District Hospital Research Articles

ThP7.10 - Perioperative Temperature in Relation to Theatre Temperature in Orthopaedic Trauma Patients in a District Hospital in NHS

Abstract Aim To understand the relation between intraoperative hypothermia and theatre temperature in Orthopaedic trauma list. Method Prospective analysis of patients listed in the trauma list at a busy district general hospital in NHS. The data collected included duration of surgery, preoperative temperature, pre induction temperature, intra-operative, post procedure, temperature in recovery and temperature post recovery, and mean ambient theatre temperature. Statistical calculations were performed on StatsDirect3 software. Results A total of 100 patients were included in the study from 1 Aug 2023 to 30 September 2023. Intraoperative hypothermia (core body temperature <= 36) was 21%. Preoperative temperature (p=0.033) and preinduction temperature (p<0.001) was statistically significant factor in influencing the intraoperative temperature. Theatre temperature was an independent predictor of intraoperative hypothermia on regression analysis (p<0.001). Conclusions Theatre temperature of 19.5 to 20.5 °C results in a core body intraoperative temperature of 36.3 to 37.3°C. Temperatures below 19.5 results in higher incidence of hypothermia. Preinduction temperature of 36.4°C results in intraoperative temperature of 36°C and a preinduction temperature of 37.1°C leads to intraoperative temperature of 36.7°C. This indicates that preoperative warming as well as a theatre temperature of 19.5 to 20.5 °C will help in reduction of the intraoperative hypothermia.

FP8.12 - Theatre time utilisation in General Surgery at a district hospital in NHS

Abstract Aim To understand the operation theatre time utilisation in the Department of General Surgery at a busy district NHS hospital. The time spent in each step of surgery and operating list at large and understand the patterns of cancellations and its’ predictors. Method Retrospective study of all elective general surgical patients from 1 Dec 2021 to 15 May 2022. Emergency cases were excluded and statistics were performed on Statsdirect3. Results Total surgeries performed were 182 with 153 true and 41 false cancellations. Mean surgical time was 84.5 minutes (mean 73min) for all general surgical cases. Lap cholecystectomies had a mean time of 92.3mins, upper GI surgeries took 178.6mins (mean) EUA and other procedures was 30.86mins, inguinal hernia 77.2mins, umbilical hernia 68.5mins. Mean anaesthesia time was 33 mins (median 31mins). Theatre time utilised was 56.45%, anaesthesia time utilised was 15.85%, surgery time utilised was 40.60% and non-clinical time was 43.55%. Mean delay in sending for first patient was 31.58mins (median 29min). Delay in calling for first patient is statistically significant (p=0.00015) for cancellation for the last patient in the list. Mean gap in between 2 consecutive cases was 35.74mins (median 22min). Conclusion Delay in sending for the patient will lead to cancellation of the last patient on the list which is proven statistically. We utilised 82.19% of the total surgery days and cancelled 17.81% days. Non clinical time comprised of 43.55%.

SP8.2 - Single centre experience in establishing a robotic colorectal surgery programme in a UK district hospital

Abstract Aim To describe our centre’s experience in establishing a robotic programme for colorectal surgery procedures. Method Demographic, peri-operative and follow-up data from a prospectively maintained database were collected for all laparoscopic and robotic assisted colorectal procedures carried out at our centre. Results 38 colorectal resections were completed with the DaVinci Xi (Intuitive Surgical, USA) robotic platform between April-December 2023. These were compared to a laparoscopic cohort of 57 consecutive colorectal resections. 37% (n=14) of the robotic cases were proctored and all were resections for malignancy. There were 57.9% (n=22) males in the robotic cohort and 50.9% (n=28) in the laparoscopic cohort. There was no statistical difference between the demographics of the two cohorts in terms of age, body mass index and ASA grade. 21/38 (55.3%) robotic resections were left sided compared to 35/57 (61.4%) laparoscopic resections. No robotic cases were converted to open or laparoscopy, but 8.8% (n=5) of laparoscopic cases were converted to open. Laparoscopic procedures were shorter (median operative time 277 min compared to 412 min, p<0.001). A stoma was formed in 13/38 (34.2%) robotic cases and 16/57 (28.1%) laparoscopic cases. All bowel anastomoses performed in the robotic cohort were stapled with 16/32 (50.0%) being intra-corporeal. The median length of stay was 5 days for both cohorts. 5.3% (n=2/38) Vs 12.3% (n=7/57) had a significant post-operative complication (Clavien-Dindo ³3). No mortalities were recorded within 90 days of the procedures. Conclusions Other than longer operative times, robotic colorectal resections in a district hospital setting is comparable to laparoscopic resections.

