scholarly journals Consenting Operative Orthopaedic Trauma Patients: Challenges and Solutions

ISRN Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Amin Kheiran ◽  
Purnajyoti Banerjee ◽  
Philip Stott
Keyword(s):  
Phase 1 ◽  
Operative Procedure ◽  
Trauma Surgery ◽  
National Standards ◽  
Junior Doctors ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Phase 2 ◽  
Consent Forms ◽  
Surgical Trainees

Guidelines exist to obtain informed consent before any operative procedure. We completed an audit cycle starting with retrospective review of 50 orthopaedic trauma procedures (Phase 1 over three months to determine the quality of consenting documentation). The results were conveyed and adequate training of the staff was arranged according to guidelines from BOA, DoH, and GMC. Compliance in filling consent forms was then prospectively assessed on 50 consecutive trauma surgeries over further three months (Phase 2). Use of abbreviations was significantly reduced (P=0.03) in Phase 2 (none) compared to 10 (20%) in Phase 1 with odds ratio of 0.04. Initially, allocation of patient’s copy was dispensed in three (6% in Phase 1) cases compared to 100% in Phase 2, when appropriate. Senior doctors (registrars or consultant) filled most consent forms. However, 7 (14%) consent forms in Phase 1 and eleven (22%) in Phase 2 were signed by Core Surgical Trainees year 2, which reflects the difference in seniority amongst junior doctors. The requirement for blood transfusion was addressed in 40% of cases where relevant and 100% cases in Phase 2. Consenting patients for trauma surgery improved in Phase 2. Regular audit is essential to maintain expected national standards.

scholarly journals An evaluation of foundation doctor training: a mixed-methods study of the impact on workforce well-being and patient care [the Evaluating the Impact of Doctors in Training (EDiT) study]

2013 ◽  
Vol 1 (15) ◽  
pp. 1-208 ◽  
Author(s):  
S Mason ◽  
C O’Keeffe ◽  
A Carter ◽  
R O’Hara ◽  
C Stride
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Longitudinal Study ◽  
Phase 1 ◽  
Well Being ◽  
Junior Doctors ◽  
Phase 2 ◽  
Adequate Quality ◽  
The Impact

BackgroundA major reform of junior doctor training was undertaken in 2004–5, with the introduction of foundation training (FT) to address perceived problems with work structure, conditions and training opportunities for postgraduate doctors. The well-being and motivation of junior doctors within the context of this change to training (and other changes such as restrictions in working hours of junior doctors and increasing demand for health care) and the consequent impact upon the quality of care provided is not well understood.ObjectivesThis study aimed to evaluate the well-being of foundation year 2 (F2) doctors in training. Phase 1 describes the aims of delivering foundation training with a focus on the role of training in supporting the well-being of F2 doctors and assesses how FT is implemented on a regional basis, particularly in emergency medicine (EM). Phase 2 identifies how F2 doctor well-being and motivation are influenced over F2 and specifically in relation to EM placements and quality of care provided to patients.MethodsPhase 1 used semistructured interviews and focus groups with postgraduate deanery leads, training leads (TLs) and F2 doctors to explore the strategic aims and implementation of FT, focusing on the specialty of EM. Phase 2 was a 12-month online longitudinal study of F2 doctors measuring levels of and changes in well-being and motivation. In a range of specialties, one of which was EM, data from measures of well-being, motivation, intention to quit, confidence and competence and job-related characteristics (e.g. work demands, task feedback, role clarity) were collected at four time points. In addition, we examined F2 doctor well-being in relation to quality of care by reviewing clinical records (criterion-based and holistic reviews) during the emergency department (ED) placement relating to head injury and chronic obstructive pulmonary disease (COPD).ResultsPhase 1 of the study found that variation exists in how successfully FT is implemented locally; F2 lacks a clearly defined end point; there is a minimal focus on the well-being of F2 doctors (only on the few already shown to be ‘in difficulty’); the ED presented a challenging but worthwhile learning environment requiring a significant amount of support from senior ED staff; and disagreement existed about the performance and confidence levels of F2 doctors. A total of 30 EDs in nine postgraduate medical deaneries participated in phase 2 with 217 foundation doctors completing the longitudinal study. F2 doctors reported significantly increased confidence in managing common acute conditions and undertaking practical procedures over their second foundation year, with the biggest increase in confidence and competence associated with their ED placement. F2 doctors had levels of job satisfaction and anxiety/depression that were comparable to or better than those of other NHS workers, and adequate quality and safety of care are being provided for head injury and COPD.ConclusionsThere are ongoing challenges in delivering high-quality FT at the local level, especially in time-pressured specialties such as EM. There are also challenges in how FT detects and manages doctors who are struggling with their work. The survey was the first to document the well-being of foundation doctors over the course of their second year, and average scores compared well with those of other doctors and health-care workers. F2 doctors are benefiting from the training provided as we found improvements in perceived confidence and competence over the year, with the ED placement being of most value to F2 doctors in this respect. Although adequate quality of care was demonstrated, we found no significant relationships between well-being of foundation doctors and the quality of care they provided to patients, suggesting the need for further work in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals 690 Orthopaedic Trauma Surgery: Has the COVID Pandemic Affected Surgical Outcomes?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Edwards ◽  
K Hristova ◽  
S Shiels ◽  
R Frostick ◽  
E Lostis ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Upper Limb ◽  
Lower Limb ◽  
Surgical Outcomes ◽  
Trauma Surgery ◽  
Mortality Data ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Major Trauma Centre ◽  
Age At Surgery

