Eastbourne District General Hospital Research Articles

Opioid stewardship amongst patients undergoing major robotic surgery at Eastbourne District General Hospital: an audit and quality improvement project

Opioid stewardship amongst patients undergoing major robotic surgery at Eastbourne District General Hospital: an audit and quality improvement project

P056 Patient Satisfaction Survey of a Newly Set-Up Fast Track Giant Cell Arteritis Service in a District General Hospital

Abstract Background/Aims Giant Cell Arteritis (GCA) is a multisystem, large and medium artery vasculitis, which results in significant comorbidity, even mortality. Prompt diagnosis is a pivotal first step in its effective management. To that effect, we set up a fast track service in Eastbourne District General Hospital (EDGH) for a one-stop-shop assessment of GCA referrals with Ultrasound Doppler. Fifteen months from service commencement, we embarked on assessing patient satisfaction of our service users. This exercise could provide vital insight into the effectiveness of our new service, and thus drive improvement. Furthermore, it is well established that patient satisfaction is associated with improved outcomes in patient care, be it due to improved compliance, engagement with the service, or overall better understanding of the underlying condition. Aims 1. To assess overall level of patient satisfaction of our new fast track GCA service against a number of internally set criteria; 2. To improve the effectiveness of the service based on feedback from the actual service users; 3. To improve the level of satisfaction of patients coming through the GCA service. Methods We set up a dedicated GCA clinic aiming to see patients within five days of referral. In order to assess overall patient satisfaction of the service, we formulated a questionnaire-based survey that was posted to 99 service users. We assessed five areas overall: appointment allocation process; staff attitude; information supplied; advice line effectiveness; overall satisfaction. Data were collected and analysed on Microsoft Excell. No patient identifiable details were collected. Results Out of the 99 feedback forms that were sent out, 51 were returned completed within the survey period. The appointment allocation process was assessed as “excellent” by 95% of responders, and “satisfactory” by 5%. Staff received 98% “excellent” rating. Information provided to the patient was assessed as 91% “excellent”, 8% “satisfactory”, and 1% “poor”. Response to advice line inquiries received 54% “excellent”, 18% “satisfactory”, and 2% “poor” rating (26% of responders answered “non-applicable”). Finally, overall satisfaction was rated at 93%, with, crucially, no service user providing a “poor” rating. Conclusion We conducted a patient survey to assess overall satisfaction of our new fast track GCA pathway, ultimately aiming at improving our service. The overwhelming majority of the feedback was positive, but we focused and acted on suggestions. Following the survey, we have a) designed a GCA “passport” with useful information for newly diagnosed patients; b) revisited the advice line with a modified information leaflet for this service; c) endeavoured to optimise the referrals process via education sessions on GCA for Hospital and Primary Care clinicians. Following a period of intervention, we will be reassessing patient satisfaction, aiming to continue improving our service. Disclosure A. Hall: None. P. Kamperidis: None. H. Perera: None. S. Panthakalam: None.

E043 Fast track giant cell arteritis service in a district general hospital using ultrasound doppler imaging

