A regional clinical audit of the provision of adjuvant systemic anti-cancer treatment following lung cancer resection in eligible patients across Greater Manchester to support national benchmarking

Introduction: Adjuvant anti-cancer systemic therapy (SACT) following lung resection improves overall survival in stage II/II non-small cell lung cancer (NSCLC). The Getting It Right First Time (GIRFT) National Specialty Report for Lung Cancer recommends centres publish adjuvant SACT rates for National benchmarking and proposes a target of >40% of eligible patients undergo SACT. We report a regional audit into the uptake of adjuvant SACT in Greater Manchester (GM). Method(s): A retrospective case review of all patients undergoing curative-intent NSCLC surgery with a pathological stage of II/III from 01/01/21 to 30/04/21. Data collected included patient demographics, uptake of adjuvant SACT, reasons for no adjuvant SACT and tolerance and complications of SACT. Result(s): 58 patients underwent surgical resection within the audit period and were eligible for adjuvant SACT. Median age was 70 years (range 45 - 81) and 60% were female. 47% (27/58) commenced adjuvant SACT;41% (24/58) were treated with chemotherapy and 7% (4/58) were treated with tyrosine kinase inhibitors. 58% (14/24) of patients that commenced adjuvant chemotherapy completed 4 cycles. Carboplatin/Vinorelbine was the commonest regimen (82%, 18/22). There were no grade III-V complications and no chemotherapy-related deaths. Dose reduction due to toxicity was required in 14% (3/22). The reasons adjuvant systemic therapy was not given were patient choice in 32% (10/31), poor physical health such that risks outweighed benefits in 42% (13/31), and other reasons (e.g. need to treat synchronous primary tumours) in 26% (8/31). COVID-19 was not recorded as a cause for adjuvant omission/ dose reduction. Conclusion(s): This data provides national benchmarking information for adjuvant SACT in NSCLC and suggests the target of >40% is achievable and appropriate. Interventions that improve patient fitness pre- and post-operatively might increase adjuvant SACT uptake. This regional audit will be extended to review all eligible patients in 2021 and further data will be presented. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

COVID-19- A Challenge for Urology Subspecialty in an overwhelmed public sector hospital: A Descriptive Review of Urology Department, Lady Reading Hospital

Background: COVID-19 has brought unprecedented changes in every aspect of life throughout the world including the healthcare delivery system. After a grinding halt in surgical practice due to this pandemic, the conventional protocols needed a thorough overhaul before kick-starting formal services. This study discusses ways and procedure changes adopted at the Urology department to navigate this crisis and extend adequate urological care to patients at the same time. Aim(s): To share our experience of patient management in the era of the COVID-19 pandemic. Method(s): It's a descriptive review article based on patient management protocols and clinical audit in the era of COVID-19 pandemic at the Departmentof Urology, MTI, Lady Reading Hospital from 20th Marchto 20th June 2020. Clinical implication the benefit of this study is how to organize things and continue health care provision in a deadly pandemic. Furthermore, it will set a precedence that how to cope with such a pandemic in the future. Conclusion(s): All surgical patients should be screened for COVID-19, with preference given to PCR tests. All elective surgeries should be put on hold as a result of the limited availability of ventilators, manpower, and hospital beds. Only semi-elective, lifesaving and oncologic surgeries that cannot be delayed should be done with full PPEs provided to every personnel frequenting operating theaters during the procedure. Furthermore, more efforts are needed to lift the infrastructure of hospitals and make them capable to face problems of such proportions in the future.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Results from the first audit of an intensive care unit in Botswana.

Background: Botswana is an economically stable middle-income country with a developing health system and a large HIV and infectious disease burden. Princess Marina Hospital (PMH) is the largest referral and teaching hospital with a mixed eight-bed intensive care unit (ICU). Objectives: To conduct an audit of PMH ICU in order to investigate major admission categories and quantify morbidity and mortality figures using a validated scoring system for quality improvement, education and planning purposes. Methods: PMH medical records and laboratory data were accessed to record demographics, referral patterns, diagnoses, HIV status, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II scores and mortality rates. Results: A total of 182 patients >14 years of age were enrolled over a 12-month period from April 2017 - March 2018. Patient's mean age was 42.9 years, males represented 56.6% of the study population and surgical conditions accounted for 46% of diagnostic categories. Sixty percent of the patients were HIV-negative and 12% had no HIV status recorded. The mean APACHE II score was 25 and the mean length of stay in ICU was 10.3 days. Higher APACHE II scores were associated with higher mortality regardless of HIV status. The overall mortality was 42.8% and there was no difference in mortality rates in ICU or at 30 days between HIV-positive and HIV-negative ICU patient groups. Conclusion: The PMH ICU population is young with a high mean APACHE II score, significant surgical and HIV burdens and a high mortality rate. PMH ICU has significant logistical challenges making comparison with international ICUs challenging, and further research is warranted. Contributions of the study: This study is the first published audit for an intensive care unit in Botswana. The findings are especially relevant for the development of critical care capacity in the country during the current COVID-19 pandemic. We advocate for the establishment of an ICU registry in the country to allow ongoing accurate research in the field of critical care medicine and to improve healthcare for all critically ill patients in Botswana.

