Hospital Discharge Research Articles

Initial Defibrillator Pad Position and Outcomes for Shockable Out-of-Hospital Cardiac Arrest

Ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) are the most treatable causes of out-of-hospital cardiac arrest (OHCA). Yet, it remains unknown if defibrillator pad position, placement in the anterior-posterior (AP) or anterior-lateral (AL) locations, impacts patient outcomes in VF or pVT OHCA. To determine the association between initial defibrillator pad placement position and OHCA outcomes for patients presenting with VF or pVT. This prospective cohort study included patients with OHCA and VF or pVT treated by a single North American emergency medical services (EMS) agency from July 1, 2019, through June 30, 2023. The study included patients with OHCA treated by a large suburban fire-based EMS agency that covers a population of 550 000. Consecutive patients with an initial EMS-assessed rhythm of VF or pVT receiving EMS defibrillation were included. Pediatric patients (younger than 18 years), interfacility transfers, arrests of obvious traumatic etiology, and patients with preexisting do-not-resuscitate status were excluded. AP or AL pad placement. Return of spontaneous circulation (ROSC) at any time with secondary outcomes of pulses present at emergency department (ED) arrival, survival to hospital admission, survival to hospital discharge, and functional survival at hospital discharge (cerebral performance category score of 2 or less). Measures included adjusted odds ratios (aOR), multivariable logistic regressions, and Fine-Gray competing risks regression. A total of 255 patients with OHCA were included (median [IQR] age, 66 [55-74] years; 63 females [24.7%]), with initial pad positioning documented as either AP (158 patients [62.0%]; median [IQR] age, 65 [54-74] years; 37 females [23.4%]) or AL (97 patients [38.0%]; median [IQR] age, 66 [57-74] years; 26 females [26.8%]). Patients with AP placement had higher adjusted odds ratio (aOR) of ROSC at any time (aOR, 2.64 [95% CI, 1.50-4.65]), but not significantly different odds of pulses present at ED arrival (1.34 [95% CI, 0.78-2.30]), survival to hospital admission (1.41 [0.82-2.43]), survival to hospital discharge (1.55 [95% CI, 0.83-2.90]), or functional survival at hospital discharge (1.86 [95% CI, 0.98-3.51]). Competing risk analysis found significantly greater cumulative incidence of ROSC among those at risk with initial AP placement compared with AL (subdistribution hazard ratio, 1.81 [95% CI, 1.23-2.67]; P = .003). In this cohort study of patients with OHCA and VF or pVT, AP defibrillator pad placement was associated with higher ROSC compared with AL placement.

FP8.2 - Sustainability Within the Abscess Pathway

Abstract Background Global warming and the current climate crisis remain a threat to global health. It is estimated that 5% of the total carbon footprint of an acute NHS organisation was attributable to general anaesthetic (GA) gases, which contributes to ongoing ozone depletion. Aims To review current practices in managing abscesses and improve sustainability within the abscess pathway in our trust. Methods Retrospective data on all patients who underwent incision and drainages (I&D) between January – July 2022 were collected and analysed. A new abscess pathway was introduced in June 2023 and departmental teaching provided to junior doctors on incision and drainage of abscesses under local anaesthetic (LA). Data on patients who underwent I&D between June – September 2023 were collected and analysed to assess the impact of the new abscess pathway. Results In the first-cycle audit, 162 patients underwent I&D, of which 119 (92%) were done under GA. Of these, 71 (60%) were suitable for LA I&Ds, 91% were admitted for their procedures. The estimated carbon footprint was 4525kg CO2e/year. In the second-cycle audit, 68 patients underwent I&D, of which 37 (76%) were done under GA. Of these, 31 (46%) were suitable for LA I&Ds, 41% were admitted for their procedures. The estimated carbon footprint was 3735kg CO2e/year. Conclusions Following implementation of the new abscess pathway, we reduced the number of patients having general anaesthetic procedures and inpatient admission. This not only improves the sustainability of our practice, but makes treatment and recovery quicker for patients, and has a lower financial burden.

