Surgical Care Practitioners Research Articles

Debate on: Laparoscopic cholecystectomy performed by a surgical care practitioner: a review of outcomes by Odogwu et al.

Debate on: Laparoscopic cholecystectomy performed by a surgical care practitioner: a review of outcomes by Odogwu et al.

WP8.9 - Laparoscopic Cholecystectomy Performed by a Surgical Care Practitioner: Review of Outcomes

Abstract Introduction Surgical Care Practitioners (SCPs) are non-medical workers involved in various aspects of management of surgical patients. The role includes assisting and performing surgical procedures. Over 60,000 laparoscopic cholecystectomies (LC) are performed annually in the UK. With ever increasing pressure on waiting lists, it is important to look at fully utilising the skills of our entire workforce. We report what we believe is the first published series of LC performed by an SCP. Materials and Methods A retrospective review of a prospectively collected database was performed. Primary outcome was any complication requiring intervention. Secondary outcomes were minor complications, operative time, length of stay, conversion and readmission. Results 170 patients were operated on. Indications were biliary colic in 127 (74.7%), cholecystitis 30 (17.6%) and pancreatitis in 13(7.6%). Mean operating time was 65 minutes (Range 35-152). 53 operations were assisted by a consultant, 110 by a senior SAS grade and 7 by a CT2. 139 (81.7%) patients were discharged on the day of surgery. 24 (14.1%) stayed one night in hospital. There were no major complications. Four patients required readmission. Two with pain and 2 with port site infections. There were no conversions or transfusions required. Conclusion There is a paucity of published data on surgical outcomes of procedures performed by SCPs. With a structured, supervised approach SCPs could be trained to take on more complex procedures and further strengthen the surgical workforce. This study demonstrates that elective LC can be safely performed by an appropriately trained and supervised SCP.

Laparoscopic cholecystectomy performed by a surgical care practitioner: a review of outcomes.

Surgical care practitioners (SCPs) are non-medical workers involved in various aspects of the management of surgical patients. The role includes assisting and performing surgical procedures. More than 60,000 laparoscopic cholecystectomies (LC) are performed annually in the UK. With ever-increasing pressure on waiting lists, it is important to look at fully utilising the skills of our entire workforce. We report what we believe is the first published series of LC performed by an SCP. A retrospective review of a prospectively collected database was performed. The primary outcome was any complication requiring intervention. Secondary outcomes were minor complications, operative time, length of stay, conversion and readmission. In total, 170 patients were operated on. Indications were biliary colic in 127 (74.7%), cholecystitis in 30 (17.6%) and pancreatitis in 13 (7.6%). Mean operating time was 65min (range 35-152min). Fifty-three operations were assisted by a consultant, 110 by a specialist or associate specialist grade (SAS) doctor and 7 by a core trainee (CT2). Some 139 (81.7%) patients were discharged on the day of surgery and 24 (14.1%) stayed one night in hospital. There were no major complications. Five patients required readmission, three with pain and two with port site infections. There were no conversions or transfusions required. There is a paucity of published data on surgical outcomes of procedures performed by SCPs. With a structured, supervised approach, SCPs could be trained to take on more complex procedures and further strengthen the surgical workforce. This study demonstrates that elective LC can be safely performed by an appropriately trained and supervised SCP.

The role of advanced clinical practitioners in general surgery

While advanced clinical practitioners (ACPs) have become increasingly important in the healthcare system, there is a lack of clarity regarding roles, expectations and regulations. This paper examines the current state of ACPs in the UK, highlighting the role of surgical care practitioners and the need for appropriate training, funding and career development opportunities. Furthermore, it emphasises the importance of stakeholders in providing adequate support for ACPs and the need for legislative and regulatory changes to ensure the success of the profession. Finally, it calls on the government and other stakeholders to recognise the role of ACPs in the healthcare system and to develop a national strategy to ensure their continued success.

Advanced non-medical roles within surgery and their engagement with assistive health technologies.

The role of the surgical care practitioner (SCP) is common in UK surgical centres. The SCP curriculum is robust and well developed in multiple specialties since it was first developed in 1989. The SCP role can often concentrate on technical skills, developing a skillset that is highly effective during traditional open surgical procedures. This skillset requires further investigation because technology-assisted surgeries are becoming more common, including the use of novel approaches to developing non-technical skills. To effectively develop this skillset, analysis of robust advanced practice frameworks is necessary, alongside clear alignment to the advanced practitioners' professional regulations. This article examines the interpretation of the advanced practice concept within technology-assisted surgeries, which is potentially guiding the evolution of advanced practice within operating theatres and improving patient care.

The role of surgical care practitioners in the extended surgical team

How do we ensure that surgical care practitioners are supported and developed?

