General Surgical Patients Research Articles

Anesthetic considerations for microlaryngeal surgery

Introduction: Microlaryngeal surgery encompasses a wide range of laryngeal procedures. Patients presenting for microlaryngeal surgery frequently have a difficult airway. The chosen approach to this airway depends on the pathology and the patient’s symptoms. The Aim of the study is to determine the risk factors and anesthetic problems during microlaryngeal surgery. Materials and Methods: A prospective cohort study including 100 patients undergoing microlaryngeal surgery in the Department of Otorhinolaryngology at the University Hospital „Queen Giovanna“ – ISUL, Sofia, in the period 2020–2021; Medical University-Sofia. Preoperative examination of the larynx is performed in all patients by Storz 8402 ZX fiber optic laryngoscope with video capability. Results and discussion: In 69% of the patients the tumor mass causing obstruction is localized in the area of the larynx, and in 31% of them the tumor mass is localized in the area of the hypopharynx. From the patients with tumor mass causing laryngeal obstruction 42% are with 1st degree of obstruction, 29% are with 2nd degree, 27% are with 3rd degree and 2% are with respiratory failure at rest. Twenty six percent (26%) of the patients had pulse rate<45 beats per minute during putting on the tube of Kleinsasser. This is very dangerous reflex reaction of the heart, which we believe is caused by parasympathetic nervous system. The rate of difficult endotracheal intubation among patients presenting for microlaryngeal surgery is higher than among the general surgical patient population. Difficulties during endotracheal intubation in our study are due to higher percent of laryngeal obstruction and pharyngeal restriction because of the intraoral masses. Conclusion: Anesthesia for microlaryngeal surgery has always been demanding, as often pathology interferes with the anesthesiologist’s field of work.

Factors influencing interhospital transfer delays in emergency general surgery: a systematic review and narrative synthesis.

Emergency general surgery is an emerging public health issue globally, with substantial healthcare burden. Interhospital transfer of critically unwell surgical patients has been the mainstay of bridging gaps in surgical coverage in regional and rural locations, despite evidence of greater morbidity and mortality. Delays in transfer invariably occurs and compounds the situation. Our aim was to examine the factors influencing interhospital transfer delays in emergency general surgical patients. A systematic search of PubMED and EmBase, was performed by two researchers from 2020 to 23rd Feb 2021, for English articles related to interhospital transfer delays in emergency general surgical patients, with an age of >16. Articles were critically appraised and data were extracted into a pre-specified data extraction form. No data was suitable for statistical analysis and a narrative synthesis was performed instead. Six relevant articles were identified from the search. All studies were retrospective cohort studies with moderate to high risk of bias. Lack of consultant surgeon input, after hours transfer, need for intensive care bed and poor transfer documentation may have a role in interhospital transfer delays. Patients with public health insurance, multiple comorbidities and non-emergency medical conditions experience longer transfer request time and may be at risk of precipitating interhospital transfer delays. Transfer delays are seen in transfers over longer distances. There is a paucity of knowledge on what and how factors influence interhospital transfer delays in emergency general surgical patients. Well-designed prospective cohort studies are required to bridge this knowledge gap.

The socio-demographics and pattern of atherosclerosis of hos-pitalized adult patients without SARS-Cov-2 infection in a new tertiary hospital in Malaysia

Background: Atherosclerosis, a chronic inflammatory condition of the arterial intimal wall projected globally to impact healthcare significantly. The pattern of atherosclerosis, namely the atherosclerotic disease and atherosclerotic risk, may or may not be the reason for hospitalization; nevertheless, they have ongoing atherosclerosis that may progress over the years. Studies have shown that both patterns of atherosclerosis play an essential role in conferring poor prognosis and contributing to the leading cause of death. We embark on a study to analyze the socio-demographic and pattern of atherosclerosis of adult patients without SARS-Cov-2 infection admitted to a new tertiary hospital in Malaysia. We exclude patients who are predicted to have a high possibility of death or discharge within 24 hours, lactating mothers, oncology patients and non-Malaysian citizens; Methods: This prospective cross-sectional study recruited general medical and surgical ward adult patients between 9th October and 1st January 2021. The data were collected using face-to-face interviews with the patients and from the medical records. For our research, we identify the patient’s affirmation on having atherosclerosis, atherosclerotic disease, atherosclerotic risks, the reason for admission and their discharge outcome.