Community-Based Exercise Programs Post Spinal Cord Injury Hospitalization: A Pilot Study for a Randomized, Multicenter, Double-Blind Controlled Setting

This study explores the effectiveness of community-based exercise programs for individuals with spinal cord injury (SCI) following hospital discharge. Given the rising incidence of SCI, particularly in South Korea, and the associated long-term disabilities, the necessity for comprehensive post-discharge rehabilitation is paramount. The study focuses on a pilot randomized multicenter double-blind controlled trial, targeting SCI patients who have completed inpatient rehabilitation and are living in the community. The primary aim is to evaluate the impact of structured exercise programs on physical fitness, functional capacity, and overall recovery. The research introduces the SpinalFit program, a community-based intervention designed to enhance muscle strength, cardiopulmonary endurance, and mobility through a combination of aerobic and resistance training. This program addresses the critical need for safe and effective rehabilitation options outside the hospital setting, utilizing circuit training with resistance bands and body-weight exercises tailored to each participant’s capacity. The study also investigates barriers to physical activity in the community for SCI patients and the potential role of community exercise centers in bridging this gap. Preliminary findings from this pilot trial are expected to provide valuable insights into optimizing exercise regimens for SCI patients, informing future large-scale studies and contributing to improved post-discharge rehabilitation strategies.

Predictors of effective kangaroo mother care, exclusive breastfeeding, and skin-to-skin contact among low birthweight newborns in Amhara, Ethiopia.

Globally, 20% of all newborns are born with low birth weight (LBW). There is, therefore, an urgent need to expedite the delivery of high-impact, evidenced-based, and low-cost interventions such as kangaroo mother care (KMC (defined as continuous skin-to-skin care) and exclusive breastfeeding for this vulnerable group. A multinational World Health Organization (WHO)-supported consortium created and tested the impact of locally-specific and globally-informed phases of KMC care on KMC uptake/scale-up across multiple sites. Here we report on the study of KMC predictors that is nested within Amhara's KMC implementation trial in Amhara, Ethiopia. We used multivariate logistic regression phases to identify diverse predictors of KMC, skin-to-skin contact, and exclusive breastfeeding at hospital discharge and day 28 of life. We analysed data from 860 LBW newborns. At day 28, implementation period (adjusted odds ratio (aOR) = 3.2-5.0), hospital facility (aOR = 3.0-4.6), and having multiple births (aOR = 0.31) were the strongest predictors of effective KMC. Meanwhile, previous death of a newborn, type of health facility where delivery occurred, and previous LBW delivery were predictors of effective KMC at both time points. No single factor predicted KMC, skin-to-skin contact, and exclusive breastfeeding at all time points and across all implementation periods. Having multiple births was a negative predictor for skin-to-skin contact, while the implementation period and having older fathers (>29 years) were strong positive predictors for exclusive breastfeeding at both discharge and day 28. Mothers with a previous history of neonatal death and current skin-to-skin-care uptake strongly predicted exclusive breastfeeding uptake at both time points. At discharge, however, having a history of preterm birth and neonatal death strongly predicted exclusive breastfeeding uptake, while multiple current births, current very LBW newborns, and the use of standard binders decreased the likelihood of exclusive breastfeeding. To achieve the effective KMC coverage target of ≥80% in Ethiopia, KMC scale-up phases may have to consider the key predictors of KMC, EBF, and SSC to effectively target beneficiaries.

