Surgical Outpatient Clinic Research Articles

Knowledge, Perception and Satisfaction with the Quality of Care among Medical and Surgical Outpatient Clinics Attendees in a Nigerian Tertiary Hospital

Introduction: Improving the quality of healthcare remains a critical need in developing countries. Donabedian’s quality of care model provides a framework to evaluate healthcare outcomes, with patient satisfaction being a key indicator. Understanding patients' perceptions, knowledge, and satisfaction is essential for enhancing healthcare delivery. Objective: This study aimed to assess patients' perceptions, knowledge, and satisfaction with the quality of care provided at a tertiary hospital in Ibadan, Nigeria. Method: A total of 401 individuals were recruited, and data was collected using a self-administered questionnaire. Data were coded, cleaned, and analyzed using SPSS version 20. Descriptive statistics were summarized in frequency tables and figures, while Chi-square tests were used to test hypotheses at a significance level of p<0.05. Result: Out of 350 valid responses, 86% of respondents demonstrated substantial knowledge about the quality of care. However, 57.1% expressed dissatisfaction with the treatment received, while 56.6% maintained a positive perception of the hospital’s services. A significant relationship was found between knowledge of healthcare quality and perception (χ2 = 11.1, df = 1, p<0.05). On the other hand, the duration of hospital stay did not significantly affect overall satisfaction (χ2 = 0.69, df = 2, p = 0.708). Conclusion: The findings highlight the need to enhance patient satisfaction in healthcare services. Periodic investigations into patient perspectives are essential for informed decision-making and continuous quality improvement in healthcare delivery.

A review of emergency laparoscopic cholecystectomies in Far North Queensland.

Access to laparoscopic cholecystectomy is more limited for remote communities and Indigenous patients internationally. To date, studies exploring the incidence of gallstone disease and access to laparoscopic cholecystectomy in Australian regional communities are limited. This study examined the rates and outcomes of emergency laparoscopic cholecystectomy (EMLC) in Far North Queensland, specifically in Indigenous and remote populations. We retrospectively examined all patients who underwent an EMLC at Cairns Hospital between 2016 and 2021. Over the study period, 634 EMLCs were undertaken. The average annual rate of 56 cases per 100 000 was considerably lower than national estimates. However, rates of EMLC were significantly higher in remote communities and Indigenous patients compared with the remaining cohort. Patients from remote communities were more likely to have pre-existing gallstone disease but were less likely to have been seen in a surgical outpatient clinic prior to admission. Despite this, surgical outcomes for EMLC were comparable to national and international standards. This study highlights the challenges in surgical healthcare provision for gallstone disease in a regional centre. The requirement for EMLC disproportionately effects geographically isolated communities and Australian Indigenous people. Addressing the healthcare barriers to management of GD in regional Australia should be a priority.

The Creation of a Free Outpatient Surgical Clinic: A Descriptive Report

Student run free clinics (SRFCs) are continuing to grow in scope and number given the significant benefits to both learners and disadvantaged patients. Despite recent growth, very few provide any form of surgical services. In order to address inequalities in patient access to care and clinical outcomes, it is imperative to include disadvantaged surgical patients, including in the settings of SRFCs. The Kansas City based chapter of Socially Responsible Surgery (SRS) opened a free, volunteer based, student and resident run outpatient surgical clinic. In this article we describe detailed steps to the establishment of the SRS Clinic to lay the framework for other SRFCs or chapters of SRS to continue to grow the number of free clinics able to provide surgical services.

Development and evaluation of a one-stop surgical outpatient clinic to tackle waiting lists

Background/Aims The COVID-19 pandemic caused substantial disruption to elective surgery, with NHS trusts still trying to work through their backlogs and reduce waiting lists. This study aimed to design, implement and evaluate a novel one-stop general surgical outpatient clinic to tackle long waiting lists post COVID-19. Methods General surgical outpatient clinics were held on 6 days between April and October 2021. The impact of these clinics was retrospectively measured using data collected from the trust's electronic database on the length of waiting lists, number of weeks before appointment and financial expenditure associated with the project. Results There were 1440 fewer patients on the outpatient waiting list after the clinics were implemented compared to before, with a 100% reduction in the number of patients waiting longer than 52 weeks for an appointment. Across the six clinic days, 93.7% of available slots were booked and patients attended 90.5% of booked slots. A net financial benefit of £128 700 was calculated. Conclusions Lessons from this project could be applied in other specialties and NHS trusts to tackle waiting lists and outpatient clinic backlog post COVID-19.

