General Hospital In Scotland Research Articles

Acanthamoebae as a protective reservoir for Pseudomonas aeruginosa in a clinical environment

Pseudomonas aeruginosa is a growing concern in healthcare-associated infections and poses significant risk to those with serious underlying health conditions. The antimicrobial resistance traits of the pathogen and ability to form biofilms make effective mitigation and disinfection strategies difficult. Added to this challenge is the role that free-living amoebae such as Acanthamoeba play in the detection, disinfection and transmission of P.aeruginosa. P. aeruginosa can survive intracellularly within amoebae, which has the potential to limit detectability and permit transmission into high-risk areas. We screened for the presence of Acanthamoeba spp. and P.aeruginosa within a functioning general hospital in Scotland using a culture and molecular approach, noting their presence at several sites over a four-month period, particularly within floor drains connecting patient rooms. In addition, microbiome analysis revealed that amoebae harbour a unique microbial community comprised primarily of Pseudomonas spp. that were not readily detected using microbiome sequencing techniques on environmental swabs. Having demonstrated that both organisms were consistently present in hospital settings, we investigated the relationship between acanthamoeba and P.aeruginosa in the laboratory, showing that (i) acanthamoeba growth rate is increased in the presence of pseudomonas biofilms and viable pseudomonas persist within the amoebae and (ii) hydrogen peroxide-based disinfectants are significantly less effective against an isolate of P.aeruginosa in the presence of acanthamoeba than when the bacteria are incubated alone. These findings suggest that amoebae, and other protists, can influence the detection and persistence of P.aeruginosa in high-risk areas and should be considered when implementing mitigation strategies.

799 Do Not Attempt Cardiopulmonary Resuscitation Decisions in Neck of Femur Fractures – Is Documentation Adequate?

Abstract Introduction ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) documentation is essential to communicate decisions regarding ceilings of care for patients to the clinical team. Patients admitted to hospital with a fractured neck of femur (#NOF) are often elderly with multiple comorbidities, and so robust and clear anticipatory care plans are especially indicated. Method All patients admitted to a large district general hospital in Scotland with a #NOF over a three-week period between 23/10/2020 and 12/11/2020 were identified prospectively and included in this audit. Patients’ demographic information, DNACPR status and the quality of their DNACPR documentation was recorded. Results 20 patients (85% Female, 15% Male) were identified and included. Median ASA grade was 3, with 77.8% of patients ASA grade 3 or 4. 63.2% of patients had DNACPR documentation in place, all of which were ASA grade 3 or above. Most DNACPR documentation had patient information clearly identifiable (91.7%), was completed preoperatively (90.9%), and involved either the patient or appropriate relative or power of attorney (91.6%). However, only 75% of patients’ documentation had the rationale for the DNACPR decision documented and only 25% of DNACPR decisions were reviewed by a senior clinician within 72 hours. No DNACPR decisions were documented as having been communicated to the wider healthcare team. Conclusions DNACPR documentation is a crucial for anticipatory care planning in #NOF patients. This audit shows improvement is needed in documenting whether decisions have been reviewed by senior clinicians, and if they have been communicated to the wider healthcare team.

A historical analysis of surgery performed between 1941 and 1942 at the Bangour Maxillofacial and Plastic Surgery Unit, Scotland

In 1939, Bangour Emergency Medical Services Hospital was built as an annexe to Edinburgh War Hospital. The Maxillofacial and Plastic Surgery Unit opened in 1941, one of the several set-ups built with the support of Sir Harold Gillies, to ensure a service with specialist skills throughout Great Britain. The unit was led by Alexander Burns Wallace, who had to rapidly adapt the service to reflect the patterns of injury reflected by the more modern warfare practiced in the Second World War, while also incorporating techniques that were, at the time, revolutionary. Although much has been written about other units, Bangour's activity revealed through its case histories' highlights that plastic surgery was developing in parallel throughout Britain. The influence of Sir Harold Gillies was clear, and his input to support the fledgling service serves as an important aspect of the newly developing specialty of plastic surgery: collaboration and sharing of knowledge. This paper analyses the work of the Maxillofacial and Plastic Surgery Unit at Bangour General Hospital in Scotland between 1941 and 1942 and demonstrates its historical significance, as well as its relevance to current practice. Ninety-two case notes from the unit recently became accessible. These were analysed and four were selected for review in this study. These cases were selected as they were well-documented with photographs and good examples of the work performed at the unit in order to highlight the innovative, creative and complicated work carried out at the Unit.