Association between late pregnancy prehypertension and adverse outcomes among newborns of women delivered at a tertiary hospital in Eastern Uganda: a prospective cohort study

BackgroundPrehypertension during pregnancy is currently not considered as a high-risk pregnancy state in existing guidelines despite recent research correlating it with higher rates of morbidity and mortality in both the mother and the fetus. Studies on prehypertension have not been conducted in Africa despite high rates of poor neonatal outcomes.AimsThe study aimed to determine the association between late pregnancy prehypertension and adverse outcomes in newborns of women with late pregnancy prehypertension at Jinja Regional Referral Hospital.Methods and materialsBetween September 2022 and January 2023, a hospital-based prospective cohort study including 300 pregnant women was conducted. Participants were divided according to third-trimester blood pressure, as determined by the JNC-8 criteria. Following hospital admission for labor and delivery, 150 normotensive women and 150 prehypertensive women were identified and followed until delivery, and their neonates were followed until death or hospital discharge. A p value of ≤ 0.05 was the threshold for statistical significance when comparing the groups using the relative risk, X2, and Mantel-Haenszel adjustment.ResultsComposite adverse neonatal outcomes were more common in prehypertensive women compared to normotensive women (48.67% versus 32.67%), particularly Small-for-Gestation Age (SGA), stillbirth, and composite adverse neonatal outcomes had significantly higher likelihood, with aRRs of 1.63 (95% CI 1.10–2.42, p = 0.037), 9.0 (95% CI 1.15–70.16, p = 0.010), and 1.55 (95% CI 1.16–2.08, p < 0.001), respectively. By a linear model, birthweight decreased by 45.1 g for every 10 mmHg rise in systolic blood pressure (p = 0.041, Pearson correlation of -0.118).Conclusion and recommendationsPrehypertension in late pregnancy increased risks for adverse neonatal outcomes, thus a need to potentially lower pregnancy hypertension cut-off levels possibly through adopting the ACC/AHA blood pressure definitions for pregnant women.

Impact of Capacity Strain on the Health Status of Patients Discharged From an Intensive Care Unit

Intensive care units (ICUs) play a vital role in hospitals and often experience capacity strain. Using data from a large teaching hospital, we empirically examine the effect of ICU capacity strain on patient discharge. We find that capacity strain has no effect on the health status of discharged patients and that capacity strain leads to a shorter length-of-stay in the ICU, but the magnitude of the effect is less than half a day in the most extreme scenarios. In post-hoc analyses, we find evidence the discharge process is expedited by starting discharges earlier in the day when capacity is strained, demonstrating that more efficient discharges can free up space without compromising patient health. In addition, we find a decrease in patient admissions during periods of capacity strain. To our knowledge, this is the first study to examine the direct relationship between ICU capacity strain and patient health at discharge, and it builds on the existing literature that has examined the effects of ICU capacity strain on proxies for patient health at discharge. We advocate that hospitals use outcome measures based on patient status at discharge to accurately assess the impact of capacity strain on quality of care. In addition, our work highlights the need for tailored research approaches and management practices for different types of ICUs, as generalizing the impact of ICU capacity strain across different settings may lead to inaccuracies.

SP2.6 - Improvements in patient discharge efficiency and safety: the impact of a dedicated Clinical Pharmacist in an Emergency General Surgery team

Abstract Introduction Efficiency in management of acute surgical admissions is related to safe clinical practice combined with good patient flow, optimising use of limited capacity. Preventable morbidity and discharge delays may significantly compromise outcomes for Emergency General Surgery (EGS) teams managing increasing numbers of admissions. Aim To investigate the effectiveness of a prescribing pharmacist employed within an EGS team in a DGH, with specific focus on patient discharge times by facilitating discharge prescription efficiency, including venous thromboembolism (VTE) prophylaxis. Methods Data was collected for two separate 1-month time periods in 2021 (Period A), before the appointment of a pharmacist and in 2023 (Period B), after pharmacist appointment. Data was analysed for (i) differences in times related to ‘to take home’ (TTH) medication prescription and (ii) prescribing of post-operative extended enoxaparin prophylaxis (EEP) following discharge. Results Mean time for prescription of TTH medications during working hours in Period A was 100 minutes (n=133, range 0-433 minutes) compared with 67 minutes (n=120, range 0-416 minutes) in Period B. Pharmacist prescribing accounted for 51.6% of TTH prescriptions with a mean prescription time of 18.6 minutes (range 0-389 minutes). During Period A, 36% of patients (n=48) who had a VTE assessment mandating EEP received this on discharge compared to 100% in Period B (n=31). Conclusions This data highlights an improvement in prescribing of TTH medications since appointment of a dedicated EGS pharmacist. The consequences of such improvements include more rapid patient flow, better patient experience and heightened patient safety by prevention of post-operative VTE through EEP.

