Aim Face to face vascular clinics were suspended at a major trauma centre at the beginning of the COVID-19 pandemic, however Royal Stoke Hospital Vascular team were still undertaking emergency vascular operations. Consequently, virtual telephone consultations were set up and delivered to facilitate post-operative follow ups. The objective of this improvement study is to compare the virtual clinic documentation against The Royal College of Surgeons of England (RCS Eng) Best Practice Guidance on Conducting Virtual Consultations, which was published in June 2020. This is important as good documentation is vital to patient care as well as being a medico-legal document. Method We retrospectively identified 30 vascular patients operated between May 2021 and June 2021; 10 of which had had a virtual telephone clinic and the majority underwent an amputation. We audited the clinic note documentation against the RCS Eng guidelines. Results Total of 9 RCS Eng guidelines were identified and audited. The first cycle revealed poor areas in documentation of the surgeon introducing themselves, confirmation of patient details, obtaining consent to proceed, summary of consult and plan discussed. Findings were presented at the trust governance meeting. Areas which required improvement in documentation were highlighted. In addition to education of surgeons, it was decided to introduce a checklist as a requirement. Conclusions Clinic note documentation is of paramount importance as it has legal and medical ramifications. The education of surgeons and introduction of a checklist to ensure compliance with RCS Eng guidelines and we will re-audit to ensure improvement.
Background In December 2019 following an outbreak of Novel coronavirus infection (COVID-19) in Wuhan, China, it spread rapidly overwhelming the healthcare systems globally. With little knowledge of COVID-19 virus, very few published reports on surgical outcomes; hospitals stopped elective surgery, whilst emergency surgery was offered only after exhausting all conservative treatment modalities. This study presents our experience of outcomes of emergency appendectomies performed during the pandemic. Methods Prospectively we collected data on 132 patients in peak pandemic period from 1st March to 5th June 2020 and data compared with 206 patients operated in similar period in2019. Patient demographics, presenting symptoms, pre-operative events, investigations, surgical management, postoperative outcomes and complications were analysed. Results Demographics and ASA grades of both cohorts were comparable. In study cohort 84.4% and 96.7% in control cohort had laparoscopic appendicectomy. Whilst the study cohort had 13.6% primary open operations, control cohort had 5.3%. Mean length of stay and early post-operative complications (<30 days) were similar in both cohorts apart from surgical site infections (p = 0.02) and one mortality in study cohort. Conclusion In these overwhelming pandemic times, although conservative treatment of acute appendicitis is an option, a proportion of patients will need surgery. Our study shows that with careful planning and strict theatre protocols, emergency appendicectomy can be safely offered with minimal risk of spreading COVID-19 infection. These observations warrant further prospective randomised studies.
Background The Covid-19 era has created a lot of uncertainty for management of common emergency and elective surgical conditions such as acute cholecystitis and other gallstone disease related emergency admissions. At our centre we continued to provide early operative intervention for patients presenting with biliary disease and acute cholecystitis throughout the Covid-19 era during both the 1st and the 2nd waves, despite a significant local surge in Covid-19 hospital admissions impacting on the available resources. Here we present the outcomes of our experience of managing such patients during the Covid-19 pandemic of 2020 of both 1st and 2nd waves. Methods A retrospective observational study was performed on all patients presenting with acute cholecystitis and biliary disease who underwent elective and emergency surgical intervention at UHNM (University Hospital of North Midlands) during the second wave of the Covid pandemic (2nd CW) between 14/10/2020 and 14/01/2021). These were then compared with patients who presented in the first Covid wave (1st CW) of 1/03/020 – 30/06/2020,) and a control group pre-covid (CG) 1/03/2019 – 30/06/2019, Patients were identified using ICD-10 codes K80 (Cholelithiasis) and K81 (Cholecystitis) and OPCS codes.J18.1 – J18.5. Primary endpoints were length of stay, 30 day readmission rates, mortality and morbidity. Results A total of 146 patients were identified who underwent laparoscopic cholecystectomy during the study time period (2ndCW). In comparison to 104 patients during the first covid wave cohort (1st CW) and the control group (CG) of 217 patients in the preceding non covid year. Length of stay (LOS) was significantly lower in the 2ndCW cohort in comparison to both the previous 1st CW cohort and the CG cohort (p < 0.0001), with readmissions also being statistically lower (5% vs 15% and 12% respectively p = 0.027). There was no statistical difference in outcomes for post-operative complications as per Clavien-Dindo classification. Conclusions Overall our study demonstrates that the recommended good practice of early surgical intervention in both emergency and elective gallstone disease can continue during the pandemic periods without any significant impact on patient care & outcomes. Also during this period length of stay was significantly shorted and lower 30 day readmission rates which are likely to be multifactorial but where lessons could be potentially learnt.
Materials and methodsIn 2017, University Hospitals Birmingham NHS Foundation Trust (UHB) set up a LocSSIP steering committee, with the commitment to develop and implement LocSSIPs across the trust. The aim of this committee was to ensure the ongoing safety of patients under UHB care and achieve a measurable reduction of serious incidences in invasive procedures conducted outside of theatres.Our aim was to create and develop LocSSIPs within the Pain Medicine Department. By making patient safety central to the introduction, we were able to identify several procedures that could benefit from LocSSIPs. Those procedures included nerve root blocks, epidurals, and denervation.
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