COVID-19 is warranted.
{"title":"WE8.7 Are Virtual Clinics for General Surgery Here to Stay? – A Single Centre Analysis","authors":"C. Leigh, Rita Deb, H. Sheth, D. Raje, N. Pore, F. Soggiu","doi":"10.1093/bjs/znac248.174","DOIUrl":"https://doi.org/10.1093/bjs/znac248.174","url":null,"abstract":"Abstract Aim Virtual clinics were rapidly established during the COVID-19 pandemic to maintain outpatient surgical care. To evaluate their use, we analysed telephone clinic outcomes and their compliance with the NHS Referral to Treatment (RTT) guidelines. Method Data was collected for patients booked into Upper GI Surgery clinics between September – December 2020 (n = 622). This included details of referral, appointments (first to most recent), patient attendance, and clinic outcomes (active monitoring, offered surgery, discharge, other). We compared first appointment management decisions between telephone and face-to-face clinics. Results 317 patients had their first appointment via telephone; 179 patients were seen initially face-to-face. For first appointments, non-attendance rate was 9.8% (31/317) in telephone clinics versus 3.9% (7/181) in face-to-face clinics. At first appointment, 8.5% (27/317) of patients consulted via telephone were offered surgery compared to 20.1% (36/179) seen face-to-face. 22.4% (71/317) of telephone clinic patients were started on active monitoring at first appointment, compared to 31.3% (56/179) of patients assessed face-to-face. 31.3% (155/496) of all patients analysed were compliant with RTT guidelines – 57.4% initiated on active monitoring; 11.6% underwent surgery. Conclusion Patients are less likely to be listed for surgery after their first assessment if this was via telephone appointment compared to face-to-face. Delays in physical examination, and clinician and/or patient hesitancy may contribute to this; higher non-attendance rates would further postpone outcomes. However, telemedicine does allow effective active monitoring. To better evaluate telemedicine's efficacy in sustaining timely patient care, comparison of compliance with the RTT guidelines for cases managed solely face-to-face pre-COVID-19 is warranted.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88039210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction General surgery departments are busy, meaning educational opportunities may be sporadic. Clinical priorities can sometimes supersede teaching and trainees may feel alienated at the periphery of the working community. In this study, we demonstrate how a reflective, multidisciplinary general surgery teaching programme was established and use this to assess the impact of structured teaching on surgical doctors of all grades in the department. Methods Twelve semi-structured telephone interviews were conducted with participants of varying grades. Transcripts were analysed using a grounded theory thematic analysis, revealing four themes: the value of teaching; learning as a community; barriers to successful training; and culture of surgery. Discussion Teaching helped juniors construct healthy narratives around general surgery and encouraged a process of professional identity formation. Pairing junior and senior colleagues allowed both to develop their skills, and reflective learning revealed new learning opportunities. Transparency across the ‘community of practice’ was achieved and the programme helped juniors overcome negative stereotypes of intimidation embedded in the hidden surgical curriculum. Conclusion Reflective, multidisciplinary learning can challenge the hidden curriculum and encourage team cohesion. A commitment to critical reflective teaching will be vital in cultivating surgeons of the future. NB: submitted to previous ASGBI congress 2020 but later withdrawn due to COVID-19 and congress being cancelled. We wish to re-present our work.
{"title":"TU5.6 Teaching to transform surgical culture: An educational programme and thematic analysis in a general surgery department","authors":"M. Davé, S. Mobarak, M. Tarazi, C. Macutkiewicz","doi":"10.1093/bjs/znac248.049","DOIUrl":"https://doi.org/10.1093/bjs/znac248.049","url":null,"abstract":"Abstract Introduction General surgery departments are busy, meaning educational opportunities may be sporadic. Clinical priorities can sometimes supersede teaching and trainees may feel alienated at the periphery of the working community. In this study, we demonstrate how a reflective, multidisciplinary general surgery teaching programme was established and use this to assess the impact of structured teaching on surgical doctors of all grades in the department. Methods Twelve semi-structured telephone interviews were conducted with participants of varying grades. Transcripts were analysed using a grounded theory thematic analysis, revealing four themes: the value of teaching; learning as a community; barriers to successful training; and culture of surgery. Discussion Teaching helped juniors construct healthy narratives around general surgery and encouraged a process of professional identity formation. Pairing junior and senior colleagues allowed both to develop their skills, and reflective learning revealed new learning opportunities. Transparency across the ‘community of practice’ was achieved and the programme helped juniors overcome negative stereotypes of intimidation embedded in the hidden surgical curriculum. Conclusion Reflective, multidisciplinary learning can challenge the hidden curriculum and encourage team cohesion. A commitment to critical reflective teaching will be vital in cultivating surgeons of the future. NB: submitted to previous ASGBI congress 2020 but later withdrawn due to COVID-19 and congress being cancelled. We wish to re-present our work.