Determining the role of remote consultations in general surgical practice in Scotland: a qualitative questionnaire-based study

INTRODUCTION Telemedicine consultations became widespread during the COVID-19 pandemic to deliver healthcare while minimising viral transmission. Research around establishing the role of remote appointments in general surgery outpatient clinics after the pandemic has not been undertaken. The aim of this study was to investigate views on remote consultations to determine this. METHODS Patients attending the adult general surgical outpatient clinic at Aberdeen Royal Infirmary between August 2021 and January 2022 as well as general surgeons from three neighbouring hospitals were invited to complete an anonymous questionnaire on the acceptability of remote and face-to-face (F2F) appointments in pre and postoperative scenarios. Differences in patients’ preferences between demographic groups, and between patients’ and surgeons’ views were analysed. RESULTS A total of 51 patients and 26 surgeons responded. Patients’ views differed depending on demographic parameters and the scenario. Patients and surgeons had similar views on preoperative consultations. Given the choice of telephone, video or F2F appointments, the F2F option was overall most popular. Patients and surgeons differed in their views on remote consultations following surgery and acute admissions. In some scenarios, young patients, those who lived in remote regions and those in employment/education preferred remote appointments. CONCLUSIONS While telemedicine is feasible and acceptable in general surgery clinics, there are differences in preferences between surgeons and patients. Patients’ preferences varied depending on their background, home circumstances and clinical context. Service provision should ensure that when remote consultations are available, patient preference is prioritised rather than surgeon ease.

WP3.5 - Laparoscopic cholecystectomy: analysis of indications, time to surgery (TTS) and complications

Abstract Aims Our aims are to establish whether current waiting times for cholecystectomy in our local trust between 01/2021 and 01/2022 are in line with NICE guidelines and compare with average national waiting times. We aim to establish the indications for cholecystectomy (CBD stones, cholecystitis, biliary colic, pancreatitis) and compare waiting times and readmission rates during the waiting period; estimate the rate of conversion to open/subtotal cholecystectomy and any subsequent complications. Methods Data collection and analysis for the period of 01/2021 – 01/2022: average waiting times, rate of conversion, indications, complications. Results 269 patients were analysed after exclusions. Of these, mean waiting time from booking to TTS for uncomplicated biliary colic was 63.26 days. The median TTS from booking was 14 days for hot gallbladders. Of patients diagnosed as biliary colic, the TTS following an acute hospital admission was 63.26 days. Similarly, the patients referred via GP to the outpatient surgical clinic for the same diagnosis was 78.88 days. 5 patients who were referred routinely via GP to the outpatient surgical clinic had complications requiring an acute surgical admission during the waiting period. The rate of conversion to open was 0% during the 1-year period. 2 patients had subtotal cholecystectomies, one of which had persistent bile leak managed with drains and subsequent ERCP. Conclusion The median TTS for hot gallbladder is in line with national standard. There is a tendency to opt for subtotal cholecystectomy as bail out as compared to the previous years.

Urgency an important factor when assessing fecal incontinence

The aim of this study was to investigate if Low Anterior Resection Syndrome (LARS) score contributed with complementary information to Wexner score when assessing fecal incontinence (FI). The hypothesis was that LARS score would be likely to provide complementary information to Wexner score in the assessment of FI regardless of etiology. LARS score has been used as a complement to traditional scoring systems to assess bowel dysfunction, targeting FI among patients after radical cystectomy, in women with endometriosis, and in colorectal cancer patients. Wexner score as a single tool does not address the complexity of FI and urgency, a disabling symptom. A retrospective cohort study at a surgical outpatient clinic included patients diagnosed with FI who answered LARS and Wexner scores questionnaires at their first visit to the clinic between 1st January 2015 and 31st December 2018. Kendall’s tau, Spearman rank correlation, Cohen’s kappa, and scatterplots were analyzed for participants and specific subgroups to assess any correlation and agreement between answers to the two scoring systems. One hundred nineteen patients met the inclusion criteria, one hundred eight women and eleven men. Kendall’s tau ranged from 0.32 to 0.39, indicating lack of correlation. Correlation coefficients using Spearman rank ranged from 0.36 to 0.55, i.e., only fair to moderate correlation. Kappa was 0.21–0.28, i.e., only slight to fair agreement. Distribution of LARS and Wexner scores in the scatterplot showed wide variability and lack of agreement. Combined use of both the Wexner and LARS scores provided complimentary information, and thus a more complete mapping of FI as well as taking all entities in consideration.