Postdischarge opioid use and persistent use after general surgery: A retrospective study

BackgroundOpioid overprescribing after surgery is a significant public health issue in most developed countries, including New Zealand. However, there is a lack of literature on the patterns and risk factors for postoperative opioid use among general surgical patients in New Zealand. This study aimed to examine opioid use in patients undergoing general surgery at Auckland District Health Board between January and December 2019 and to identify factors associated with opioid use after surgery and persistent opioid use (defined as having filled ≥1 opioid prescription in the 91 to 180 days after surgery). Methods and MaterialsThis is a retrospective cohort study. Data from patients’ electronic clinical records and community pharmacy dispensing records were extracted to obtain data on sociodemographics, surgical characteristics, comorbidities, co-prescribed medications, and opioid use. ResultsA total of 1,110 patients were included in the study, with 42.4% dispensed an opioid following discharge after surgery. Of opioid-naïve patients who filled opioids after surgery (n = 401), 9.5% became persistent opioid users. Preoperative use of nonopioid analgesics, longer hospital stays, higher operation severity, procedure type, and higher pain scores were positively associated with opioid use, whereas older age was a negative predictor. Longer hospital stays, an initial discharge prescription with high opioid load, and female sex increased the risk of persistent opioid use. Conversely, a higher severity of surgery was associated with lower risk of persistent opioid use. ConclusionThe findings suggest that a considerable proportion of patients become persistent opioid users after surgery. The risk factors identified can guide clinicians to prescribe in a manner that reduces opioid-related adverse outcomes and help guide future interventions.

Impact of the COVID-19 pandemic on the management and outcomes of emergency surgical patients: A retrospective cohort study.

The COVID-19 pandemic has led to drastic measures being implemented for the management of surgical patients across all health services worldwide, including the National Health Service in the United Kingdom. It is suspected that the virus has had a detrimental effect on perioperative morbidity and mortality. Therefore, the aim of this study was to assess the impact of the COVID-19 pandemic on these outcomes in emergency general surgical patients. Emergency general surgical admissions were included in this retrospective cohort study in one of the COVID-19 hotspots in the South East of England. The primary outcome was the 30-day mortality rate. Secondary outcomes included the length of stay in hospital, complication rate and severity grade and admission rates to the ITU. Of 123 patients, COVID-19 was detected in 12.2%. Testing was not carried out in 26%. When comparing COVID-positive to COVID-negative patients, the mean age was 71.8 + 8.8 vs. 50.7 + 5.7, respectively, and female patients accounted for 40.0 vs. 52.6%. The 30-day mortality rate was 26.7 vs. 3.9 (OR 6.49, p = 0.02), respectively. The length of stay in hospital was 20.5 + 22.2 vs. 7.7 + 9.8 (p < 0.01), the rate of complications was 80.0 vs. 23.7 (OR 12.9, p < 0.01), and the rate of admission to the ITU was 33.3 vs. 7.9% (OR 5.83, p = 0.01). This study demonstrates the detrimental effect of COVID-19 on emergency general surgery, with significantly worsened surgical outcomes.

