SP2.7 - A Consultant General Surgeon's approach to evaluating malnutrition in emergencies: a qualitative study

Abstract

Abstract Background Patients undergoing an emergency laparotomy are often malnourished. Identifying malnourished patients is a prerequisite to offering targeted nutritional support. This study explores how consultants identify malnourished patients, why they use that approach and the barriers experienced. Methods General surgical consultants involved in emergency surgery were invited. We used purposive sampling to ensure a broad representation of consultant experience across different practice settings. Following ethical approval (UREC 050436), semi-structured interviews were conducted online, audio-visually recorded and transcribed verbatim. Interviews were coded and analysed in NVivo. A framework was developed and reviewed by an independent researcher and supervising team. Interviews continued until saturation. Results Eighteen interviews were conducted (14 male, consultant experience 6 months-23 years) across three hospital settings (4 district general, 10 teaching, 4 intestinal failure unit). Identifying malnutrition consisted of three themes: ‘surgeon’ (knowledge, experience, planning ahead); ‘patient’ (selection, composition, clinical progress, operative considerations); and ‘institution’ (collaboration, extended surgical team). Three themes also encompass the barriers experienced: ‘surgeon’ (understanding, culture, ownership, time constraints); ‘institution’ (provision, staffing, conflict, hospital setting); and ‘wider context’ (research, external factors). These influenced clinical decision making, which had two themes; ‘to join or not to join’ (risk taking, site of anastomosis) and ‘nutritional support’ (timing, delivery). Discussion This study highlights a range of barriers that consultants experience when assessing patients for malnutrition, which affects operative and clinical decision making. It provides a framework upon which issues can be addressed by surgeons and policy makers in order to improve outcomes for malnourished patients.