Patient Turnover Research Articles

Effect of Consultation Number on the Assessment and Treatment of Polycystic Ovary Syndrome.

The basic medical education stage is not enough to support physicians to fully diagnose and evaluate polycystic ovary syndrome (PCOS). The study aims to discover the difference in treatment choice between participants with different annual consultation number of PCOS, to promote lifelong learning, and drive balanced development within healthcare. This is a multicenter cross-sectional survey. Participants' basic information, knowledge of PCOS and treatment options were collected online. According to the annual consultation number of patients with PCOS, physicians were divided into three groups: 0-50 people/yr, 50-200 people/yr, and >200 people/yr, and the results were derived from χ2 test, Fisher exact test, and multivariate logistic regression analysis. The study analyzed 1689 questionnaires, and 1206 physicians (71.4%) received less than 50 women per year, 388 physicians (30.0%) with an annual number of 50-200 women, and 95 physicians (5.6%) with patient turnover for more than 200 people. Reproductive endocrinologists generally have higher access to the clinic. As the number of visits increases, more and more physicians would perceive patients as more likely to have abnormal blood glucose and heavy weight. Physicians with large numbers of consultations are more likely to use Asian or Chinese standards to assess obesity. The multivariate analysis involved variables such as age, hospital level, specialty, and patient turnover annually, and more young doctors actively assessed lipid profile (odds ratio (OR) 1.56, 95% confidence interval (CI) (1.16, 2.16)), and primary hospitals (OR 0.65 CI (0.44, 0.89)) chose OGTT for blood glucose assessment less than tertiary hospitals. Physicians in secondary hospitals are more aggressive in evaluating androgens. Our survey found differences in endocrine assessment, metabolic screening, and treatment in PCOS women in terms of the number of obstetrician-gynecologists who received different patient consultation numbers. The importance of continuing education for physicians is emphasized, to promote lifelong learning.

Bone metabolism and inflammatory biomarkers in radiographic and non-radiographic axial spondyloarthritis patients: a comprehensive evaluation.

Axial spondyloarthritis (axSpA) is a heterogeneous disease that can be represented by radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA). This study aimed to evaluate the relationship between the markers of inflammation and bone turnover in r-axSpA patients and nr-axSpA patients. A cross-sectional study included 29 r-axSpA patients, 10 nr-axSpA patients, and 20 controls matched for age and sex. Plasma markers related to bone remodeling such as human procollagen type 1 N-terminal propeptide (P1NP), sclerostin, tartrate-resistant acid phosphatase 5b (TRACP5b), receptor activator of nuclear factor kappa B ligand (RANKL), and osteoprotegerin (OPG) were measured by an ELISA kit. A panel of 92 inflammatory molecules was analyzed by proximity extension assay. R-axSpA patients had decreased plasma levels of P1NP, a marker of bone formation, compared to controls. In addition, r-axSpA patients exhibited decreased plasma levels of sclerostin, an anti-anabolic bone hormone, which would not explain the co-existence of decreased plasma P1NP concentration; however, sclerostin levels could also be influenced by inflammatory processes. Plasma markers of osteoclast activity were similar in all groups. Regarding inflammation-related molecules, nr-axSpA patients showed increased levels of serum interleukin 13 (IL13) as compared with both r-axSpA patients and controls, which may participate in the prevention of inflammation. On the other hand, r-axSpA patients had higher levels of pro-inflammatory molecules compared to controls (i.e., IL6, Oncostatin M, and TNF receptor superfamily member 9). Correlation analysis showed that sclerostin was inversely associated with IL6 and Oncostatin M among others. Altogether, different inflammatory profiles may play a role in the development of the skeletal features in axSpA patients particularly related to decreased bone formation. The relationship between sclerostin and inflammation and the protective actions of IL13 could be of relevance in the axSpA pathology, which is a topic for further investigation.

Reduced mitochondrial respiration in peripheral T cells after paediatric heamatopoietic stem cell transplantation.