Cost impact of introducing a treatment escalation/limitation plan during patients' last hospital admission before death.

A recent study found that the use of a treatment escalation/limitation plan (TELP) was associated with a significant reduction in non-beneficial interventions (NBIs) and harms in patients admitted acutely who subsequently died. We quantify the economic benefit of the use of a TELP. NBIs were micro-costed. Mean costs for patients with a TELP were compared to patients without a TELP using generalized linear model regression, and results were extrapolated to the Scottish population. Medical, surgical and intensive care units of district general hospital in Scotland, UK. Two hundred and eighty-seven consecutive patients who died over 3 months in 2017. Of these, death was 'expected' in 245 (85.4%) using Gold Standards Framework criteria. Treatment escalation/limitation plan. Between-group difference in estimated mean cost of NBIs. The group with a TELP (n = 152) had a mean reduction in hospital costs due to NBIs of GB £220.29 (US $;281.97) compared to those without a TELP (n = 132) (95% confidence intervals GB £323.31 (US $413.84) to GB £117.27 (US $150.11), P = <0.001). Assuming that a TELP could be put in place for all expected deaths in Scottish hospitals, the potential annual saving would be GB £2.4 million (US $3.1 million) from having a TELP in place for all 'expected' deaths in hospital. The use of a TELP in an acute hospital setting may result in a reduction in costs attributable to NBIs.

Changes in Emergency General Surgery During Covid-19 in Scotland: A Prospective Cohort Study.

IntroductionCovid-19 has had a significant impact on all aspects of health care. We aimed to characterise the trends in emergency general surgery at a district general hospital in Scotland.MethodsA prospective cohort study was performed from 23/03/20 to 07/05/20. All emergency general surgery patients were included. Demographics, diagnosis and management were recorded along with Covid-19 testing and results. Thirty-day mortality and readmission rates were also noted. Similar data were collected on patients admitted during the same period in 2019 to allow for comparison.ResultsA total of 294 patients were included. There was a 58.3 per cent reduction in admissions when comparing 2020 with 2019 (85 vs 209); however, there was no difference in age (53.2 vs 57.2 years, p = 0.169) or length of stay (4.8 vs 3.7 days, p = 0.133). During 2020, the diagnosis of appendicitis increased (4.3 vs 18.8 per cent, p = < 0.05) as did severity (0 per cent > grade 1 vs 58.3 per cent > grade 1, p = < 0.05). The proportion of patients undergoing surgery increased (19.1 vs 42.3 per cent, p = < 0.05) as did the mean operating time (102.4 vs 145.7 min, p = < 0.05). Surgery was performed in 1 confirmed and 1 suspected Covid-19 patient. The latter died within 30 days. There were no 30-day readmissions with Covid-19 symptoms.ConclusionCovid-19 has significantly impacted the number of admissions to emergency general surgery. However, emergency operating continues to be needed at pre-Covid-19 levels and as such provisions need to be made to facilitate this.

Living at home after emergency hospital admission: prospective cohort study in older adults with and without cognitive spectrum disorder

BackgroundCognitive spectrum disorders (CSDs) are common in hospitalised older adults and associated with adverse outcomes. Their association with the maintenance of independent living has not been established. The aim was to establish the role of CSDs on the likelihood of living at home 30 days after discharge or being newly admitted to a care home.MethodsA prospective cohort study with routine data linkage was conducted based on admissions data from the acute medical unit of a district general hospital in Scotland. 5570 people aged ≥ 65 years admitted from a private residence who survived to discharge and received the Older Persons Routine Acute Assessment (OPRAA) during an incident emergency medical admission were included.The outcome measures were living at home, defined as a private residential address, 30 days after discharge and new care home admission at hospital discharge. Outcomes were ascertained through linkage to routine data sources.ResultsOf the 5570 individuals admitted from a private residence who survived to discharge, those without a CSD were more likely to be living at home at 30 days than those with a CSD (93.4% versus 81.7%; difference 11.7%, 95%CI 9.7–13.8%). New discharge to a care home affected 236 (4.2%) of the cohort, 181 (76.7%) of whom had a CSD. Logistic regression modelling identified that all four CSD categories were associated with a reduced likelihood of living at home and an increased likelihood of discharge to a care home. Those with delirium superimposed on dementia were the least likely to be living at home (OR 0.25), followed by those with dementia (OR 0.43), then unspecified cognitive impairment (OR 0.55) and finally delirium (OR 0.57).ConclusionsIndividuals with a CSD are at significantly increased risk of not returning home after hospitalisation, and those with CSDs account for the majority of new admissions to care homes on discharge. Individuals with delirium superimposed on dementia are the most affected. We need to understand how to configure and deliver healthcare services to enable older people to remain as independent as possible for as long as possible and to ensure transitions of care are managed supportively.