Abstract Background/Aims Giant cell arteritis (GCA) is the commonest large and medium artery vasculitis, a multisystem condition that results in significant comorbidity and mortality. Corticosteroids are pivotal in remission induction and maintenance therapy, but complications can arise either due to delayed treatment, or unnecessary treatment of GCA mimics. This renders quick diagnosis of GCA vital. Temporal artery biopsy (TAB) has traditionally been the golden standard diagnostic modality, but it requires a surgical setting, resulting in delays. Temporal artery ultrasound doppler scanning (TA UDS), however, has now been incorporated by both BSR and EULAR in their recommendations, offering a diagnostic tool with high specificity and sensitivity. Aims 1. To set up a fast track GCA diagnostic service in an one-stop-shop outpatient clinical setting with inhouse ultrasound; 2. To limit dependence of GCA diagnosis on TAB Methods We set up a dedicated GCA clinic at Eastbourne District General Hospital aiming to see patients within five days of referral. In the clinic, patients were categorised to low, moderate or high GCA risk via a pre-test probability score, and had TA UDS by an expert rheumatologist. We collected data on number of UDS performed, scan outcomes, and TAB requests over a 17-month period. Results Total number of referrals with suspected GCA was 147, mainly via general practice and ophthalmology, with 117 already having been started on corticosteroids by the referrer. Overall, 93% of patients were seen within five days of initial referral, with 32% within 72 hours of steroid commencement. We scanned 138 patients (94%) and diagnosed GCA in 41 (30%) of them. Of the nine we did not scan, six had very low probability score and were given alternative diagnoses; two were out of the window for diagnostics and GCA was diagnosed clinically; and one could not be scanned due to technical reasons, so a TAB was requested. Crucially, this was the only TAB requested during this period. Conclusion Our fast track service has facilitated prompt review of GCA referrals with the use of ultrasound, limiting the need for a TAB. The pathway enables both prompt commencement of appropriate steroid-weaning regimens in confirmed GCA, but also facilitates timely discontinuation of corticosteroids in patients with excluded GCA, thus minimising future complications either way. Typically, it takes more than three weeks to arrange a TAB. Moreover, ultrasound use avoids an invasive procedure with potential for surgical complications. From a healthcare system point of view, there are certain cost-saving implications in using ultrasound for GCA diagnosis. These can range from reduced demand for outpatient clinics, theatre slots and theatre staff, to minimisation of any future complications be it post-op, disease- or steroid- related. Finally, a service user survey, aiming to improve our pathway, documented improved patient satisfaction. Disclosure P. Kamperidis: None. A. Hall: None. H. Perera: None. S. Panthakalam: None.

A 365-day overview of accident and Emergency Department referrals to the Oral and Maxillofacial Department at the Eastbourne District General Hospital, UK: were they appropriate?

article: A 365-day overview of accident and Emergency Department referrals to the Oral and Maxillofacial Department at the Eastbourne District General Hospital, UK: were they appropriate? - European Journal of Oral and Maxillofacial Surgery 2022 April;6(1):6-10 - Minerva Medica - Journals

909 ENT Telephone Clinic During COVID-19 Pandemic

Abstract Introduction In response to the COVID-19 pandemic, ENT services in NHS hospitals have fundamentally changed the way they function. Focus is narrowed on emergency care and cancer care, with cancellation of most elective procedures. In response to this, 2 week wait (2ww) ENT telephone clinics were set up. This project reviewed the effectiveness of ENT telephone clinic appointments in managing 2ww referrals and to determine whether the introduction of 2ww telephone clinics improves patient waiting times and appropriates of referrals. Method Retrospective review of ENT telephone clinic 2ww referral outcomes at Eastbourne District General Hospital and the effectiveness of managing these patients. Results A total of 58 ENT Telephone Clinic 2ww referrals from the GP were reviewed. After a telephone consultation 63% of patients were referred to 2ww imaging, from which 70% were discharged following imaging. 83% of patient offered face to face appointment following imaging, required further investigation or treatment, again reducing delay in diagnosis. Conclusions Telephone clinic is an effective way of managing 2ww referral patients. In the ongoing pandemic, telephone clinics will be used to manage cancer pathways. This study shows that a large number of patients are discharged after imaging following a telephone clinic. Further study is required to determine whether low scoring patients on symptom-based risk calculators for cancer referrals could be directly referred to imaging to avoid delay in diagnosis, reduce anxiety as well as allow appropriate resource allocation.

A Retrospective Observational Study: Is Absolute Lymphocyte Count a Prognostic Marker in COVID-19?