Abstract Aim To compare the surgical outcomes following orthopaedic trauma surgery before and during the COVID pandemic in an adult Major Trauma Centre. Method A retrospective chart review was conducted for all patients undergoing orthopaedic trauma surgery before (01/12/2019 to 29/02/2020) and during (01/03/2020 to 10/06/2020) the COVID pandemic. A Chi-square test was used to compare frequencies of type of anaesthetic used, postoperative ITU admission, any surgical complications and mortality. Data was collected 90 days after surgery. Results During the pre-COVID period, 501 patients (mean age at surgery 64y 4m; 222 male (44%)) underwent orthopaedic trauma surgery (395 lower limb (79%); 86 upper limb (17%); 28 pelvis (6%)) compared to 474 patients (mean age at surgery 61y 8m; 219 male (48%)) during the COVID period (388 lower limb (82%); 58 upper limb (12%); 23 pelvis (5%)). There was a significant increase in the use of a spinal as the main anaesthetic during the pandemic (9 (2%) vs 115 (24%), p < 0.001) and fewer trauma patients were admitted to ITU postoperatively (42 (8%) vs 16 (3%), p0.001). There was no difference in the rate of postoperative complications (103 (21%) vs 95 (20%), p0.841) or mortality at 90 days (42 (8%) vs 43 (9%), p0.703). Of the 244 COVID swabs done during the COVID period, 8 (3%) were positive. Conclusions Despite widespread operational disruption and a change in anaesthetic practice, there was no change in the rate of postoperative complications or mortality following orthopaedic trauma surgery.

A National Survey of Ultra Clean Air Theatre Use in Orthopaedic Trauma

2012 ◽  
Vol 94 (5) ◽  
pp. 185-186
Author(s):  
N Jarvis ◽  
S Dheerendra ◽  
D Chappell ◽  
A Goel ◽  
P Pidikiti
Keyword(s):  
Total Joint Replacement ◽  
Trauma Surgery ◽  
Fragility Fractures ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Infection Rates ◽  
Operating Theatres ◽  
Deep Surgical Site Infection ◽  
Clean Air ◽  
The Cost

The consequences of deep surgical site infection (SSI) following orthopaedic operations can be devastating. Trauma patients, especially those suffering fragility fractures, tend to have less reserve and more co-morbidities than elective patients; infection in their case may be even more catastrophic. It is also expensive: Dreghorn et al calculated that revising infected arthroplasties was up to four times the cost of a primary total joint replacement. Maintaining low infection rates in trauma surgery depends on meticulous surgical technique, peri-operative antibiotics and scrupulous theatre standards, including the use of laminar or ultra clean air (UCA) operating theatres for sterile orthopaedic procedures.

scholarly journals Patient understanding regarding opioid use in an orthopaedic trauma surgery population: a survey study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Amy L. Xu ◽  
Alexandra M. Dunham ◽  
Zachary O. Enumah ◽  
Casey J. Humbyrd
Keyword(s):  
Side Effects ◽  
Trauma Surgery ◽  
Withdrawal Symptoms ◽  
Survey Study ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Opioid Use ◽  
Personal Experiences ◽  
Level Of Understanding ◽  
White Patients