Retrospective evaluation of factors affecting successful fit testing of respiratory protective equipment during the early phase of COVID-19.

OBJECTIVES: Respiratory protective equipment is critical to protect healthcare workers from COVID-19 infection, which includes filtering facepiece respirators (FFP3). There are reports of fitting issues within healthcare workers, although the factors affecting fitting outcomes are largely unknown. This study aimed to evaluate factors affecting respirator fitting outcomes. DESIGN: This is a retrospective evaluation study. We conducted a secondary analysis of a national database of fit testing outcomes in England between July and August 2020. SETTINGS: The study involves National Health Service (NHS) hospitals in England. PARTICIPANTS: A total of 9592 observations regarding fit test outcomes from 5604 healthcare workers were included in the analysis. INTERVENTION: Fit testing of FFP3 on a cohort of healthcare workers in England, working in the NHS. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measure was the fit testing result, that is, pass or fail with a specific respirator. Key demographics, including age, gender, ethnicity and face measurements of 5604 healthcare workers, were used to compare fitting outcomes. RESULTS: A total of 9592 observations from 5604 healthcare workers were included in the analysis. A mixed-effects logistic regression model was used to determine the factors which affected fit testing outcome. Results showed that males experienced a significantly (p<0.05) higher fit test success than females (OR 1.51; 95% CI 1.27 to 1.81). Those with non-white ethnicities demonstrated significantly lower odds of successful respirator fitting; black (OR 0.65; 95% CI 0.51 to 0.83), Asian (OR 0.62; 95% CI 0.52 to 0.74) and mixed (OR 0.60; 95% CI 0.45 to 0.79. CONCLUSION: During the early phase of COVID-19, females and non-white ethnicities were less likely to have a successful respirator fitting. Further research is needed to design new respirators which provide equal opportunity for comfortable, effective fitting of these devices.

Evolving swabbing practices for COVID-19 in a New Zealand emergency department during the early stages of an emerging pandemic.

OBJECTIVE: To review if tests for suspected COVID-19 were performed according to the Ministry of Health (MoH) case definitions, identify patterns associated with testing outside of the case definition, and discuss the potential impacts on hospital services. METHODS: This was a retrospective audit of patients presenting to the Wellington Hospital ED between 24 March 2020 and 27 April 2020 who were swabbed for COVID-19 in ED. Swabs were audited against the March 15th and April 8th MoH COVID-19 case definitions. RESULTS: Five hundred and thirty-six COVID-19 swabs for 518 patients were taken during the study period. There was poor alignment of testing with the March 15th case definition, with only 11.6% of the 164 swabs taken during this period meeting the case definition. Of the 145 swabs that did not meet the case definition, the majority (n = 119, 82.1%) met symptom criteria only. Alignment of testing with the wider April 8th case definition was much higher with 88.2% meeting criteria. Factors associated with being swabbed despite not meeting the case definitions included fever >38°, a diagnosis of cancer, subsequent hospital admission, and for the March case definition only 'contact with a traveller'. CONCLUSION: There were associations found between testing outside of criteria and specific variables potentially perceived as high-risk. Poor alignment of testing with case definitions can impact hospital services through the (mis)use of limited laboratory testing capacity and implications for resource management. Improved communication and feedback between clinicians and policymakers may improve case definition implementation in a clinical setting.