Delivering Hospice Level Care for Palliative Inpatients at a District General Hospital

The Record of End of Life Care (RELC) is an initiative within NHS Lanarkshire to improve the documentation of care of palliative patients in the last days of life. Our aim was to achieve hospice level care in the hospital setting. Three wards were chosen to pilot the Record of End of Life Care – Cardiology, Respiratory and Renal at a 500 bedded District General Hospital in Scotland. A retrospective 3 month review of deaths was undertaken. Each death was allocated a score out of 12 (this was named the 12Score). The highest possible score was 12 indicating there was documented evidence for 12 agreed domains of care. Following this the RELC was introduced to ward staff. A number of interventions were piloted with varying success. Notably, a weekly Mortality Meeting was instituted. This was nurse led to achieve continuity but all members of staff participated. Also, an anticipatory care form was created for chronic conditions. Overall a culture of reflective practice was promoted with relation to end of life care. 38 deaths occurred in the initial review period. The patients with the highest scores all had either a Cancer Diagnosis or Specialist Palliative Care (SPC) Team involvement. All patients with a score of 0 to 6 were either Non-malignant patients or did not have SPC involvement. Since introducing the RELC and subsequent interventions, 12Scores have improved. Of all the patients whose care was guided by the RELC, the lowest score was 7 and 50% were greater than 10. In addition to this, Non-malignant deaths and deaths without SPC involvement are now achieving scores of greater than 7. Death is invariably subjective however, guidance on exemplary practice alongside a shift in culture allows us to assess, document and improve on the quality of care delivered.

Timely identification of patients with frailty at the 'front door' of acute hospitals.

Early identification of frailty at the front door of the acute hospital is vital to allow rapid comprehensive geriatric assessment and care pathway development in the most appropriate location. This article discusses the importance of developing robust processes to enable early identification and management of frailty in the acute hospital. It also highlights the benefits of developing a dynamic team of professionals at the front door of the acute hospital who are effectively trained to undertake comprehensive assessment. Effective care planning for older people with frailty requires meticulous coordination through collaboration across health and social care and this is demonstrated using an effective model which has been developed in a district general hospital in Scotland.

Colorectal cancer outcomes in nonagenarian patients: A case series

BackgroundIncreased life expectancy and improved medical management of co-morbidities has led to an increasing number of nonagenarian patients with colorectal cancer being considered for surgical intervention. This study aims to describe the morbidity and mortality of nonagenarians who had operative and non-operative management for colorectal cancer. Materials and MethodsA retrospective study of consecutive colorectal cancer patients from 2010 to 2016 in a district general hospital in Scotland who were 90 years old or above was performed. Demographic and perioperative data were obtained from case note review. Survival analysis and multivariable regression was conducted to determine factors associated with cancer-specific and all-cause mortality. ResultsForty-nine patients were identified; 24 patients underwent operative management (median age: 91) while 25 received non-operative management (median age: 92). Fifteen patients (62.5%) had an elective operation, and 8 (37.5%) had an urgent or emergency procedure. None of the patients treated operatively suffered a significant complication or anastomotic leakage. Median hospital stay was 14 days. Five patients (20.8%) required a higher level of care in the community following discharge. Surgical mortality within 30 days was 4.2%. Patients undergoing an elective operation had a significantly improved survival compared to those undergoing an emergency operation or non-operative management. On multivariable analyses, non-operative management, and presence of metastases at diagnosis were associated with higher cancer-specific mortality. ConclusionElective operative management for carefully selected nonagenarian patients with colorectal cancer is generally acceptable in terms of morbidity and mortality. The majority of operatively managed patients returned to the same functional level of care following discharge. Patients with metastases at the outset and those requiring emergency surgery have a poorer prognosis.

Targeted Screening of Hip Dysplasia in Newborns: Experience at a District General Hospital in Scotland.

