Theatre List Research Articles

EGS P20 Registrar-led theatre lists: A safe and effective way to provide a consistent Hot Gallbladder service

Abstract Background Dedicated Hot Gallbladder lists are proven to be cost effective and provide greater patient satisfaction. Unfortunately, the high volume of cases and the lack of available hospital resources make it very challenging to provide a consistent service. The aim of this study is to evaluate the safety and efficacy of the Registrar/SAS doctor led Hot Gallbladder service introduced in our Hospital over a year ago. Methods A system was developed with a middle grade doctor reporting to an UGI consultant surgeon and one SPOC in the waiting list office to streamline the service. A dedicated scoring system questionnaire (GalBAG form – Galbladder Booking and Grading form) was validated in retrospective and prospective series, and subsequently used to assess and grade patients into GOLD, SILVER & BRONZE cases based on expected difficulty and predicted length of the operation. Cases were listed based on surgeon compatibility. Outcomes measured include complications, unplanned admissions and re-admissions, need for further procedures, efficiency of the theatre lists and compared to national averages. Results Our registrar-led lists have successfully performed over 100 hot laparoscopic cholecystectomies. Complication rates, unplanned admissions, readmissions, and need for additional procedures align with national averages. Only one biliary injury occurred but was successfully treated endoscopically. The efficiency of the lists has improved with time as well as the ability to schedule progressively more complex cases Theatre utilization increased for patients referred through the Hot Gallbladder pathway. The GalBAG form accurately predicted difficulty and aided decision-making. Our Hospital now offers a secure and reliable Hot Gallbladder service, receiving positive feedback from patients and GIRFT. Conclusions In the current climate of increased waiting lists and lack of resources to provide dedicated urgent surgical services, a Registrar-led theatre list service with adequate backup/supervision could represent a safe, efficient, consistent and cost effective model to offer a Hot Gallbladder service.

EGS P34 CEPOD Booking Audit in General Surgery

Abstract Background Repeated internal audits suggested 20% of patients booked into the emergency general surgery theatre list failed to achieve their allotted time to theatre. We wished to investigate this further, identify potential reasons and whether any delay resulted in patient harm. Methods We retrospectively reviewed 760 consecutive adult patients over a 12 month period booked for appendicectomy, hernia repair, laparoscopic cholecystectomy or abscess I+D. We excluded laparotomies and patients under 18yoa. We recorded pre-operative CEPOD classification, adherence to the timeframe and reasons for delays. Outcome measures included total length of stay(TOLOS), post-op length of stay (POLOS) and unexpected intraoperative findings. Results Of 760 emergency procedures, 638 (84%) achieved the desired time frame and 122 (16%) were delayed. Of the 122 delayed cases, 99 (81%) were appropriately booked (clinical review). Most delays were caused by a higher priority emergency but in one third of delays no reason was recorded. There was no difference in median POLOS or unexpected findings between the two groups of those achieving expected time to theatre and those delayed. Conclusions Despite our initial concerns regarding delays to theatre this only occurred in 16% of the study group with no discernible difference in outcomes as measured. The repeated clinical review of potentially delayed emergency patients accessing the operating theatre appears to be safe.

928 The Golden Patient: A Concept to Improve Trauma Theatre Efficiency

Abstract Aim Golden patient (GP) is a pre-selected first patient on the next day’s trauma theatre list, with suitable medical fitness and a clear surgical plan. This study aimed to evaluate whether the GP concept improved the start times of theatre lists and the operating efficiency of the Aberdeen trauma unit. Method This prospective study compared theatre starting times before and following an intervention to improve consideration of the GP concept among both trauma and theatre staff. Data was collected from pre-planned trauma theatre lists on Bluespier software the evening before and the morning of the list. The comparative mean of operation start times between the groups was established and a two-sided t-test was performed to evaluate the significance between the groups. Results Post-interventional analysis identified 32 GPs out of which 28 persisted as first patients on the lists. The remaining 4 patients were deferred either due to an overnight emergency that took priority or a change in medical status that required them to be moved down the list. The mean operation start time was 10:00 compared to 10:14 pre-intervention. Further, in the re-audit, the mean operation start time was reduced by 39 minutes (p<0.01) when the GP remained first on the list. Conclusions The concept of GP has improved the theatre start times which is further evident in the delay to the start of the list when the GP is not employed. Additional contributing factors that influence theatre efficiency and require further review include anaesthetic planning, patient transport and others.