Recovery and functional differentiation of T-cell subsets are central for the development of immune function and complications after allogeneic hematopoietic stem cell transplantation (HSCT), but little is known about the cellular respiration and factors influencing T-cell metabolic fitness during immune maturation after HSCT. We included 20 HSCT patients and analysed mitochondrial oxidative phosphorylation and mitochondrial fitness in peripheral blood mononuclear cell samples collected at days +90 and +180 after HSCT. Phenotypic analysis revealed lower overall T-cell counts, lower CD4+/CD8+ ratio and a skewed distribution of early T-cell subsets at day +90, gradually recovering by day +180. Although ATP turnover in HSCT patients was similar to healthy controls, the spare respiratory capacity (SRC) of T cells, reflecting the available energy reserve, was significantly reduced at day +90 and +180 compared to healthy controls. This reduction in SRC was not correlated with the occurrence of acute graft-versus-host disease (aGVHD), the intensity of conditioning regimens and markers of T-cell exhaustion. We found significantly depressed SRC until six months post-HSCT, but we were not able to identify transplant-related risk factors or associations with the clinical outcome.

Design and development of patient care voice actuated bed in hospital

Manually adjusting hospital beds presents significant challenges for healthcare professionals, which affects their workflow and patient care outcomes. Manual bed modifications consume a significant amount of time, resulting in nurses being less available for other crucial duties. Patient needs can be delayed, and the quality of care delivered overall can be lowered. Manually adjusting the bed to ensure safety and comfort is a risky practice that could result in incorrect placement that can worsen pre-existing medical issues or cause discomfort and pressure sores. In addition, the demand for accurate and frequent bed changes during the day increases the strain on nurses, especially in situations with high patient turnover or complex care needs. The objective of this study is to create a hospital bed that responds to voice commands to improve patient care and monitoring. The bed's voice recognition technology allows patients to adjust their positions and improve comfort and accessibility, particularly for individuals with mobility issues. It includes sensors that continuously measure the patient's heart rate and temperature while they are in bed. These sensors provide real-time data, enabling prompt detection of any irregularities and facilitating immediate intervention in the patient's heartbeat and temperature. The combination of voice control and continuous health monitoring ensures a higher standard of patient care, improves patient autonomy, and reduces the workload on medical staff. The aim of this innovative bed is to create a healthcare environment that is more responsive and efficient, which ultimately leads to better patient outcomes and enhanced overall hospital efficiency.

Effects of empagliflozin on collagen biomarkers in patients with heart failure: Findings from the EMPEROR trials.

Extracellular matrix remodelling is one of the key pathways involved in heart failure (HF) progression. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) may have a role in attenuating myocardial fibrosis. The impact of SGLT2i on blood markers of collagen turnover in humans is not fully elucidated. This study aimed to investigate the effect of empagliflozin on serum markers of collagen turnover in patients enrolled in the EMPEROR-Preserved and EMPEROR-Reduced trials. Overall, 1084 patients (545 in empagliflozin and 539 in placebo) were included in the analysis. Procollagen type I carboxy-terminal propeptide (PICP), a fragment of N-terminal type III collagen (PRO-C3), procollagen type I amino-terminal peptide (PINP), a fragment of C-terminal type VIa3 collagen (PRO-C6), a fragment of type I collagen (C1M), and a fragment of type III collagen (C3M) were measured in serum at baseline, 12 and 52 weeks. A mixed model repeated measurements model was used to evaluate the effect of empagliflozin versus placebo on the analysed biomarkers. Higher baseline PICP, PRO-C6 and PINP levels were associated with older age, a more severe HF presentation, higher levels of natriuretic peptides and high-sensitivity troponin T, and the presence of comorbid conditions such as chronic kidney disease and atrial fibrillation. Higher PICP levels were associated with the occurrence of the study primary endpoint (a composite of HF hospitalization or cardiovascular death), and PRO-C6 and PINP were associated with the occurrence of sustained worsening of kidney function. On the other hand, PRO-C3, C1M, and C3M were not associated with worse HF severity or study outcomes. Compared to placebo, empagliflozin reduced PICP at week 12 by 5% and at week 52 by 8% (week 12: geometric mean ratio = 0.95, 95% confidence interval [CI] 0.91-0.99, p = 0.012; week 52: geometric mean ratio = 0.92, 95% CI 0.88-0.97, p = 0.003). Additionally, empagliflozin reduced PRO-C3 at week 52 by 7% (week 12: geometric mean ratio = 0.98, 95% CI 0.95-1.02, p = 0.42; week 52: geometric mean ratio = 0.93, 95% CI 0.89-0.98, p = 0.003), without impact on other collagen markers. Our observations are consistent with experimental observations that empagliflozin down-regulates profibrotic signalling. The importance of such an effect for the clinical benefits of SGLT2i in HF remains to be elucidated.