ThP3.14 - Four-Year Experience of Laparoscopic Transcystic common bile duct exploration at a District Hospital

Abstract Aim This study aims to assess the outcomes of Laparoscopic Common Bile Duct Exploration (LCBDE) as a single-stage procedure for symptomatic choledocholithiasis. Methods In this retrospective analysis we included 87 patients with high suspicion of common bile duct (CBD) stones, imaging proven choledocholithiasis or failed Endoscopic Retrograde cholangiopancreatography (ERCP). These patients underwent either LCBDE or CBD exploration under fluoroscopy between 2019 and 2023. Results Among the 87 patients selected for a single stage procedure, 59 underwent Laparoscopic transcystic CBDE. Successful CBDE was achieved in 40 cases (68%), with four patients after failed ERCP. In one case on table ERCP with rendez-vous technique was used to complete CBD clearance. Two of them needed complementary post operative ERCP to remove impacted stones. Most cases with unsuccessful CBDE, 19 in total (32%), was due to difficult cannulation of a narrow cystic duct. Three were managed with on table ERCP and five had post-operative ERCP. Six patients (7%) experienced unplanned readmissions, three with retained stones post-successful stone clearance and two after clear on table cholangiogram, who were managed with ERCP. Bile leak occurred in two cases and it was self-limited within 14 days. The mean hospital length of stay (LOS) was 5,3 days with a median LOS of 4 days. Conclusion Transcystic LCBDE, when surgical expertise and experience are available, is an effective and safe procedure for treating choledocholithiasis, providing comprehensive CBD clearance while avoiding the risks associated with ERCP.

SP9.2 - Changes in frailty and discharge destination post emergency laparotomy

Abstract Aims Frailty affects morbidity and mortality post emergency laparotomy (EmLap). Studies have shown that some frail patients do not return to baseline post EmLap. We aim to explore the change in frailty status at 90-day post EmLap and the association between pre-EmLap frailty and changes in home environment on discharge. Methods EmLap patients age ≥65years from a district hospital were recruited from May 2022 to April 2023. Discharge data were collected prospectively, and frailty was assessed using Rockwood Clinical Frailty Scale at pre-EmLap and day-90 post-EmLap with score >4 as frail. EmLap patients with no complete 90-day follow-up were excluded. P-value of <0.05 was considered significant. Results 63 EmLap patients were included, 57.1% were female and median age was 75years. 17.5% were frail pre-EmLap and on day-90 post-EmLap, 33.3% were found frail (15.9% developed frailty). Pre-EmLap, all patients came from home with 13.6% had package of care service (POC) already in place. On discharge post-EmLap, 27% had change of home environment; 1 to care home, 1 still an inpatient at 90-day post EmLap, 2 had new POC and 13 had increased POC. Of this cohort, 52.9% were frail pre-EmLap. There was a significant association between pre-EmLap frailty and change in home circumstances on discharge (p<0.00001). Conclusion About 16% developed frailty post-EmLap with almost a third had a change in home environment on discharge. Frailty should be assessed in all EmLap patients to improve shared decision making and development of post-EmLap discharge strategies.

WP4.16 - Gallstone ileus as an infrequent cause of bowel obstruction- a review of small cohort

Abstract Introduction It is uncommon cause of small bowel obstruction, presents 1 – 5% of adult population. It is a rare complication of chronic cholecystitis which lead to cholecysto-enteric fistula and impaction of gall stone in GI tract leading to mechanical bowel obstruction. Our aim is to report the natural history and management of this condition in District Hospital. Method Retrospective 10 years of data was collected with CT findings of intestinal obstruction with gall stone ileus. It included 10 patients over 10 years whose medical records were evaluated retrospectively. Results Majority of patients were female (90%, n:9) with mean age of 81.6 years (range 61-96) although 90% of population were above 70 years. Presenting complaints were mostly pain and vomiting. Onset of symptoms between 2- 7 days. The site of obstruction was mostly ileum (n=9) with exception of one case in sigmoid proximal to stricture and size of stone was ranging ffrom2.5 to 4 cm, moreover most of the patients had previous history of gall stone (n=7) with one post cholecystectomy status. During routine investigations 50 % of patients had deranged LFT &AKI and 50-60% had raised inflammatory markers (WBC,CRP).Intervention as Enterolithotomy was the preferred approach (n=8,2 lap ,7 open) and non operative management was performed in two cases.The mean post op length of stay were 10 days in open and 5 days in Lap respectively. Conclusions Elderly female patients are more prone to have gallstone ileus particularly with a past medical history of gall stone and the preferred management option is Enterolithotomy which could be open or laparoscopic depending on expertise of the Surgeon.