379 Consenting on the Day of Surgery – Futility or Formality?

Abstract Aim Obtaining written informed consent is essential prior to proceeding with any surgical intervention. There is no consensus on the timing of when consent is complete. We aimed to assess the consent practices in our institution. Method A prospective snapshot audit was conducted on consecutive elective general surgical patients over a 4-week Period (August 2021). Data was collected on the content of pre-operative consent discussions as well as when the consent form was completed. Local audit approval was obtained Results 56 patients underwent an elective general surgical procedure. Median age was 55. 73% (n = 41) were female. 63% cases were for malignant disease (n = 35). All patients completed a consent form 1. 54 patients had documented pre-operative consultations with a consultant. In all malignant cases, patients underwent discussion with a cancer specialist nurse present. All patients received a diagnosis and discussion regarding treatment. 69% of patients underwent discussion about alternative treatment options and a discussion about surgical risk took place in 30% of cases. 95% of patients signed their consent form on the day of surgery with 80% registrars and 20% consultants countersigning the forms respectively. Conclusions Despite the majority of patient completing their consent form on the day of surgery, the preceding consent discussions would suggest that consent is a process, and that completion of the form is a formality.

386 Consent Practices in General Surgery – the Importance of the “Process”?

Abstract Aim Achieving valid informed consent is an essential component of the shared decision-making process. National guidance exists on the content of consent discussions. However, controversy exists as to when consent should be obtained. We aimed to assess consent practices in our institution. Method A Prospective snapshot audit was conducted on consecutive general surgical patients undergoing elective surgery over a 4-week period. Information on consent discussions were obtained from electronic patient care records and from the written consent form prior to surgery. Local audit approval was granted. Results 56 patients underwent an elective general surgical procedure in August 2021. Median age was 55. 73% (n = 41) were female. 63% of cases were for malignant disease (n = 35). All patients had capacity. 95% (n = 53) completed their consent form on the day of surgery. 54 patients had documented pre-operative consultant consultations with all patients receiving a diagnosis and discussion regarding treatment. 69% of patients underwent discussion about alternative options. Discussion about surgical risk took place in 30% of cases. Conclusions Variation exists in pre-operative consent discussions. However, these discussions reflect consent as a “continuum” which may carry greater importance than the act of signing a consent form at an isolated time point.

Evaluating the feasibility of a web-based discharge education programme to improve general surgical patients’ postdischarge recovery: a pilot randomised controlled trial

ObjectiveTo assess the feasibility of implementing a web-based discharge education programme for general surgery patients both prior to and after hospital discharge.Design, setting and participantsThis is a prospective, two-arm, pilot...

Кардіопротективний ефект інгаляційних анестетиків

На сьогодні є різниця між експериментальними даними на тваринах і клінічними результатами у пацієнтів кардіохірургічного і загальнохірургічного профілю. Протективна дія інгаляційних анестетиків ґрунтується на тих самих шляхах, що закладають основу захисту від ішемічного прекондиціонування. Наведено експериментальні дані щодо провідної ролі севофлурану й ізофлурану в активації мітохондріальних K+-каналів молекули аденозинтрифосфату аналогічно до того, що природним чином відбувається при ішемічному ураженні. Також в експерименті показано, що інгаляція севофлураном поліпшувала відновлення скоротливості міокарда до 67 % порівняно з 28 % у контрольній групі. Інший механізм кардіопротекції полягає у зміні активності мітохондріального переходу модуляції й активації цитокінів, що є ключовим внутрішньоклітинним сигнальним шляхом апоптозу. Наступний механізм кардіопротекції при використанні інгаляційних анестетиків — це зміна позаклітинного сигналу кіназ. Надано висновки клінічних досліджень щодо застосування інгаляційних анестетиків. Збереження мітохондріального споживання кисню вказує на кардіопротективний ефект внаслідок дії ізофлурану. Клінічні дослідження визначають, що сила стиснення шлуночків була значно поліпшена в групі севофлурану (з 53 до 85 %) і в групі десфлурану (з 53 до 86 %). Майбутні дослідження повинні оцінити найбільш оптимальний анестетик, його концентрацію та протокол для кращого кардіопротекторного ефекту.