A comparison of pre-radiotherapy extractions prior to and during the pandemic at charing cross hospital

Osteoradionecrosis has considerable morbidity and can adversely affect the quality of life of patients who undergo radiotherapy as part of the treatment for their head and neck cancer. This can be reduced by a thorough dental assessment and extractions of teeth with poor prognosis prior to radiotherapy, ideally at least ten days before radiotherapy commences. Aim and objectives: The dental department at Charing Cross Hospital has an established pathway to assess patients prior to radiotherapy. The aim of the audit was to evaluate whether during the coronavirus pandemic there was timely dental assessment prior to radiotherapy and extractions carried out in sufficient time before start of radiotherapy in accordance with the Royal College of Surgeons 2012 guidelines. Method(s): Data was collected retrospectively from patient records over two eight monthly periods (May 2019 -Jan 2020 prior to the pandemic and April 2020 - November 2020 during the pandemic). Parameters analysed included: the number of patients referred;time interval between referral and assessment;number of patients requiring extractions and time interval between extraction completion and commencement of radiotherapy. Result(s): Seventy-six patients with head and neck cancer were referred for dental assessment over the audit period. The most recent audit showed 96.4% of patients were assessed within ten days of referral. Extractions were undertaken on 63.6% of patients, 92.9% were in excess of ten days before radiotherapy, 42.9% over 20 days. Conclusion(s): National guidelines for extractions are being met in 92.9% of cases and the majority in excess of minimum timing recommended. The dental clinic is providing quality care for this patient group as measured by this audit, showing a positive service outcome.Copyright © 2021 The Authors

Office 365: Microsoft Lists as a tool for a secure online second-line/systemic drug database

Pre-COVID our dermatology department had slightly fragmented and unreliable methods of storing the details of patients receiving second-line and systemic medications, such as immunosuppressive agents. Often, this information was held within individual Microsoft Excel worksheets on desktop PCs. At the onset of the COVID-19 pandemic in 2020, rapid access to this information was required to allow high-risk patients and shielding groups to be identified. We spent significant time updating and merging these separate files to form a single document. At that stage, multiuser updates and simultaneous working on a single document was not feasible, and there was often duplication and being 'locked out'. A multirow section of our newly combined document was also inadvertently deleted and could not be recovered. Thankfully, at an early stage of the COVID-19 pandemic, Microsoft 365 was rapidly adopted and rolled out in our health board. The aim was to provide a comprehensive, all-in-one digital workspace, including communications, cloud storage, backup and syncing, and productivity apps to aid working remotely and from home. Our department, in a tertiary teaching hospital, migrated to this software and it rapidly helped facilitate increased digital collaboration between clinical team members. It was recognized that its cloud storage capability would be a useful tool to help centralize and store an online, amendable patient database to record details of current and previous second- line treatments, and important information relating to shielding and COVID-19 risk status. One of the revamped application functions within Office 365 is Microsoft Lists. This offers real-time, online, secure functionality, with the ability to colour-code patients by drug, consultant and COVID-19 risk status. All members of our team have access, including administrative and clinical pharmacy staff, allowing each patient record to be easily accessed and updated. There is an additional functionality to allow email notifications of any updates (e.g. when made to specific patient entries) and even direct notification to associated stakeholders (such as government COVID-19 risk and shielding bodies). This set-up has also provided an ideal platform to allow research and clinical audit activities to be performed, which can be backwards formatted into Microsoft Excel, again for any data interpretation. Removed entries for patients no longer on second-line drugs can be automatically transferred to a linked archive list. In summary, this digital project highlights our departmental experience in using Microsoft Lists as an online, secure, cloud-based portal for patients on second-line medications and to record accurately COVID-19 risk status. It is easy to use, pleasing on the eye and its functionality could be transferrable to other clinical areas, such as in skin cancer or diagnosis logs.

Emergence of BA.4/BA.5 Omicron Sub-lineages and Increased SARS-CoV-2 Incidence in Senegal

