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. Method(s): This QIp consistedof 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. Result(s): 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(s): 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.
ABSTRACT
Introduction: Breast Incidentalomas occur as an unexpected abnormality demonstrated on imaging performed for unrelated symptoms. Pre-COVID19 pandemic management involved urgent referrals for initial breast team evaluation. Clinical encounters occurred prior to the Multi-Disciplinary Team meeting (MDT). COVID-19 restrictions necessitated streamlining and optimising service provision with clinically appropriate encounters. Our aim was to re-audit (SU-CA-21-22-068) findings and management of breast incidentalomas during the pandemic. Methods: Pre-pandemic analysis of practice (November 2019 - January 2020) led us to the intervention of all referrals straight to MDT without an unnecessary prior clinical encounter, with secondary planned investigations and clinical assessment thereafter. Completion of audit loop and analysis included referral information, MDT outcome, imaging, and clinical correspondence with descriptive analysis. Results: Post-intervention 61 patients were referred to the MDT over an 18-month period (February 2020 - October 2021). 90% of patients were referred following CT scans. Median age 71 (range 32-93), 38% of patients had no additional breast imaging and 74% of patients did not require a tissue biopsy. 15% (n=9) were diagnosed with new breast cancer, 36% were new benign, with 34% already known lesions. 16% of patients required no further intervention. Conclusion: 15% of incidentalomas were diagnosed as malignancies, compared to local 3-4% from one stop clinics. Prompt referral to MDT accelerates triple assessment and tissue diagnosis. Streamlining of patient care optimised appropriate clinical encounters for vulnerable patients. Early senior radiological assessment at the MDT of incidentalomas during COVID-19 provided confirmation of benign features and therefore no further intervention and reassurance for 16% of patients.