Glomus tumor of gastric antrum: A rare differential

Introduction: Gastric glomus tumor is a rare clinical entity. Surgical excision could be avoided in selected patients if the diagnosis of glomus tumor could be made preoperatively. Cross-sectional imaging and endoscopic ultrasound (EUS) provide vital clues to nudge us in the right direction; however, these are inconclusive. Histopathology remains the gold standard for diagnosis of this condition. Case Report: We report a case of a man in his 60s who presented to the surgical outpatient clinic with long-standing history of abdominal bloating and discomfort. Upper gastrointestinal endoscopy revealed a submucosal lesion, and contrast-enhanced computed tomography (CECT) of the abdomen revealed a homogeneously enhancing lesion in the antrum of the stomach. Following successful surgical excision, histopathological examination established the diagnosis of gastric glomus tumor. This case presentation elaborates on the clinical features of this rare clinical entity and the various options available for diagnosis and management. Conclusion: Glomus tumors are rare mesenchymal tumors that need to be differentiated from other submucosal lesions and should be considered as a differential for submucosal lesions in the distal stomach. Endoscopic ultrasound and CT findings may provide clues to guide us toward the diagnosis; however, diagnosis can be confirmed only with histopathology. Surgical excision with negative margins either by laparoscopic or open operation is the treatment of choice.

The safety and efficacy of ambulatory urologic surgery A paradigm shift towards optimizing resource use in outpatient settings.

Amid substantial surgical wait lists, novel methods are needed to improve the delivery of surgical care in Canada. One strategy involves shifting select surgeries from hospitals into community ambulatory centers, which expedite procedures and allow hospitals to prioritize critical and complex patients. We sought to evaluate surgical outcomes at a novel, Canadian urologic clinic and surgical center. A retrospective study was conducted at a novel, accredited surgical facility and outpatient ambulatory clinic from August 2022 to August 2023. Procedures ranged from scrotal and transurethral surgeries to inflatable penile prosthesis insertion. Traditional outpatient procedures, including vasectomy and cystoscopy, were excluded. All patients were discharged the same day and seen 4-6 weeks post-procedure. Variables of interest included surgery type, anesthesia administered, additional clinic appointments, unplanned family physician appointments, visits to the emergency department (ED), and hospital admissions. In a 12-month period, 519 surgeries were performed. The mean patient age was 49.6±17.3 years, with most classified as American Society of Anesthesiologists (ASA) 1-2 (88.8%). Most (95.8%, n=497) patients did not require medical care outside the clinic before their scheduled followup; 2.5% (n=13) visited the ED presenting for wound concerns, postoperative pain, query infection, or catheter-related concerns. Only 1.7% (n=9) required an unscheduled appointment with their family physician, with concerns being inadequate postoperative pain management (n=4) or suspected infection (n=4). No patient required hospital admission. Many urologic surgeries classically performed in hospital operating rooms can be safely performed in a non-hospital, outpatient surgical facility with preservation of good outcomes. This strategy can potentially improve the efficiency of urologic healthcare delivery in select patients.

Profiles of Cancer Patients at Surgical Oncology Outpatient Clinic at Dharmais Cancer Hospital as National Referral Hospital in Indonesia from 2017 to 2021

Profiles of Cancer Patients at Surgical Oncology Outpatient Clinic at Dharmais Cancer Hospital as National Referral Hospital in Indonesia from 2017 to 2021

Outcomes following inguinal and subinguinal urologic procedures under deep intravenous sedation.