The introduction of a Surgical Care Practitioner training programme to an acute National Health Service trust and an exploration of the interrelationships between Surgical Care Practitioners, their trainers and surgical trainees.

This study aimed to explore the impact of the introduction of a Surgical Care Practitioner programme on junior surgical training within an acute National Health Service trust. A qualitative methodology of semi-structured interviews was used to gather information from eight Surgical Care Practitioners, eight surgical trainees and eight consultant grade trainers. The authors found an overall positive and mutually beneficial outcome of the training programme, with surgical trainees unanimous that the presence of the Surgical Care Practitioners freed them up for more time to be spent in theatre, as well as acting as highly experienced surgical assistants when the trainees were operating on their own. This study found significant mutual benefits to surgical trainees and Surgical Care Practitioners, as well as smoother running of the wards, theatres and the clinical firms through the addition of a highly skilled and versatile Surgical Care Practitioner workforce.

DAY-CASE PARTIAL AND TOTAL KNEE ARTHROPLASTY: A DISTRICT GENERAL HOSPITAL EXPERIENCE

There has been a significant increase in the demand for arthroplasty as a result of the Covid 19 pandemic and lack of beds on the green pathway. The average length of in-hospital stay following knee replacements has been successfully reduced over the years following introduction and adoption of enhanced recovery protocols. Day case arthroplasty has the potential to be efficient as well as cost-effective. We present our day case pathway for elective knee arthroplasty and early results of its adoption at a district general hospital.Our pathway was developed through a multidisciplinary input from surgeons, anaesthetists, physiotherapists, nursing staff, administrative staff, surgical care practitioners and pharmacists. Inclusion criteria were defined to identify patients suitable for cay case arthroplasty. Results of 32 patients who underwent day case partial and total knee replacement at our institution between 2018 to 2022 are presented.31 out of 32 (97%) were discharged safely on the day of surgery. Patients were discharged at a mean of 7 hours following surgery. There were no re-admissions following discharge. There were no surgical complications at a mean follow-up of 2 years. Patient feedback revealed high levels of satisfaction and that they would recommend the pathway to others. Cost analysis revealed savings towards bed costs.Our early results demonstrate day case knee arthroplasty to be safe and cost effective. With limited resources to tackle the enormous backlog of arthroplasty, it offers the potential to make theatre utilization efficient.

O093 The adrenal incidentaloma clinic: a novel and streamlined approach

Abstract Introduction An incidental adrenal nodule is present in 1–3% of abdominal cross-sectional imaging and pose a diagnostic dilemma for the investigating clinician. Adrenal nodules can be functional or pose a cancer risk, hence a complete adrenal hormone profile investigation is necessary. Methods We piloted a streamlined clinic within the endocrine surgery department for assessing adrenal incidentalomas by trained surgical care practitioners. Data was collected retrospectively for patients reviewed from March 2020 to September 2021 to evaluate its efficacy and the completion of investigations. Results 98 new patients were seen, with an average age of 64.97 (±13.91) years. The mean time from referral to review was 37.61 (±26.07) days. The mean nodule size was 21.74 (±9.93) mm (range: 6.00–73.00 mm) and were most commonly identified on CT virtual colonoscopy (28.6%), CT abdomen and pelvis (20.4%) and Trauma CT (10.2%), with over two-thirds of referrals from colorectal services (38.9%) and Emergency Medicine (29.5%). 82.7% of patients had metanephrines tested, 79.6% for aldosterone-renin ratio and 75.5% for overnight dexamethasone suppression test following clinic attendance. 8.6% of patients had raised metanephrines, with 25.6% for aldosterone-renin ratio and 37.8% for overnight dexamethasone suppression test. 27.8% were referred on for further assessment with an adrenal CT. Three patients were operated on, one for phaeochromocytoma and two patients for metastases. Conclusion Preliminary results suggest this clinic provides efficient services with good completion of investigations and follow-up. It offers clinicians unfamiliar with or unable to organise adrenal investigations, a dedicated clinic, to ensure appropriate clinical assessments. Take-home message This dedicated incidentaloma clinic contributes to the effective use of resources in doing hormonal profiling for patients and identification of patients at risk of functional and malignant adrenal disease.

Surgical care practitioners: an audit across the surgical specialties.

The Royal College of Surgeons of England (RCS), when devising their curriculum for surgical care practitioners (SCPs), aimed to provide a level of training to produce a practitioner able to work across the surgical patient's journey, providing care to, arguably, an advanced level. This audit planned to examine the reality of this. SCPs from a closed group, on the Facebook social media platform were invited to complete an online questionnaire about their role as an SCP. A total of 92 responses were gathered from across the surgical specialty SCP community and from around the UK. Data were collected on the breakdown of the SCP's role and working practices. The data collected demonstrated the multifunctional nature of the SCP and their ability to work at a level as envisioned by the RCS curriculum.