AimOur study aimed to find a correlation between low absolute lymphocyte count and COVID-19-related mortality.MethodsThis study followed a retrospective observational cohort design to analyze the data of patients who presented with symptoms and signs of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), at the Conquest Hospital and Eastbourne District General Hospital in East Sussex, United Kingdom, between February 10, 2020 and May 1, 2020, retrospectively. Survival and mortality for the first 30 days and comorbidities were analyzed for all patients who were tested for COVID-19 irrespective of swab results and had blood lymphocyte levels taken at the time of their visit to the ED and their data were analyzed for statistical significance.ResultsA total of 1226 patients had SARS-CoV-2 RNA identification swabs taken between February 10, 2020 and May 1, 2020. A cohort of 742 patients of these patients tested for COVID-19 also had blood lymphocyte levels measured.Overall, the lymphocyte count did not differ significantly between patients suspected to have COVID-19 infection with either positive or negative COVID-19 swab results.The lymphocyte count, however, was significantly lower in those who died from COVID-19 (p < 0.001) but when comorbidities were analyzed, we found an association between an increased number of comorbidities and a significantly decreased lymphocyte count.ConclusionOnce adjusted for comorbidities, the lymphocyte count had no association with COVID-19 infection and mortality.

The long-term effect of thermal-guided second-generation cryoablation in paroxysmal and persistent atrial fibrillation

BackgroundSecond-generation cryoballoon ablation is safe and effective in patients with paroxysmal (PAF) and persistent atrial fibrillation (AF). ObjectiveThis study aimed to assess the long-term clinical outcomes and freedom from AF in patients undergoing thermal-guided cryoablation without the use of an electrical mapping catheter. MethodsAll patients who had undergone thermal-guided second-generation cryoablation without electrical mapping between January 2015 and April 2018 at Eastbourne District General Hospital were retrospectively analysed. Success was defined as freedom from atrial arrhythmia lasting >30 s during the follow up period. ResultsThe study included 234 patients with a mean age of 65.3 ± 10.6 years. There were 134 (57.0%) and 100 (42.7%) patients who had PAF and persistent AF respectively.Arrhythmia recurrence occurred in 38 of 134 (28.4%) PAF and 42 of 100 (42.0%) persistent AF patients after mean follow up of 40 ± 9.2 months. The patients with PAF had a significantly greater freedom from arrhythmia than patients with persistent AF (p = .040). The mean procedure time was 55.5 ± 12.2 min and the mean fluoroscopy time was 10.9 ± 4.8 min 73.5% of patients were discharged on the same day. ConclusionThermal-guided cryoablation is feasible, safe and results in freedom from arrhythmia in the majority of paroxysmal and persistent AF patients in the long term. Randomised controlled trials are required to confirm the findings of this study.

Conjunctival oncocytic adenocarcinoma of lacrimal gland origin

AbstractPurposeTo present a rare case of a conjunctival tumour, in a patient who presented to the Ophthalmology department at Eastbourne District General Hospital with ocular surface symptoms.MethodsReview of patient case notes and electronic patient record.ResultsAn 83‐year old man presented with a 6‐month history of dry, gritty sensation in the right eye with a recent reduction in vision. He had a history of previously treated squamous cell carcinoma of the scalp. Examination revealed a large lesion extending from the conjunctival surface onto the temporal aspect of the cornea. The visual acuity was 6/12 with pinhole and there was no affect on ocular motility. Systemic evaluation did not suggest any features of metastatic disease and an MRI scan was unremarkable. The patient underwent an incisional biopsy of the lesion and histopathology showed a moderately differentiated adenocarcinoma with oncocytic features. Immunohistochemistry was positive for CK5/6, CK7, EMA and p63. He underwent successful excision of the lesion with adjuvant chemotherapy.ConclusionOncocytic adenocarcinoma (OCA) is a rare epithelial tumour that usually arises from the ductal cell lining of apocrine glandular structures. The oncocytes have a distinctive large size with granular acidophilic cytoplasm secondary to the presence of extensive mitochondria with fragmented cristae. The tumour is more commonly associated with the kidneys, thyroid and salivary glands. Cases within the eye although rare are associated with caruncle, lacrimal sac, accessory lacrimal glands of the conjunctiva and in the lacrimal gland. Cytokeratin (CK) are intermediate filaments found in the cytoskeleton of epithelial tissue and are used in the differential diagnosis of neoplasms as their expression varies with cell origin. CK5/6 found to be expressed in our patient is a marker of stratified squamous epithelium. The patient was also negative for CK 20 expression which would be seen in simple epithelium.

Home Orthostatic Training in Elderly Patients with Vasovagal Syncope - A Prospective Randomised Controlled Trial.