1158 Outcome of Hot Laparoscopic Cholecystectomy Service Evaluation in Morriston Hospital, SBUHB

Abstract Aim Symptomatic Gall Bladder disease is a common general surgery presentation. NICE guidelines recommend performing laparoscopic cholecystectomy (within 1 week of diagnosis) for patients with acute cholecystitis. Patients who had gall stone pancreatitis should have laparoscopic cholecystectomy on the index admission. Historically poor availability of theatre slots has resulted in unacceptable delays in our health board. The objective of this study was to evaluate adherence to these recommendations before and after an intervention to improve theatre access. Method A retrospective study of inpatient laparoscopic cholecystectomies between 20/06/2022 and 28/11/2022 was undertaken in Morriston Hospital. On 20/09/2022, dedicated theatre lists for laparoscopic cholecystectomy were moved from afternoon sessions to morning or all-day sessions with the intention of minimising delays. Baseline patient and operative details were captured from electronic health records. Outcomes were adherence to recommendations from NICE and time to procedure from booking and number of procedures done before and after the intervention. Result 85 patients were included (42 patients before (Group 1) and 43 after the intervention (Group 2). 100% of patient from group 1 received cholecystectomy within a week of booking compared to 86% from group 2 (P = 0.09). Mean time to procedure was 2.5 days and 3.5 days for group 1 and group 2 respectively (P = 0.076). 3.5 patients received cholecystectomy per week in group 1 as compared to 4.4 in group 2. Conclusions Changing the timing of Theatre lists from Afternoon to Morning/all day resulted in more patients receiving cholecystectomies without compromising time from booking to procedure

13 Surgical Priming Improves Operative Performance in Surgical Trainees: A Crossover Randomised Control Trial

Abstract Aim The aim of this study was to evaluate the impact of a surgical warm-up using a virtual reality simulator on operative performance. Method This was a single-blinded cross-over randomised control trial in a single tertiary Orthopaedic training centre. Orthopaedic trainees were recruited, and each morning participants rostered to theatre were randomised to either undergo a simulated surgical procedure on a virtual reality simulation system prior to their first case as primary operator (priming arm), or to perform their usual preparatory routine for surgery (control arm). Consultant orthopaedic trainers were recruited within the orthopaedic unit to carry out subjective surgical performance assessments using a validated global rating scale tool on the first case the participant performed on 46 the list as primary operator. Results Over 3 study periods a total of 151 datapoints were collected, with 49 matched datapoints across priming status and procedural level of difficulty. Subjective assessment tools consistently demonstrated improved operative performance by participants following surgical priming (p = 0.001). Conclusions This study highlights that introduction of preoperative priming to improve operative preparation and optimises operative performance. This has not only implications for improved resident training, but also signals towards beneficial downstream effects on patient outcomes, and theatre list planning.

834 A 5-Year Retrospective Review of Intra-Operative Cholangiogram Utilisation: Do We Need a Pathway?

Abstract Aim Current guidance gives no clear consensus on using routine vs selective intra-operative cholangiograms (IOC) during laparoscopic cholecystectomy. This is a controversial area with underuse risking bile-duct injury but overuse wasting theatre time and resources. The study aimed to review our local practice of IOC. Method Data was collected from electronic records for all patients undergoing IOCs from 2017 to 2022 at a single District General Hospital (DGH). Statistical analysis was performed using R. Results Ninety-six patients underwent IOC (74 elective, 22 emergency). In 64 (67%), use of IOC was decided pre-operatively (planned), 28 (29%) was decided intra-operatively (unplanned), and unclear in four cases (4%). All patients underwent pre-operative imaging. Imaging was negative for choledocholithiasis in 61 cases (64%). Indications for IOCs were abnormal anatomy (18%), deranged biochemistry (32%), abnormal imaging (21%) and confirmed choledocholithiasis (7%). The indication for IOC was unclear in 21 patients (22%). IOCs revealed abnormal findings in 21 cases; 10 required post-operative ERCP/EUS, 6 required further imaging and three were referred to a tertiary centre (for potential bile duct injury). On average, elective cases with unplanned IOC lasted 28 minutes longer (95% CI 4 to 52, p = 0.013) than planned IOC. Conclusions Our study revealed that IOC indication was not documented consistently, and unplanned elective IOC cases lasted significantly longer. Therefore, we propose a local pathway to identify, pre-operatively, the patients who need IOC. This will result in safer patient care and less operating time and resources. Furthermore, dedicated IOC lists may help DGHs streamline theatre lists and improve efficiency.