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73072397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aims To audit the management (ambulation versus admission) of acute diverticulitis presenting to a London DGH. Methods A retrospective clinical audit. Data on cases of acute diverticulitis presenting to the general surgical department at Ealing Hospital were collected over a period of 92 days. The medical notes were screened and the indication for admission in hospital was recorded. Each admission was then assessed for compliance with standard criteria for appropriate admission, derived from national guidelines by NICE. Patients admitted despite not meting these criteria were deemed as inappropriate admissions. Results mAll patient referrals to General Surgery at Ealing Hospital were screened from 1/7/21 to 30/9/21. 618 patients were identified. A total of 18 patients presented with radiologically-confirmed diverticulitis in this period (2.9%). Of these, 14 patients were admitted (77.8%). None of the patients ambulated met the criteria for admission. If the admitting teams were to adhere to National Guidelines, 15 of the 18 patients presented and 11 of the 14 patients admitted could have been safely ambulated. In inappropriately-admitted cases, none received surgical intervention. The mean number of days spent in hospital for inappropriate admissions was 3.27 (Range 1–8 days). This translates to 49 patient-days that could have been safely avoided according to national guidelines. The cost incurred by the NHS by the inappropriate admission of these patients is estimated at £78,400 p.a. Conclusions Safe ambulation of patients presenting with acute uncomplicated diverticulitis can improve departmental efficacy, patient flow and ultimately reduce bed pressures and expenditure associated with hospital admissions.
{"title":"SP4.1.2 Management and Ambulation of Uncomplicated Acute Diverticulitis during the COVID-19 Pandemic – A Clinical Audit in a District General Hospital","authors":"Hussein Elghazaly, Payman Dahaghin, Panagiotis Drymousis","doi":"10.1093/bjs/znac247.042","DOIUrl":"https://doi.org/10.1093/bjs/znac247.042","url":null,"abstract":"Abstract Aims To audit the management (ambulation versus admission) of acute diverticulitis presenting to a London DGH. Methods A retrospective clinical audit. Data on cases of acute diverticulitis presenting to the general surgical department at Ealing Hospital were collected over a period of 92 days. The medical notes were screened and the indication for admission in hospital was recorded. Each admission was then assessed for compliance with standard criteria for appropriate admission, derived from national guidelines by NICE. Patients admitted despite not meting these criteria were deemed as inappropriate admissions. Results mAll patient referrals to General Surgery at Ealing Hospital were screened from 1/7/21 to 30/9/21. 618 patients were identified. A total of 18 patients presented with radiologically-confirmed diverticulitis in this period (2.9%). Of these, 14 patients were admitted (77.8%). None of the patients ambulated met the criteria for admission. If the admitting teams were to adhere to National Guidelines, 15 of the 18 patients presented and 11 of the 14 patients admitted could have been safely ambulated. In inappropriately-admitted cases, none received surgical intervention. The mean number of days spent in hospital for inappropriate admissions was 3.27 (Range 1–8 days). This translates to 49 patient-days that could have been safely avoided according to national guidelines. The cost incurred by the NHS by the inappropriate admission of these patients is estimated at £78,400 p.a. Conclusions Safe ambulation of patients presenting with acute uncomplicated diverticulitis can improve departmental efficacy, patient flow and ultimately reduce bed pressures and expenditure associated with hospital admissions.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87281142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction Vicissitudes including re-deployment, elective cancellations, and remote educational events have restricted training opportunities during the COVID pandemic. This study aimed to analyse COVID's impact on global Higher Surgical Trainee (HST) performance metrics including hospital adaptability and variance. Materials and Method Intercollegiate Surgical Curriculum Programme (ISCP) portfolios of 50 HSTs (median age 36 (range 29–46) yr., female 15, male 35), including 191 six-month rotational placements, were analysed over two years (March 2019 to 2021). Primary effect measures were: operative logbook numbers, index procedures validated against curriculum requirements and Work Based Assessments (WBA). Results During COVID-19, operative experience per placement declined 26.1% (median 211 vs. 156, p<0.010), with a 32.1% decline in trainee primary surgeon experience (162 vs. 110, p<0.010). Regarding index procedures: cholecystectomy declined 45.5% (11 vs. 6, p=0.027) and inguinal hernia 62.5% (8 vs. 3, p<0.010). WBAs were similar (17 vs. 13, p=0.364). Despite relative equivalence before COVID, median total number of operative procedures performed in District General Hospitals (DGH, n=65) were 40.9% fewer than Tertiary Hospitals (TH, n=110, p<0.010). Radar plots of composite metrics ranged from 11.1 to 75.6% coverage before (p=0.011) vs. 13.3 to 68.9% after COVID (p=0.015). Discussion Hospital training metrics varied over five-fold, a difference likely amplified by COVID, with THs more adaptable to existential shared lessons.
