A Perspective on Theatre Efficiency in Terms of Theatre Utilisation and Theatre Costs and the Effects of Infection Control Protocols on These During the COVID-19 Pandemic.

Background and aim The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on healthcare systems. Several local infection control methods were put in place, which have now evolved and continued in some form or the other. According to various research, as the time duration for distinct phases in the pathway rose, trauma theatre efficiency reduced. However, there is no literature, to our knowledge, that has explicitly looked at theatre utilisation and cost efficiency compared them and expressed theatre efficiency in these terms. The aim of this article is to study theatre efficiency in terms of utilisation and costs before and during the pandemic and understand the influence of infection control protocols on these. Materials and methods The data were collected retrospectively from the ORMIS theatre management software (iPath Softwares, Ohio), from December 2019 (pre-COVID) and December 2020 (COVID). Turnaround time, utilisation time and combined operative time were defined and compared. Costs incurred due to over-running, under-running and turnaround time were compared. Results Theatre utilization was 101% during COVID and 86.63% pre-COVID. The average cost of over-running as well as under-running a theatre list during the pandemic was significantly higher. Conclusion Optimal theatre utilisation and reduced time between cases improve theatre efficiency. Turnaround time, if reduced, can not only decrease costs but also increase efficiency.Theatre utilisation and efficiency can be maintained even with new infection control protocols, but these are not cost-efficient.

Comparison Between Mini-Sternotomy and Full Sternotomy for Aortic Valve Replacement: A 10-Year Retrospective Study.

Introduction Aortic valve replacement (AVR) is a mainstay treatment for moderate to severe aortic valve stenosis. This retrospective study aimed to compare the clinical outcomes of mini-sternotomy and conventional sternotomy. Methodology This 10-year retrospective study compared the clinical outcomes of mini-sternotomy and full sternotomy. Patient-related outcomes include sternal wound dehiscence, operative time, length of hospital stay, and Intensive Care Unit (ICU) stay, whereas intraoperative parameters such as cardiopulmonary bypass (CPB) time and Aortic Cross Clamp time (ACCt) were compared between the two treatment groups. Results A total of 371 patients underwent AVR. Among them, 238 patients had AVR with full sternotomy and 133 patients had a mini-sternotomy. Full sternotomy patients had significantly lower bleeding than those in the mini-AVR group (p-0.002). The operation time was also found to be significantly higher in the mini-AVR group. The duration of hospital stays, ICU stay, and deep sternal wound dehiscence were recorded to be statistically insignificant between the two treatment groups. Atrial fibrillation, sternal wound dehiscence, stroke and perioperative myocardial infarctions, were equally observed between the two groups. Conclusion Mini-sternotomy is a safe option for AVR. The same number of complications were observed between the two groups; however, there was a reduction in the duration of hospital stay and ICU stay amongst the mini-sternotomy group.

Locked the Car, Why Not the Computer: A Qualitative and Quantitative Study on Data Safety Compliance.

Information technology has become an integral part of health care in the United Kingdom National Health Service (NHS). All health care professionals are required to have a certain level of cyber ethics and knowledge of computers. This is assured by regular mandatory training. The government of the United Kingdom has charted out a course to strengthen cyber security and prevent any crises like Wannacry. Simple things like leaving a computer unlocked can pose a potential threat to the cyber security of the whole NHS. These cannot be addressed with money alone, as they involve complex interactions of human factors. Such seemingly simple non-compliance results often in harm to the patient or breach of confidentiality. We tried to find out the compliance among junior doctors to the Trust Information Technology (IT) Safe Usage Policy. We made interventions and interviewed junior doctors to find out the reasons for non-compliance. We re-audited in order to see if our interventions helped. We also audited compliance in another Trust independently, which showed that this problem is not specific to a particular trust. Here we suggest the changes that all Trusts can make and follow our model to audit their compliance.

Compliance With the Cauda Equina Pathway: Results of a Closed-Loop Audit.

Introduction The British Association of Spine Surgeons (BASS) and Society of British Neurological Surgeons (SBNS) recommend urgent MRI imaging and operative intervention in patients with suspected cauda equina syndrome (CES). Due to the lack of a 24-hour MRI service and the centralisation of neurosurgery to large tertiary centres, there is a need for an evidence-based protocol for the referral of patients presenting with back pain, with red flags to specialist tertiary neurosurgical centres. Methods The standard operating procedure (SOP) at our local hospital outlines steps in the assessment, triage and onward referral of patients presenting with symptoms of acute CES. A closed-loop audit cycle was performed; the first cycle was between September and December 2020 and the second was between January and April 2021. Recommendations made after the first cycle were actioned prior to re-audit. Results There was 100% compliance regarding discussions with neurosurgery following MRI and appropriate management following neurosurgical advice. There was a 21.1% increase in appropriate discussions with neurosurgery by the emergency department (ED), increased accurate documentation of red flags (5% anal tone and 21% perianal sensation). There was a 53% decrease in senior ED doctor referral to neurosurgery, although 100% referrals were discussed with an ED senior prior to referral, and a 20% decrease in compliance regarding neurosurgery plan documentation. Conclusion We were able to improve our compliance with several aspects of the SOP using simple measures. We could not improve one aspect of SOP, namely, a discussion with the specialist centre being performed by a senior doctor. Since CES requires timely management and early scanning, we recommend a robust protocol at the admitting hospital. This paper presents the protocol at our hospital and the rationale behind it. We discuss what affects our compliance with the SOP and how simple interventions have helped us improve.

Asymptomatic Severe Acquired von Willebrand's Syndrome in Association With a Glioblastoma Multiforme: A Case Report.

To our knowledge, this is the first reported case of a severe acquired von Willebrand's Syndrome (avWS) in association with a Glioblastoma Multiforme (GBM). We report a case of a 70-year-old male who presented to the hospital with neurologic findings secondary to a thalamic mass and subsequent hydrocephalus but without any prior history of any bleeding diathesis. A biopsy and septum pellucidotomy was considered and coagulation parameters from pre-operative chemistry returned deranged. Further investigations for bleeding disorders have been performed and an avWS was diagnosed due to the low levels of factor VIII, vWF:Ag, and vWF:RiCoF. The patient responded to a single dose of IVIG and hence the contemplated procedure has been performed. Subsequently, a histopathologic diagnosis of a GBM was made and unfortunately no further treatment was pursued due to the patient's poor response to the initial surgical intervention.