1268 An Audit of the Time to Surgery Following Diagnosis of Gallstone Pancreatitis

Abstract Aim To assess the compliance of our trust with the British Gastroenterology guidelines (BSG) on the management of gallstone pancreatitis which recommends that patients should undergo definitive treatment of laparoscopic cholecystectomy during the index admission or within 2 weeks of discharge to prevent readmission with biliary complications. Method This was a retrospective study of patients admitted with gallstone pancreatitis over a 3-month period between January 2021 and March 2021. We collected data from electronic medical records (EPR) and collated them on Microsoft Excel. Data was gathered on patient demographics, diagnosis at presentation, number of days to surgery, rate of readmission and the reasons for this. Results A total of 21 patients were admitted with gallstone pancreatitis. The median age was 50 years and 52% of them were male. 14 (67%) patients had laparoscopic cholecystectomy and only 9 (64%) of these had it within the 2-week window. 7 (33%) patients did not have surgery. Of these, 4 of them were not eligible, 1 went private and 2 patients are still awaiting surgery. The median wait for surgery was 3 days. The average time to surgery was 64 days. There were 6 readmissions whilst waiting for surgery with pain being the most common reason. Conclusions 64% of patients had definitive treatment of laparoscopic cholecystectomy within the 2-week time frame demonstrating poor compliance with the BSG guidelines. We have introduced a semi-emergency theatre list once a week to accommodate definitive management of patients with gallstone pancreatitis and will re-audit the data to evaluate for improvement.

275 The Declining Elective Workload of a Consultant Surgeon

Abstract Aim The elective workload of a consultant surgeon has changed considerably over time. We aimed to describe these changes and explore possible reasons behind them. Method All elective procedures performed by a single consultant vascular and general surgeon at a district general hospital were identified for the years 2000 and 2019. Cases were classified by complexity (major, moderate or minor) and specialty (general, vascular, colorectal, upper GI, plastics, endocrine, breast, urology or other). Results In 2000 there were 41 full and 50 half day theatre lists compared to 24 full and 47 half day lists in 2019. The total number of procedures fell by 39.25% (400 in 2000 versus 243 in 2019). The mean number of procedures per full and half day list was 5.46 and 3.50 in 2000 compared to 4.67 and 2.80 in 2019. There were 51 major (12.75%), 189 moderate (47.25%) and 160 minor (40%) procedures compared to 8 major (3.29%), 99 moderate (40.74%) and 137 minor (56.37%) in 2019. Most cases were general or vascular (82.5% in 2000, 97.53% in 2019) but the breadth was greater in 2000 (9 versus 4 specialties). Conclusions The number of lists, total procedures performed and mean cases per list are lower despite increasing demand. The breadth and complexity of cases has also decreased. The reasons for this are likely multi-factorial but may include the use of varying anaesthetic and scrub teams, the introduction of checklists, changes to consent procedures, centralisation of services, the presence of a trainee in theatre and changes to specialty training.

1021 Documentation in Laparoscopic Appendicectomy: Are We Getting It “Write” First Time?

Abstract Aim The Get It Right First Time (GIRFT) initiative was introduced to improve unwarranted variations in practice and improve patient care. GIRFT have published a series of recommendations for surgeons nationwide, which includes operative documentation. We aimed to assess completeness of documentation for laparoscopic appendicectomies in a district general hospital and identify methods of improvements, based on the GIRFT recommendations. Method We retrospectively searched prospectively maintained theatre lists for all “Laparoscopic Appendicectomy” performed from July to November 2022, then confirmed operations against the hospital’s electronic coding. All patients of any age were included; patients with an operation note not available online were excluded. Operation note documentation was analysed against the 34 GIRFT guideline recommendations. Results A total of 49 patients were included in the study. 38% of operation notes concorded with the recommendations outlined by GIRFT guidelines on laparoscopic appendicectomy documentation. 43% of the operation notes did not document in accordance with the 34 points and 8% documented incompletely. The 34 GIRFT recommendations were broken down into pre-operative, intra-operative and post-operative documentation sections. Highest levels of concordance were seen within intra-operative documentation, with 46% correctly including all necessary GIRFT recommendations. Pre-operative documentation had the poorest results – 56% not documenting in accordance with GIRFT. Conclusions Surgeons had varying levels of concordance with the GIRFT guidelines when recording laparoscopic appendicectomy notes. We have introduced a standardised proforma, based on the GIFT guidelines, to our practice and plan to re-assess compliance to ensure optimal documentation.

