S56 Abstracts / International Journal of Surgery 47 (2017) S15eS108
the database of Medical practitioner’s tribunal service (MPTS) which is
0531: MAINTAINING OPERATION NOTE QUALITY FOLLOWING THE
INTRODUCTION OF AN ELECTRONIC PROFORMA: A COMPLETE AUDIT
CYCLE
E. Decker*, S. Williams, A.M. Jawad, M. Mohamed. Department of General
Surgery, Medway Maritime Hospital, Kent, UK.
Background: Royal College of Surgeons (RCS) guidelines advise 21 inclu-
sion criteria for operative notes. Following the introduction of an electronic
proforma in 2015, our district general hospital (DGH) demonstrated sig-
nificant improvement in operation note quality. Our study re-audits local
practice following one year.
Method: Data were collected from operation notes over a 2-week period in
November 2016 and compared with RCS criteria. Additional analysis of
typewritten versus handwritten notes was performed. Results were
compared to those obtained in 2015.
Result: 257 operative notes were analysed (187 in 2015 audit). There was
significant increase in proforma use (45% vs 16%, p<0.001). Over 95%
included full patient details, date, surgeon, procedure, closure technique
and post-operative instructions; no significant difference identified be-
tween studies. Fewest mentioned criteria were: use of prosthesis (20%),
estimated blood loss (22%), time of operation (24%) and differentiation
between elective and emergency procedures (25%). No significant differ-
ence seen in use of typed operation notes (p¼0.82) or legibility of hand-
written notes (p¼0.23).
Conclusion: This audit cycle demonstrates significant increase in proforma
use since its introduction in 2015. Operative note quality has been main-
tained since 2015. Annual audit and clinician education will aid continued
improvement in operative notes and safe handover.
0533: INCIDENCE AND CAUSES OF OPERATIVE CASE CANCELLATION ON
DAY OF SURGERY AT QUEEN ELIZABETH HOSPITAL KING'S LYNN
M. Yao*. Queen Elizabeth Hospital, King's Lynn, Norfolk, UK.
Aim: To assess the incidence and causes of cancellation of surgical oper-
ations on day of surgery in order to streamline service, increase efficiency
and maximise operative resources.
Method: Total number of operative cases for main theatre and day surgery
for calendar year 2015 was generated using hospital records.
Causes were classified into hospital and patient related causes, and their
sub classifications.
30 case notes were pulled and analysed in detail regarding classification
and documentation.
Result: Cancellation on day of surgery accounted for 4.1% (143 of 3222) of
total operative cases.
Results showed patient related causes at 28.4% and hospital related causes
71.6%.
Subclassification showed highest incidence of patient related cause to be
‘did not attend’ 11.9%, whereas hospital related causes were ‘lack of beds’,
10.4% and ‘lack of theatre time’, 12.0%.
Analysis of 30 case notes were classified into preventable, unpreventable
and unknown causes of cancellation.
Conclusion: Reclassification due to incorrect coding revealed a more ac-
curate picture as to why cases were being cancelled. Recommendations
from case notes included greater emphasis on reinforcing preoperative
plans. A system to contact patients before their surgery, and a proforma for
cancellation of cases on day of surgery to aid future audit, were proposed.
0536: ARE THERE ANY DOCTOR CHARACTERISTICS TO PREDICT THE
TYPE OF THE OFFENCE LEADING TOWARDS A GMC INVESTIGATION?
G. Demetriou*. East Sussex NHS Trust, East Sussex, UK.
Introduction: We investigated correlations between the different groups
of doctors and their charges. This can lead to better awareness amongst
postgraduate centers with the aim to design specific educational sessions
depending on the doctors they employ so they can raise awareness and
tackle this increasing trend of complains.
Method: Retrospective analysis of doctors who were investigated by GMC
over the period of July 2015 to February 2016. The data was collected from
freely available online.
