OUR EXPERIENCE OF EMERGENCY SURGERY ADMISSIONS: A JOURNEY IN THE RIGHT DIRECTION?
Chukwuebuka Anyaegbuna, Yasmin Grant, Frank Mayaya, Ali Zehadi, Ruwan Kasturi, Jason Saunders
Newham University Hospital, London, United Kingdom
NCEPOD guidelines mandate emergency admissions are assessed by a relevant consultant within 12 hours of the decision to admit.1 Moreover, the GMC’s Good Medical Practice highlights that documentation should be an integral part of every healthcare professional’s practice.2
Aims and Objectives:
Our aim was to conduct a closed loop audit investigating the documentation and assessment of emergency surgical admissions according to NCEPOD and GMC guidelines.
An initial audit loop was conducted with retrospective data collection using acute surgical admission proformas from 1st-31st October 2017 at a London District General Hospital.
Findings were subsequently presented at departmental meetings with recommendations to improve practice. A closed loop re-audit was conducted between 1st-31st December 2017. Statistical analysis was conducted using STATA 14.2.
In the first audit cycle, 94 patients were identified. In the second audit cycle 89 patients were identified.
In the re-audit, 100% of patients were identified correctly with all respective details filled in. This is a 2% increase from the original audit.
Forty-two per cent of the patients had a documentation of a review of systems. This represents a 5% increase in the re-audit compared to the original audit.
On average, about 82% of patients had some form of documentation for past medical/surgical/drug history. This represents a roughly 12% increase in the re-audit compared to the audit.
On average, 54% of patients had documentation for basic observations such as temperature, heart rate, respiratory rate, blood pressure and O2 saturations. This represents a 2% decrease in the re-audit compared to the audit.
Around 88% of the patients went to the ward with an initial action plan documented. This was a decrease in the re-audit compared to the original audit where 94% of the patients had a documented plan.
In the re-audit, 13% of patients went to the ward with a filled acute surgical admission proforma. This represents an increase from 4% in the original audit.
Around 92% of patients were assessed by the post-take consultant within 12 hours of being admitted. This was a 12% increase compared to the original audit.
Overall, this re-audit has managed to show a nearly 10% improvement in documentation of medical notes at the hospital compared to the original audit. Also, there was a 12% increase in number of patients were documented as assessed by the relevant consultant within 12 hours of being admitted in the second audit loop. An increase more in line with NCEPOD guidelines.1
However, certain sections of the form such as observations and initial action plan did not show improvements. This suggests that although increased education of the importance of the surgical proforma has improved our completion rate, there is still work to be done. We must continue to audit this process.