We aimed to investigate the surgical outcomes following inguinal and subinguinal urologic procedures under deep intravenous sedation (DIVS) with multimodal local anesthesia (LA). We conducted a retrospective cohort study from September 2022 to December 2023 including adult patients deemed eligible for day surgery (American Society of Anesthesiologist score 1-3) undergoing radical orchiectomy (RO), microscopic varicocelectomy (MV), or microscopic denervation of the spermatic cord (MDSC). All procedures were performed at a single urologic ambulatory surgical center and outpatient clinic, and by a single surgeon (PP). Procedures were performed through a subinguinal or inguinal approach with DIVS and adjunctive multimodal LA. We evaluated intraoperative complications and relevant surgical outcomes and parameters. A total of 103 patients were included in the analysis with a mean age ± standard deviation of 37.3±9.6. This included 25 patients who underwent RO, 54 patients who underwent MV, and 24 patients who underwent MDSC. All procedures were completed successfully without intraoperative complications. Oncologic outcomes were preserved, fertility outcomes improved, and pain scores reduced similarly to the expected rates in the literature. Our preliminary results demonstrate the safety, effectiveness, and feasibility of performing inguinal and subinguinal urologic procedures under DIVS with LA. These findings suggest that this technique preserves high-quality care while avoiding the unnecessary risks of general or spinal anesthesia, representing an opportunity to transfer these cases outside of hospitals' operating rooms into outpatient ambulatory centers.

Daflon 500mg is used for the treatment of all grades of hemorrhoids

Background: Hemorrhoidal diseases are very common diseases found in surgical outpatient clinics, affecting populations all over the world. Treatments for the different grades of hemorrhoids include lifestyle changes, conservative medical therapy, and operative interventions. Objective: To assess the conservative treatment response of all grades of hemorrhoidal disease (grades 1-4) to a venotonic agent (Daflon 500mg). Patients and Methods: This is a prospective observational study of 196 patients with hemorrhoids, conducted during the period from January 2015 to January 2020, All treated with the standard dose of a venotonic agent (Daflon 500mg). An observation of the reduction and disappearance of the signs and symptoms of the different grades of the disease was done at 1, 3, and 6 months. Results: The mean age of the patients was 46.6 (range 14–85) years. The majority (41.84%) were diagnosed with grade III hemorrhoidal disease and 30.1% with grade II disease; Grade I and Grade IV constitute 9.69% and 18.37%, respectively. excellent improvement observed in about 72.45%, temporary response seen in 15.82% of cases. Conclusion: Daflon 500 mg is an effective first-line conservative treatment for all four grades of hemorrhoidal diseases, including grade 4, which has a 44.74% permanent response rate. This medical treatment, in turn, reduces the chance of surgical intervention and its complications.

Reducing No-Show Appointments in Preanesthesia Screening

PurposePreanesthesia screening is critical to evaluate the patient’s medical and surgical history prior to any procedure or surgery to assess for risks and to optimize outcomes during the perioperative period. Missed appointments impede the ability to identify comorbidities, perform cardiac testing, review laboratory results and current medications. No-shows also result in a waste of clinical resources and impacts the schedules of Advance Practice Providers (APPs). The purpose of this quality improvement project was to decrease the number of missed appointments in the outpatient preanesthesia and surgical screening clinic and the impact on provider satisfaction. DesignThe design of this quality improvement project was pre and post design. Automated and live phone calls reminders were provided for patients scheduled in the outpatient preanesthesia. Data was collected to compare missed appointment rates from a 3-month period prior to the project implementation and a 3-month period afterwards. MethodsPre-data collection included the number of no-shows in the EHR system from the previous 3 months. Participants included all adult patients who are scheduled for a pre-anesthesia surgical screening appointment. Provider satisfaction was assessed using a 5-question survey, pre and post innovation. FindingsReminder systems had a statistically significant impact on reducing the number of no-shows in the preanesthesia and surgical screening clinic (PASS). No significant impact was shown in provider satisfaction. ConclusionImplementation of a reminder system can help to reduce no show rates in clinics. Patient no-shows overload the health system by reducing the productivity of providers and waste resources including use of clinic staff, longer wait times for other patients, and the timing providers put into chart preparation.

Pelvic floor disorders and impact on sexual function: a cross-sectional study among non-sexually active and sexually active women.