Aim: The aim of this study was to assess the effect of home orthostatic training (HOT) on autonomic reflexes in elderly patients with vasovagal syncope (VVS). Methods: Design and Setting: A single-blind randomised control trial was conducted at Eastbourne District General Hospital, East Sussex NHS Trust. Patients: Individuals with recurrent syncope underwent tilt-table testing between August 2007 and October 2009.Those with at least two syncopal episodes and tilt-test proven VVS were recruited. Participants were divided into those aged >65 years (O65) and those aged <65 years (U65). Interventions: Patients in the O65 group were randomised 1:1 to receive active HOT (O65+) or sham HOT (O65-). The U65 group received active HOT. Participants performed HOT/sham HOT and recorded their training and symptoms. Patients had a repeat tilt test at 3 months. Outcome Measures: Time to syncope at repeat tilt-table testing, low-frequency heart rate variability (LF-HRV), high-frequency heart rate variability (HF-HRV), mean upslope baroreflex sensitivity (BRS) and mean downslope BRS were assessed. Results: A total of 106 patients with recurrent syncope underwent tilt-table testing. Of these, 45 consecutive patients (30 in the O65 group and 15 in the U65 group) were recruited. Two, one and three patients withdrew or were lost-to-follow-up in the O65+, O65-, and U65 groups, respectively. Symptomatic benefit occurred in four (31 %) of the O65+, four (29 %) of the O65-, and six (50 %) of the U65. None of the autonomic measures changed significantly in any group. No difference was seen with HF-HRV, LF-HRV mean upslope BRS and mean downslope BRS. Fifty per-cent of the O65+ group stopped training because of back pain. Time constraint (25 %) was the most common reason for cessation in the U65 group. Conclusions: Despite good tilt training compliance, no improvement in autonomic measures in any group was shown. The most common reason for cessation of training was back pain in the elderly groups. This study does not support the use of HOT in elderly patients.

Remote monitoring of cardiovascular disease: great promise, but do not forget the patient!

After more than 20 years, the conflict of interest (COI) movement has failed to substantiate its central claim that interactions between physicians, researchers and the medical products industry cause physicians to make clinical decisions that are adverse to the best interests of their patients. The COI movement's instigators have produced no solid evidence of harm commensurate with their extravagant allegations. At the same time, they have diverted resources away from more worthwhile pursuits, such as basic and applied medical research, clinical care and medical education towards onerous compliance exercises and obtrusive laws. Perhaps worst of all, they have made it respectable to ignore the epistemological foundations of medical science, diverting attention away from the scientific merit of the information presented and focusing it instead on the identity and motives of those who present the information.

Does a patient satisfaction questionnaire improve quality of care received in local continence clinics? An audit of patient satisfaction in a district general hospital

Does a patient satisfaction questionnaire improve quality of care received in local continence clinics? An audit of patient satisfaction in a district general hospital

065 Atrial fibrillation ablation in a district general hospital: 3 years experience

IntroductionThe practice of atrial fibrillation (AF) ablation is increasing exponentially. At present, these procedures are performed in a small number of surgical tertiary centres. In order to meet the growing...

The use of pre-operative computed tomography in the assessment of the acute abdomen

While there are a lot of data on the accuracy of computed tomography (CT) in diagnosing specific causes of an acute abdomen, there is very little information on the accuracy of CT in the acute general surgical admissions workload. We look at the diagnostic accuracy of CT in patients presenting with an acute abdomen who ultimately required a laparotomy. Patients who underwent an emergency laparotomy between 2008 and 2010 at Eastbourne District General Hospital with pre-operative CT on the same admission were included in the study. The CT report was compared with the laparotomy and histology findings and, where a discrepancy existed, the original imaging was reviewed by a senior consultant blinded to the original report and laparotomy findings. A total of 196 emergency laparotomies were performed over the 2-year period, with 112 patients undergoing preoperative CT. Fifteen patients were excluded from the study due to missing notes. In the remaining 97 patients, 80 CT reports correlated with the final operative diagnosis, giving a diagnostic accuracy of 82%. Of these, the on-call registrar was the initial reporter in 37 scans, with a diagnostic accuracy of 78%. On review of the CT by a second consultant, this increased to 90 correlations, yielding an accuracy of 93%. Delay between CT and the operation did not significantly alter diagnostic accuracy, nor was there any statistically significant reduction in accuracy in reports issued by on-call registrars. On first reporting, CT misses 18% of diagnoses that ultimately require operative intervention. Reducing the threshold for obtaining a second consultant radiologist review significantly improves the diagnostic accuracy to 93%.