National Health Service Quality Improvement Scotland (NHS QIS) published a health technology scoping report in 2006 acknowledging that there are serious concerns within Scotland in relation to Developmental Dysplasia of Hip (DDH) as there is no formal screening program in place and there are significant variations between NHS boards leading to confusion for staff and parents. NHS QIS identified need for audit work to improve hip screening in Scotland. The aim of this study is review of current practice of selective screening for DDH. All newborns who had their first hip scan during one year period (2014) were included in this retrospective study and followed up until June 2015 to include any surgical intervention for dysplastic hip. Out of 428 babies (856 hip scans), abnormality was seen in 119 babies/147 hips (134 Graf 2a/2b, 10 hips were 2c and 3 hips were Graf grade 3). Average age when first scan was performed was 5 weeks (range 3 weeks to 22 weeks). Analysis of risk factors in 119 babies with abnormal scan was consistent with literature (83 breech, 12 family history, 12 HBW, 10 instability and 2 twins of breech). Twelve babies (16 hips) required treatment and were successfully treated in Pavlik harness. There was one case of missed/late dislocation, which lived in outside catchment area for 3 years since birth. During this study period there was no case of avascular necrosis or femoral nerve palsy as a result of treatment. In our experience, selective hip screening by ultrasound scan is useful in avoiding overtreatment and minimizing late presentations.

Optimizing the assessment of suicidal behavior: The application of curtailment techniques

BackgroundGiven their length, commonly used scales to assess suicide risk, such as the Beck Scale for Suicide Ideation (SSI) are of limited use as screening tools. In the current study we tested whether deterministic and stochastic curtailment can be applied to shorten the 19-item SSI, without compromising its accuracy. MethodsData from 366 patients, who were seen by a liaison psychiatry service in a general hospital in Scotland after a suicide attempt, were used. Within 24h of admission, the SSI was administered; 15 months later, it was determined whether a patient was re-admitted to a hospital as the result of another suicide attempt. We fitted a Receiver Operating Characteristic curve to derive the best cut-off value of the SSI for predicting future suicidal behavior. Using this cut-off, both deterministic and stochastic curtailment were simulated on the item score patterns of the SSI. ResultsA cut-off value of SSI≥6 provided the best classification accuracy for future suicidal behavior. Using this cut-off, we found that both deterministic and stochastic curtailment reduce the length of the SSI, without reducing the accuracy of the final classification decision. With stochastic curtailment, on average, less than 8 items are needed to assess whether administration of the full-length test will result in an SSI score below or above the cut-off value of 6. LimitationsNew studies using other datasets should re-validate the optimal cut-off for risk of repeated suicidal behavior after being treated in a hospital following an attempt. ConclusionsCurtailment can be used to simplify the assessment of suicidal behavior, and should be considered as an alternative to the full scale.

Risk assessment in acute non-variceal upper GI bleeding: the AIMS65 score in comparison with the Glasgow–Blatchford score in a Scottish population

IntroductionThe early use of risk stratification scores is recommended for patients presenting with acute non-variceal upper gastrointestinal (GI) bleeds (ANVGIB). AIMS65 is a novel, recently derived scoring system, which has...

PWE-109 Bleeding the bronze diabetics:prospective audit against local, national and european guidelines of venesection in hereditary haemochromatosis at a district general hospital in scotland

<h3>Introduction</h3> Patients with haemochromatosis and evidence of iron excess should be treated with venesection. This confers a normal life expectancy in the absence of cirrhosis and diabetes. Over 400 patients regularly attend Wishaw for venesection. We aimed to document haemoglobin and ferritin; and whether venesection is done based on these results. We additionally checked genotype. <h3>Method</h3> Prospective audit of all gastroenterology patients with hereditary haemochromatosis attending for venesection over 7 weeks. Results compared against local, BCSH and EASL guidelines. <h3>Results</h3> There were 61 attendances by 41 patients. Ferritin was regularly checked but 6 patients were venesected despite already achieving the target (&lt;50 μg/L). 6 patients did not have haemoglobin checked before venesection. 8 patients were venesected despite low haemoglobin. 25 of 41 patients had been genotyped. Liver biopsy had been performed in only 2 of 11 patients in whom it was indicated. <h3>Conclusion</h3> There is scope to improve safe venesection based on ferritin and haemoglobin. There was variation in how aggressively patients were venesected in clinic. One contributing factor is thought to be the differing target values used by haematologists and gastroenterologists in the hospital. In an attempt to address this the venesection protocol is to be standardised across patients. This is a popular change with venesection clinic staff. Another factor is that patients9 individual venesection booklets do not follow their case notes to clinic appointments. This would allow clinicians to monitor patients9 venesection more actively. <h3>Disclosure of interest</h3> None Declared.