EP625 - Perioperative complications in general surgical patients at a district hospital in NHS

Abstract Aims To try and use the Clavien-Dindo system of grading of surgical complications to General Surgical patients at NMGH. To understand the predictors of grades of surgical complications. Propose the use of the CD system in regular mortality and morbidity meetings. Methods Retrospective cohort study. Total patients studied were 104. List of all elective and emergency general surgical patients at NMGH from 1st Feb to 2nd March 2023 collected from HIVE. Data collected included MRN, age, sex, BMI, ASA category, surgical time, blood loss, type of surgery, complication and CD grade. CD grade was calculated from the patient notes. Statistical analysis was performed on StatsDirect3 from MFT. Results 26.9 % (n = 28) of the patients developed CD grades complications overall. Mild complications (grade 1 and 2) were 18.2 %. Serious complications (grade 3 and 4) were 7.7 %. CD 5 was 0.96 %. 51 % of emergency cases develop complications (Mild 29%, serious 20%, death 2 %). 11 % of elective cases develop mild complications and no serious complications. Age and ASA grade have no statistically significant relationship in the present study. Higher BMI is associated with lower grades of complications in this study. Conclusion Female patients in an emergency setting with a blood loss of greater than 100 ml and a surgical time of 150 minutes or greater developing grade 2 complications. Emergency cases carry 4.6 times more complication rates than elective cases. Blood loss of 50 ml or greater would give rise to CD 1 or greater. Surgical time of lesser than 125 minutes gives CD 1. Surgical time 125 to 200 minutes gives CD 2.

SP8.4 - Retrospective comparison of core surgical trainee procedural experience gained in Scottish rural, general and tertiary hospitals

Abstract Introduction and Aims Core surgical trainees are placed across all hospital types in Scotland, including rural, general and tertiary hospitals. The extent and nature of the procedural experience gained in these different settings has not been previously compared in the Scottish context. Two recent studies concluded that trainees in rural hospitals have access to high case numbers across several surgical specialties. (1,2) The aim of this study is to compare the procedural experiences obtained by core surgical trainees in Scotland, across 3 different settings: in rural, district and tertiary hospitals. Methods Core surgical trainees who undertook training in Scotland between August 2012 to 2022 were identified through digital records (eLogbook data). Operative experiences in 6-month core surgical placements were compared between Rural General (R1), District General (A2, A3) and university/tertiary including children (A1, A4) Hospitals. Results After data cleaning, 241 trainees’ data were available for analysis. The mean number of procedures completed by trainees in a standard 6-month placement was 112 in R1 hospitals, 169 and 94 in A2 and A3 hospitals respectively and 140 and 116 in A1 and A4 hospitals respectively. There was no statistically significant difference between hospital settings (p = 0.072). Conclusion Core surgical trainees have equivalent access to surgical caseloads across all hospital settings in Scotland.

WP2.11 - Improving prescription of discharge medications for day case surgery patients using electronic patient records system (EPIC); a closed loop audit

Abstract Aim It is important to provide patients who have undergone day surgery with appropriate analgesia, antiemetics, and laxatives. Failure to do this can result in a poor patient experience, patient requests for advice, readmission and morbidity. This study audited our adherence to the GIRFT guidelines for day case discharge prescribing. Methods Data was collected retrospectively on the discharge medications for all patients undergoing elective, day case laparoscopic cholecystectomy and inguinal hernia repair at two district general hospitals in our trust over a five-week period. A pre-populated discharge medication order set was then created on the Trust's electronic health records system (EPIC) to improve adherence to the GIRFT guidelines. Discharge medications were observed over a subsequent four-week period. Results Prior to our intervention, adherence to GIRFT guidelines was poor with 25% of patients only received the correct discharge medications. Following introduction of the pre-populated order set, 83% of patients received the correct discharge medications. Conclusions This audit demonstrates that utilizing electronic systems effectively can improve efficiency, ensure patient safety and enhance patient care.