{"title":"TU3.6 Surgical training salvage during COVID-19: a hospital quality perspective","authors":"O. Luton, K. Mellor, C. Eley, W. Lewis, R. Egan","doi":"10.1093/bjs/znac248.030","DOIUrl":"https://doi.org/10.1093/bjs/znac248.030","url":null,"abstract":"Abstract Introduction Vicissitudes including re-deployment, elective cancellations, and remote educational events have restricted training opportunities during the COVID pandemic. This study aimed to analyse COVID's impact on global Higher Surgical Trainee (HST) performance metrics including hospital adaptability and variance. Materials and Method Intercollegiate Surgical Curriculum Programme (ISCP) portfolios of 50 HSTs (median age 36 (range 29–46) yr., female 15, male 35), including 191 six-month rotational placements, were analysed over two years (March 2019 to 2021). Primary effect measures were: operative logbook numbers, index procedures validated against curriculum requirements and Work Based Assessments (WBA). Results During COVID-19, operative experience per placement declined 26.1% (median 211 vs. 156, p<0.010), with a 32.1% decline in trainee primary surgeon experience (162 vs. 110, p<0.010). Regarding index procedures: cholecystectomy declined 45.5% (11 vs. 6, p=0.027) and inguinal hernia 62.5% (8 vs. 3, p<0.010). WBAs were similar (17 vs. 13, p=0.364). Despite relative equivalence before COVID, median total number of operative procedures performed in District General Hospitals (DGH, n=65) were 40.9% fewer than Tertiary Hospitals (TH, n=110, p<0.010). Radar plots of composite metrics ranged from 11.1 to 75.6% coverage before (p=0.011) vs. 13.3 to 68.9% after COVID (p=0.015). Discussion Hospital training metrics varied over five-fold, a difference likely amplified by COVID, with THs more adaptable to existential shared lessons.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88393455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angus Mccance, Ellen Ainger, Rebecca Black, Roland Fernandes
Abstract Aims To limit exposure risk in view of the current COVID-19 pandemic, telephone clinics have become the mainstay of outpatient assessment. Although there is data from primary care, there is little evidence for the suitability of telemedicine within General Surgery. The lack of clinical examination can be dissatisfying for both patient and surgeon. The aim of this study was to explore patient satisfaction from telephone clinics in a General Surgery setting. Methods Data was collected prospectively from general surgery clinic appointments by a single surgeon in a District General Hospital from September 2021. Demographic data was obtained in addition to a short questionnaire at the end of their consultation. Patients were asked to score their experience out of 5 (5 being most favourable) and their preference in comparison to face to face appointments. Results 156 patients were included in the study, of which 95% of patients were contactable. 98% of patients gave the experience a satisfaction score of 3 or more out of 5. The median satisfaction score was 5. 97% expressed a preference over a Face-to-Face appointment. 7% of patients required a further Face-to-Face consultation and this group were more likely to have a lower patient satisfaction score. Conclusion Telephone clinics within general surgery achieve excellent satisfaction for the majority of patients. The patient experience could be further optimised by careful selection of patient suitability for the service. The data provides supportive evidence to the NHS Long Term Plan to reduce Face-to Face outpatient appointments by one third before 2024.
{"title":"WE8.9 Do Telephone Clinics Lead to Greater Patient Satisfaction in General Surgical Outpatients?","authors":"Angus Mccance, Ellen Ainger, Rebecca Black, Roland Fernandes","doi":"10.1093/bjs/znac248.176","DOIUrl":"https://doi.org/10.1093/bjs/znac248.176","url":null,"abstract":"Abstract Aims To limit exposure risk in view of the current COVID-19 pandemic, telephone clinics have become the mainstay of outpatient assessment. Although there is data from primary care, there is little evidence for the suitability of telemedicine within General Surgery. The lack of clinical examination can be dissatisfying for both patient and surgeon. The aim of this study was to explore patient satisfaction from telephone clinics in a General Surgery setting. Methods Data was collected prospectively from general surgery clinic appointments by a single surgeon in a District General Hospital from September 2021. Demographic data was obtained in addition to a short questionnaire at the end of their consultation. Patients were asked to score their experience out of 5 (5 being most favourable) and their preference in comparison to face to face appointments. Results 156 patients were included in the study, of which 95% of patients were contactable. 98% of patients gave the experience a satisfaction score of 3 or more out of 5. The median satisfaction score was 5. 97% expressed a preference over a Face-to-Face appointment. 7% of patients required a further Face-to-Face consultation and this group were more likely to have a lower patient satisfaction score. Conclusion Telephone clinics within general surgery achieve excellent satisfaction for the majority of patients. The patient experience could be further optimised by careful selection of patient suitability for the service. The data provides supportive evidence to the NHS Long Term Plan to reduce Face-to Face outpatient appointments by one third before 2024.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"149 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86251016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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