Importance of Hospital Infection Control.

The increasing demand for healthcare-acquired infection (HAI) control practices and services has intensified the need to evaluate care quality. The World Health Organization (WHO) introduced an infection prevention and control (IPC) framework to mitigate the impact of HAIs, crucial for ensuring patient safety in hospitals. HAIs acquired after hospitalization pose significant challenges due to factors such as compromised immunity, invasive medical procedures, and antibiotic-resistant pathogens, which have dire consequences, including higher mortality rates and increased healthcare costs. Healthcare workers (HCWs) are critical in implementing IPC measures. Infection control programs that include strategies such as hand hygiene, personal protective equipment (PPE), environmental cleaning, and surveillance have become standard. However, challenges such as resistance to change, resource limitations, patient turnover, and variability in patient conditions persist. Strategies to maintain hospital infection control involve rigorous compliance monitoring, staff education, advanced technologies such as artificial intelligence (AI), machine learning (ML), telemedicine, and innovative sanitation methods. The future of hospital infection control may involve increased integration of environmental monitoring, antimicrobial stewardship, and patient participation while leveraging collaboration among healthcare facilities. The review highlights the criticality of hospital infection control and suggests trends and opportunities to strengthen prevention efforts and patient safety.

Lymphopenia and high Ki-67 expression in peripheral blood CD4+ and CD8+ T cells associate with progressive sarcoidosis

BackgroundEarly identification of patients at risk for progressive sarcoidosis may improve intervention. High bronchoalveolar lavage fluid (BALF) lymphocytes and peripheral blood (PB) lymphopenia are associated with worse prognosis. The mechanisms...

Towards a greater understanding of reduced response to aspirin in children with congenital heart disease post-cardiac surgery using immature platelet fraction

ObjectiveA high platelet turnover rate may produce a population of platelets that confers an inadequate response to aspirin. We aimed to investigate the relationship between residual platelet aggregation and platelet turnover in paediatric cardiology patients on aspirin monotherapy by evaluating the fraction of immature platelets as a marker for turnover and secondly to test the predictive value of the immature platelet fraction (IPF) to classify patients as responsive or non-responsive to aspirin. MethodsSixty patients divided into two age categories (≤90 days, >90 days of age) were included in this prospective observational study. Patients were then stratified into tertiles using their IPF level. Platelet studies included thromboelastography with platelet mapping (TEGPM). ResultsThe overall incidence of ‘inadequate response to aspirin’ was 38 % in our patient cohort recently post-cardiac surgery a consequence that warrants further study. The frequency of inadequate response to aspirin was higher in the upper tertile of IPF when compared to the lower tertile, (88 %) versus (4 %) respectively (p < 0.05). The ‘cut off’ for IPF was determined to be 3.9 % with a sensitivity of 95.7 %, and a specificity of 92.9 % (area under the curve of 0.955 [CI 0.896–1.014, p < 0.05]). ConclusionThis study demonstrates that inadequate response to aspirin occurs in approximately 38 % of patients undergoing specific high-risk congenital cardiac procedures using the dosing practice of a national centre. This study supports the hypothesis that an elevated platelet turnover may result in aspirin being less effective in patients who are recently post cardiac surgery. These data are of direct translational relevance.