Latent Profile Analysis of Pressure Injury Knowledge Levels Among Nursing Staff in Tertiary General Hospitals.

Aims/Background The prevalence of pressure injuries (PIs) is a widely used clinical indicator of patient safety and quality of care. Nurses' understanding of pressure injury (PI) can significantly impact the treatment outcomes for patients. This study, based on latent profile analysis (LPA), reveals the characteristics associated with PI knowledge levels among clinical nurses in district and county tertiary medical institutions. We aim to help nursing managers formulate training plans accurately so that clinical nurses can provide high-level skin care services for patients. Method In June 2023, 1482 nurse staff from 4 tertiary general hospitals at the district and county level in Chengdu were chosen as research subjects using the convenience sampling method. Responses to the general information questionnaire, the Chinese Version of Pressure Ulcer Knowledge Assessment Tool (C-PUKAT), and the Chinese Version of Attitude towards Pressure ulcer Prevention (C-APuP) were used to compare the population's characteristics based on LPA. Results Three latent profiles of nurses' PI knowledge were identified: weak foundation type (46.3%), strengthening foundation type (42.7%), and special improvement type (11.0%). Subjects' departments, administrative positions, highest degrees and PI prevention attitude scores, as well as whether they have participated in the training, all differed significantly between latent profile groups (p < 0.05). Conclusion The PI knowledge level of nursing staff at the district and county tertiary general hospitals requires urgent improvement. Nursing managers should prioritize the management level and quality of PI training among clinical nursing staff. Precise training programs can be developed based on different categories of nursing staff to enhance their PI knowledge, thereby effectively improving the quality of healthcare for inpatients.

Burnout experience among healthcare workers post third COVID-19 wave in India; findings of a cross-sectional study

Background The pandemic exacerbated burnout experienced by healthcare personnel, whose mental health had long been a public health concern before COVID-19. This study used the Copenhagen burnout inventory (CBI) tool to assess burnout and identify predictors among Indian healthcare workers managing COVID-19. Methods A cross-sectional study was conducted from June to December 2022, after the third pandemic wave. A web-based, fillable Google form was used to recruit COVID-19 management professionals from multiple Jaipur district hospitals. Healthcare professionals provided socio-demographic, work-related, and CBI scores. Multiple linear regression was used to control for model covariant independent variables. Results We evaluated the responses of a total of 578 participants with a mean age of 36.59 ± 9.1 years. Based on the CBI cut-off score of 50, 68.1% reported burnout. A total of 67.5%, 56.4%, and 48.6% of healthcare workers reported work-related, personal, and patient-related burnout, respectively. High burnout scores were significantly associated with the nursing profession (β = 7.89, 95% CI; 3.66, 12.11, p &lt; 0.0001). The p-value indicates the probability of observing the data if the null hypothesis is true, and the confidence interval shows the range within which we can be 95% confident that the true effect lies. An independent relationship exists between male gender and higher personal-related burnout scores (β = 4.45, 95% CI 1.9–6.9). Conclusion This study identified key indicators that need further emphasis and the need for organizational and individual-level burnout monitoring in healthcare delivery sectors. Health workers continue to experience burnout due to a combination of personal, professional, and patient-related factors. This underscores the need for targeted organizational and individual interventions. The findings also suggest that the CBI tool could identify healthcare worker burnout risk groups.

EP621 - Surgical waiting times at a busy general surgical unit at a district hospital oin NHS