Coagulation Screening in Patients Admitted to the Acute Surgical Receiving Unit - Ninewells Hospital, Dundee, Scotland

Introduction: Establish whether compliance to guidelines for routine pre-operative coagulation screening set by the National Institute for Health and Care Excellence (2016) is used on general surgical patients. Observe set components from guidelines with respect to the admission, dependent on grade of surgery and patient’s ASA grade. To determine financial loss per year from inappropriate/unnecessary coagulation testing performed on patients. Method: Review of all coagulation screening bloods taken for general surgical admissions to the acute surgical receiving ward over a 2 week period. The cost of one coagulation screen in NHS Tayside is £2.69. Clinical notes were reviewed in order to determine if criteria was met for performing a coagulation screening on admission. The results of the initial audit were presented at the Clinical Effectiveness meeting. The audit was repeated 2 weeks following a teaching session. Results: 200 individuals were included in the first cycle of the audit. It was found that 168 tests were ordered (161 unnecessary, 7 correctly screened, and 32 patients excluded appropriately). During the re-audit 208 patients were involved, and 153 tests were performed (151 unnecessary, 2 correctly screened, 55 patients excluded appropriately. Conclusion: As a result of the audit, coagulation screen sampling had decreased from 80.5% to 72.6%, an improvement of 7.9%. This equated to a savings of £26.90 over the duration of audit period (£699.20 per annum). This audit has demonstrated a change in clinical practice with potential significant financial benefit for the NHS.

Nurse's knowledge, practice and associated factors towards hypothermia prevention among trauma patients Visiting Woldiya and Dessie Comprehensive Specialized Hospitals, North East Ethiopia, 2022

BackgroundHypothermia is a condition which is common in emergency and general surgical patients. Trauma patients are particularly prone to hypothermia for multiple reasons and are associated with poor patient outcomes. This study aims to assess nurse's knowledge, practice and associated factors towards hypothermia prevention among trauma patients Visiting Woldiya and Dessie Comprehensive Specialized Hospitals. MethodsInstitutional-based cross-sectional study design was conducted at Woldiya and Dessie Comprehensive specialized hospital from February–March2022. The data was collected on 328 nurses working in these hospitals by structured self-administer questioner. EPi-dataversions 4.6.0 andSPSS version25 wereused for data entry, cleaning and analysis. Tables, text and graphs were used to present the data. Bivariable and multivariable logistic regression was performed to examine the association between dependent and independent variables with Odds ratio at 95% confidence interval. ResultIn this study half (50.9 %) respondents had poor knowledge on hypothermia prevention in trauma patients and 65.9 % respondents have poor practice as well. Working < 6 years (AOR = 2.034(1.098, 3.770)), diploma certificate (AOR = 5.200(1.244, 21.733)) and adolescent age (AOR = 0.296(0.094, 0.936)) have significance association with nurses knowledge on hypothermia in trauma victims. Working < 5 years (AOR=0.387(0.197, 0.761)) and BSc degree (AOR = 0.282(0.141, 0.563)) have significance association with nurses practice on hypothermia prevention in trauma victims. ConclusionNursing knowledge and practice regarding hypothermia prevention in trauma patients is poor in this study. Age, work experience and educational level affect knowledge and the last two affect the practice of nurses on preventing hypothermia in trauma patients.

Management of difficult and failed intubation in the general surgical population: a historical cohort study in a tertiary care centre.