Result: In total 92 males and 8 females were investigated. We performed a
Chi-Square analysis of the year and place of qualification, sex, and specialty
with the type of offence. The type of offence was grouped according to the
different categories that GMC is using to categorise the offences.
Analysis: The only significant correlation was found between place of
qualification and type of offence (P:0.002)
Discussion: Doctors involved in criminal offences are more likely to be U.K
graduates where those with “acting honestly and fairly” and “professional
performance” allegations were more likely to have graduated from Asia.
Male doctors were significantly more likely to be investigated by GMC (92%
Vs 8%).
0564: PATIENT SAFETY IN SURGERY IN SUB-SAHARAN AFRICA: A MULTI-
METHOD EVALUATION OF PERIOPERATIVE PRACTICE AND SAFETY CUL-
TURE AT AARESOURCE-POOR RURAL HOSPITAL
M.F. Bath*1, E. Norris 2, J.E.F. Fitzgerald 3. 1 University of Cambridge,
Cambridge, UK; 2 West Middlesex University Hospital, London, UK; 3 Lifebox
Foundation, London, UK.
Aim: To evaluate the current state of surgical safety at a rural hospital
setting in sub-Saharan Africa.
Method: Data collection was divided into three main topics of focus,
assessing (1) completion rate of the WHO Surgical Safety Checklist; (2)
availability of essential surgical provisions using the WHO Tool for Situa-
tional Analysis to Assess Emergency and Essential Surgical Care; (3) staff
perceptions of surgical safety using the AHRQ Hospital Survey on Patient
Safety.
Result: 37.1% (147/396) of WHO Surgical Safety Checklist points were
covered across all operations over a 4-week period. 20.0% (3/15) of infra-
structure, 75.8% (25/33) of interventions, and 30% (12/40) of equipment
and supplies that were deemed essential could be provided by the hos-
pital. Hospital staff had a 55% positive response to hospital patient safety,
yet the frequency of events reporting was 33%.
Conclusion: Despite a significant lack of resources, a wide array of
essential interventions are still performed in rural sub-Saharan hospitals.
The use of safety checklists and events reporting was noticeably low and
needs substantial improvement. Along with financial investment from
developed healthcare systems, wider changes to cultural and organisa-
tional systems are needed to ensure improvements in patient safety can
readily be achieved globally.
0579: PLAIN ABDOMINAL RADIOGRAPHS e IS IT A KNEE JERK REFLEX?
K.S. Khan*1, V. Kirupanandan 2, S.A. Khan 3, T. Khan 1, B. Renwick 1,
S. Mahmud 1. 1 Hairmyres Hospital, East Kilbride, NHS Lanarkshire, UK;
2
Glasgow Medical School, Glasgow, UK; 3 Monklands Hospital, Airdrie, NHS
Lanarkshire, UK.
Aim: Abdominal X-Rays (AXRs) have low diagnostic yield and high false
negative rates, despite this they are overused and Royal College of Radi-
ologist (RCR) guidelines are not complied with. The primary aim of this
study was to see adherence to RCR guidelines. The secondary aim was to
see diagnostic yield and need for any further investigations.
Method: Multicentre retrospective cohort study of all AXRs conducted
over three months’ period in three acute hospitals. Patients were divided
into two groups; acute surgical admissions (ASA) group and ‘other’ group.
AXRs reports and electronic case-notes were analyse for clinical in-
dications, diagnoses and secondary investigations. Findings were divided
into three groups; negative, non-specific and specific. Statistical analysis
was done using chi squared and Yates correction.
Result: 1657 patients were identified, of these 634 (38.3%) were in ASA
group. In ASA group, 82.4% complied with RCR guidelines compared to
71.3% in the ‘other’ group (p-value 0.0001). 18.2% in ASA group had specific
finding compared to 18.7% in ‘other’ group (p-value 0.352). 64.5% of pa-
tients in ASA group had further investigations compared to 33.2% in ‘other’
group (p-value 0.0001).