FP2.3 - Is the Oakland score a reliable tool for safe discharge in lower gastrointestinal bleed patients?

Abstract Aim There are no NICE guidelines regarding safe discharge of patients with lower gastrointestinal bleeds (LGIB). The aim of this study was to investigate the effectiveness and safety of the Oakland score, as suggested by the British Society of Gastroenterology guidelines, in patients presenting with LGIB at William Harvey hospital. Methods Patients with LGIB who presented to A&amp;E or inpatient referral from January to December 2023 were included in this retrospective study. Data was extracted from patient’s Sunrise documentation. The Oakland score for each patient was calculated. Those with a score of ≤8 were deemed safe for discharge; those with a higher score were deemed unsuitable. Patients’ admission, safe discharges and adverse outcomes, such as representation, blood transfusion, or further intervention, were investigated. The area under the receiver-operating characteristic curve (AUROC) for the Oakland score and adverse outcome was calculated. Results 123 patients were included. A total of 144 presentations to hospital, 29 had an Oakland score ≤8; 17 (58.6%) cases were safely discharged, 8 (27.6%) admitted and 4 (13.8%) represented. 115 had a score &amp;gt;8; 37 (32.2%) were safely discharged, 72 (62.6%) admitted and 41 (35.7%) experienced at least one adverse outcome. The AUROC for safe discharge was 0.84. Conclusion The Oakland score seems to be a safe and reliable tool for identifying LGIB patients who could be safely discharged home without hospital intervention. However, further research is required to assess whether a score &amp;gt;8 could be used as many higher risk patients did not experience adverse outcomes.

Drowning Among Children 1–4 Years of Age in California, 2017–2021

Background and Objectives: Drowning, the leading cause of unintentional injury death among California children less than five years of age, averaged 49 annual fatalities for the years 2010–2021. The California Pool Safety Act aims to reduce fatalities by requiring safety measures around residential pools. This study was designed to analyze annual fatality rates and drowning incidents in California among children 1–4 years of age from 2017–2021. Methods: We identified fatalities, injury hospitalizations, and emergency department (ED) visits from California state vital statistics death data and state hospital and ED discharge data using the EpiCenter California Injury Data Online website. Results: Over the five-year study period, 4,166 drowning incidents were identified: 234 were fatalities, 846 were hospitalizations, and 3,086 were ED visits. The observed difference in fatality rates from 2017 to 2021 failed to achieve statistical significance (P = 0.88). Location-based analysis of the 234 fatal drowning incidents revealed that pools were the most common injury site, accounting for 65% of the cases. Conclusion: Drowning remains the leading cause of unintentional, injury-related death among California children 1–4 years of age, as the annual rate of fatality over the five-year study period did not decline. While the EpiCenter California Injury Data Online website is excellent for analyzing annual rates of drowning incidents among California residents over time, it is limited in providing insight into modifiable risk factors and event circumstances that can further inform prevention. The development of robust integrated fatal and non-fatal local, state, and national systematic data collection systems could aid in moving the needle in decreasing pool fatalities among young children.