920 Regular Formal Surgical Skills Training for Undergraduates - an Easy Way to Increase Enthusiasm for Postgraduate Surgical Training?

Abstract Aim Despite the publication of a clearly defined surgical curriculum by the Royal College of Surgeons of England, the availability of surgical training opportunities at medical school remains highly variable [1]. While one-off training days can increase students’ surgical skills confidence, we wanted to explore the effect of a regular skills course on students’ skills confidence, and the effect this had on their willingness to attend theatre lists and purse surgical training after graduation. Method We designed a 6-session training program covering the Basic Surgical Skills curriculum produced by the RCS. It also included robotic surgery simulation. The course was run twice due to high demand for places. Core trainees were recruited to help supervise the course. The course was sponsored by both ASiT and Medtronic and was free for attendees. Results The course received excellent feedback. Free text sections highlighted how regular skills training allowed for consolidating learning. Attendees were significantly more likely to feel confident in performing all the techniques covered after the course (Chi Squared, p < 0.05). 16/17 attendees (94.1%) candidates agreed that the course filled a gap in what teaching is provided by the medical school, and all attendees felt more confident attending theatre lists after attending the course. Of note, most students agreed the course had increased their inclination towards a surgical career (12/17 70.2%.). Conclusions The course highlights the importance of regular surgical skills teaching. It also highlights an important knock-on effect of making students more confident attending lists, and more likely to pursue surgical careers.

WTP5.2 Length of stay and it’s predictors after elective general surgical procedures at a district hospital in NHS

Abstract Aims To study the length of stay of patients following elective general surgical procedures at a district hospital in NHS and the predictors for long stay. To be able to better predict the pattern of hospital stay and discharge. To understand the patients which stay longer in the hospital. Methods Retrospective analysis of elective general surgeries conducted at a busy district hospital in NHS from December 2021 to May 2022. Emergency cases were excluded. Data was collected form the theatreman app, which was hospital number, age, sex, ASA category, surgical time, anaesthesia time, list number of the patient in the theatre list. Statistical calculations were done on the StatsDirect 3 software. Results A total of 181 patients were studied of which 90 male and 91 female patients. Total admission days utilised were 318 and a median of 1 day per elective surgical patient. 94 patients (52 %) got discharged on the 0 post operative day (POD), 67 (37 %) were discharged on POD 1, 12 (6.6 %) on POD 2, 1 (0.55 %) on POD 3, 2 (1.1 %) on POD 4, 1 (0.55 %) on POD 5, 3 (1.65 %) on POD 6, 1 (0.55 %) on POD 12. Multiple linear regression analysis resulted in a p <0.0001 for surgical time and ASA grade and 0.0231 for age. Conclusion Surgical time, ASA grade and age have a statistically significant correlation on the length of stay after elective surgeries. Patients aged > 60 years, ASA >2 and Surgical time > 100 minutes will stay for 2 days or more in the hospital and such patients must be booked as inpatient.

600 Longer than expected stay in elective general surgical patients - understanding the dynamics

Abstract Aims To find the number of patients listed as elective day case or elective inpatient in general surgical department. To understand the dynamics of the day case surgeries and the predictors of lengthy stay. Methods Retrospective analysis of all the elective patients listed in general surgery from December 2021 to May 2022. The age, sex, list number of the patient in the theatre list, surgical time, anaesthetic time and ASA grade were compared against the length of stay. A total of 181 patient studied. Type of surgery listed and reason for longer stay collected from the evolve notes of the patients. Elective surgical patients were included and emergencies excluded. Statistical analysis done on StatsDirect 3. Results A total of 181 patients studied and 163 (90 %) were listed as day case (DC) and 18 (10%) as inpatient (IP). Median post-op day (POD) discharge for IP was 1 and DC was 0. Median age for IP was 57.5 years and DC was 49 years. Median surgical time was 85.5 minutes for IP and 72 minutes for DC. Median anaesthetic time was 34.5 minutes for IP and 31 minutes for DC. Discussions Overnight observation is the most common reason for the patients to stay in longer seen in 71.4 % patients. Late presentation to ward is the second most common reason, seen in 25 % patients. Median POD discharge for patients with overnight observation and drain is 2. Patients with documented overnight observation + drain + weekend results in POD 4 discharge. Drain – median POD 2 (min 1 max 12). NG – median POD 5 (min 2 max 6).

