Search results

1 – 10 of over 1000
To view the access options for this content please click here
Article
Publication date: 5 October 2015

Chris Johnstone, Rachel Harwood, Andrew Gilliam and Andrew Mitchell

Early access to senior decision makers and investigations has improved outcomes for many conditions. A surgical clinical decisions unit (CDU) was created to allow rapid…

Abstract

Purpose

Early access to senior decision makers and investigations has improved outcomes for many conditions. A surgical clinical decisions unit (CDU) was created to allow rapid assessment and investigation by on-call senior surgical team members to facilitate decision making and, if appropriate, discharge within a set time frame (less than four hours). The purpose of this paper is to compare outcomes for unscheduled general surgery admissions to the hospital before and after commissioning this unit.

Design/methodology/approach

Prospectively collected hospital episode statistics data were compared for all general surgical admissions for one year prior to (July 2010-June 2011) and two years after (July 2011-June 2013) the introduction of the CDU. Statistical analysis using the Mann Whitney U-test was performed.

Findings

More patients were discharged within 24 hours (12 per cent vs 20 per cent, p < 0.001) and total hospital stay decreased (4.6 days vs 3.2 days, p < 0.001) following introduction of CDU. Admission via A & E (273 vs 212, p < 0.01) was also decreased. Overall there was a 25.3 per cent reduction in emergency surgical admissions. No difference was noted in 30-day readmission rates (47 vs 49, p=0.29).

Originality/value

The introduction of a CDU in has increased early discharge rates and facilitated safe early discharge, reducing overall hospital stay for unscheduled general surgical admissions. This has decreased fixed bed costs and improved patient flow by decreasing surgical care episodes routed through the emergency department (ED). In all, 30-day readmission rates have not been influenced by shorter hospital stay. Service redesign involving early senior decision making and patient investigation increases efficiency and patient satisfaction within unscheduled general surgical care. Not original but significant in that the model has not been widely implemented and this is a useful addition to the literature.

Details

Clinical Governance: An International Journal, vol. 20 no. 4
Type: Research Article
ISSN: 1477-7274

Keywords

To view the access options for this content please click here
Article
Publication date: 7 August 2018

Alexandra Khoury, Mark Jones, Christopher Buckle, Mark Williamson and Guy Slater

Weekend surgery carries higher mortality than weekday surgery, with complications most commonly arising within the first 48 hours. There is a reduced ability to identify…

Abstract

Purpose

Weekend surgery carries higher mortality than weekday surgery, with complications most commonly arising within the first 48 hours. There is a reduced ability to identify complications at the weekend, with early signs going undetected in the absence of thorough early patient review, particularly in the elderly with multiple co-morbidities. Weekend working practices vary amongst UK hospitals and specialties. The weekend effect has been a prominent feature in the literature over the past decade. The purpose of this paper is to identify the number of patients undergoing weekend surgery who receive a Day 1 post-operative review and improve this outcome by implementing an effective change.

Design/methodology/approach

It was observed that not all patients undergoing surgery on a Friday or Saturday at the authors’ District General Hospital were receiving Day 1 post-operative review by a clinician. A retrospective audit was carried out to identify percentage of patients reviewed on post-operative Day 1 at the weekend. A change in handover practice was implemented before re-audit.

Findings

In Phase 1, 54 per cent of patients received Day 1 post-operative reviews at the weekend against a set standard of 100 per cent. A simple change to handover practice was implemented to improve patient safety in the immediate post-operative period resulting in 96 per cent of patients reviewed on Day 1 post-operatively at re-audit.

Originality/value

This study confirms that simple changes in handover practices can produce effective and translatable improvements to weekend working. This further contributes to the body of literature that acknowledges the existence of a weekend effect, but aims to evolve weekend working practices to accommodate improvement within current staffing and resource availability by maximising efficiency and communication.

Details

International Journal of Health Governance, vol. 23 no. 4
Type: Research Article
ISSN: 2059-4631

Keywords

To view the access options for this content please click here
Article
Publication date: 8 October 2018

Declan Dunne, Nikhil Lal, Nagarajan Pranesh, Michael Spry, Christopher Mcfaul and Paul Rooney

A clinical audit is a key component of the clinical governance framework. The rate of audit completion in general surgery has not been investigated. The purpose of this…

Abstract

Purpose

A clinical audit is a key component of the clinical governance framework. The rate of audit completion in general surgery has not been investigated. The purpose of this paper is to assess the rates of audit activity and completion and explore the barriers to successful audit completion.