Local anesthesia versus saddle block for open hemorrhoidectomy: cost-analysis from a randomized, double blind controlled trial

BackgroundDespite the benefits attributed to the use of local anesthesia (LA) for open hemorrhoidectomy (OH) in developed countries, this technique is still not considered as the first line technique in low-income countries such as Uganda; therefore, we aimed at comparing the cost of OH under LA versus Saddle block among patients with 3rd or 4th degree hemorrhoids.MethodsThis trial was conducted from December 2021 to May 2022 among patients with primary uncomplicated 3rd or 4th degree hemorrhoids. The operating time, and direct costs in (US$) including medical and non-medical were recorded. We analysed the cost in the two groups (local anesthesia versus saddle block) using SPSS version 23.0.ResultsFindings of fifty-eight patients were analysed including 29 participants per group. There was a significant difference in operating time and cost among the two groups (p < 0.05). The mean operating time was 15.52 ± 5.34(SD) minutes versus 33.72 ± 11.54 min for OH under LA and SB respectively. The mean cost of OH under LA was 57.42 ± 8.90 US$ compared to 63.38 ± 12.77US$ in SB group.ConclusionThe use of local anesthesia for OH was found to have less operating time with high-cost effectiveness. Being affordable, local anesthesia can help to increase the turnover of patients who would otherwise wait for the availability of anesthesia provider. Policy makers should emphasize its applicability in low-income settings to help in the achievement of 2030 global surgery goals.Trial registrationPan African Clinical Trials Registry, PACTR202110667430356. Registered on 08/10/2021.

OGBN P21 Improving patient satisfaction with discharge information after laparoscopic cholecystectomy: a quality improvement project

Abstract Background With the rise in day case surgery, there has been an increase in both nurse-led discharge and patient turnover. Patients recovering from anaesthesia frequently retain less, therefore information delivered to patients regarding post-operative recovery is sometimes lost or forgotten. The aim of this quality improvement project was to improve both the quality of information and the patient satisfaction with the information provided to them upon discharge following laparoscopic cholecystectomy. Methods Patient satisfaction was assessed using questionnaires at baseline and following each Plan- Do-Study-Act (PDSA) cycle. In PDSA 1, a generic discharge summary delivering standard post-operative instructions, was distributed to patients on discharge. For PDSA 2, a detailed leaflet, encompassing information requested by previously surveyed patients, entitled “going home after your gall-bladder surgery” was provided in addition to the discharge summaries. Results At baseline we found all patients were receiving some sort of discharge information after laparoscopic cholecystectomy. Key information such as wound care, dietary advice and expected pain, was frequently missed. We found that patients were not satisfied, with an average reported satisfaction of 55%. After PDSA 1 patient satisfaction rose to 66%. However,the generic discharge summary missed advice for patients going home with drains and driving advice. With introduction of the detailed leaflet, patient reported satisfaction reached 100%. Conclusions Introducing detailed discharge leaflets improved the patient satisfaction with the information they received on discharge. We anticipate this will in turn reduce patient concerns and need to seek further medical attention. Similar leaflets can be distributed for day case operations such as hernias. This serves as a useful measure to aid patient recovery at home and supports a high turnover day case surgery list.

Effects of empaglifozin on collagen biomarkers in patients with heart failure. Results from the EMPEROR trials