Implementation of a Novel Pathway to Integrate Palliative and Oncology Care for Patients With Acute Myeloid Leukemia in a Community Hospital

PURPOSE Historically, patients with hematologic malignancies are referred to palliative care less often and later in the disease trajectory than those with solid tumors. Recent evidence demonstrates the benefit of early, integrated inpatient palliative care (PC) for patients with acute myeloid leukemia (AML) receiving chemotherapy at academic centers. The current study evaluated the feasibility of implementing standardized early palliative care services (PCS) during hospitalization for AML treatment in a community setting. METHODS Starting June 2018, automated consultations for PCS were incorporated into clinical pathways to encourage early, integrated services for patients receiving chemotherapy for AML with an expected hospital stay of 4-6 weeks. Expectations were established that consultations would be performed within 72 hours of request; patients would have two visits per week by a palliative care clinician and at least one visit by a member of the interdisciplinary team. To measure the feasibility of this intervention, data on number of patients who received palliative care consultation and time to palliative care consultation were compared with institutional historical controls. RESULTS On the basis of retrospective chart review, the postintervention group (n = 21) had greater PCS compared with historical controls (n = 28; 95% v 36%). The average number of PC team member visits per patient was significantly greater after the intervention: PC clinicians (1.04-8.05, P &lt; .001), chaplains (1.3-3.3, P = .0085), and social workers (1.0-4.3, P &lt; .001). Of those patients who received PCS, 74% had their initial palliative medicine consultation within 3 days of a clinician's order and 100% within 4 days. CONCLUSION We have demonstrated the feasibility of implementing standardized integration of PCS for patients with AML hospitalized for treatment in a community setting.

WP2.8 - Patient experience of surgeon-patient communication in general surgery in Northern Ireland: a qualitative analysis

Abstract Aims This project explores the patient experience and perception of surgeon-patient communication in general surgery in Northern Ireland. Through qualitative analysis of patient feedback, this project aims to identify pertinent aspects of communication that significantly impact the patient experience within the context of inpatient surgical care, and compare this to existing literary consensus. Methods Patient feedback data was collected from Care Opinion, accessed at https://www.careopinion.org.uk. Search parameters included stories about general surgery and communication, spanning a period of twelve months, submitted from the five health and social care trusts in Northern Ireland. 121 of 178 search returns met the inclusion criteria for analysis. Braun and Clarke’s Thematic Analysis framework was selected for coding data and identifying themes and understand participant experiences within the data set. Results Three themes emerged from analysis of patient feedback. These themes were the aspects of patient-doctor communication that were valued most by patients during admission. They include the pitch at which information is delivered, the frequency of updates patients were given regarding their care, and provision of question and answer opportunity with their surgeon. Conclusions The important discovery from this analysis is that contemporary literary knowledge does not fully represent the patient experience of doctor-patient communication in Northern Ireland. Instead, analysis of patient feedback has identified new aspects of communication that most impact patient experience, and has yielded new means of understanding and achieving patient-centred practice.

Balancing barriers and strategies - Nurses' experiences of conducting lifestyle counseling.

Over 70% of the disease burden in Europe is the result of chronic diseases caused by lifestyle. Lifestyle counseling can improve lifestyle habits and thereby health. However, according to research, there are several barriers to healthcare personnel carrying out counseling. The aim of this study was to explore nurses' experiences of conducting lifestyle counseling. A qualitative descriptive study was conducted in southern Sweden between August 2021 and December 2021. Eleven nurses were recruited from both inpatient and outpatient care in northeastern Sweden through a combination of purposive and snowball sampling. Individual semistructured interviews were performed digitally using an interview guide. The interviews were analyzed via qualitative content analysis. The nurses experienced several challenges in performing lifestyle counseling. However, knowledge gaps, sensitive topics, organizational dynamics, and time constraints were balanced using strategies. The theme of their responses can be explained by the following categories: "Collaboration with patients is key," "From self-interest to teamwork," and "The organization can assist or hinder." Lifestyle counseling needs to be prioritized within healthcare. Nurses need tools and knowledge to be able to feel comfortable with the task. All healthcare organizations need to work with lifestyle counseling in a structured way according to national guidelines.

EP232 - Delayed Discharges – How do we compare post pandemic?

