Impact of a structured template and staff training on compliance and quality of clinical handover.

INTRODUCTION: Change in junior doctors working pattern has brought effective and safe clinical handover into a central role to ensure the patient safety and high quality care. We investigated whether the compliance and quality of clinical handover could be improved through the use of a standardised and structured handover template. METHODS: A computerised template was developed in accordance with handover guidelines provided by the Royal College of Surgeons of England. Pre- and post-intervention audits against an eleven-point dataset pertaining to the handover of acute surgical admissions were undertaken. The results from the two discrete audits periods were compared to examine the impact of intervention. RESULTS: There were 137 acute surgical admissions during pre-intervention and 155 admissions in post-intervention audit period. A significant improvement in overall handover practice was observed in post-intervention period. The documentation of patient hospital number (84 (61%) vs. 132 (85%) p<0.001), past medical history (39 (28%) vs. 75 (48%) p<0.001) and patient assessment by a senior member of the on-call team (3 (2%) vs. 125 (85%) p<0.001) all demonstrated significant improvements upon use of structured template. Compliance to effective handover improved following increased awareness of the importance of safe clinical handover among the junior doctors. CONCLUSION: Implementation of a standardised guideline-based structured handover template and training of junior doctors are likely to improve compliance to agreed standards, promote quality of care, and protect patient safety.

Parastomal hernia causing gastric emphysema.

We report a case of a parastomal hernia in which the stomach became incarcerated. This is an unusual yet serious complication of parastomal hernias.

Vascular hamartoma of the mediastinum: a case report.

Vascular hamartoma of the mediastinum is a rare benign vascular tumor. A 13-year-old girl presented with back pain, persistent coughing, palpitation, and angina pectoris. Preoperative investigations demonstrated an enlarging mass involving the superior mediastinum extending posteriorly (T6-T8). An encapsulated, 6x5x3 cm dark purplish mass adherent to the aortic wall was found. The main mediastinal mass was totally excised but limited resection was carried out in the paravertebral region. Microscopic examination revealed a vascular hamartoma.

Multicentricity in renal cell carcinoma.

OBJECTIVE: To find the incidence of multicentric renal cell carcinoma and its possible relationship to the other clinical and pathologic findings. METHODS: A total of 40 patients with renal cell carcinoma underwent radical nephrectomy between March 1994 and January 1996 at Hacettepe University, School of Medicine, Department of Urology. All of the materials were examined grossly and histologically by the same pathologist. RESULTS: Among 40 kidneys 4 had satellite carcinoma (10%), 3 of them had been shown by preoperative imaging techniques, 1 was found histopathologically. CONCLUSION: If preoperative imaging techniques do not show additional lesion in the kidney besides the small early stage primary in incidentally discovered patients, the incidence of satellite renal cell carcinoma is low enough to justify nephron sparing surgery.