Abstract Aims To understand the general surgical waiting times at NMGH. To estimate the degree of mismatch among the original booking consultant and performing surgeon. To accurately assess the median waiting times for each type of surgery. Methods Retrospective observational study. Data collected include date of surgery, date of listing for surgery, consultant listing for surgery and name of surgeon performing procedure, MRN, age, sex and type of surgery. Times calculated from the original listing for surgery in the clinic or during inpatient and actual date of surgery. Results Total patients included in the study were 330. Overall median delay for all the surgical cases was 345.5 days (49.35 weeks). 173 female patients and 157 male patients were included. Patients’ records were checked for any cancellations or refusal for surgery, but most did not present any reason for delay and hence the date of booking and surgery done were recorded. Conclusion Overall colorectal waiting time at NMGH is median 393.5 days (56.2 weeks), mean time of 298.6 days (42.6 weeks) which is higher than MFT mean time of 26 weeks. Overall, for colorectal cases, about 62 % of times, the booking Consultant is the operating surgeon. Overall General Surgery waiting time at NMGH is median 356.6 days (50.9 weeks), mean 318 days (45.4 weeks) which is higher than MFT mean waiting time of 33 weeks. Median waiting time for lap chole is 369.5 days (52.7 weeks), mean 317.6 days (45.3 weeks) which is within the NHS standards of 18 to 52 weeks (1). West Suffolk NHS foundation Trust has published the mean waiting time of 53 weeks.

FP5.13 - Implementing a Lumbar Puncture Teaching Course at a General District Hospital

Abstract Aim Prior to our course, there had been no formal lumbar puncture (LP) teaching at the hospital. Furthermore, a pre-course questionnaire had determined 50% of respondents (9/18) were “not so familiar” OR “not at all familiar” in describing the steps involved in performing an LP. 72% (13/18) were “not at all” confident in conducting the procedure. As the need for practical LP teaching was noted, a course was devised to familiarise trainees with LPs and improve confidence. Method The course was implemented with supervision from the anaesthetics department at the hospital. This included an E-module, face to face simulation of consenting and practicing LPs on a back model. The course was offered to foundation trainees and medical students from several universities in the region. Results From the post-course questionnaire the following results had been gathered 1) 7 out of 9 participants reported that they were “very familiar” in performing the steps of an LP (78%) 2) 5/9 were now “moderately” confident in performing an LP 3) 78% were “very familiar” with the indications and contraindications of LPs. Conclusion The course had led to a significant improvement in the understanding and confidence in performing LPs among the participants. Simulated learning is an effective method of teaching complex practical skills to junior trainees. Further work includes inviting trainees from within the region and implementing an online demonstration as part of the E-module.

WP4.2 - Covid positivity: the pandemic surgical referral telephone triage legacy lives on

Abstract Introduction Covid restrictions provided opportunities for novel approaches to patient assessment. Innovative telephone triage of surgical referrals at Great Western Hospital, a UK District General Hospital, resulted in reduction in those patients reviewed and discharged the same day from 56% to 23.6%. Furthermore, 28.4% of admissions were avoided by triage. This novel work was adapted for the Ambulatory Emergency Care (AEC) department of Yeovil District Hospital, in response to exponential increases in Primary Care and Emergency Department referrals. Aims To develop a telephone triage system to get the right patient to the right place at the right time, reviewed by the right team. Methods Over the two-week study period (18/9–29/9/2023) a dedicated triage telephone line enabled a discussion between referring clinician and an experienced surgeon. Four outcomes were offered:AdviceOutpatient review within 1 weekHot clinic review within 24-48 hoursSame-day review by the on-call team Prospective referral data (18/9–29/9/2023) and retrospective non-triage data (1/9–14/9/2023) were gathered. Triage effects were measured by outcome comparison with non-triage data. Results A total of 193 patients were discussed. 48% were Emergency Department referrals, 25% from General Practitioners. Same-day reviews reduced by 35%. Overall, the on-call workload decreased by 68%. Return to AEC for review reduced by 99%. Reduction in average time spent by patients in AEC from 6.9 to 1.29 hours, saved up to 6 bed-days per day and facilitated significant cost savings. Conclusions Novel approaches can be cost effective and positively impact patient care.

Teamwork Training: Practicing Skills of Primary Resuscitation and Stabilization of a Newborn in the Delivery Room

The quality and safety of medical care in modern medicine are determined by the level of formation of team competence of clinical specialists. The article describes 8 years of experience in the formation of good practice and interaction of an educational institution for advanced training of medical workers with city medical institutions of the obstetric profile and obstetric departments that are part of the FAP and the Central District Hospital of the Omsk Region using the example of simulation trainings of team interaction in primary resuscitation of a newborn in the delivery room.