Design/methodology/approach

This was a multi-centre study evaluating current surgical audit practice. A standardised audit proforma was designed. All clinical audits in general surgery during a two-year period were identified and retrospectively reviewed. Data held by the audit departments were collated, and individual audit teams were contacted to verify the data accuracy. Audit teams failing to complete the full audit cycle with a re-audit were asked to explain the underlying reasons behind this.

Findings

Of the six trusts approached, two refused to participate, and one failed to initiate the project. A total of 39 audits were registered across three surgical directorates. Only 15 out of 39 audits completed at least one audit cycle, with 4 deemed of no value to re-audit. Only seven audits were completed to re-audit. Achieving a publication or a presentation was the most cited reason for not completing the audit loop.

Originality/value

This study demonstrates that the poor rates of audit completion rate found in other areas of clinical medicine pervade general surgery. Improved completion of an audit is essential and strategies to achieve this are urgently needed.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 8
Type: Research Article
ISSN: 0952-6862

Keywords

To view the access options for this content please click here
Article
Publication date: 4 May 2021

Nor Hamizah Miswan, Chee Seng Chan and Chong Guan Ng

This paper develops a robust hospital readmission prediction framework by combining the feature selection algorithm and machine learning (ML) classifiers. The improved…

Abstract

Purpose

This paper develops a robust hospital readmission prediction framework by combining the feature selection algorithm and machine learning (ML) classifiers. The improved feature selection is proposed by considering the uncertainty in patient's attributes that leads to the output variable.

Design/methodology/approach

First, data preprocessing is conducted which includes how raw data is managed. Second, the impactful features are selected through feature selection process. It started with calculating the relational grade of each patient towards readmission using grey relational analysis (GRA) and the grade is used as the target values for feature selection. Then, the influenced features are selected using the Least Absolute Shrinkage and Selection Operator (LASSO) method. This proposed method is termed as Grey-LASSO feature selection. The final task is the readmission prediction using ML classifiers.

Findings

The proposed method offered good performances with a minimum feature subset up to 54–65% discarded features. Multi-Layer Perceptron with Grey-LASSO gave the best performance.

Research limitations/implications

The performance of Grey-LASSO is justified in two readmission datasets. Further research is required to examine the generalisability to other datasets.

Originality/value

In designing the feature selection algorithm, the selection on influenced input variables was based on the integration of GRA and LASSO. Specifically, GRA is a part of the grey system theory, which was employed to analyse the relation between systems under uncertain conditions. The LASSO approach was adopted due to its ability for sparse data representation.

Details

Grey Systems: Theory and Application, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2043-9377

Keywords

To view the access options for this content please click here
Article
Publication date: 13 June 2008

Vardhini Vijay, Sarmad Kazzaz and Jonathan Refson

The purpose of this paper is to examine the activity of a purpose‐built elective surgery unit in a busy district general hospital and the patient journey associated with…

Downloads
1049

Abstract

Purpose

The purpose of this paper is to examine the activity of a purpose‐built elective surgery unit in a busy district general hospital and the patient journey associated with same day admission to the elective surgery unit.

Design/methodology/approach

This paper describes the layout of the elective surgery unit in a busy district general hospital and the associated patient journey. Early challenges are identified and potential cost savings calculated.

Findings

The potential for cost savings in the NHS with purpose‐built units for elective surgery are immense.

Originality/value

An elective surgery unit has not been described in detail before. Apart from its value to the NHS, hospitals in developing countries can benefit from knowing about the early challenges, described in the paper, that were faced.

Details

International Journal of Health Care Quality Assurance, vol. 21 no. 4
Type: Research Article
ISSN: 0952-6862

Keywords

To view the access options for this content please click here
Article
Publication date: 6 January 2012

Mehmet Savsar and Moiedh M. Al‐Ajmi

The purpose of this paper is to determine the significant factors that cause delays in surgery operations in a hospital and factors that affect productivity of surgery clinics.

Abstract

Purpose

The purpose of this paper is to determine the significant factors that cause delays in surgery operations in a hospital and factors that affect productivity of surgery clinics.

Design/methodology/approach

Data are collected from surgery clinics of an international hospital to identify main factors that affect delays in surgery operation. A design of experiment is then performed and the significance of the effects of these factors is determined. A regression model was also developed to find a relation between surgery delays and the selected factors.