Ultrasound guided Core Biopsy, Fine Needle Aspiration Cytology and Surgical Excision Biopsy in the diagnosis of metastatic squamous cell carcinoma in the head and neck: An eleven year experience

This study aims to review our 11 year experience of diagnosing metastatic squamous cell carcinoma presenting as head and neck lumps. The techniques of Ultrasound guided Core Biopsy (USCB), Fine Needle Aspiration Cytology (FNAC) and Surgical Excision Biopsy (SEB) are compared. All patients with metastatic squamous cell carcinoma (SCC) involving the lymph nodes of the head and neck or parotid gland, diagnosed at Eastbourne District General Hospital between January 1998 and November 2009 were identified. The following data items were collated: biopsy location (e.g. cervical lymph node or parotid), any history of likely primary SCC and site, type of biopsy used to establish a conclusive diagnosis (index diagnostic technique), previous biopsies, the technique and their results, subsequent histology results. A total of 90 patients were diagnosed with metastatic squamous cell carcinoma. The index diagnostic technique was USCB in 48 patients, FNAC in 29 and SEB in 13. In 72 (80%) patients the index biopsy was the sole tissue sample taken prior to surgery or other treatment. The remaining 18 patients underwent a total of 22 previous biopsies prior to the index biopsy. 95% (21/22) of these previous biopsies were non-definitive FNAC and 5% (1/22) was a non-definitive USCB. FNACs also demonstrated the highest non-diagnostic rate (42%). The accuracy of USCB and FNAC in correlating with final histopathology was 97% and 85% respectively. USCB demonstrates excellent results in the diagnosis of metastatic SCC in the head and neck with higher accuracy and greater reliability than FNAC.

Anaesthetists' and surgeons' attitudes towards informed consent in the UK: an observational study

BackgroundThe attitudes of patients' to consent have changed over the years, but there has been little systematic study of the attitudes of anaesthetists and surgeons in this process. We aimed to describe observations made on the attitudes of medical professionals working in the UK to issues surrounding informed consent.MethodA questionnaire made up of 35 statements addressing the process of consent for anaesthesia and surgery was distributed to randomly selected anaesthetists and surgeons in Queen's Medical Centre (Nottingham), Royal Sussex County Hospital (Brighton) and Eastbourne District General Hospital (Eastbourne) during 2007. Participants were asked to what extent they agreed with statements regarding consent.ResultsOf 234 questionnaires distributed, 63% were returned. Of the respondents 79% agreed that the main purpose of the consent process is to respect patient autonomy. While 55% of the examined cohort agreed that the consent process maybe inappropriate as patients do not usually remember all the information given to them. Furthermore, 84% of the participants agreed that what the procedure aims to achieve should be explained to the patient during the consent process. While of the participants, over 70% agreed that major risks of incidence greater than 1/100 should be disclosed to the patient as part of the consent process.ConclusionsThe majority of respondents appear to hold attitudes in standing with current guidelines on informed consent however there was still a significant minority who held more paternalistic views to the consent process bringing into question the need for further training in the area.

