ABSTRACT
Aims: Low doctor morale and mental well-being is associated with poor patient care, especially during The COVID-19 pandemic. We report on a local initiative, Feel Good Factor (FGF), and its impact on doctors and The department. Method(s): FGF is a monthly presentation at The departmental meeting implemented at WHH, started in December 2019;where kind acts are applauded. A 10-item questionnaire was distributed to doctors working in two Surgery Departments (WHH and QEQM) in May 2021. Questionnaires collected demographic data, awareness of both positive/negative events and mental well-being using Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Data was collected on audits, QIp's, sickness due to mental health, junior progression and publications. Result(s): 48 doctors responded (58.3% QEQM). There was no significant difference in overall WEMWBS score. Doctors in The WHH Department were more decisive (70% vs 25%, P = 0.043);positive incident reporting was higher at WHH (25.0% vs 0.0%, P = 0.025). A trust-wide record number of 45 audits, 22 publications, 6 national studies and 11 juniors progressed in 2020. Patient clinical marker of NELA mortality was one of The leaSt. There was no sickness leave due to mental health. FGF was also shortlisted for The annual BMJ awards. Conclusion(s): FGF is associated with increased awareness of positive events. Improved doctor morale led to widespread participation in projects and departmental output leading to national recognition. Initiatives such as FGF should be encouraged and advertised to other departments, to improve The hospital rating.
ABSTRACT
Aims: Paediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2 (PIMS-TS) is a novel hyperinflammatory condition that most commonly presents with an acute abdomen. Here we present a case of PIMS-TS mimicking appendicitis and a review of The literature with a proposed protocol for managing abdominal pain in patients with recent SARS-CoV-2 infection. Result(s): An 8-year old girl presented with suspected appendicitis. She underwent a day case open appendicectomy with normal appendix confirmed on histology. Unfortunately, she re-presented The following day with persistently high fever and was investigated for post-appendicectomy complication. She was started on intravenous antibiotics. MRI of abdomen and pelvis showed no collection but evidence of lymphadenopathy. on post-operative day four she was transferred to The tertiary centre PICU for specialist management of suspected severe PIMS-TS. Common abdominal radiological findings in PIMS-TS include ascites, bowel wall thickening and mesenteric inflammation. In addition, CRp and ferritin have been found to be significantly higher in PIMS-TS. White cells may be raised with neutrophilia and lymphopaenia. In addition, highly deranged inflammatory markers in The context of a normal abdominal imaging are more consistent with PIMS-TS than appendicitis. We propose anyone with these findings is considered as having PIMS-TS and requires urgent imaging including combined senior surgical and paediatrician review. Conclusion(s): PIMS-TS may present mimicking acute appendicitis and given The severe cardiac compromise that can develop in patients with PIMS-TS is it important to avoid unnecessary General anaesthetic and abdominal Surgery where possible. Our proposed protocol could help reduce unnecessary abdominal Surgery in these patients.
ABSTRACT
Aims: Over 65,000 cholecystectomies are performed each year in The United Kingdom with increasing waiting-list times due to The CoVID-19 pandemic. This study set out to understand The cost to The NHS of complications experienced whilst awaiting cholecystectomy. Method(s): A retrospective cohort study was carried out for all patients who had been awaiting elective cholecystectomy for more than 20 weeks On The 17th September 2021 at a large NHS Foundation Trust. Demographic data was collected at The time of listing. Re-admission data was collected from patient notes. It included clinical history, blood results and imaging investigations. Associated costs were calculated. Result(s): 900 patients included in The study (median age 56 years, 71.7% female). 138 patients (15.3%) re-presented to hospital whilst On The waiting list with complications of gallstone disease. Of these, 51 had more than one presentation to hospital with 18 patients having more than three presentations. This was equivalent to 625 days in hospital, with only 79 same day discharges, and multiple investigations were performed (ultrasound scan = 79;CT scan = 31, MRCp = 47, ERCp = 21). This was estimated to have cost a minimum of 364,917. Assuming an average time for an elective cholecystectomy of 90 mins at a cost of 1,200 per hour, 202 additional cholecystectomies could have been performed. Conclusion(s): This study highlights The enormous potential to reduce patient suffering by increasing The number of elective cholecystectomy lists, and at no overall additional cost to The trust.
ABSTRACT
Aims: Telemedicine is being increasingly used in outpatient settings following The COVID-19 pandemic. This study aimed to determine if self-estimated body mass index (BMI), from telephone consultation, was accurate and useful for planning prior to elective General surgery. Method(s): Age, gender and estimated BMI were collected from consecutive patients attending a pre-operative telephone clinic under a single surgeon at a district General hospital in The South of England between April and October 2021. Actual BMI was measured on The day of Surgery and compared. Result(s): 124 patients were included (median age 59 years, 49.2% male). BMI was accurately estimated by 38, under-estimated by 33 and over-estimated by 53 participants. Overall, there was a significant difference in The pre-operative and post-operative BMI (P = 0.003). This was significant for females (median change 0.1, IQR 0.0-0.7, P = 0.002) but not for males (median change 0.0, IQR-0.1, 0.2, P = 0.479). Those with an actual BMI >29.9 had a significantly higher median change (0.2 (0.0, 1.1) compared to those with BMI <29.9 (0.0 (-0.2, 0.1);P <0.001). only 2 patients could have required a change in surgeon on The day of The procedure (P = 0.500). Conclusion(s): Self-estimated BMI is a suitable method for assessing patients for planning in elective General surgical procedures, particularly for males. However, it is important to be aware of those with higher BMIs, particularly females, who may underestimate their BMI.