Transition Towards Laparoscopic Appendicectomy at a UK Center Over a 7-Year Period

Acute appendicitis remains the most common indication for emergency abdominal surgery in the United Kingdom. Although laparoscopic appendicectomy has demonstrable advantages over open appendicectomy, uptake has not been universal. The aims of this study were to describe trends in laparoscopic appendicectomy in a District General Hospital in Scotland. Retrospective review of appendix histopathology records within NHS Fife between 2003 and 2010. Note review of cases of acute appendicitis managed with laparoscopic appendicectomy was performed. Perioperative variables in perforated and nonperforated appendicitis were compared. A multivariate logistic regression analysis to determine factors associated with developing complications was performed. Between 2003 and 2010, 237 laparoscopic appendicectomies were performed. The rate of laparoscopic appendicectomy increased from 2.5% in 2003 to 78% in 2010. In 50% of cases, the trainee surgeon was the primary operator. Complications occurred in 9.6% and the mortality rate was 0.4%. No factors on multivariate logistic regression predicted development of complications. We describe a change in practice towards laparoscopic appendicectomy for the treatment of acute appendicitis over a 7-year period. Furthermore, laparoscopic appendicectomy is associated with acceptable morbidity rates.

Patient Self‐assessment of Nasal Fractures and Self‐referral to an Ear, Nose, and Throat Department

To assess if patients can safely self-assess their need for ear, nose, and throat (ENT) review following initial emergency department attendance for nasal trauma. This prospective study was divided into 2 parts. The initial part evaluated an information sheet for patients to lead them through a self-assessment to establish if they require ENT review following nasal injury. The second part of the study investigated outcomes following the introduction of the self-assessment. This work was conducted at a District General Hospital in Scotland. Forty-nine consecutive patients underwent self-assessment plus blinded otolaryngology assessment, after which self-assessment was introduced as routine. This was evaluated comparing outcomes of 49 new consecutive nasal injuries against the original group using subjective patient scores of nasal cosmesis and nasal airway following injury and any subsequent treatment. There was no significant difference in outcome between the 2 study periods. After the introduction of self-assessment, there was a large reduction in the nonattendance rate for nasal injuries and in the attendances of patients with nasal injuries not requiring manipulation. In our institution, patients can be relied on to safely self-assess their nasal injuries to decide if they need ENT review when provided with appropriate information. This reduces the outpatient burden on the ENT department with no deterioration in subjective patient outcomes.

Capturing the concealed: Interprofessional practice and older patients' participation in decision-making about discharge after acute hospitalization

The aim of this paper is to investigate ways in which the dynamics of interprofessional work shaped older patients' “participation” in decision-making about discharge from acute hospital care in a medical directorate of a District General Hospital in Scotland. Twenty-two purposively selected older patients and their key professional hospital carers in three different ward environments participated in the study. An ethnographic approach was adopted, involving semi-structured interviews with patients and staff combined with rigorous observation of the practical context for staff and patient interactions during the discharge planning process over a 5-month period. Patients' and staff's understanding of “decision-making” and their priorities for discharge were different, but patients' perspectives fragmented and became invisible. Care routines, which centred around assessments and the decisions that flowed from these tended to exclude both staff and patients from active decision-making. Research and practice on patient involvement in discharge decision-making needs to focus on the organizational context, which shapes patients', unpaid carers' and staff's interactions and the dynamics by which some views are privileged and others excluded. Procedurally driven care routines and their impact on patients', carers' and staff's opportunity to actively engage in decision-making should be re-considered from an empowerment perspective.

Prevention of recurrence of venous ulceration: Randomized controlled trial of class 2 and class 3 elastic compression

To compare venous ulcer recurrence and compliance with two strengths of compression hosiery. This study was a randomized controlled trial with a 5-year follow-up. The setting was the leg ulcer clinics of a teaching and a district general hospital in Scotland, United Kingdom. Patients were 300 outpatients with recently healed venous ulcers, with no significant arterial disease, rheumatoid disease, or diabetes mellitus. Interventions were fitting and supply of class 2 or class 3 compression hosiery. Four-monthly refitting by trained orthotists and surveillance by specialist nurses were performed. The main outcome measures were recurrence of leg ulceration and compliance with treatment. Thirty-six percent (107/300) of patients had recurrent leg ulceration by 5 years. Recurrence occurred in 59 (39%) of 151 class 2 elastic compression cases and in 48 (32%) of class 3 compression cases. One hundred six patients did not comply with their randomized compression class, 63 (42%) in class 3 and 43 (28%) in class 2. The difference in recurrence is not statistically significant, but our estimate of the effectiveness of class 3 hosiery is diluted by the lower compliance rate in this group. Restricted ankle movement and four or more previous ulcers were associated with a higher risk of recurrence. There was no evidence of a difference in recurrence rates at the classic level of significance (5%), but the lowest recurrence rates were seen in people who wore the highest degree of compression. Therefore, patients should wear the highest level of compression that is comfortable.