Abstract Background Extracellular matrix remodeling is one of the key pathways in progression of Heart Failure (HF). Clinical trials demonstrated that SGLT-2 inhibitors improved cardiovascular outcomes in HF patients, which may be partly explained by an effect on cardiac remodeling. Supporting data from preclinical studies suggested effects of SGLT-2 inhibitors on collagen synthesis and attenuation of fibrosis. However, the effect of SGLT-2 inhibitors on collagen turnover in HF patients is not fully elucidated. Purpose In patients of the EMPEROR-Preserved and EMPEROR-Reduced trials, across a wide spectrum of ejection fraction and renal function, the effect of empagliflozin on serum markers of collagen turnover was investigated. Methods 1084 patients (545 in empagliflozin and 539 in placebo) were included in the analysis. Biomarkers measured from serum samples at baseline, 12 and 52 weeks included PICP (a collagen type I formation marker; ELISA), PRO-C3 (a collagen type III formation marker; ECLIA), PINP (a collagen type I formation marker; ECLIA, Roche Diagnostics), PRO-C6 (a collagen type VI formation marker; ECLIA), C1M and C3M (markers of collagen type I and III degradation CLIA). A mixed model repeated measurements model (MMRM) was used to evaluate the treatment effects on the analysed biomarkers. Results Treatment with empagliflozin vs. placebo reduced PICP levels at week 12 and week 52, and reduced PRO-C3 at week 52. In contrast, no significant effect was observed on PINP, PRO-C6, C1M or C3M levels (Table 1). Conclusion Among patients with chronic HF, across a wide range of EF and of renal function, treatment with empagliflozin reduced the serum levels of PICP, a collagen type I formation marker, both at weeks 12 and 52 and PRO-C3, a collagen type III formation marker, at week 52. These results add support for an anti-fibrotic effect of empagliflozin and may help to explain the clinical effect of SGLT-2 inhibitors on cardiac remodeling.

Negative pressure booth with HEPA filter reduces the risk of airborne infection associated with transoesophageal echocardiography

Abstract Background The pandemic of coronavirus infection 2019 has persisted, despite reductions in disease severity and deaths. Transoesophageal echocardiography (TOE) is one of the aerosol-generating procedures and increases the risk of airborne infection. However, the effective strategy to reduce the risk has not been fully established. Purpose To evaluate the effectiveness of negative-pressure booth with high-efficiency particulate air (HEPA) filter in control of aerosol generated by TOE. Methods and Results In the TOE examination room, we installed negative-pressure booth. This booth has an air supply port on the ceiling and exhaust port on the head side of examination table, and the airflow is controlled by a push-pull method (Figure 1). The air changes per hour (ACH) for the entire room with was only 8, but 38 inside the booth, meeting the CDC recommended standard for airborne infection isolation room (ACH≥12). Visualization of the airflow by laser light scattering showed that the airflow in the booth bent the trajectory of particulates produced by the patient's cough and sent them to the exhaust port (Figure 2A). The size-specific quantifications for &amp;gt;0.3μm-, &amp;gt;0.5μm-, &amp;gt;1.0μm-diameter particles by a particle counter revealed that the peak particle concentrations within the booth were reduced by approximately 70% after 7 min of ventilation (Figure 2B) in unattended situation. In clinical setting, we monitored particle counts during TOE in 70 cases. Echocardiologists were at greater risk of aerosol exposure than assistants. Multiple regression analysis revealed that patients’ discomfort level during TOE and less experienced echocardiologists were independently correlated with increased particle counts (β=0.376, p=0.003 and β=0.355, p=0.005, respectively). However, aerosols generated in the early time of TEE were almost eliminated by the end of the examination by negative pressure booth. Conclusion The negative pressure booth effectively and quickly reduces small particles equating aerosols. It might be effective to reduce the risk of airborne infection and shorten the patients turnover time of TOE room even in the pandemic of infectious diseases.Figure 1Figure 2

Increased local bone turnover in patients with chronic periprosthetic joint infection.

The management of periprosthetic joint infection (PJI) remains a major challenge in orthopaedic surgery. In this study, we aimed to characterize the local bone microstructure and metabolism in a clinical cohort of patients with chronic PJI. Periprosthetic femoral trabecular bone specimens were obtained from patients suffering from chronic PJI of the hip and knee (n = 20). Microbiological analysis was performed on preoperative joint aspirates and tissue specimens obtained during revision surgery. Microstructural and cellular bone parameters were analyzed in bone specimens by histomorphometry on undecalcified sections complemented by tartrate-resistant acid phosphatase immunohistochemistry. Data were compared with control specimens obtained during primary arthroplasty (n = 20) and aseptic revision (n = 20). PJI specimens exhibited a higher bone volume, thickened trabeculae, and increased osteoid parameters compared to both control groups, suggesting an accelerated bone turnover with sclerotic microstructure. On the cellular level, osteoblast and osteoclast parameters were markedly increased in the PJI cohort. Furthermore, a positive association between serum (CRP) but not synovial (white blood cell (WBC) count) inflammatory markers and osteoclast indices could be detected. Comparison between different pathogens revealed increased osteoclastic bone resorption parameters without a concomitant increase in osteoblasts in bone specimens from patients with Staphylococcus aureus infection, compared to those with detection of Staphylococcus epidermidis and Cutibacterium spp. This study provides insights into the local bone metabolism in chronic PJI, demonstrating osteosclerosis with high bone turnover. The fact that Staphylococcus aureus was associated with distinctly increased osteoclast indices strongly suggests early surgical treatment to prevent periprosthetic bone alterations.