Background: The Omicron variant B.1.1.529 has led to a new dynamic in the COVID-19 pan-demic, with an increase in cases worldwide. Its rapid propagation favors the emergence of novel sub-lineages, including BA.4 and BA.5. The latter has shown increased transmissibility compared to other Omicron sub-lineages. In Senegal, the emergence of the Omicron variant in December 2021 characterized the triggering of a short and dense epidemiological wave that peaked at the end of February. This wave was followed by a period with a significant drop in the number of COVID-19 cases, but an upsurge in SARS-CoV-2 infection has been noted since mid-June. Objective(s): The purpose of this brief report is to give an update regarding the genomic situation of SARS-CoV-2 in Dakar during this phase of recrudescence of cases. Method(s): We performed amplicon-based SARS-CoV-2 sequencing on nasopharyngeal swab samples from declared COVID-19 patients and outbound travelers that tested positive. Result(s): Ongoing genomic surveillance activities showed that more than half of recent COVID-19 cases were due to the BA.4 and BA.5 sub-lineages that share two critical mutations associated with increased transmissibility and immune response escape. The circulation of recombinants between Omicron sub-lineages was also noted. Conclusion(s): Despite the lack of proven severity of BA.4 and BA.5 sub-lineages, their increased transmis-sibility causes a rapid spread of the virus, hence a surge in the number of cases. This rapid spread consti-tutes a greater risk of exposure for vulnerable patients. To tackle this issue, any increase in the number of cases must be monitored to support public health stakeholders. Therefore, genomic surveillance is an ever-essential element in managing this pandemic.Copyright © 2022 Bentham Science Publishers.

Audit Methodologies in Pandemic Clinic Alert: What is the Real Assurance for the Patient?

This paper analyzes the factors that explain the increased use of special reports by hospital facility auditors, such as the formalization of the clinical pandemic template Covid-19, wondering if they look like evaluation studies. It examines their training as well as their impact as well as the institutional use implicit in the performance audit. From an anthropological perspective, the audit could traditionally be considered as "Rituals of Verification”, recognizing the procedure and the evaluation have social effects, in public management. In addition, auditing practices may often seem "trivial, inevitable part of a bureaucratic process”, but taken together and over time, they are probably part of a distinct cultural artifact. Like the audit, the performance assessment function is to allow for accountability, but there is also an emphasis on collective learning. The audit is therefore an essential part of the assessment in hospital management, contributing to the realization of financial responsibility, guaranteed the institutional legitimacy of the managerial decision-making system. Copyright © FrancoAngeli.

An outpatient service evaluation in a UK tertiary referral centre for paediatric and adolescent gynaecology

Background: Pressure on waiting lists prompted this service evaluation in a tertiary referral centre for paediatric and adolescent gynaecology (PAG). The service is located in Bristol in England. The centre is one of 11 commissioned by NHS England to provide care for patients with congenital gynaecological anomalies, as well as seeing patients with other PAG presentations from aged 2 upwards. Alongside general PAG clinics, there is a quarterly multi-disciplinary transition clinic for children with differences in sex development and a monthly joint adult endocrinology / gynaecology clinic where patients with Turner Syndrome are seen annually. Aim(s): To collect and analyse data pertaining to the pre-Covid PAG outpatient service, to inform1 anticipated service developments aimed at reducing waiting list times for new patients and streamlining of services for certain patient groups Methods: This service evaluation was registered with the local clinical audit team (GYNAE/SE/2020-21-11). We performed a retrospective review of the electronic notes of every PAG appointment from 1st March 2019 - 29th February 2020 (pre-Covid-19 UK restrictions). A database of PAG clinics was created and then the team manually went through each appointment's notes / letters and extracted the relevant data which was entered into a Microsoft Excel spreadsheet. Result(s): There were 385 appointments during this time period. There was data available for 376 appointments and 338 of these were filled by PAG patients. 72 appointments were (21%) for primary ovarian insufficiency (POI) of late effects of childhood cancer, 53 (16%) were for patients with Turner syndrome and 48 (14%) for heavy menstrual bleeding, of which 23 (48%) were new referrals, with this being the most common reason for referral to the team. The remaining appointments were for a variety of conditions. Conclusions and Actions: Our services would benefit from streamlining to maximise capacity and reduce waiting times. To this end: - A second endocrinologist has been recruited to double capacity for the Turner Syndrome clinic2. - An adolescent heavy menstrual bleeding clinic3,4 has been set up to streamline care for these patients. This is a one-stop face-to-face clinic offering a transabdominal pelvic ultrasound scan and a telephone follow-up 3 or 6 months later - To consider a POI / late effects of childhood cancer service to run alongside the menopause and reproductive medicine clinics with psychology support5 PAG constitutes a wide range of diagnoses, and a regular assessment is helpful to ensure care can be offered as efficiently as possible.Copyright © 2023