The current state of the surgical care team in the United Kingdom: Shall we 'do a time out'?

The reduction of junior doctors' working hours over the last two decades paved the way to non-medical practitioners providing care traditionally discharged by surgeons and other medics. These registered practitioners play a vital role in the care of patients in surgery and work within multi-disciplinary teams comprising surgical care practitioners, advanced clinical practitioners in surgery, and physician associates, with significant experience in nursing or allied health care professional practice. Health Education England and the Royal Colleges of Surgeons have invested considerably in developing the relevant educational frameworks to support and quality assure the training of non-medical practitioners. Notwithstanding, to ascertain whether advanced and extended practice have been developed appropriately, a wide critical stance is needed. This article aims to begin to analyse the status quo of the extended surgical team and of the associated pitfalls and challenges, making conservative comparisons between the roles with the international scene. The objective is to help students, trainees and all involved in surgical care to adopt an informed and critical viewpoint about the extended surgical team in the United Kingdom, in the hope that this can lead to improvement and forward planning in workforce design for the benefit of patients and their communities.

TP8.2.28 Can surgical advanced care practitioners provide a cost effective local anaesthetic minor procedures service? Results from a 5-year retrospective study

Abstract Aims Surgical Advanced Clinical Practitioners (SACP) form part of the extended surgical workforce and are drawn from allied health care backgrounds. The primary aim of this study was to determine if there is a financial benefit performing minor surgical procedures on dedicated SACP lists compared to consultant surgeon lists. Methods This was a retrospective cohort study including all patients who had a minor ‘lumps and bumps’ procedure undertaken between April 2014 and August 2019 at Anonymous Hospitals NHS Trust (AHT) under local anaesthetic by the general surgery team. Data such as lesion type, theatre staffing levels and operating time was collected. The cost of the procedure was calculated by operating time multiplied by cost of staff of per minute according to local banding. Results A total of 1399 patients had a lesion excised; the majority were carried out by a doctor n = 907, the rest independently by a SACP. The majority of lesions excised were lipomas and cysts. There was no difference in the median surgical time (20 minutes, IQR 14) taken to operate on each patient by SACPs and doctors. Minor procedures carried out on consultant surgeon lists cost 62.4% (£21.72) more on average than those on SACP lists (£56.55 vs £34.83 median respectively, p < 0.001) due to excess staff for these cases. Conclusion A dedicated and independent SACP ‘lumps and bumps’ list has shown to be a financially beneficial service. Operative times are similar to doctors. These lists free staff for consultant lists, potentially permitting more major cases.

EP.TH.893Virtual Clinic follow-up in Laparoscopic Fundoplication Surgery

Abstract Aims There are clinical and financial incentives to reduce follow-up NHS clinics after elective surgery. 55% of our laparoscopic anti-reflux procedures are day-cases procedures. To reduce consultant clinic workload and unnecessary face-to-face patient reviews, we introduced a laparoscopic surgical care practitioner (LSCP) based Virtual Clinic. Methods Patients were telephoned on day 1 and 5 to ensure they were managing their diet without significant post-operative symptoms. This was followed by a Virtual Clinic follow-up at 6-8 weeks, using a universal list of questions and template, and an electronic letter with outcomes recorded. 149 patients underwent laparoscopic fundoplication surgery from September 2016 – May 2018. All follow-up clinics, both virtual and face-to-face, were recorded electronically. These were reviewed, data collected and analysed. Results Between September 2016 – May 2018, 149 patients had laparoscopic fundoplication surgery at our trust with the following clinic outcomes: Conclusions Our LSCP Virtual Clinics discharged 50 out of 149 (33%) patients with no need for face-to-face clinic time, and no detriment to patient care. Those requiring further follow-up were patients who had difficulty managing dietary changes, or experiencing symptoms like dysphagia, often needing physical review and further investigations. Furthermore, patients have expressed high satisfaction with this service. Virtual clinic follow-up is safe, patient-friendly, and reduces both clinical and financial load on NHS outpatient clinics.

1145 Achilles Tendon Rupture Management: Improving Our Pathway

Abstract Background Achilles tendon ruptures are the most common tendon injury which affect predominantly middle age males. The yearly incidence is 31/100,000, with a rising incidence due to an increasingly active older generation1. Conservative versus operative management options shows no significant difference in rates of re-rupture or length of rehabilitation2. Delays in imaging have been found to delay definitive treatment and led to multiple attendances in the outpatient clinic. Method A retrospective analysis was performed patients diagnosed with an Achilles tendon rupture from September 2016 to February 2017 throughout the East Kent Trust. Patients were identified via clinical coding of ED attendance. Following implementation of the pathway in October 2018, a second retrospective analysis of patients identified between October 2018 and March 2019 was performed. Patients with re-ruptures or < 16 years old were excluded from the study. Results Following introduction of the pathway, there has been a 100% increase in the number of ultrasound scans performed, with the rupture gap size documented in 50% of these. The time to decision for conservatively managed patients dropped from 8 to 2 days. The number of clinic appointments also dropped from 3 to 2 with the management of patients predominantly in the plaster room. Conclusions The pathway has streamlined the process for patients following their injury. The majority of patients are seen by a senior clinician within 72 hours and a treatment plan clarified. The use of surgical care practitioner led clinics have allowed continuity of care for these patients and swift escalation when required.