OR13-03 Assessment Of Skeletal Health Including Bone Density, Turnover, Microarchitecture And Osteoporosis In Patients With Sheehan’s Syndrome: A Prospective, Multicentric Study In Asian Indians

Abstract Disclosure: L. Das: None. B. Laway: None. J. Sahoo: None. S.K. Bhadada: None. P. Dutta: None. Introduction: Sheehan’s syndrome (SS) is a rare cause of hypopituitarism. Evidence on skeletal health in patients with this condition is limited, and data on bone geometry, structure and volumetric bone mineral density (BMD) are lacking. We aimed to comprehensively explore skeletal fragility in a multicentric cohort of treated SS. Patients and Methods: Patients with SS were recruited for analysis of demographic, clinico-biochemical and hormonal profile including bone turnover markers. Areal BMD, T- and Z-scores and trabecular bone score (TBS) were evaluated using DXA. In a subset of patients (n=29) as well as age-and BMI-matched controls (n=34), high-resolution peripheral quantitative computed tomography (HRpQCT, XtremeCT II, Scanco Medical AG, Switzerland) was performed to assess bone geometry and microarchitecture. Results: There were a total of 105 patients with SS with a mean age 45.2 ± 10.5 years and a lag of 7.4 ± 5.5 years from disease onset to diagnosis. Regular levothyroxine replacement was ongoing in 91.2% and glucocorticoid replacement in 86.1% of the cohort. Past HRT replacement was done in 66.7% patients. Bone turnover markers (P1NP, CTX) were not significantly different between cases and controls. The T- score [-2.3 (-3.0 to -1.6) vs -1.5 (-3.0 to -0.7)] and Z-score [-1.4 (-2.1 to -1.2) vs -0.6 (-2.1 to -0.1)] at the lumbar spine (LS) and the T- score [-1.8 (-2.3 to -1.3) vs -0.8 (-2.1 to -0.1)] and Z-score [-1.1 (-1.7 to -0.4) vs -0.4 (-1.0 to 0.2)] at the femoral neck (FN) were lower in cases as compared to controls (trend towards significance). Osteopenia or osteoporosis was prevalent in significantly greater proportion of the cases as compared to controls, at LS (96.3% vs 64.7%), FN (91.7% vs 47%) and ultradistal radius (65.2% vs 11.8%). Bone microarchitectural assessment showed no significant differences between TBS, or bone geometry. However, trabecular volumetric bone mineral density was higher at both tibia (p&amp;lt;0.05) and radius (p&amp;gt;0.05) in cases as opposed to age-and BMI-matched controls. There was a weak negative correlation between glucocorticoid and levothyroxine replacement duration and BMD at both LS and FN (p&amp;lt;0.05), but not with replacement dose. Conclusion: Osteopenia-osteoporosis is highly prevalent in SS. BMD at both LS and FN is negatively correlated with duration of glucocorticoid and levothyroxine exposure. There are no significant differences in bone microarchitecture or geometry but tibial trabecular volumetric BMD is greater in treated SS. Presentation: Friday, June 16, 2023