The Role of Middle Management in Building Sustainability Competitive Advantage Through Organization Capability in District Hospitals Banyuwangi: Cross Level Analysis Approach

In the competitive healthcare industry, organizations, including hospitals, strive for sustainable advantages. Key to this is organizational capability, managing resources, processes, and innovation toward strategic goals. This study analyzes how middle management involvement affects these capabilities. Conducted in Banyuwangi's hospitals, it employed a descriptive cross-sectional method, using literature, observation, and questionnaires. Data analysis via SEM PLS showed middle management involvement and autonomy positively influence organizational capabilities. Competency intensity mediates this relationship. Organizational capabilities also positively impact sustainable competitive advantage. Inertial organizations mediate capabilities towards this advantage. These findings highlight the critical role of middle management in enhancing organizational capabilities for sustainable competitiveness in the healthcare sector.

Etiology and antimicrobial susceptibility patterns of bacteria causing pneumonia among adult patients with signs and symptoms of lower respiratory tract infections during the COVID-19 pandemic in Mwanza, Tanzania: a cross-sectional study

BackgroundBacterial pneumonia is among the leading causes of morbidity and mortality worldwide. The extensive misuse and overuse of antibiotics observed during the Corona Virus Disease 2019 (COVID-19) pandemic may have changed the patterns of pathogens causing bacterial pneumonia and their antibiotic susceptibility profiles. This study was designed to establish the prevalence of culture-confirmed bacterial pneumonia and describe their antimicrobial susceptibility profile in adult patients who presented with signs and symptoms of lower respiratory tract infections (LRTIs) during the COVID-19 pandemic.MethodologyThis hospital-based cross-sectional study was conducted from July 2021 to July 2022 at a zonal referral hospital and two district hospitals in Mwanza, Tanzania. Demographic and clinical data were collected using a standardized questionnaire. Sputum samples were processed by conventional culture followed by the identification of isolates and antibiotic susceptibility testing. Descriptive data analysis was performed using STATA version 15.0.ResultsA total of 286 patients with a median age of 40 (IQR 29–60) years were enrolled in the study. More than half of the patients enrolled were females (52.4%, n = 150). The overall prevalence of bacterial pneumonia was 34.3% (n = 98). The majority of the bacterial pathogens isolated were Gram-negative bacteria (GNB) (61.2%, 60/98), with a predominance of Klebsiella spp., 38.8% (38/98), followed by Streptococcus pyogenes (21.4%, 21/98). Multi drug resistant (MDR) bacteria were detected in 72/98 (73.5%) of the isolates. The proportions of GNB-resistant strains were 60.0% (36/60) for ciprofloxacin, 60% (36/60) for amoxicillin, 60% (36/60) for amoxicillin, 68.3% (41/60) for trimethoprim-sulfamethoxazole and 58.3% (35/60) for ceftriaxone.ConclusionOne-third of the patients with signs and symptoms of LRTIs had laboratory-confirmed bacterial pneumonia with a predominance of Gram negative MDR bacteria. This calls for continuous antimicrobial resistance (AMR) surveillance and antimicrobial stewardship programs in the study setting and other settings in developing countries as important strategies for tackling AMR.

ANALYSIS OF SERVICE QUALITY ON PATIENT SATISFACTION IN INPATIENT INSTALLATIONS OF REGIONAL HOSPITAL 2024

Good service is not only measured by luxurious facilities, complete technology and physical appearance, employee attitudes and behavior must also show high professionalism and commitment. Quality of health services refers to the level of perfection of health services that makes every patient feel satisfied. This study aims to determine factors related to service quality and patient satisfaction at the Inpatient Installation of Ogan Ilir District Hospital in 2024. Quantitative research design with a cross-sectional approach. The population in this study was 854 inpatients at the Ogan Ilir District Hospital. The sample in the research consisted of 90 respondents. The sampling technique uses purposive sampling, using the Slovin formula. This research was carried out on March 13 - April 17 2024. Data was collected using a questionnaire. Bivariate data analysis using the chi-square test and multivariate using logistic regression. The research results show that there is a relationship between responsiveness (p value 0.005) and tangibles (p value 0.001). There is no relationship between reliability (p value 0.86), assurance (p value 0.76) and empathy (p value 0.96). The most dominant factor in patient satisfaction in the Inpatient Installation of Ogan Ilir District Hospital in 2024 is tangibles (p value 0.00), (OR 0.183). The conclusion is that there is a relationship between responsiveness and tangible. Suggestions from the research results can provide input about the quality of service on patient satisfaction in the Inpatient Installation of the Ogan Ilir Regency Regional Hospital in 2024 and contribute to improving health services