Abstract Background Prior studies have assessed provider knowledge and factors associated with opioid misuse; similar studies evaluating patient knowledge are lacking. The purpose of this study was to assess the degree of understanding regarding opioid use in orthopaedic trauma patients. We also sought to determine the demographic factors and clinical and personal experiences associated with level of understanding. Methods One hundred and sixty-six adult orthopaedic trauma surgery patients across two clinical sites of an academic institution participated in an internet-based survey (2352 invited, 7.1% response rate). Demographic, clinical, and personal experience variables, as well as perceptions surrounding opioid use were collected. Relationships between patient characteristics and opioid perceptions were identified using univariate and multivariable logistic regressions. Alpha = 0.05. Results Excellent recognition (> 85% correct) of common opioids, side effects, withdrawal symptoms, and disposal methods was demonstrated by 29%, 10%, 30%, and 2.4% of patients; poor recognition (< 55%) by 11%, 56%, 33%, and 52% of patients, respectively. Compared with white patients, non-white patients had 7.8 times greater odds (95% confidence interval [CI] 1.9–31) of perceiving addiction discrepancy (p = 0.004). Employed patients with higher education levels were less likely to have excellent understanding of side effects (adjusted odds ratio [aOR] 0.06, 95% CI 0.006–0.56; p = 0.01) and to understand that dependence can occur within 2 weeks (aOR 0.28, 95% CI 0.09–0.86; p = 0.03) than unemployed patients. Patients in the second least disadvantaged ADI quartile were more knowledgeable about side effects (aOR 8.8, 95% CI 1.7–46) and withdrawal symptoms (aOR 2.7, 95% CI 1.0–7.2; p = 0.046) than those in the least disadvantaged quartile. Patients who knew someone who was dependent or overdosed on opioids were less likely to perceive addiction discrepancy (aOR 0.24, 95% CI 0.07–0.76; p = 0.02) as well as more likely to have excellent knowledge of withdrawal symptoms (aOR 2.6, 95% CI 1.1–6.5, p = 0.03) and to understand that dependence can develop within 2 weeks (aOR 3.8, 95% CI 1.5–9.8, p = 0.005). Conclusions Level of understanding regarding opioid use is low among orthopaedic trauma surgery patients. Clinical and personal experiences with opioids, in addition to demographics, should be emphasized in the clinical history.

scholarly journals 254 An Audit to Assess the Completion of Consent Forms in the Department of Trauma and Orthopaedics

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Sultana
Keyword(s):  
Operative Procedure ◽  
Consent Form ◽  
Junior Doctors ◽  
Cross Sectional ◽  
Nice Guidelines ◽  
Consent Forms ◽  
Adequate Information ◽  
Orthopaedic Ward ◽  
Essential Prerequisite ◽  
Legal Consequences

Abstract Aim The objective was to audit how well the consent forms were being completed by junior doctors and registrars in the orthopaedic ward. This helped to assess whether the consent forms before orthopaedic procedures were being filled out according to the standards stated in the RCS and NICE guidelines. Method The initial audit was carried out in January 2020 in the three orthopaedic surgery wards at the Queen’s Medical Centre in Nottingham. Cross sectional data was collected by checking the consent forms to assess whether the important headings and sub-headings were filled out legibly with adequate information. Results All consent forms filled up in the study sample had the patient details and the name of the surgery written completely and accurately. 75.6% of the forms had the name of the Responsible Health Professional written, while the remaining had left the space blank or wrote an incorrect name. More than 90% of the forms had the intended benefit, and the possible risks of the orthopaedic operation written in the most suitable format. The likelihood of a blood transfusion being required was filled out in 78.6% of the forms. All consent forms were signed by a doctor, however, only 53% of the doctors provided both their name in print and contact number in the consent form. Conclusions Consent is an essential prerequisite for any operative procedure. By detecting the parts of the consent form that were frequently filled out inadequately, awareness was raised about the possible legal consequences of it.

scholarly journals 420 Accuracy of Documenting Complications When Consenting Patients for Laparoscopic Appendectomy

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B B Karki
Keyword(s):  
Informed Consent ◽  
Laparoscopic Appendectomy ◽  
Medical Professional ◽  
Junior Doctors ◽  
Consent Forms ◽  
Surgical Trainees ◽  
Specific Complication ◽  
Source Of Information