WTP7.6 Novel ambulatory surgical pathways can reduce operation waiting times whilst maintaining patient outcomes

Abstract Introduction A record number of patients are currently awaiting NHS treatment. A novel ambulatory surgical pathway (Rapid Access Theatre (RAT) lists) can reduce patient wait times for common operations such as cholecystectomies and ease the burden on the traditional elective operating list. However, it is important that this approach does not jeopardise patient safety. Method All non-inpatient cholecystectomies carried out in a large teaching hospital from 01/10/21 – 31/01/22 were analysed. Operations carried out on RAT lists were compared to those on elective lists for time to surgery from listing, post-op length of stay (LOS), number of patient returns within 30 days and rate of post-op complications. Results There were 85 cholecystectomies carried out on RAT lists and 86 carried out on elective lists. The average time to surgery from listing was 70.56 days for RAT lists and 152.19 for elective lists (p = 0.0005). The average post-op LOS was 0.73 for RAT lists and 1.00 for elective lists (p = 0.43). The number of patients who returned to hospital within 30 days of their operation was 8 (10.39%) for RAT lists and 11 (14.86%) for elective lists (p = 0.751). The number of post-op complications was 10 (13.33%) for RAT lists and 13 (17.81%) for elective lists (p = 0.52). Conclusions The introduction of a novel ambulatory surgical pathway (RAT lists) has reduced the waiting time for cholecystectomies whilst maintaining outcomes and patient safety. This pathway is therefore cost effective and an important tool for reducing length waiting lists.

FTP5.8 Gall bladder service developments to improve outcomes based on national guidelines

Abstract Introduction Nationally, acute gallstone disease accounts for over 1/3rd of emergency general surgery admissions and referrals. Guidelines recommend laparoscopic cholecystectomy within 1 week for acute cholecystitis, on index admission for acute gallstone pancreatitis and within 18 weeks for uncomplicated gallstone disease. Presently, NHS Trusts struggle to meet these targets due to unrelenting demand for limited resources. We present interventions to improve a laparoscopic cholecystectomy service which nearly halved the elective surgery waiting time. Method Retrospective data was collected on patients who underwent elective laparoscopic cholecystectomy at a DGH pre- and post-intervention (March-July 2021 & January-April 2022). Data collected from electronic medical records included patient demographics, waiting list times, operation details and post-operative outcomes. Interventions included introduction of a boarding card which included Cholecystectomy As A Day-case (CAAD) scoring and laparoscopic cholecystectomy standard operating procedure (SOP). The SOP specified criteria for preoperative investigations, theatre list organisation, post-operative admission and high-risk patients requiring specialist surgeon input. Results Pre-intervention cycle included 82 patients, with 78 patients booked as day-case operations and 40.2% unplanned postoperative admissions rate. The post-intervention period assessed 72 patients, with 46 patients booked as day-cases and 30.6% unplanned postoperative admissions. The median day-case LOS remained at 0 days pre- and post-intervention. Median elective laparoscopic cholecystectomy waiting time significantly decreased from 140 to 75 days (p< 0.0001). Conclusion Our study demonstrates interventions to restructure a laparoscopic cholecystectomy service significantly shortened waiting times, with national targets of 18-week wait for uncomplicated gallstone disease surgery met. Additionally, fewer unplanned postoperative admissions allows better bed management therefore reducing disruption to elective and emergency service delivery.

WTP7.11 CEPOD Booking Audit in General Surgery

Abstract Introduction and Objectives Repeated internal audits suggested 20% of patients booked into the emergency general surgery theatre list failed to achieve their allotted time to theatre. We wished to investigate this further, identify potential reasons and whether any delay resulted in patient harm. Materials and Methods We retrospectively reviewed 748 consecutive adult patients over a 12 month period booked for appendicectomy, hernia repair, laparoscopic cholecystectomy or abscess I+D. We excluded laparotomies and patients under 18yoa. We recorded pre-operative CEPOD classification, adherence to the timeframe and reasons for delays. Outcome measures included post-op length of stay (POLOS), prolonged hospital stay, and unexpected intraoperative findings. Results Of 748 emergency procedures, 632 (85%) achieved the desired time frame and 116 (15%) were delayed. Of the 116 delayed cases, 94 (81%) were appropriately booked (clinical review). Most delays were caused by a higher priority emergency but in one third of delays no reason was recorded. There was no difference in mean POLOS or unexpected findings between the two groups of those achieving expected time to theatre and those delayed. Conclusions Despite our initial concerns regarding delays to theatre this only occurred in 15% of the study group with no discernible difference in outcomes as measured. The repeated clinical review of potentially delayed emergency patients accessing the operating theatre appears to be safe. Improved documentation for delays and accurate pre-operative bookings across all surgical teams will aid running and assessing the emergency provision.