Pelvic floor disorders are common and associated with impaired sexual function in women. To assess women with pelvic floor disorders and describe factors associated with not being sexually active and those associated with sexual function in sexually active women. A cross-sectional study was conducted that included nonpregnant women with symptoms of pelvic floor disorders who were referred to the urogynecologic and surgical outpatient clinic at 2 Norwegian university hospitals: St Olavs Hospital, Trondheim University Hospital, and the University Hospital of Northern Norway, Tromsø. Women answered a questionnaire anonymously. Pelvic Organ Prolapse Incontinence Sexual Questionnaire-IUGA Revised. Of 157 respondents, 111 (71%) reported being sexually active (with or without a partner), and 46 (29%) reported not being sexually active. As compared with sexually active women, not sexually active women were older (mean ± SD, 60.2 ± 13.3 vs 51 ± 12.1 years; P < .001), more were menopausal (78% vs 47%, P = .001), and more had symptom debut <1year (31% vs 9%, P < .001). They reported more distress related to pelvic floor disorders, especially pelvic organ prolapse. In a multivariate logistic regression analysis, menopausal women and women with symptom debut <1year were 4 times more likely to be not sexually active than premenopausal women (odds ratio, 4.0; 95% CI, 1.7-9.2) and women with symptom debut ≥1year (odds ratio, 4.0; 95% CI, 1.5-10.7). In sexually active women, colorectal-anal distress was negatively associated with 5 of 6 domains of sexual function: arousal/orgasm (ß = -0.36; 95% CI, -0.02 to -0.005), partner related (ß = -0.28; 95% CI, -0.01 to -0.002), condition specific (ß = -0.39; 95% CI, -0.002 to -0.009), global quality (ß = -0.23; 95% CI, -0.02 to -0.002), and condition impact (ß = -0.34; 95% CI, -0.02 to -0.006). Health care professionals should discuss sexual function in patients with pelvic floor disorders, especially menopausal women and women with colorectal-anal symptoms. The study used condition-specific measures and recruited women from 2 university hospitals with wide range of age. Limitations include the small sample size and wide confidence intervals. The number of women who considered themselves not sexually active was low, and item nonresponse levels among these women where somewhat high. Of 625 eligible women, 200 (32%) answered the questionnaire. Sexual health and sexual function are still surrounded with taboo, and some women were probably not comfortable answering the questions. Menopausal women and women with recent onset of symptoms of pelvic floor disorders are more likely to be sexually inactive, and colorectal-anal symptoms have the most negative impact on sexual function in sexually active women.

Risk Factors for Non-Healing Wounds-A Single-Centre Study.

Background: Chronic wounds present a significant clinical, social, and economic challenge. This study aimed to objectify the risk factors of healing outcomes and the duration of chronic wounds from various etiologies. Methods: Patients treated for non-healing wounds at the surgical outpatient clinic of the Olomouc Military Hospital were involved. Data from patients treated between 8/2021 and 9/2023 were selected. Patients were mostly treated as outpatients, with microbiological follow-up indicated in cases of advanced signs of inflammation. Results: There were 149 patients who met our selection criteria (the mean age was 64.4 years). Predominant causes of wounds involved diabetes (30.9%), post-trauma (25.5%), pressure ulcers (14.8%), surgical site infections (14.8%), and vascular ulcers (14.1%). Patient outcomes included wound resolution in 77.2% of patients (with a mean healing time of 110.9 days), amputation in 14.1%, and wound-related death in 8.7% of patients. Non-healing cases (amputation/death) were predicted by several local factors including an initial depth greater than 1 cm, wound secretion, inflammatory base, and a maximum wound size. Systemic factors included most strongly clinically manifested atherosclerosis and its risk factors. Of the 110 swabs performed, 103 identified at least 1 bacterial genus. The dominant risk factor for a prolonged healing duration was bacterial infection. Wounds contaminated by Proteus or Pseudomonas had prolonged healing times of 87 days (p = 0.02) and 72 days (p = 0.045), respectively. Conclusions: The early identification of local and systemic risk factors contributes to the successful resolution of chronic wounds and a reduced duration of healing.