Removal of an impalpable thyroglossal cyst using ultrasound‐guided wire localisation – a technical note

Clinical OtolaryngologyVolume 32, Issue 2 p. 141-142 Removal of an impalpable thyroglossal cyst using ultrasound-guided wire localisation – a technical note M.J. Purayidathil, M.J. Purayidathil Department of ENT, Amala Institute of Medical Sciences, Trichur, Kerela, IndiaSearch for more papers by this authorG. Manjaly, G. Manjaly ENTSearch for more papers by this authorD.C. Howlett, D.C. Howlett Radiology, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK, E-mail: [email protected]Search for more papers by this author M.J. Purayidathil, M.J. Purayidathil Department of ENT, Amala Institute of Medical Sciences, Trichur, Kerela, IndiaSearch for more papers by this authorG. Manjaly, G. Manjaly ENTSearch for more papers by this authorD.C. Howlett, D.C. Howlett Radiology, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK, E-mail: [email protected]Search for more papers by this author First published: 02 April 2007 https://doi.org/10.1111/j.1365-2273.2007.01348.xCitations: 8Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume32, Issue2April 2007Pages 141-142 RelatedInformation

Clinical audit documenting insertion date of peripheral intravenous cannulae

The Royal College Of Nursing (RCN) have evidence-based guidelines with regard to optimal time for changing peripheral intravenous cannulae (PIC) and documentation post-insertion (patient and nursing notes). This clinical audit assesses the compliance with respect to the RCN and Eastbourne District General Hospital guidelines of documenting the date post-insertion of PIC, optimal time for changing cannulae and rates of superficial phlebitis on the surgical wards. All PIC, their dressings, sites and intravenous infusions were examined on all inpatients on the surgical wards on three random days. Staff awareness with regard to RCN and local guidelines for optimal time to change peripheral venous cannulae and documentation post-insertion was assessed. The majority of staff nurses correctly stated that the optimal time for changing an uncomplicated PIC was 72 hours, despite this 13.8% had a cannulae which had been inserted for more than 72 hours. Our study has found that despite medical and nursing staff being aware of RCN and local guidelines, there is still poor compliance with regards to documentation, optimal time for changing and thus increased levels of superficial phlebitis post insertion of PIC.

A six-month audit of the isolation of Fusobacterium necrophorum from patients with sore throat in a district general hospital

Fusobacterium necrophorum is an obligate anaerobe believed to be a member of the normal flora of the human oropharangeal and urogenital tract. It has been associated with deep-seated infections and was first described in 1936 by Lemierre, a French microbiologist. There is now strong evidence to suggest that it is also a cause of recurrent sore throat and persistent sore throat syndrome (PSTS) without leading to full systemic infection. It is considered to be the second most common cause of sore throat after group A β-haemolytic streptococci. This study was performed over a six-month period (October 2004 to March 2005) at the Eastbourne District General Hospital. All throat swabs received in the laboratory are cultured routinely for haemolytic group A streptococci and pathogenic Corynebacteria spp. During the study period an extra fastidious anaerobic blood agar plate with neomycin was inoculated, with a 30 µg vancomycin disc placed at the junction of the second and third streaks. This was examined after 48 h for the presence of F. necrophorum. A total of 1157 swabs were processed during the study period: 156 were positive for haemolytic group A streptococci, 57 were positive for F. necrophorum, 47 for group C haemolytic streptococci, nine for group G haemolytic streptococci, and one was positive for C. ulcerans. Patient age ranged from less than a year old to 88. The majority of F. necrophorum isolates were from patients in the 11–25 age group, with an isolation rate of 9.48% (44/464). This age group accounted for 40% (464/1157) of the swabs received during the study period and 77% (44/57) of these were positive for F. necrophorum. Group A haemolytic streptococci showed an overall isolation rate of 13.5%, with peaks of 23% in the 0–10 and 26–35 age ranges. Together, these two organisms were responsible for 18.4% (213/1157) of all throat infections in this study. The results presented here indicate that F. necrophorum is second to group A haemolytic streptococci as a cause of sore throat, especially in the young adult, and introduction of routine culture should be considered.

Pauline Freeman's death was tragic but the nurses are not to blame.

As the 'single qualified nurse' on duty the night Pauline Freeman died at Eastbourne District General Hospital, I would like to respond to some inaccuracies in your article on the subject (features September 6).

Wisdom from tragedy

Pauline Freeman's death at Eastbourne District General Hospital in 1998 sparked widespread publicity and an inquiry. Ms Freeman's twin sister, a former nurse, believes understaffing played a key part in the tragedy.