Abstract Aims A delayed discharge is when a patient is declared medically fit for discharge (MFFD), yet still requiring an inpatient bed as other circumstances prevent leaving the hospital. This 2nd cycle audit was to assess the proportion of inpatients that are MFFD in comparison to the previous data collected in 2019, assessing level of improvement, implications of cost on the NHS and reasons for delayed discharge. Methodology The data was collected on the 27th of February 2023 encompassing 17 different wards in the hospital, compared to the 1st cycle on 26th February 2019. Analysis covered; Specialty, Age, Reason for the delay, Gender and Number of Days delayed. The number of inpatients on the day (n=432), of which 78 were MFFD (18%). The procurement team provided a figure of £392 for cost per bed per night. Results Findings showed approximately 1 in 5.5 patients had a delayed discharged in 2023 in comparison to that of 1 in 4 patients as seen in 2019. With estimated costs incurred being approximately £31,000 on the day cost in the 2nd cycle in comparison to £27,000 in the 1st cycle. The Audit highlighted the most common reason for delay in discharge was Completion of Assessment (Occupational Therapy/Physiotherapy/Social Worker) and Further Non-Acute NHS Care. Conclusion Even though there was considerable improvement in the number of people experiencing a delayed discharge, the estimated costing was still appreciably higher. To improve financial sustainability taking advantage of Government funding would see £200milion put towards the safe discharge of patients.

Nasal hemorrhage - risk factors and management in 707 outpatient and inpatient patients

Epistaxis is one of the most common emergencies in otorhinolaryngology. The spectrum ranges from mild, self-limiting cases to life-threatening hemorrhages. Depending on the severity and course of the condition, management can be either outpatient or involve inpatient monitoring, possibly with surgical treatment.A retrospective systematic evaluation was conducted on all outpatient and inpatient patient data diagnosed with epistaxis from January to December 2021. Epistaxis associated with tumors, trauma, and postoperative epistaxis were excluded.A total of 707 patients were included. Seasonally, the highest number of patients presented in January. Outpatient management was possible for 80.8% of the cases, while 19.2% required inpatient admission. Among the inpatients, 15.4% required surgical intervention. Within the entire study cohort, 61.1% of the patients were male. Among the inpatients who underwent surgical treatment, the proportion of male patients was even higher (81.0%). The majority (73.1%) of the inpatients were on at least one anticoagulant medication. Advanced age (p=0.044) and the presence of posterior epistaxis (p<0.001) were significantly associated with the need for inpatient treatment. No children required inpatient care.Epistaxis is a common condition in otorhinolaryngology, predominantly affecting older male patients and those on anticoagulant therapy in severe cases within the studied cohort. Surgical intervention under general anesthesia was infrequently necessary for the treatment of epistaxis in the overall study population (3%).

WP3.14 - A Single Unit Service Review in Northern Ireland: The Ever-increasing Acute Surgical Take and the Need for Service Adaptation

Abstract Aims Referrals to the on-call general surgeons in the unit has increased significantly over the past year. Staff levels and hospital resources have not changed to reflect this increasing demand on the service. Our aim is to evaluate the increase in numbers and develop a strategic plan for resolution. Methods A database of referrals to the on-call surgical team was developed using the daily handover records. Two periods of data collection were undertaken, each lasting a duration of 30 days, taking place approximately one year apart. Patient demographics and clinical information was gathered using our electronic care record and electronic notes record. Data gathered included diagnosis, treatment, investigations, interventions, length of stay, suitability for ambulation and follow up. Results The total number of patients referred to the on-call team during cycle one was 233, compared with 405 in cycle two; this is a 74% increase in referrals. During the windows of data collection, 75% of patients with an unscheduled admission did not undergo any intervention and 80% were deemed suitable for ambulation. Conclusion Increasing demands on the NHS require a forward-thinking approach to how we provide an acute surgical service. This study demonstrates that a large proportion of patients are suitable for an ambulatory model of care and development of this service would be a valuable adjunct to the unit. To propose an ambulatory service providing urgent surgical assessment would be an asset to the Trust; potential outcomes would include improving the patient experience, reducing inpatient admissions and bed days, with the associated cost-saving.

