The Journal of One-Day Surgery

Evaluation of an ambulatory abscess pathway in a district general hospital and the impact of COVID on ensuring long term compliance.

2023-10-25T17:39:15+00:00

Introduction

Superficial skin abscesses are common and can lead to significant illness if not managed promptly. The gold standard treatment is incision and drainage (I&D), as, often antibiotics alone do not lead to resolution. This multi-cycle retrospective study audits the practice in a district general hospital by assessing the efficiency of a day case abscess pathway.

Methods

Phase 1 established standards for creating the pathway by streamlining patients to be operated on dedicated days, phase 2 evaluated the effect on waiting times for I&D, and phase 3 assessed the efficacy of the pathway after the impact of COVID. Data collected includes gender, age, comorbidities, time of admission to the surgical assessment unit, time sent for by theatre, anaesthetic agent, and discharge date.

Results

Phase 1 was conducted from 2017 to 2018, included 87 cases, and the average wait time was 8 hours 29 minutes for I&D. Phase 2 included 32 cases from August to October 2019, showed an average wait of 4 hours 43 minutes with 2 patients requiring overnight admission. Phase 3 included 208 patients from January to December 2022, showed an average wait of 4 hours 55 minutes with 21% requiring an unplanned overnight admission.

Conclusion

This study showed that there is significant benefit of a day case abscess pathway. It leads to fewer admissions, improving patient satisfaction and saving money for hospital trusts. There needs to be strict criteria to ensure that appropriate patients are triaged to them. This will require ongoing refinement and both medical and nursing staff education.

30-day readmission rate following laparoscopic cholecystectomy in North Devon District Hospital over a three-year period – a closed loop audit

2024-01-17T10:09:14+00:00

Introduction

Laparoscopic cholecystectomy is the most performed hepatobiliary procedure in the United Kingdom and worldwide. Readmission rate following surgery is considered a key performance indicator and care quality measure. Reducing this will allow for effective cost savings in the National Health Service. The aim was to determine 30-day readmission rate post-laparoscopic cholecystectomy, identify the indications for readmission and reduce this rate.

Methods

From a database of consecutive patients undergoing cholecystectomy over a 3-year period between 2019-2021, data on demography, comorbidity, and 30-day readmission rates over three separate time periods were extracted and evaluated. Findings were presented at the local departmental governance meeting after each audit round. Recommendations including introducing a standardised post-operative analgesia protocol were made and implemented prior to re-audit.

Results

A total of 883 patients had laparoscopic cholecystectomy: 69% females and 31% males. 70% were performed as day case. Overall readmission rate was 6% (5%; day case and 6%; overnight-cases). Readmission rates were 4%, 6% and 6% for years 2019, 2020 and 2021 respectively. Indications for readmission were biliary in 22% and non-biliary in 78%. Common indications for readmission were abdominal pain, postoperative infection, retained stone and pancreatitis. Non-specific abdominal pain was the commonest indication. Following adjustment for comorbidity; increasing age and male gender were associated with an increased rate for admission.

Conclusion

Readmission rates following laparoscopic cholecystectomy in North Devon District Hospital over a three-year period were less than 10% in accordance with Association of Upper Gastrointestinal Surgeons standards. Standards have been maintained following a re-audit.

President's Letter JODS 34.1

2024-02-26T18:42:09+00:00

Editor-in-Chief Letter JODS 34.1

2024-02-26T18:43:12+00:00

Experience of introducing the UroLift System to the Urological Investigations Unit

2024-02-26T18:22:03+00:00

This article is sponsored by Teleflex