The objective of this study was to describe the incidence, management, and complications of difficult and failed endotracheal intubation in a general surgical population. This historical cohort study included all cases of difficult endotracheal intubation in general surgical patients at Mount Sinai Hospital (Toronto, ON, Canada) from 1 January 2011 to 31 December 2017. Patient charts and electronic records were reviewed to collect data on airway management and complications. Endotracheal intubation was graded as "difficult" if more than two attempts with direct laryngoscopy or if additional equipment for second or subsequent attempts was required, and "failed" if it could not be achieved despite the attempts. The primary outcome was the incidence of difficult and failed intubation. The secondary outcomes were complications, difficult airway parameters, mask ventilation, number of intubation attempts, and rescue devices including the eventually successful method. We identified 111 cases of difficult intubation (0.26%) and 14 cases of failed intubation (0.03%) in 42,805 surgical cases requiring endotracheal intubation over the seven-year period. The incidence was highest in 2012 (0.36%) and lowest in 2017 (0.13%). Difficulty was anticipated in 84 (76%) patients. The median (range) number of intubation attempts was 2 (2-5). Videolaryngoscopy was the eventually successful method in those with unsuccessful first attempt direct laryngoscopy (n = 91) and videolaryngoscopy (n = 17) in 71% and 77% cases, respectively. Intubation failed in 14 patients, three of whom required a surgical airway because the lungs could not be ventilated. Poor visualization of the glottis (93%) and airway bleeding (36%) were the leading causes of failed intubation. Desaturation was seen in 8%, airway bleeding in 7%, and airway edema in 6% of cases of difficult intubation. The incidences of difficult and failed intubations in our study were 2.6 and 0.3 per 1,000 surgeries requiring laryngoscopies, respectively, with a decrease over time. Videolaryngoscopy showed a high success rate as a rescue device.

Composite Inflammatory Indicators as Early Predictor of Intra-abdominal Infections after General Surgery.

ObjectiveTo identify rapid and accurate early diagnostic indicators for intra-abdominal infection (IAI) after general surgery.MethodsWe conducted a retrospective analysis of 3,810 general surgical patients in our hospital from August 2017 to July 2018. The predictive value of PCT, CRP, TNFα, and IL6 on postoperative days (PODs) 1 and 3 and composite indicators for complicated IAIs among surgical patients was clarified.ResultsThere were 271 patients in the infected group and 614 patients in the uninfected group using IAI diagnostic criteria in this study. CRP, PCT, TNFα, and IL6 in the infected group were significantly higher than the uninfected group on POD1 and POD3. In the infected group, the composition of the four indicators on POD1 (AUC 0.819) and POD3 (AUC 0.848) showed higher predictive efficiency than the individual indicators (AUC 0.670–0.805).ConclusionThe composite of CRP, PCT, TNFα, and IL6 can be used as a predictor of postoperative abdominal infectious complications with high sensitivity and specificity on POD1 and POD3, which can provide a basis for early diagnosis of postoperative abdominal infectious complications.

O07 SHORT-TERM OUTCOMES OF A MULTICENTRE PROSPECTIVE STUDY USING A “VISIBLE” PVDF ONLAY MESH FOR THE PREVENTION OF MIDLINE INCISIONAL HERNIA

Abstract Aim Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under MRI. Material and Methods This is a prospective multicentre observational cohort study. Preliminary results from the first three months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. MRIs were performed six weeks after treatment. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position. Results Between July 2016 and December 2020, 178 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with BMI being the only significant risk factor (OR = 1.14, 95% CI = 1.00-1.31, p = 0.048). The formation of a seroma was also associated with BMI (OR = 1.11, 95% CI = 1.02-1.21, p = 0.02). Conclusions The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to understand how the mesh behaves during the early process of integration.

Metabolic syndrome and associated factors among severely ill psychiatric and non-psychiatric patients: a comparative cross-sectional study in Eastern Ethiopia