The Surgical Care Practitioner role in Achilles tendon re-rupture: A case study.

The value of a Surgical Care Practitioner to an orthopaedic team is demonstrated in this case study of a patient who presented with a re-ruptured Achilles tendon. It highlights the role the practitioner plays in the patient journey and illustrates it's value throughout the clinical course from consultation through to discharge. The Surgical Care Practitioner, as a member of the extended surgical team can help to explain the diagnosis and associated treatment options, facilitate informed consent and provide expert procedural assistance to the surgeon. A Surgical Care Practitioner is ideally placed to answer patient queries and aid in rehabilitation.

Wrist fracture management and the role of surgical care practitioner through the patient's journey.

The presentation of this case study involves an exploration of the patient's journey in detail after having a traumatic wrist fracture, which is recognised as one of the most common fractures encountered daily in emergency services by junior doctors and practitioners. However, this article not only analyses the medical guidance for this type of case, but also the importance of the surgical care practitioner role in trauma and orthopaedics. All practitioners attending patients in emergency services are required to develop a good knowledge of anatomy, physiology, patient's examination technique, classifications and consequently being aware of the possible surgical options for treatment of the fracture. They will also need to fully understand the legal implications of consent to ensure safe practice.

Hip aspiration culture: analysing data from a single operator series investigating periprosthetic joint infection.

Introduction: We undertook this study to know the sensitivity, specificity and post-test probabilities of hip aspiration when diagnosing periprosthetic hip infections. We also examined “dry tap” (injection with saline and aspiration) results and aspiration volumes. Methods: This is a retrospective cohort study of patients aspirated for suspected periprosthetic joint infection between July 2012 and October 2016. All aspirations were carried out by one trained surgical care practitioner (SCP). All aspirations followed an aseptic technique and fluoroscopic guidance. Aspiration was compared to tissue biopsy taken at revision. Aspiration volumes were analysed for comparison. Results: Between January 2012 and September 2016, 461 hip aspirations were performed by our SCP. Of these 125 progressed to revision. We calculated sensitivity 59 % (confidence interval (CI) 35 %–82 %) and specificity 94 % (CI 89 %–98 %). Pre-test probability for our cohort was 0.14. Positive post-test probability was 0.59 and negative post-test probability 0.06. Aspiration volume for infected () and non-infected () joints was compared and showed no significant difference. Dry taps were experienced five times; in each instance the dry tap agreed with the biopsy result. Conclusions: Our data show that hip aspiration culture is a highly specific investigation for diagnosing infection but that it is not sensitive. Aspiration volume showed no significant difference between infected and non-infected groups. Each time a joint was infiltrated with saline to achieve a result, the result matched tissue sampling.

The role of the surgical care practitioner during the COVID-19 pandemic: An audit of experiences.

The Surgical Care Practitioner is a medical associate profession role, working to an advanced level, undertaken by registered nurses, operating department practitioners or physiotherapists, on completion of a Royal College of Surgeons accredited course. The COVID-19 pandemic has led to all heath care professionals needing to adapt to help support the health care system as it tackles its effect. Audit of roles undertaken by Surgical Care Practitioners during the COVID-19 pandemic in the context of Royal College of Surgeons (2014) Curriculum to review the utilisation of this medical associate profession role. The online questionnaire service, SurveyMonkey®, was used to collect data on the activities being undertaken by the Surgical Care Practitioner during the COVID-19 pandemic. Eighty Surgical Care Practitioners from across seven different surgical specialties within the United Kingdom completed the online survey. Nearly half stated that they remained mostly working in their substantive role, just less than a third helped in critical care units, with the remaining redeployed in equal shares to emergency departments or assisting on wards with nurses and as part of medical teams. A brief description of their activities was also recorded. This audit has demonstrated the versatility of the Surgical Care Practitioner and ability to adapt during the pandemic.

The learning curve of a surgical care practitioner performing local anaesthetic transperineal prostate biopsies: Cancer rate detection and complications

The learning curve of a surgical care practitioner performing local anaesthetic transperineal prostate biopsies: Cancer rate detection and complications

Surgical role expansion among the NHS workforce.

Professor Alan Glasper, from the University of Southampton, discusses the new government initiative to train nurses and other healthcare staff to become surgical care practitioners.