A Quality Improvement Project Centred Around the Introduction of an Exception Reporting Pathway

Aim: Exception Reporting (ER) is applicable to surgical training so can therefore be used for a variety of reasons. This Quality Improvement Project aims to positively change the attitudes and ease the process of ER. Method: We conducted a qualitative survey distributed amongst medical and surgical trainees and supervisors from the Royal Liverpool and Aintree Hospitals which focused on assessing their attitudes towards ER. The second measure was a retrospective review in which we compared the number of ER from September-December in 2019 and 2020. We created a poster showing a clear pathway to ER and the repeated the cycle above including both measures. Results: We received over a hundred responses to our original survey, with half being trainees and the other being supervisors. It was clear that, huge deficits were discernible in trainee and supervisor understanding of the process and its outcomes. After introducing the ER pathway, a significant improvement in understanding towards ER was noted with 98.4% (from 84.5%) of trainees and supervisors understanding what ER is and 52.8% (from 42.7%) better understanding outcomes. Despite this, there seems to be a shift in attitude toward ER with a 10.7% increase in exception reporting within a 10-month period. Conclusions: Our project highlights the importance of exception reporting, and its perception between clinical staff. With the presence of COVID rotas, the introduction of new trainees to the trust, and the higher emphasis on doctor burnout and patient safety in the news, ER measures remain our closest tool to observing such dynamic attitudes and acting on them.

Colorectal cancer (CRC) outcomes prior to and during the COVID-19 pandemic

The COVID-19 pandemic (PAN) has had a major effect on colorectal cancer (CRC) treatment. There is little data comparing pre-pandemic (Pre PAN) and pandemic (PAN) CRC outcomes. Aims and Methods: Using data extracted from the Somerset Cancer Database, we compared CRC patients diagnosed in the 6 months prior to (Pre-PAN) and following (PAN) national lockdown on 23/03/2020. Outcome measures included: cancer stage, resection rate, stoma rate, Clavien-Dindo score and 90 day mortality. Statistical analyses included Chi-squared and Mann-Whitney- U tests. Results: N = 136 patients (M:F = 80:56, Median age = 67). There was no excess morbidity or mortality between the two groups. Conclusion: Reassuringly there was no excess mortality or morbidity demonstrating the efficacy of COVID surgical protocols. PAN patients presented with advanced tumour stage, this may be due to suspension of the screening programme. Decreased diagnoses may be due to loss of investigative resource or patient factors such as fear of COVID.