BackgroundMetabolic syndrome is a major public health challenge in both developed and developing countries. The burden of this disease is high, even in patients with psychiatric disorders. However, very little is known about the association between metabolic syndrome and psychiatric illness in Ethiopia. Therefore, the aim of this study was to investigate the magnitude of metabolic syndrome and its components among psychiatric clients.MethodsA comparative cross-sectional study was undertaken between psychiatric patients and age—and sex-matched non-psychiatric controls at the Dilchora referral hospital. The study included 192 study participants (96 psychiatric patients and 96 non- psychiatric controls from general medical and surgical patients). The National Cholesterol Education Program: Adult Treatment Panel III criteria were used to diagnose metabolic syndromes. The data were cleaned and analyzed using the Statistical Package for Social Sciences, Version 21. All intergroup comparisons for continuous data were performed using an independent sample t-test, whereas categorical data were analyzed using the Chi-square test. Logistic regression analysis was used to identify the association between metabolic syndrome and the associated variables.ResultsThe magnitude of metabolic syndrome among psychiatric patients was 36.5% (95%CI: 27.6, 47.4) compared to non-psychiatric control patients, 21.9% (95%CI: 13.5, 30.3), p = 0.02. The prevalence of MetS components, such as waist circumference (25.0% vs. 14.3%), lower-high density lipoprotein level (35.4% vs. 20.8%), higher systolic blood pressure (41.7% vs. 29.2%) and higher fasting blood glucose (40.6% vs. 18.8%) showed statistically significant differences between the exposed and non-exposed groups. Age greater than 50 years (AOR: 2.8, CI: 1.14, 20.0, p < 0.05); being female (AOR: 7.4, CI: 2.0, 27.6, p < 0.05), being urban residence (AOR: 6.4, CI: 2.2, 20.6, p < 0.05), ever alcohol intake (AOR: 5.3, CI: 1.3, 21.2), being physically inactive (AOR: 3.52, CI: 1.1, 12.9, p < 0.05) and family history of hypertension (AOR: 2.52, CI: 1.1, 12.2, p < 0.05) were independent predictors of metabolic syndrome (p < 0.05).ConclusionsThere is a high burden of metabolic syndrome and its components in patients with severe psychiatric disorders. Therefore, screening and mitigation strategies for metabolic syndrome and their components should be implemented in the management of psychiatric disorders.

Variations in nursing baccalaureate education and 30-day inpatient surgical mortality

BackgroundIn 2010, the IOM recommended an increase in the proportion of bachelor's-prepared (BSN) nurses to 80% by 2020. This goal was largely based on evidence linking hospitals with higher proportions of BSN nurses to better patient outcomes. Though, evidence is lacking on whether outcomes differ by a hospital's composition of initial BSN and transitional RN-to-BSN nurses. PurposeThe purpose of this study is to determine whether risk-adjusted odds of surgical mortality are associated with a hospital's proportion of initial BSN and transitional RN-to-BSN nurses. MethodsLogistic regression models were used to analyze cross-sectional data of general surgical patients, nurses, and hospitals in four large states in 2015 to 2016. FindingsHigher hospital proportions of BSN nurses, regardless of educational pathway, are associated with lower odds of 30-day inpatient surgical mortality. DiscussionFindings support promoting multiple BSN educational pathways to reach the IOM's recommendation of at least an 80% BSN workforce.

Development of a web-based discharge education intervention to improve the postdischarge recovery of general surgical patients.

Postoperative complications contribute to unplanned hospital readmissions, reoperations, and increased mortality for surgical patients. Discharge education for general surgical patients is often inadequate, and challenged by organizational, clinician and patient factors. This research describes the development of the web-based discharge education intervention to improve patients' knowledge, skills, and confidence in self-managing their recovery after general surgery. The intervention was informed by the UK Medical Research Council guidance for developing and evaluating complex interventions and Knowledge-to-Action framework, consisting of four iterative stages. Stakeholder engagement was undertaken throughout the development process and a logic model was utilized to map the working mechanism of the intervention. The concept of patient activation and Knowles adult learning theory underpinned the development process. The literature review and stakeholders' engagement in qualitative interviews and a series of meetings resulted in a web-based discharge education program with three different components: (1) post general surgery warning signs; (2) post general surgery everyday care instructions; and (3) animation video on wound potential wound complications. The web-based discharge education was developed according to the needs and preferences of healthcare providers and general surgical patients. Despite the rigorous and systematic approach used to develop the intervention, its effectiveness requires testing. This comprehensive iterative approach serves as a guide for others planning web-based interventions designed for surgical patients and the research approach used may inform those developing web-based interventions for other patient groups.