Record Keeping of External Calls to the Maxillofacial Department

Introduction/Aims: External telephone calls to the Northampton Maxillofacial department are often from Kettering General Hospital, GPs, GDPs, or patients. There was no system as to where or how to record details taken from external telephone calls. Therefore, not all calls were being noted. A proforma sheet was created to provide staff with a place to document call details. Compliance of record keeping was recorded. The aim of this clinical audit quality improvement project is to improve and measure the compliance of record keeping of external telephone calls to the Maxillofacial department. Material(s) and Method(s): The gold standard of record keeping is 100% compliance as per GDC Principle 4. A proforma sheet was created and a charting system meant calls were logged. Completed proformas were scanned onto the department's desktop. Audit cycles were conducted over one month. The first cycle was conducted from 20th December 2021 until the 20th January 2022. Intervention was then carried out, including discussion of results at a staff meeting, training on record keeping and one to one supportive feedback to colleagues on their record keeping of external calls. After this, a second cycle was conducted from the 1st March 2022 until the 31st March 2022. Results/Statistics: In cycle 1, 29 external calls were taken, with 19 documented. Record keeping compliance of external calls was 66%. The gold standard was not achieved. 32% of calls were from patients/relatives of patients, 31% of calls were from Kettering General, 21% from GPs and 16% from GDPs. 43% were regarding facial swellings and 22% were trauma related. The remaining calls which each had a weighting of 5%, were regarding: dog bites, orthodontics, osteotomies, biopsies, parotidectomies, trigeminal neuralgia and oral antral fistulas. 12 patients were advised to attend the A&E department, 3 patients were admitted for emergency surgical treatment, and 5 were booked for a review at a trauma clinic. In cycle 2, there was significant improvement, as record keeping compliance of external calls was 85%. 20 external telephone calls were noted, with 17 recorded using the proforma sheets. 16% of calls were regarding facial swellings, 21% were trauma related, 26% had post-extraction concerns, 5% had COVID-19 queries, 16% had delayed healing, 11% involved uncontrollable bleeding and the final 5% called for antibiotic advice. 9 patients were advised to attend the A&E department, 1 patient was admitted for emergency surgical treatment, and 7 were booked on to a trauma clinic. Conclusions/Clinical Relevance: The audit raises awareness for ethical record keeping, patient safety and legal implications. It highlights areas for teaching, such as management of facial swellings. As the gold standard was not achieved, the aim is to re-audit after more intervention, to improve compliance of good record keeping to 100%. The Maxillofacial department at Kettering General are also looking to implement the proformas and audit. This demonstrates the project can be generalised to more hospitals. Copyright © 2022

A model respiratory personal protective programme for the New Zealand healthcare industry

In the absence of advice from the workplace regulator, a model respiratory protection programme for healthcare workers is presented based in healthcare and wider industry experience. Hospital and other healthcare institutions can use this as a basis for their programmes in preparation for the next infective disease outbreak. Copyright © NZMA.

Clinical Audit on Critical Time Standards for Hyperacute Stroke Management in Addenbrooke's Hospital, Cambridge, Uk: Measuring against National Targets

Background and Aims: The aim of this project was to compare the performance of Addenbrooke's acute stroke team from September 2018 - September 2021 to the UK National Stroke Service Model time-targets for hyperacute stroke management. This period was chosen to cover performance before and during COVID, because the pandemic instigated radical changes in hyperacute stroke management processes and team structure in Addenbrooke's Hospital. From this audit, we hoped to determine the effects of these changes - the strengths and weaknesses of different team and process permutations to advise the development of an ideal stroke service model. Method(s): Data on door-to-1st responder time, door-to-CT time, door-to-thrombolysis time, door-to-thrombectomy time and door-toconsultant time for patients presenting during working hours (Mon-Fri, 0900-1700) from September 2018 to September 2021 was extracted from Addenbrooke's Hospital SSNAP database. Statistical analysis revealed a non-parametric distribution, thus median time and IQR were calculated for comparison between different covering teams. Kruskal- Wallis analysis was used to compare data of different teams, and subsequently, if significance was identified, pairwise Mann-Whitney U tests were conducted to determine statistically different groups. Result(s): Door-to-1st responder, door-to-CT, door-to-thrombolysis, door-to-thrombectomy, and door-to-consultant time varied over the 3 years depending on cover. Group 4 was identified as having significantly lower door-to-1st responder and door-to-consultant times. Conclusion(s): Better staffing and top-down prioritisation for consultant review were identified as factors supporting quicker management. Reduction of door-to-CT time, simplification of CT algorithm for rapid thrombolysis and expansion of thrombectomy services were identified as changes which could potentially improve hyperacute stroke management in Addenbrooke's Hospital. (Figure Presented).