Findings

The results show that such factors as the type of doctors and missing information significantly affect the delay in surgery operations as compared with some other factors, such as admission time considered in the study.

Research limitations/implications

The models developed and the results obtained in this paper are specific to the application presented. However, the procedures are general and can be applied to similar problems.

Practical implications

The results of the study can be used to control important factors to reduce the delays in surgery operations, reduce risks in patient health related to these delays, reduce hospital costs and improve the productivity of these clinics.

Originality/value

The paper considers a management problem related to surgery delays which has not been considered before and presents a procedure to study the causes of the problem. It provides a methodology that could be used to study similar problems in health care management systems and to improve these systems by analyzing operations and activities with respect to the factors that affect productivity and efficiency of such operations.

Details

International Journal of Health Care Quality Assurance, vol. 25 no. 1
Type: Research Article
ISSN: 0952-6862

Keywords

To view the access options for this content please click here
Article
Publication date: 1 January 2014

Kirsten McArdle, Edmund Leung, Neil Cruickshank and Veronique Laloe

The Royal College of Surgeons published Standards for Unscheduled Surgical Care in response to variable clinical outcomes for emergency surgery. The purpose of this study…

Abstract

Purpose

The Royal College of Surgeons published Standards for Unscheduled Surgical Care in response to variable clinical outcomes for emergency surgery. The purpose of this study is to assess for feasibility of a district hospital providing care in accordance to the recommendations.

Design/methodology/approach

A total of 100 consecutive patient unscheduled episodes of care were prospectively included. Information regarding demographics, timeliness of investigations, operations, consultant input and clinical outcomes was collated. All patients were risk-adjusted for mortality. The data were compared to the guidelines.

Findings

A total of 91 patients were included; 80 patients underwent surgery. There were 18 deaths (22.5 per cent), eight (10 per cent) post-operative within 30 days. There was no statistical difference between deaths and day of admission or surgery. There were 39 critically-ill patients, none were reviewed by a consultant within the recommended 30 minutes. Of the critically-ill patients, 23 underwent CT scanning, none within the recommended 30 minutes. All patients were operated within the recommended timeframe by urgency grading. For those predicted mortality rate >5 per cent, a consultant was present in theatre for 97 per cent of cases. All patients had a consultant review within 24 hours of admission.

Originality/value

To the authors' knowledge this is the first evaluation of the practical difficulties in achieving consultant delivered care in surgery in a district general hospital. These results are interesting to clinicians and service planners involved in developing emergency services. Adhering to these guidelines would require significant re-allocation of resources in most hospitals and may require centralisation of services.

Details

Clinical Governance: An International Journal, vol. 19 no. 1
Type: Research Article
ISSN: 1477-7274

Keywords

To view the access options for this content please click here
Article
Publication date: 12 March 2018

Charles Hubert Blouin-Delisle, Renee Drolet, Serge Gagnon, Stephane Turcotte, Sylvie Boutet, Martin Coulombe and Eric Daneau

The purpose of this paper is to increase efficiency in ORs without affecting quality of care by improving the workflow processes. Administrative processes independent of…

Abstract

Purpose

The purpose of this paper is to increase efficiency in ORs without affecting quality of care by improving the workflow processes. Administrative processes independent of the surgical act can be challenging and may lead to clinical impacts such as increasing delays. The authors hypothesized that a Lean project could improve efficiency of surgical processes by reducing the length of stays in the recovery ward.

Design/methodology/approach

Two similar Lean projects were performed in the surgery departments of two hospitals of the Centre Hospitalier Universitaire de Québec: Hôtel Dieu de Quebec (HDQ) and Hôpital de l'Enfant Jesus (HEJ). The HDQ project designed around a Define, Measure, Analyse, Improve and Control process revision and a Kaizen workshop focused on patients who were hospitalized in a specific care unit after surgery and the HEJ project targeted patients in a post-operative ambulatory context. The recovery ward output delay was measured retrospectively before and after project.

Findings

For the HDQ Lean project, wasted time in the recovery ward was reduced by 62 minutes (68 percent reduction) between the two groups. The authors also observed an increase of about 25 percent of all admissions made in the daytime after the project compared to the time period before the project. For the HEJ Lean project, time passed in the recovery ward was reduced by 6 min (29 percent reduction).