Establishing a perioperative medicine for older people undergoing surgery service for general surgical patients at a district general hospital

There is growing recognition of the need for perioperative medicine services for older surgical patients. Comprehensive geriatric assessment and optimisation methodology has been successfully used to improve perioperative outcomes at tertiary centres. This paper describes translation of an established model of geriatrician-led perioperative care to a district general hospital (DGH) setting. A mixed methods quality improvement programme was used and included stakeholder co-design, identification of core components, definition of mechanisms for change, and measurement of impact through qualitative and quantitative approaches. Within 18 months, a substantive perioperative service for older people was established at a DGH, funded by the surgical directorate. Key outcomes included reduction in length of stay and 30-day readmission and positive staff and patient experience. This study is in keeping with improvement science literature demonstrating the importance of a mixed-methods approach in translating an evidenced-based intervention into another setting, maintaining fidelity and replicating results.

EP.TU.526Is a foundation interim year one post better for improving confidence in general surgery in a tertiary centre or a district general hospital?

Abstract Aims 1. Understand the confidence levels in caring for general surgical patients of current foundation year one (FY1) doctors in who have had foundation interim year one (FiY1) post in a tertiary centre (TC) and a district general hospital (DGH). 2. Determine whether there is a difference in the experience of the FiY1 post in a TC or DGH. Methods FY1s doctors were surveyed throughout August – December 2020. Nine questions used Likert scales (1 to 5: not at all confident to very confident) over some common general surgical themes. Data was initially inputted using Google Docs and analysed in Microsoft Excel. Results 20% (6/30) from a DGH and 80% (24/30) from a TC Confidence levels were higher for FY1s who had a FiY1 post in a TC as opposed to a DGH in dealing with acute general surgical patients, appendicitis and scrubbing in theatre. Confidence levels were the same in both a TC and DGH for FY1s in managing those with hepatobiliary disease, prescribing fluids for resuscitation and maintenance as well as speaking to a family when a patient is dying and speaking to a patient when their diagnosis is unknown. Conclusions FY1s who had a FiY1 post in a TC had better confidence levels in more areas as opposed to a DGH. The experience of the FiY1 post should be more standardised to ensure the growth of confidence across all areas identified in the survey.

EP.FRI.510 The Management of Hyperkalaemia in Acute General Surgical Inpatients

Abstract Aims Hyperkalaemia is very common in hospitalised patients especially in peri-operative settings. It is associated with increased length of stay, morbidity and mortality. Here we review the management of hyperkalaemia in emergency surgery inpatients compared to the recommended national guidelines. With the identification of any gaps, we will introduce a new protocol to standardize practice as the basis of our educational intervention. Methods A retrospective observational study of adult surgical inpatients between July and December 2020. 20 patients with a K+ &amp;gt;5.5 during their inpatient stay were identified. Data on their clinical management was extracted from their electronic data record and handover database and analysed. Results Of the 20 patients identified, 13 had mild (5.5-6), 3 moderate (6-6.5) and 4 severe (&amp;gt;6.5) hyperkalaemia. Mortality was 0 and 100% of patients with K + ≥6.5 received timely emergency treatment in line with guidelines. However, there was a wide variation in the type of treatment given with 100% of cases not aligning with current guidelines. Additionally, in only 40% of cases was the hyperkalaemia documented and only 20% of patients received an ECG; a recommendation even in mild cases. Conclusions There is a need to standardise practice in the clinical management of hyperkalaemia and align with recent, validated guidance. A clear and easily accessible algorithm reinforced by an educational intervention to junior doctors may improve the management of high potassium in surgical inpatients and improve outcomes. Following this intervention, the standard will be re-audited.