Using an original triage and on call management tool aids identification and assessment of the acutely unwell surgical patient.

Until now, there have been no published surgical triage tools. We have developed the first such tool with a tiered escalation policy, aiming to improve identification and management of critically unwell patients. The existing sheet which is used to track new referrals and admissions to the surgical assessment unit was reviewed. The sheet was updated and a traffic light triage tool generated using National Early Warning Scores (NEWS), sepsis criteria and user discretion. A tiered escalation policy to guide urgency of assessment was introduced and education sessions for all staff undertaken, to ensure understanding and compliance. Through multiple 'plan-do-study-act' cycles, the new system and its efficiency have been analysed. Prior to intervention, documentation of NEWS did not occur and only 13% of admission observations were communicated to the surgical team. Following multiple cycles and interventions, 93% of patients were fully triaged, and 80% of 'red' and 'amber' patients' observations were communicated to the surgical team. The average time for a registrar to review a 'red' patient was 37 min and 79% of 'green' patients were reviewed within an hour of their presentation. Rapid identification of the unwell patient is crucial. Here we publish the first triage tool that enables early assessment of septic and otherwise potentially unwell surgical patients.

Improving oxygen prescribing rates by tailoring interventions for specific healthcare professional groups.

Oxygen prescription remains a nationwide problem. The dangers associated with unregulated oxygen administration are well described in the literature with the potential for serious harm in patients with chronic hypercapnia, as well as potentially delaying discharge in patients who are administered it without a prescription. This project identifies poor compliance with regional and national standards and sets out to improve the frequency of oxygen prescribing on a cardiology ward. By studying the problem at a Somerset district general hospital we identified two main groups of professionals responsible for the poor compliance, nursing staff (who administer the oxygen) and junior doctors (who should prescribe it). A series of interventions was designed to firstly raise awareness of the problem within these two groups before going on to target each group with a further intervention over 24 weeks. At baseline we found only 11.3% of patients receiving oxygen had it prescribed. At the end of the project this had improved to 69.6%. We also found that following raised awareness in the nursing staff and introduction of a bedside warning the number of patients receiving oxygen on the ward fell by 35%. In conclusion, this project outlines a strategy for improving oxygen prescribing rates on a medical ward. By targeting different populations we had hoped to see a cumulative improvement after each improvement cycle, however, some resistance from junior doctors in engaging with our third intervention was reflected with a slight decrease in prescribing rates. Further work should address this issue and look to apply this strategy across a wider clinical area with a greater sample size to see if the results are replicable on a larger scale.