Novel diagrammatical analyses of turnover of patients with cancer

Background/Aims The Inverted Nomogramma di Gandy is a diagrammatical method for evaluating staff turnover in large organisations. This exploratory research investigated whether it could be applied to cohorts of ‘active’ patients with cancer (those within the first 5 years of diagnosis) and provide additional insights into the underlying dynamics of cancer incidence and prevalence. Methods The Inverted Nomogramma di Gandy method was applied using relevant data for all clinical commissioning groups in England in 2017. This article details the data and results for breast and lung cancer. To evaluate the method's usefulness to healthcare practitioners, a report was circulated throughout the Cheshire and Merseyside Cancer Alliance, with readers asked to respond to a 15-item survey about their perceptions of the method and its usefulness. Results were analysed using descriptive statistics. Results There were wide variations in incidence and prevalence of breast and lung cancer across England. The diagram showed dispersed patterns for cancer alliances and identified the locations of individual outliers, revealing the underlying dynamics. The patterns for breast cancer and lung cancer were very different; even within the Cheshire and Merseyside Cancer Alliance there were some marked variations between locations. Survey respondents were generally neutral or positive about the method. Conclusions This diagrammatical method provided useful analyses that were complementary to incidence and prevalence data, and potentially useful for practitioners. Because the method uses existing available data, it could be rapidly introduced to services.

The clinical impact of pectoral nerve block in an 'enhanced recovery after surgery' program in breast surgery.

Background: Pectoral nerve block (PECS) is increasingly performed in breast surgery. Aim: The study evaluated the clinical impact of these blocks in the postoperative course. Patients & methods: In this case-control study, patients undergoing breast surgery with 'enhanced recovery after surgery' pathways were divided into group 1 (57 patients) in whom PECS was performed before general anesthesia, and group 2 (57 patients) in whom only general anesthesia was effected. Results: Postoperative opioid consumption (p<0.002), pain at 32 h after surgery (p<0.005) and the length of stay (p<0.003) were significantly lower in group 1. Conclusion: Reducing opioid consumption and pain after surgery, PECS could favor a faster recovery with a reduction in length of stay, ensuring a higher turnover of patients undergoing breast surgery.

157 Budget impact analysis of Holter monitors provision in an outpatient clinic

Abstract Background Outpatient clinic attendees (aged &amp;gt;64) commonly present with falls, dizziness, syncope and palpitations. The most common non-invasive investigation ordered includes continuous ambulatory electrocardiography monitoring, namely the Holter monitor. The clinic is outsourcing Holter monitor requests to the Cardiology Department, with a long waiting list. If the patient wishes the test to be done sooner in a private hospital, it costs between 160 to 295 euros, covered by the patient’s private healthcare insurance. Methods A budget analysis was carried out to further evaluate by provisioning 5 Holter monitors in the outpatient clinic to quicken patient turnover and reduce the cardiology department waiting list. The intervention scope was limited to the designated clinic of approximately 450 patients a month. The intervention is not for generating revenue for the clinic. The budget analysis doesn’t include sensitivity analysis from the best-case towards worst-case scenarios of Holter frequency usage and duration of Holter monitoring. The objectives of the proposed change are to lessen the turnaround time by 20% for the patients from being assessed until discharge from the clinic without having delayed investigation of the Holter monitor, to have a timely and accurate diagnosis of suspected arrhythmia and the appropriate management within the new intervention. Results The decision tree, utilising the Decision analytic modelling, resource identification, cost implication, estimated changes including 2-hour staff training, capital, year one to year five costs, potential cost savings year-on-year, cost-per-wear comparison against the private hospital provider, pre and post-intervention scenario analysis were constructed. Conclusion The budget impact analysis designed a simple cost calculator to add additional tests of Holter monitors that rely on the decision model approach. It shows a potential cost saving within a five-year horizon and increases the number of patients’ attendance by optimising patient turnover. Apart from the cost and organisation, there are other positive impacts towards financial and clinical areas, ensuring high-quality service for the population.