SP9.8 An Audit of Intraoperative Hypothermia Rates in Adults Undergoing Emergency Surgery in a Tertiary General Surgical Unit and Evaluation of the Efficacy of Preoperative and Intraoperative Forced-Air Warming on Achieving Intraoperative Normothermia

Abstract Aims Surgical site infections (SSIs) inflict significant economic burden on the NHS. Preoperative and intraoperative hypothermia are risk factors for SSIs. Evidence shows that maintenance of intraoperative normothermia significantly reduces SSI rates. Perioperative SSI bundles addressing factors including hair removal, antibiotic prophylaxis, skin preparation, drape positioning, and hypothermia are critical to improving SSI rates. We aim to audit rates of intraoperative hypothermia in our surgical caseload and evaluate the efficacy of preoperative and intraoperative forced-air warming through bespoke gowns in achieving intraoperative normothermia. Methods We conducted a retrospective audit of the intraoperative core temperatures of all adult patients undergoing surgical procedures on the emergency theatre list of a general surgery department and who had a temperature at knife-to-skin recorded (n=88). We then ran a prospective trial, outfitting patients listed for surgery (n=15) with forced-air warming gowns. Patients underwent forced-air warming with the gowns for 45 minutes on the surgical ward, throughout anaesthetic induction, and intraoperatively. Patient core temperature was measured at baseline, upon arrival at the anaesthetic room, and at knife-to-skin. Results Baseline audit data showed over 18% of patients were hypothermic at knife-to-skin. Contrastingly, 100% of patients wearing forced-air warming gowns were normothermic at knife-to-skin. The mean core temperature at knife-to-skin was significantly higher in patients wearing warming gowns (p=0.012). Conclusions Forced-air warming gowns are superior to traditional hospital gowns, blankets and surgical access forced-air warming devices in achieving intraoperative normothermia. They are an effective, sustainable, and cost-neutral, ‘all-in-one’ alternative to current perioperative protocol and will reduce SSI rates.

ThTP2.7 A 5-year retrospective review of intra-operative cholangiogram utilisation: do we need a pathway?

Abstract Aim Current guidance gives no clear consensus on using routine vs selective intra-operative cholangiograms (IOC) during laparoscopic cholecystectomy. This is a controversial area with underuse risking bile-duct injury but overuse wasting theatre time and resources. The study aimed to review our local practice of IOC. Method Data was collected from electronic records for all patients undergoing IOCs from 2017 to 2022 at a single District General Hospital (DGH). Statistical analysis was performed using R. Results Ninety-six patients underwent IOC (74 elective, 22 emergency). In 64 (67%), use of IOC was decided pre-operatively (planned), 28 (29%) was decided intra-operatively (unplanned), and unclear in four cases (4%). All patients underwent pre-operative imaging. Imaging was negative for choledocholithiasis in 61 cases (64%). Indications for IOCs were abnormal anatomy (18%), deranged biochemistry (32%), abnormal imaging (21%) and confirmed choledocholithiasis (7%). The indication for IOC was unclear in 21 patients (22%). IOCs revealed abnormal findings in 21 cases; 10 required post-operative ERCP/EUS, 6 required further imaging and three were referred to a tertiary centre (for potential bile duct injury). On average, elective cases with unplanned IOC lasted 28 minutes longer (95% CI 4 to 52, p=0.013) than planned IOC. Conclusions Our study revealed that IOC indication was not documented consistently, and unplanned elective IOC cases lasted significantly longer. Therefore, we propose a local pathway to identify, pre-operatively, the patients who need IOC. This will result in safer patient care and less operating time and resources. Furthermore, dedicated IOC lists may help DGHs streamline theatre lists and improve efficiency.

How has Covid-19 impacted the training of Urology trainees in South Wales?