Ocrelizumab dosing according to CD19+ cell count monitoring in multiple sclerosis: a tertiary centre audit during the SARS-CoV-2 pandemic

Introduction: In March 2020, to prevent the risk of infection from SARS-CoV-2 in people with multiple sclerosis (MS) on Ocrelizumab, notably associated with an immunosuppressed state, the Association of British Neurologists (ABN) advised delaying the infusions until the recovery of CD19+ cells to over 1% of the total lymphocyte population. The indication is based on observations from multinational experience using Rituximab, suggesting that an Ocrelizumab infusion may remain effective at controlling MS for longer than 6 months. Objective(s): We will analyse data on the delayed time intervals between Ocrelizumab infusions, the rate of relapses and signs of disease activity or progression reported for 209 patients in the audited period. Aim(s): We aim at assessing the efficacy of dosing Ocrelizumab according to CD19+ cell count in terms of MS control. Method(s): The study was designed as a clinical audit. 209 patients under the care of the MS centre of the Queen Elisabeth Hospital Birmingham were included in the audit. The protocol suggested by the ABN was applied to all of them from mid-March 2020 onwards. 2 years after, we collected data on the time intervals between the infusions, the relapses and radiological findings reported for the 209 subjects in the audited period. Result(s): A total of 424 Ocrelizumab infusions were administered. 123 (29%) were first infusions. 301 (71%) were either second, third, fourth, fifth or sixth infusions. Of those 301 infusions, 235 (78,07%) were administered after 8 months or more from the preceding one, whereas 66 (21,92%) were performed at a time interval of 6-7 months. Of 209 patients, 8 (3,82%) experienced a clinical relapse not supported by radiological signs of disease activity or progression. 4 patients (1,91%) presented clinical manifestations of a relapse confirmed by radiological findings of disease activity or progression. For 1 patient (0,47%) the magnetic resonance imaging showed evidence of increased lesion load not associated with any new clinical sign or symptom. In addition, 4 patients (1,91%) reported subjective feelings of worsening MS that they attributed to infusions being delayed and were re-established on standard sixth-month interval infusions. Conclusion(s): Ocrelizumab dosing according to CD19+ cell count monitoring remained effective at controlling MS in the majority of the 209 patients included in the audit while preventing unnecessary exposure to SARS-CoV-2 infection related to hospital attendance.

Management and ambulation of uncomplicated acute diverticulitis during the CoVID-19 Pandemic-a clinical audit in a district general hospital

Aims: To audit The management (ambulation versus admission) of acute diverticulitis presenting to a London DGH. Method(s): 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. Result(s): 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. Conclusion(s): 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.

Study protocol for developing a novel approach for improving supply chain management for SARS-CoV-2 point of care diagnostic services in resource-limited settings: a case study of Mopani District in Limpopo province, South Africa.

INTRODUCTION: Recent evidence shows that point-of-care (POC) testing is a more feasible alternative for diagnosis of COVID-19 in settings that have poor access to laboratory diagnostic services. Equitable access to POC testing can be optimised through well-established supply chain management (SCM) systems. The proposed study aims to develop a novel approach for improving SCM for COVID-19 POC diagnostic services in resource-limited settings with poor access to laboratory diagnostic services, using Mopani District in Limpopo Province, South Africa as a study setting. METHODS AND ANALYSIS: This study was guided by results of the scoping review. Following the scoping review, we propose a mixed-methods study, which will be implemented in three phases. First, we will perform a geospatial analysis to investigate the spatial distribution of COVID-19 testing services. Second, we will perform an audit of POC diagnostic services including its supply chain to evaluate the effect of SCM on accessibility of COVID-19 POC diagnostic services and reveal SCM barriers and enablers of accessibility of COVID-19 POC diagnostic services. Third, we will perform a nominal group technique to collaborate with key stakeholders in co-creation of a novel approach for improving SCM systems for COVID-19 POC diagnostic services. For the geospatial analysis, we will employ the ArcGIS Software. For the analysis of quantitative and qualitative data that will be generated from the audit and nominal group discussion, we will employ Stata software and NVivo software, respectively. ETHICS AND DISSEMINATION: This study has been ethically reviewed and approved by two institutional review boards: University of Pretoria Faculty of Health Sciences Research Ethics Committee (approval number 655/2021) and Limpopo Department of Health Research Ethics Committee (approval number LP-2021-12-007). The results of this study will be disseminated through national and international presentations and peer-reviewed publications.