Improved outcomes in paediatric laparoscopic anorectoplasty for ano-rectal malformations using enhanced recovery after surgery protocols: A study from Central India

BackgroundThe revolutionary concept of using the body's innate stress response to surgery to access the advantage of early recovery in the postoperative period has changed the overall outcome of health systems of LMICs in terms of cost-effectiveness and increased patient turnover. Hence, is now the standard of care in many adult surgical specialities, but with very little evidence in paediatric surgical fields. This lacuna in the knowledge was identified and addressed which yielded positively comparable results. MethodsThis is a retrospective and prospective validation study conducted in the Department of General Surgery, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, Madhya Pradesh, India between 1st March 2020 - 30th May 2022. The peri‑operative parameters affecting convalescence after surgery were reviewed and the results of the conventional peri‑operative protocols were compared with the ERAS group. Results50 patients with Ano-rectal malformations underwent laparoscopic anorectoplasty, of which 25 patients were treated with conventional peri‑operative protocol and 25 were treated with ERAS protocol. The results obtained were comparable and effective with the existing results in adult surgical specialities and also were statistically significant in most of the parameters. ConclusionShorter hospital stay reduces the financial burden alleviating both the physical and psychological stress of the patients and their parents. Also, judicious use of the available resources can increase the patient turnover of the existing health systems with the same financial assistance.

FTP6.1 A little respect! A closed-loop audit increasing awareness of ReSPECT forms in a busy general surgical department

Abstract Aims ReSPECT forms have been introduced by Resuscitation Council UK to provide recommendations for patients’ emergency care. The primary aim of the audit was to assess the completion rate of ReSPECT forms on a busy surgical ward. Secondly, the audit aimed to both increase the awareness and the completion rate of ReSPECT forms. Methods Data was collected in the form of random spot-checks of completed ReSPECT forms for all general surgical inpatients at our general hospital. The first intervention involved the addition of a column to the surgical ‘take’ list to highlight the presence or absence of ReSPECT forms. Team education using a novel poster, prioritising the urgency of completion of ReSPECT forms dependent on patient’s co-morbidities, and a teaching session was the intervention for the second cycle. Results The initial completion rate of accurate ReSPECT forms was 31%. Following the first intervention the ‘ReSPECT column’ on the list had been completed for 15% of inpatients and the overall completion rate of ReSPECT forms was 35%. After the ReSPECT poster and teaching the usage of the ‘ReSPECT column’ increased to 39% and overall completion rate was 33%. Conclusions The addition of a column to the acute, surgical list was a simple and effective way of increasing awareness of completed ReSPECT forms. Increased compliance may be achieved by finding more efficient methods of monitoring completion. Overall completion of ReSPECT forms had improved with the interventions, however, due to the high turnover of surgical patients, there are still further improvements possible.

Provision of chaplaincy services in U.S. hospitals: A strategic conformity perspective.

Increasingly, hospitals are expected to provide patient-centered care that attends to patients' health needs, including spiritual care needs. Chaplaincy services help to meet patients' spiritual care needs, which have been shown to have a positive impact on health outcomes. Variation in the provision of chaplaincy services suggests hospitals do not uniformly conform to the expectation of making chaplaincy services available. The aim of this study was to examine the availability and factors that influence hospitals' provision of chaplaincy services. Data were combined from the American Hospital Association annual surveys with the Area Health Resource File at the county level from 2010 to 2019. Observations on general, acute-care community hospitals were analyzed (45,384 hospital-year observations) using logistic regression that clustered standard errors at the hospital level. Hospitals with Joint Commission accreditation, more staffed beds, nonprofit and government ownership, teaching status, one or more intensive care units, a higher percentage of Medicare inpatient days, church affiliation, and system membership were more likely to provide chaplaincy services than their counterparts. Certification as a trauma hospital and market competition showed no influence on the provision of chaplaincy services. The lack of chaplaincy services in many hospitals may be due to limited resources, workforce shortage, or a lack of consensus on scope and nature of chaplaincy services. Chaplaincy services are an underutilized resource that influences patient experience, clinician burnout and turnover, and the goal of ensuring care is patient-centered. Administrators should consider stronger partnerships where services are provided; researchers and policymakers should consider how the lack of these services in some hospitals may reinforce existing health disparities.