Originality/value

These projects produced an improvement in the flow of the OR without targeting clinical practices in the OR itself. They demonstrated that change in administrative processes can have a great impact on the flow of clinical pathways and highlight the need for comprehensive and precise monitoring of every step of the elective surgery patient trajectory.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 2
Type: Research Article
ISSN: 0952-6862

Keywords

To view the access options for this content please click here
Article
Publication date: 1 May 2007

C.U. Dussa, K. Durve and K. Singhal

The purpose of this paper is to find the incidence and medical reasons for cancellations of elective orthopaedic cases following admission for an operation in a district…

Downloads
760

Abstract

Purpose

The purpose of this paper is to find the incidence and medical reasons for cancellations of elective orthopaedic cases following admission for an operation in a district general hospital. The paper also aims to determine the deficiencies in the local preoperative assessment protocol.

Design/methodology/approach

This is a retrospective study. The elective orthopaedic surgeries cancelled following their admission into the hospital due to medical reasons between January 2003 and December 2004, were identified. These cases were reviewed using the preoperative assessment charts and case notes. The NHS Modernisation Agency's guidelines, National Good Practice Guidance on Preoperative Assessment for Inpatient Surgery, are taken as the benchmark for comparison.

Findings

The paper finds that 44 elective orthopaedic cases were cancelled due to medical reasons. Of these patients, 64 per cent did not have a pre‐operative assessment prior to the admission for the planned surgery; 6 per cent had inadequate documentation of relevant past medical history; and 30 per cent (patients with significant medical problems) were not referred to the anaesthetist for advice although these problems were identified during the pre‐operative assessment.

Research limitations/implications

It is possible to stimulate good medical practice through audit.

Practical implications

Cancellation of an elective operation is not uncommon in hospital practice. This paper aims to highlight the possible avoidable causes for such cancellations. The paper identifies such deficiencies in the local preoperative assessment protocol and suggests remedies to improve the quality of care. These improvements and close adherence to the guidelines are important as preoperative assessment by nurse‐led clinics are being increasingly practised through out the UK.

Originality/value

The paper fulfils its aims of identifying the medical causes for cancellation of an operation and also the existing deficiencies in the preoperative assessment practice. The paper values the importance of adherence to NHS Modernising Agency's guidelines in preoperative assessment. It is useful not only to the Orthopaedic department but also to the department managers.

Details

Clinical Governance: An International Journal, vol. 12 no. 2
Type: Research Article
ISSN: 1477-7274

Keywords

To view the access options for this content please click here
Article
Publication date: 9 February 2010

David Borowski, Margaret Knox, Venkat Kanakala, Stuart Richardson, Keith Seymour, Stephen Attwood and Bary Slater

Gallstone‐related illnesses are one of the most common reasons for emergency hospital admissions, often with serious complications. Standard treatment of uncomplicated…

Abstract

Purpose

Gallstone‐related illnesses are one of the most common reasons for emergency hospital admissions, often with serious complications. Standard treatment of uncomplicated gallstone‐disease is by laparoscopic cholecystectomy, which can be safely and cost‐effectively performed during a short hospital stay or as day‐case. This paper aims to evaluate the referral pattern of patients with gallstones, which treatment is given and whether patients admitted as emergency could have benefited from earlier elective referral. The management of these patients is examined in the context of payment by results to determine cost and potential savings.

Design/methodology/approach

The approach takens was prospective clinical audit and patient questionnaire in a district general hospital. Cost comparisons were made using secondary care income (NHS tariff) and estimated cost of hospitalisation, investigations and treatment.

Findings

Between May and July 2007, 114 patients were admitted with symptomatic gallstones, 62 (54.4 per cent) were emergencies. Cholecystectomy was performed in all 52 elective patients and performed or planned for 59/62 (95.2 per cent) emergencies. A total 17/62 emergencies (27.4 per cent) presented with complications of gallstones. 38/62 (61.3 per cent) had similar symptoms before, with 21/38 (55.3 per cent) diagnosed in primary care or by another hospital department. 11 (52.4 per cent) of these had not been referred for a surgical opinion; taking account of age, co‐morbidity and data acquired for elective admissions, the cost of their treatment could have been reduced by at least £16,194.

Originality/value

A large proportion of patients admitted with symptomatic biliary disease could have been referred earlier and electively. Such referral practice could improve the quality of care and reduce cost for the NHS both in primary and secondary care.

Details

International Journal of Health Care Quality Assurance, vol. 23 no. 2
Type: Research Article
ISSN: 0952-6862

Keywords

1 – 10 of over 1000