To determine whether Covid19 had a tangible effect on urology training in Wales. There has been no Welsh data available concerning how training has changed during the covid pandemic. This survey evaluated the overall impact on training, with the primary aims to identify changes in clinical and academic activities and evaluate a trainees' wellbeing during the crisis. Online questionnaires were sent to all Urology Trainees; n = 20 (83% response) working in the Welsh deanery in the United Kingdom, asking about changes in training particularly within operating list, out-patient clinics, diagnostic activities, educational courses, teaching sessions and examinations. Across Wales trainees experienced a reduction in operating procedures, clinics and teaching courses. Due to a redesign of services, there was only a minimal impact on training for cancer diagnostics and Multi-Disciplinary Team (MDT) meetings. The majority of trainees felt their index procedures and ability to complete training will be affected. Cancer work, including cancer related theatre lists, diagnostics and MDT were maintained. Trainees lacked confidence that they would reach their operative competencies and struggle to successfully complete training. Following BAPIO discussion, we suggest that training programmes readjust to focus on areas where exposure has been lacking.

A national survey of surgical training in gynaecology: 2014–2021

ObjectivesOver the last decade barriers to surgical training have been identified, including reducing access to theatre lists, reducing numbers of major surgical procedures being performed, increasing numbers of trainees and reduction in working hours since the introduction of the European Work Time Directive (EWTD). We aimed to assess the impact of these challenges on training in gynaecology over time.Study Design.We designed a study which aimed to assess both trainers and trainees perception of gynaecological surgical training in Ireland. The purpose of this was to identify confidence levels and challenges and to highlight potential areas for future improvement of surgical training in gynaecology.A a cross-sectional survey was distributed to all trainees and trainers registered with the Royal College of Physicians of Ireland Obstetrics and Gynaecology higher specialist training programme in 2014, 2017 and again in 2021. ResultsDuring the study period trainees’ confidence that the training programme prepared them to perform gynaecological surgery fell significantly. This fall in confidence was most evident for trainees’ ability to perform abdominal hysterectomy (40.9% vs 15.2%, χ2 = 4.61, p =.03) and vaginal hysterectomy (31.8% vs 12.1%, χ2 = 4.58, p =.03) when comparing 2014 with 2021. All trainees reporteded that gynaecology was not given adequate time in the training programme to prepare them to practice independently as consultants. Themes identified by participants to improve training included dedicated access to theatre time with a named trainer, increased simulation training and subspecialisation at later stages of training. ConclusionOur findings show an overall decrease in trainees’ and trainers’ confidence in the surgical training available in gynaecology over an eight-year period.. This is particularly true for major gynaecology procedures. Efforts must be made to ensure trainees have improved access to surgical training in gynaecology. Potential solutions include improving access to simulation and incorporation of subspecialist training into later stages of training.

Time and Motion Studies to assess surgical productivity in cataract theatre lists within the National Health Service: Immediate Sequential Bilateral Cataract Surgery versus Delayed Sequential Bilateral Cataract Surgery.

To compare productivity of National Health Service cataract lists performing unilateral cataract (UC) surgery vs Immediate Sequential Bilateral Cataract Surgery (ISBCS). Five 4-hour lists with ISBCS cases and five with UC were observed using time and motion studies (TMS). Individual tasks and timings of each staff member in theatre was recorded by two observers. All operations were performed by consultant surgeons under local anaesthesia (LA). Median number of eyes operated per 4-hour list was 8 (range 6-8) in the ISBCS group and 5 (5-7) in the UC group (p = 0.028). Mean total theatre time (defined as time between the entry of the first patient and the exit of the last patient from theatre) was 177.12 (SD 73.62) minutes in the ISBCS group and 139.16 (SD 47.73) minutes in the UC group (p = 0.36). Mean time to complete two consecutive unilateral cataract surgery operations was 48.71 minutes compared to 42.23 minutes for a single ISBCS case (13.30% time saved). Based on our collected TMS data, a possible 5 consecutive ISBCS cases and 1 UC (total 11 cataract surgeries) could be performed during a four-hour theatre session, with a theatre utilisation quotient of 97.20%, contrasting to nine consecutive UC, with a theatre utilisation quotient of 90.40%. Performing consecutive ISBCS cases under LA on routine cataract surgery lists can increase surgical efficiency. TMS are a useful way to investigate surgical productivity and test theoretical models for efficiency improvements.