ThP6.6 - Enhancing Management Strategies: Exploring the Expansion of Low-Risk Criteria in Glasgow-Blatchford Scoring for Acute Upper Gastrointestinal Bleeding – A Retrospective Cohort Study

Abstract Aims Glasgow-Blatchford Scoring (GBS) determines the need for further interventions in patients presenting with acute upper gastrointestinal bleeding (AUGIB). We aimed to study whether we can safely expand low-risk criteria to patients with GBS 2 and manage them as urgent outpatient. Methods A retrospective study of consecutive adult patients who had inpatient endoscopy for AUGIB in a single surgical unit from September 2021 to September 2022. Patient demographics, clinical and laboratory findings, GBS and endoscopic findings was analysed. Low-risk was defined as GBS 0-1 and high-risk as GBS ≥3. Results 150 patients were identified; 79 (58.7%) were male and median age of 63 years (IQR 53-76). Median total length-of-stay was 3.7 days (IQR 1.9=7.8). Similar to the low-risk group, patients with GBS 2 presented with lower range and frequency of symptoms as the high-risk group (p=0.0002). Severity correlated with admission haemoglobin (p=0.001) and urea count (p&amp;lt;0.0001) but not relevant comorbidities (p=0.560) and admission observations (p=0.456). The frequency of benign endoscopic findings in patients with GBS 2 were similar to the low-risk group with no malignant findings noted. This group also had similar rates of past and re-attendances for AUGIB and 30-day mortality of 0% to the low-risk group. Conclusion While our study has a small sample size, it suggests promising prospect that patients with GBS 2 may not need inpatient endoscopy. Future multi-centre studies are crucial to validate and strengthen this proposition. The potential advantages include decreased inpatient admissions, reduced healthcare costs, and alleviating pressures on emergency endoscopy unit.

EP51 - Uses of pharmaceutical and mechanical VTE prophylaxis - A clinical audit

Abstract Aim Venous thromboembolism (VTE) is a serious global health care safety concern for both patients and staff. Although it has been amply demonstrated that pharmaceutical and mechanical methods of prophylaxis against VTE are effective, their application has been uneven and insufficient. The purpose of this audit was to assess junior physicians working in general surgery, regarding their adherence to local and NICE guidelines regarding the pharmacological VTE prophylaxis practice as well as the mechanical prophylaxis Methodology Pre-intervention audit took place for two weeks. Throughout the course, it covered every adult general surgical emergency inpatient admission at conquest hospital who were deemed indicated for VTE prophylaxis. Each evening while the patients were still in the hospital, data was collected using the prescription charts, nursing and medical notes. The proforma used for data collection detailed the characteristics of VTE risk, the prophylactic medication prescribed for each patient, TED stockings and whether or not this aligned with the NICE clinical guideline (CG) 46,6.8. Post intervention took place for two weeks after teaching of junior doctors and the same as above was carried out, using the new proforma Results Pre-intervention showed that 87% of patients had the proforma filled in and 100% of patients received the appropriate dose of pharmaceutical prophylaxis. However, less than 40% of patients received the appropriate mechanical prophylaxis. Therefore, intervention was made in the form of a new proforma and teaching to junior. Post intervention data is currently being carried out Conclusion Implementation was necessary to ensure that at-risk patients receive appropriate prophylaxis.