Sonographic features of sternal pseudotumour in children

AbstractIntroductionSternal pseudotumour is an important but rare entity thought to be an inflammatory, non‐neoplastic lesion that can mimic tumours. The purpose of this paper was to illustrate the imaging features of this lesion to avoid unnecessary investigations.MethodsThe clinical notes and imaging features of four patients with a diagnosis of sternal pseudotumour were reviewed over a period from February 2016 to July 2019.ResultsAll patients were afebrile with no history of trauma. The median age at presentation was 12.5 months. The median length of symptoms prior to presentation was 3.5 days. One patient had a mildly elevated C‐reactive protein. Chest radiographs showed a pre‐sternal soft‐tissue mass, with or without osseous destruction of the subjacent sternum. Ultrasound showed a heterogeneous, hypoechoic pre‐sternal soft‐tissue mass with variable internal vascularity with extension between sternal ossification centres. CT and MRI showed an enhancing dumbbell‐shaped lesion with a pre‐sternal and retro‐sternal soft‐tissue component. The median time to complete resolution was 3 months. One patient had a biopsy that showed chronic inflammation and fibrosis.DiscussionThese lesions present in young children typically with a 1‐ to 2‐week history of a focal 2‐ to 4‐cm swelling over the sternum. The aetiology is unknown but may be on the basis of a yet‐to‐be identified pathogen. Inflammatory markers and cultures are normal or mildly elevated. Important differential considerations include sternal osteomyelitis or neoplastic causes such as Ewing sarcoma, rhabdomyosarcoma, Langerhans cell histiocytosis and infantile fibrosarcoma.ConclusionSternal pseudotumor is a rare but important entity to be aware of to avoid unnecessary invasive biopsy or further investigations. Our suggestion is that this is a ‘Don't touch’ lesion that requires close short‐interval follow‐up at a surgical outpatient clinic and with ultrasound until resolution.

Tackling efficiency in a high demand orthopaedic clinic.

Surgical outpatient clinics continuously face challenges in delivering efficient and effective care. An expanding population and chronic staff shortages makes sustainability critical. The primary objective of this study was to identify modifiable factors contributing to longer wait times in an orthopaedic outpatient clinic. A single-centre prospective observational cohort study was conducted at Western Australia's state trauma centre. Over a four-week period, clinicians completed forms identifying delays in clinic, and clinic numbers were captured through an electronic booking system. Data was analysed using SPSS v27. Face-to-face (FTF) and telehealth (TH) clinic volumes grew by 18.9% and 361.1% respectively between 2018 and 2022. For the study period, 754 forms were completed for attending clinic patients. This captured 42.4% and 96.8% of FTF and TH actual attendance. The average wait time for doctor consultation was 63.9 min. Wait times significantly reduced when x-rays were performed prior to clinic (P < 0.001), and when an unaccredited registrar held the on-call phone (P < 0.001). Trauma clinics ran overtime in 95% of cases compared to elective clinics in which 25% ran overtime. The golden staffing ratio was one doctor for 13 patients. TH experienced few delays related to technological fault. This study demonstrates that clinic volume continues to rise. It highlights the demand for adequate staffing and identifies several modifiable factors that influence clinic efficiency. It demonstrates the growth of TH as an alternative modality for outpatient surgical services and its potential for future expansion.

Physical activity, sleep disorders, and type of work in the prevention of cognitive function decline in patients with hypertension