Prevalence Of Congenital Abnormalities On Routine Antenatal Ultrasonography During Second And Third Trimester Of Pregnancy: A Study In A District Hospital Of North East India

Background Prevalence of congenital anomalies varies greatly from country to country. It is reported about 2.5% in India. In India, congenital anomalies are responsible for 15% of perinatal mortality and for 10% to 15% of neonatal deaths. The main aim of the study is to evaluate the prevalence of the congenital anomalies and malformation patterns in our hospital population. Material &amp; Method This is a cross-sectional study carried out in the ‘Radiology unit’ of ‘District Hospital, Gomati’, Tripura. The study population includes about 910 antenatal mothers in the second and third trimester, who were referred to ‘Radiology unit’ from the outpatient and inpatient departments of ‘Obstetrics and Gynaecology’ of the same hospital between September 2017 to February 2018 were included in the study. Data of Antenatal ultrasounds was statistically analyzed on structured data collection form to determine the prevalence of congenital anomaly in 2nd &amp; 3rd trimester. Results: Total 910 numbers of 2nd and 3rd trimester prenatal ultrasonography (USG) were done. Out of these 18 numbers of congenital anomalies were detected. The antenatal prevalence of congenital anomalies was 1.97%. The mean maternal age and mean gestational age at diagnosis was 22.9 years and 27.7 weeks respectively. Genitourinary system defect was the commonest (27.77%), of which maximum number had pyelactasis i.e. 3 (16.66%) cases. Conclusion: Ultrasonography is a cost-effective, non-invasive and sensitive tool in detecting the congenital anomalies antenatally in the hands of an experienced radiologist. Besides the first-trimester USG, the second trimester scan is mandatory in detecting anomaly in the growing foetus, as the majority of congenital anomalies are detected between 20 and 22 weeks of pregnancy

Audit of the Acute Management of Renal Colic in District Hospitals Within a National Health Service Trust.

Renal colic is a prevalent acute urological emergency caused by urinary stones and commonly manifests as severe loin pain. This audit assesses the management of acute renal colic at a National Health Service (NHS) Trust in the West Midlands, England, comparing practices against theNational Institute for Clinical Excellence (NICE) and the British Association of Urological Surgeons (BAUS) guidelines. This retrospective audit reviewed 417 patients with suspected renal colic over a month. Data collected included patients' demographics, time to complete CT scan, laboratory investigations requested and management modalities. Patients assessed were either admitted through the Emergency Department, Surgical Assessment Unit, or previously admitted for other conditions on the wards. The audit benchmarked against NICE and BAUS guidelines, focusing on diagnostic timeliness and management, including essential blood investigations. Data analysis performed using SPSS (IBM Corp., Armonk, NY, USA) included descriptive statistics and Chi-square tests, with significance set at p < 0.05. A total of 417 patients met the inclusion criteria. The average age of patients was 47.4 years with slightly higher male population (51.1%). The diagnostic rate for renal or ureteric stones using computed tomography of the kidneys, ureters, and bladder (CT-KUB) was 41.2%. The positive detection rate was significantly higher in males (54%) compared to females (27.5%) while females have more alternate diagnosis than males (13.7% vs 6.1%). The average completion time of CT-KUB was nine hours with 7.7% of patients having their CT-KUB beyond the 24-hour benchmark. Most patients (48%) were managed conservatively with analgesia, 32% received tamsulosin as medical expulsive therapy and others had interventions like ureteric stent insertion (9.3%), nephrostomy (6.4%) or primary ureteroscopy (4.1%). The audit of renal colic management at our centre revealed a 41.2% diagnostic rate for renal or ureteric stones via CT-KUB, with a significantly higher rate in males than females. Diagnostic delays were minimal, with only 7.7% of scans exceeding 24 hours. Conservative management was common, however non-steroidal anti-inflammatory drugs (NSAIDs) were underutilized despite guideline recommendations. There was a notable gender disparity in diagnostic and alternate findings rates. The results showed the need for adherence to pain management protocols and highlight the effectiveness of existing renal colic protocol, while also pointing to potential areas for improvement in treatment uniformity and guideline adherence.