Nurses’ opportunistic interventions with patients in relation to smoking

This paper reports a study exploring nurses' provision of opportunistic health education on smoking for hospital patients. Smoking cessation guidelines recommend assessment of patients' smoking habits and provision of smoking cessation advice when possible, and highlight the importance of the role of nurses in health promotion and health education. In the past, nurses have been criticized for lack of knowledge, skills and confidence in relation to health education and the perception that it is additional to, rather than integrated with, nursing care. A qualitative case study design was selected to explore the health education practice of 12 nurses working in acute wards in three general hospitals in Scotland. Data were collected in 2000 through non-participant observation, semi-structured interviews and the use of a radio-microphone to record nurse-patient interactions. The data analysis was guided by four key elements of health education practice: 'the teachable moment', 'readiness to learn', 'the provision of health information' and 'oral communication'. Smoking was part of the nurses' agenda, as most recognized opportunities to introduce health education on smoking during nursing care, suggesting a tentative move towards the integration of health education with nursing care. Evidence from patients' interactions indicated ample opportunity for nurses to provide smoking-related health information. However, the content of nurses' interactions on smoking was variable, with some limited by poor communication skills and inadequate knowledge of smoking and smoking cessation. The context of the interactions was also important in understanding some of the restrictions on conversational progress. Nurses require the knowledge and skills to perform a health education role, and the inclusion of smoking cessation guidelines in nursing curricula would contribute to this. Where patients are in hospitals for short periods of time, opportunistic health education on smoking needs to be introduced as the basis for more specialist intervention.

Reinke's oedema, hormones and hormone replacement therapy

To study the implications of hormone replacement therapy (HRT) treatment in the pathogenesis of Reinke's oedema (via a possible pseudo-hypothyroidism effect), and also to study why the disease affects a predominantly post-menopausal female population. Prospective case series study. Two teaching hospitals and two district general hospitals in Scotland, UK. Thirty-three patients diagnosed with Reinke's oedema who presented in the out-patient department before or after treatment. Thyroid function tests were normal in all but two cases. Only three patients were receiving HRT treatment. The study produced no evidence to support a relationship between HRT treatment and the pathogenesis of Reinke's oedema; this supports previous studies which concluded that thyroid function was not related to the development of Reinke's oedema. Some new ideas regarding hormonal factors in Reinke's oedema are discussed.

Use of intravenous steroids at induction of anaesthesia for adult tonsillectomy to reduce post‐operative nausea and vomiting and pain: a double‐blind randomized controlled trial

To assess the effectiveness of intravenous steroids at induction of anaesthetic to reduce post-operative nausea and vomiting and pain after adult tonsillectomy. Prospective, double-blind, randomized, placebo controlled trial, with ethical approval, following Consolidated Standards of Reporting Trials guidelines. District General Hospital in Scotland, UK. Seventy-two adults between 16 and 70 years, American Association of Anaethetists (ASA) 1, listed for elective tonsillectomy. Single dose of either 10 mg of dexamethasone or 2 mL of saline after induction with a consistent anaesthetic technique. Patients filled in a visual analogue scale relating to pain and post-operative nausea and vomiting for the day of operation and 7 days after operation. The time to first ingestion of food and drink after operation was also noted. Data completion rate of 64% (46 of 72 patients enrolled). Statistically significant relative decrease (62%P = 0.001) in the incidence of post-operative nausea and vomiting was seen in those treated with dexamethasone. Statistically significant relative decrease (23%P = 0.016) in post-operative pain scores for the day of operation was seen in those treated with dexamethasone. Significant decrease (17.5%, P < 0.001) in mean pain score for seven post-operative days was seen in those treated with dexamethasone. No adverse effects were seen. Dexamethasone given as a single dose of 10 mg at induction of anaesthesia for adult tonsillectomy is an effective, safe and inexpensive method for reducing morbidity in adult tonsillectomy.