BackgroundHypertensive patients are likelier to have cognitive function decline (CFD). This study aimed to explore physical activity level, sleep disorders, and type of work that influenced intervention effects on cognitive function decline in hypertensive patients and to establish a decision tree model to analyze their predictive significance on the incidence of CFD in hypertensive patients.MethodsThis cross-sectional study recruited patients with essential hypertension from several hospitals in Shandong Province from May 2022 to December 2022. Subject exclusion criteria included individuals diagnosed with congestive heart failure, valvular heart disease, cardiac surgery, hepatic and renal dysfunction, and malignancy. Recruitment is through multiple channels such as hospital medical and surgical outpatient clinics, wards, and health examination centers. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Moreover, we obtained information on the patients' type of work through a questionnaire and their level of physical activity through the International Physical Activity Questionnaire (IPAQ).ResultsThe logistic regression analysis results indicate that sleep disorder is a significant risk factor for CFD in hypertension patients(OR:1.85, 95%CI:[1.16,2.94]), mental workers(OR:0.12, 95%CI: [0.04,0.37]) and those who perform both manual and mental workers(OR: 0.5, 95%CI: [0.29,0.86]) exhibit protective effects against CFD. Compared to low-intensity, moderate physical activity(OR: 0.53, 95%CI: [0.32,0.87]) and high-intensity physical activity(OR: 0.26, 95%CI: [0.12,0.58]) protects against CFD in hypertension patients. The importance of predictors in the decision tree model was ranked as follows: physical activity level (54%), type of work (27%), and sleep disorders (19%). The area under the ROC curves the decision tree model predicted was 0.72 [95% CI: 0.68 to 0.76].ConclusionModerate and high-intensity physical activity may reduce the risk of developing CFD in hypertensive patients. Sleep disorders is a risk factor for CFD in hypertensive patients. Hypertensive patients who engage in mental work and high-intensity physical activity effectively mitigate the onset of CFD in hypertensive patients.

Referrals to a Surgical Emergency Clinic in a District General Hospital

Abstract Aims The referral pathway for the consultant-led Surgical Emergency Clinic (SEC) at our District General Hospital has no triage process. Anecdotally there are issues with inappropriate patients being booked for this clinic, taking up valuable slots and consultant time, and causing patient dissatisfaction. This was audited to see how the clinic is being utilised. Methods A retrospective case note review spanning 8 months looked at 250 patients seen in SEC. The origin of referrals, reason for referral, investigations, and clinic outcomes were recorded. Using this, patients were classified as ‘appropriate’ or ‘inappropriate’ for SEC. Results Referrals came from the following sources: 158 from general practice, 54 from the emergency department, and 38 directly from the surgical team. 58% were deemed to be appropriate referrals, while the remaining 42% were deemed inappropriate for SEC. 84 patients (33.6%) had imaging performed on the same day as their appointment, while 74 patients (30%) had investigations requested for a later date. 156 (62.4%) patients were discharged, 25 (10%) were redirected to a suitable surgical specialty outpatient clinic, and 16 (6.4%) were referred to other specialties. 10.4% had an acute surgical admission or same day CEPOD theatre, and 8.4% were listed for theatre on an elective/urgent basis. Conclusion This suggests SEC is not being used optimally and highlights a need to restructure the referral process. Physician Associates and Advanced Clinical Practitioners will be trained to assist consultants and triage referrals to improve patient flow, the efficiency of SEC, and hopefully the patient experience.

OGC P13 CNS and Dietitian led clinical follow-up with support from a survivorship multi-disciplinary team meeting: A model of care for patients after oesophago-gastric (OG) cancer surgery

Abstract Background Major upper gastro-intestinal (UGI) cancer surgery in combination with chemotherapy offers the best chance of cure for patients with oesophageal and gastric cancer. However, these treatments have significant long-term side-effects resulting in a high symptom burden in this patient group. This adversely affects quality of life and places significant demands on healthcare after surgery. There is a large variation in follow-up services nationally, with little guidance on optimal practice. Methods A clinical nurse specialist (CNS) and Dietitian led clinic has been utilised in this patient group for 12 years at St Thomas’ hospital, with UGI surgeon support as required. In 2021, a survivorship multi-disciplinary team meeting (MDM) consisting of CNS, Dietitian, Gastroenterologist, UGI surgeon and psychologist was introduced. This aimed to support the clinic by discussing management of complex cases. Results Since 2011, approximately 3000 patient consults have been undertaken in the survivorship clinic. These patients benefited from specialist follow-up, expertise in symptom management, holistic needs assessments, recurrence surveillance and specialist dietetic advice. These patients were removed from surgical and oncology out-patient clinics, creating greater capacity in these services. Patient feedback has consistently supported this model of follow-up. Complex patients are discussed in the survivorship MDM which supports the clinic. Conclusions CNS and Dietitian led clinics, alongside a survivorship MDM, may provide a better model of follow-up compared to traditional surgical clinics by offering a greater breadth of expertise and consistency of follow-up. Evaluation of patient centred outcomes and economic analysis, in addition to on-going national initiatives to standardise the investigation and management of symptoms following major UGI surgery, would support replicating this model in other centres.