EP502 - Outcome of 5 years of endoscopic oesophageal stenting: a retrospective analysis

Abstract Background Oesophageal endoscopic stenting has a wide range of indications however dysphagia and use in cancer of the oesophagus is by far the most common, being the 14th most common cancer in the UK, despite advances in diagnosis and therapy with patients often presenting at advanced stages of the disease. Greater than 50% of presentations are at an advanced stage of disease where resection is often not possible and palliation is required. Palliation often is a potential combination of palliative chemotherapy, radiotherapy and endoscopic stenting to control the disease burden and improve symptoms. One of the most limiting palliative symptoms is dysphagia for which oesophageal stenting has become the standard of treatment showing immediate results. However, intra/post procedural complication rates can be high leading to: oesophageal perforation, mediastinitis, aspiration pneumonia, failed stent insertion or slippage. Method A retrospective analysis of 97 patients who underwent oesophageal stenting, in a 5 year time period between 2018-2023 in the Dumfries Royal Infirmary, a large district general hospital. Patients electronic notes were retrospectively analysed for patient characteristics, indication for stenting, early complications, successful hospital discharge and mortality. Conclusion The retrospective study demonstrated oesophageal stenting is a relatively safe procedure with a low mortality and the majority of patients being discharged from hospital. However, complications are not uncommon and patients should be properly counselled; on the risks, benefits and also food habits to prevent bolus.

Pregnant Women Presenting to Psychiatric Emergency Services: A Retrospective Chart Review from India

Background: Managing psychiatric emergencies during pregnancy is often challenging, as the safety of both the mother and the unborn fetus needs to be considered. This study aimed to examine the nature of psychiatric emergencies in pregnancy, their management, and clinical outcomes in women presenting to a psychiatry emergency room (ER). Methods: Charts of perinatal women consulting psychiatry ER between January 2016 and June 2021 were reviewed for the nature of the psychiatric emergency, pregnancy details, psychiatric symptoms, sociodemographic information, medical comorbidities, clinical diagnosis, and care plan. Results: Among 286 perinatal women who attended psychiatry ER, 57 (19.9%) patients were pregnant. Over half ( n = 30, 52.6%) women were multiparous and in their second trimester ( n = 29, 50.9%). Bipolar disorder ( n = 22, 38.6%) was the most common diagnosis. Agitation/aggression ( n = 34, 59.6%) was the most common reason for visiting ER, with risk of self-harm ( n = 14, 24.6%) and risk of harm to the fetus ( n = 7, 12.3%) being other reasons. Emergency psychotropic medications were used in 32 (56.1%) women, with the use of haloperidol in combination with promethazine ( n = 12, 37.5%) or lorazepam ( n = 8, 25%) being the most common. Conclusion: One-fifth of women in the perinatal period presenting to the ER were pregnant. Agitation and aggression were the most common reasons. Parenteral medications were commonly used, and more than a fifth required inpatient care, emphasizing the seriousness of risk.

SAME day amBulatory c (SAMBA): a multicenter, prospective, randomized clinical trial protocol

BackgroundA recent meta-analysis concluded that outpatient appendectomy appears feasible and safe, but there is a lack of high-quality evidence and a randomized trial is needed. The aim of this trial is to demonstrate that outpatient appendectomy is non-inferior to conventional inpatient appendectomy in terms of overall morbi-mortality on the 30th postoperative day (D30).MethodsSAMBA is a prospective, randomized, controlled, multicenter non-inferiority trial. We will include 1400 patients admitted to 15 French hospitals between January 2023 and June 2025. Inclusion criteria are patients aged between 15 and 74 years presenting acute uncomplicated appendicitis suitable to be operated by laparoscopy.Patients will be randomized to receive outpatient care (day-surgery) or conventional inpatient care with overnight hospitalization in the surgery department. The primary outcome is postoperative morbi-mortality at D30. Secondary outcomes include time from diagnosis to appendectomy, length of total hospital stay, re-hospitalization, interventional radiology, re-interventions until D30, conversion from outpatient to inpatient, and quality of life and patient satisfaction using validated questionnaires.DiscussionThe SAMBA trial tests the hypothesis that outpatient surgery (i.e., without an overnight hospital stay) of uncomplicated acute appendicitis is a feasible and reliable procedure in establishments with a technical platform able to support this management strategy.Trial registrationClinicalTrials.gov NCT05691348. Registered on 20 January 2023.