Abstract Background Appropriately performed informed consent acts as a shield against false complaints or claims of malpractice against the doctors. Laparoscopic Appendectomy accounts for a significant portion of general surgical workload hence shows a difference in the patient consenting. Method A proforma was devised which included recognised complications of Laparoscopic Appendectomy and grade of the consenting medical professional. The proforma containing 10 standard complications was then cross-referenced with the consent forms of 38 patients and the documented risks in each form was noted. Result The result showed a wide variation in the documentation of complications based on the grades of the medical professional. Out of 38 consent forms, 32/38 ( 84.21 %) were completed by Junior Grade Doctors out of which 15/32 by FY2 and 17/32 by Core Surgical Trainees (CST) and 6/38 (15.78 %) by Specialist Registrars (SpR). Of the set standard 10 complications, FY2 documented an average of 4.2, CST documented 6.2 and SpR documented 8.16 complications. Conclusions The study showed a need of improvement in the documentation of complications especially among Junior Doctors. Procedure specific complication stickers was developed for a standardised list of complications which will act as a source of information for the patient and prompt doctors to discuss the risks.

scholarly journals Biomarkers to Guide the Timing of Surgery: Neutrophil and Monocyte L-Selectin Predict Postoperative Sepsis in Orthopaedic Trauma Patients

2021 ◽  
Vol 10 (10) ◽  
pp. 2207
Author(s):  
Gabrielle Daisy Briggs ◽  
Karla Lemmert ◽  
Natalie Jane Lott ◽  
Theo de Malmanche ◽  
Zsolt Janos Balogh
Keyword(s):  
Trauma Surgery ◽  
Predictive Ability ◽  
Perioperative Period ◽  
Multiple Organ ◽  
Long Bone ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Postoperative Sepsis ◽  
Activation Markers ◽  
Reactive Protein

Deciding whether to delay non-lifesaving orthopaedic trauma surgery to prevent multiple organ failure (MOF) or sepsis is frequently disputed and largely based on expert opinion. We hypothesise that neutrophils and monocytes differentially express activation markers prior to patients developing these complications. Peripheral blood from 20 healthy controls and 162 patients requiring major orthopaedic intervention was collected perioperatively. Neutrophil and monocyte L-selectin, CD64, CD11, CD18, and CXCR1 expression were measured using flow cytometry. The predictive ability for MOF and sepsis was assessed using the Receiver Operating Characteristic (ROC) comparing to C-reactive protein (CRP). Neutrophil and monocyte L-selectin were significantly higher in patients who developed sepsis. Neutrophil L-selectin (AUC 0.692 [95%CI 0.574–0.810]) and monocyte L-selectin (AUC 0.761 [95%CI 0.632–0.891]) were significant predictors of sepsis and were not significantly different to CRP (AUC 0.772 [95%CI 0.650–0.853]). Monocyte L-selectin was predictive of MOF preoperatively and postoperatively (preop AUC 0.790 [95%CI 0.622–0.958]). CD64 and CRP were predictive of MOF at one-day postop (AUC 0.808 [95%CI 0.643–0.974] and AUC 0.809 [95%CI 0.662–0.956], respectively). In the perioperative period, elevated neutrophil and monocyte L-selectin are predictors of postoperative sepsis. Larger validation studies should focus on these biomarkers for deciding the timing of long bone/pelvic fracture fixation.

scholarly journals P36 Consent for Orthopaedic Trauma Surgery during the COVID-19 Pandemic

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
J Walker ◽  
A Davies ◽  
T Heaton ◽  
S Sabharwal ◽  
M Fertleman ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Best Practice ◽  
Trauma Surgery ◽  
Consent Form ◽  
Nosocomial Transmission ◽  
Orthopaedic Trauma ◽  
Staff Education ◽  
Consent Forms ◽  
Surgical Services ◽  
The Third

Abstract Surgical services have been hugely disrupted by COVID-19 and have had to evolve rapidly in response. The best practice for consent mandates that risks associated with surgical treatment during a pandemic be discussed. This study aimed to assess whether patients undergoing orthopaedic operations were being consented for the risk of contacting COVID-19 and ITU care. All orthopaedic consent forms from four-week periods in March, June and July were reviewed. Measures such as staff education were implemented after the second cycle. Of consent forms for 37 operations performed in March, only 1 mentioned the risk of contracting COVID-19 and zero mentioned ITU. During June, 89 consent forms were reviewed, 32 mentioned COVID-19 and 10 discussed ITU admission. Following educational measures, the third cycle showed a significant improvement as of 100 consent form records available for review, 73 included risk of COVID-19 whilst 26 mentioned ITU. The results show that earlier in the pandemic, surgeons at our centre were not counselling patients regarding COVID-19. This improved slightly between the first and second cycles, likely reflecting increased awareness of the nosocomial transmission of COVID-19. Educational measures contributed to a significant improvement in the third cycle. Planned interventions include use of electronic consent forms which incorporate COVID-19 infection and associated risks.

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