Procedural Risk in Congenital Cardiac Catheterization (PREDIC 3 T)

Background Advancements in the field, including novel procedures and multiple interventions, require an updated approach to accurately assess patient risk. This study aims to modernize patient hemodynamic and procedural risk classification through the creation of risk assessment tools to be used in congenital cardiac catheterization. Methods and Results Data were collected for all cases performed at sites participating in the C3PO (Congenital Cardiac Catheterization Project on Outcomes) multicenter registry. Between January 2014 and December 2017, 23 119 cases were recorded in 13 participating institutions, of which 88% of patients were <18 years of age and 25% <1 year of age; a high‐severity adverse event occurred in 1193 (5.2%). Case types were defined by procedure(s) performed and grouped on the basis of association with the outcome, high‐severity adverse event. Thirty‐four unique case types were determined and stratified into 6 risk categories. Six hemodynamic indicator variables were empirically assessed, and a novel hemodynamic vulnerability score was determined by the frequency of high‐severity adverse events. In a multivariable model, case‐type risk category (odds ratios for category: 0=0.46, 1=1.00, 2=1.40, 3=2.68, 4=3.64, and 5=5.25; all P ≤0.005) and hemodynamic vulnerability score (odds ratio for score: 0=1.00, 1=1.27, 2=1.89, and ≥3=2.03; all P ≤0.006) remained independent predictors of patient risk. Conclusions These case‐type risk categories and the weighted hemodynamic vulnerability score both serve as independent predictors of patient risk for high‐severity adverse events. This contemporary procedure‐type risk metric and weighted hemodynamic vulnerability score will improve our understanding of patient and procedural outcomes.

Home Healthcare Clinicians’ Perspectives on Electronic Health Records: A Qualitative Study

Clinicians’ perspectives on the electronic health records (EHR) in home healthcare (HHC) are understudied. To explore this topic, qualitative interviews were conducted with 15 HHC clinicians in the Northeastern USA. Thematic analysis was conducted to identify key themes emerging from the interviews. While some EHR benefits were recognized, overall satisfaction with the EHR was low. The results suggest EHR limitations are tied to poor usability, restrictions, and redundancy in documentation leading to increased documentation workload. Clinicians have recommendations to mitigate these limitations via additional EHR functions and better patient risk detection. Future stakeholders should consider the results of this study when developing and updating the EHR in HHC.

Patients’ perception of safety climate in Irish general practice: a cross-sectional study

Background Although patients have the potential to provide important information on patient safety, considerably fewer patient-report measures of safety climate (SC) have been applied in the primary care setting as compared to secondary care. Our aim was to examine the application of a patient-report measure of safety climate in an Irish population to understand patient perceptions of safety in general practice and identify potential areas for improvement. Specifically, our research questions were: 1. What are patients’ perceptions of SC in Irish general practice? 2. Do patient risk factors impact perceptions of SC? 3. Do patient responses to an open-ended question about safety enhance our understanding of patient safety beyond that obtained from a quantitative measure of SC? Methods The Patient Perspective of Safety in General Practice (PPS-GP) survey was distributed to primary care patients in Ireland. The survey consisted of both Likert-response items, and free-text entry questions in relation to the safety of care. A series of five separate hierarchical regressions were used to examine the relationship between a range of patient-related variables and each of the survey subscales. A deductive content analysis approach was used to code the free-text responses. Results A total of 584 completed online and paper surveys were received. Respondents generally had positive perceptions of safety across all five SC subscales of the PPS-GP. Regarding patient risk factors, younger age and being of non-Irish nationality were consistently associated with more negative SC perceptions. Analysis of the free-text responses revealed considerably poorer patient perceptions (n = 85, 65.4%) of the safety experience in primary care. Conclusion Our findings indicate that despite being under-utilised, patients’ perceptions are a valuable source of information for measuring SC, with promising implications for safety improvement in general practice. Further consideration should be given to how best to utilise this data in order to improve safety in primary care.

P051 NATIONAL TRENDS IN VOLUME, COSTS, AND PATIENT RISK PROFILE OF INPATIENTS UNDERGOING INCISIONAL HERNIA REPAIR IN RELATION TO ABDOMINAL SURGERY

Aim We describe trends in inpatient burden by volume, cost, and patient risk profiles of incisional hernia repair (IHR) as compared to other abdominal surgery (AS) procedures in the United States. Material and Methods Patients undergoing AS were identified using the National Inpatient Sample (2008-2018) by ICD-9/ICD-10 codes. National weighted procedure rates and hospital costs were ascertained and plotted using sampling weights and normalized per 1,000,000 people. Regression models allowed identification of statistical significance of trends and prediction of mean differences in rates, costs and patient characteristics. Results Over 38,000,000 AS discharges were identified, averaging 3.5 million annually, with over 1,200,000 discharges following IHR (3.1% of all AS). The difference between AS and IHR significantly decreased over time from 12,702 procedures per million (PPM) to 9,039 PPM. Open and laparoscopic AS down-trended (46.2% and 20.8%, respectively), whereas robotic AS up-trended (95.2% [all p &lt; 0.01]). Open IHR down-trended (60.9%) and laparoscopic IHR up-trended (83.6%, [both p &lt; 0.01]). Robotic IHR increased by 99.5% (p = 0.17). Average annual national charges for AS and IHR were $183.8 and $6.6 billion, respectively. Costs increased by 20.3% for AS and 25.6% for IHR. Patients undergoing IHR were 45-64 years old (46%), female (63.1%), White (68.1%), publicly insured (55.1%), with moderate loss of function (43.2%) and ≥2 comorbidities (43.3%). Conclusions IH continues to carry a significant societal and healthcare burden. With AS decreasing and IHR remaining stable from 2008 to 2018, the percentage of patients developing IH after AS has increased, as well as cost per IHR, critically underscoring the need to adopt and implement risk reduction and hernia prevention.

Systematic reviews of observational studies of Risk of Thrombosis and Bleeding in General and Gynecologic Surgery (ROTBIGGS): introduction and methodology

Background Venous thromboembolism (VTE) and bleeding are serious and potentially fatal complications of surgical procedures. Pharmacological thromboprophylaxis decreases the risk of VTE but increases the risk of major post-operative bleeding. The decision to use pharmacologic prophylaxis therefore represents a trade-off that critically depends on the incidence of VTE and bleeding in the absence of prophylaxis. These baseline risks vary widely between procedures, but their magnitude is uncertain. Systematic reviews addressing baseline risks are scarce, needed, and require innovations in methodology. Indeed, systematic summaries of these baseline risk estimates exist neither in general nor gynecologic surgery. We will fill this knowledge gap by performing a series of systematic reviews and meta-analyses of the procedure-specific and patient risk factor stratified risk estimates in general and gynecologic surgeries. Methods We will perform comprehensive literature searches for observational studies in general and gynecologic surgery reporting symptomatic VTE or bleeding estimates. Pairs of methodologically trained reviewers will independently assess the studies for eligibility, evaluate the risk of bias by using an instrument developed for this review, and extract data. We will perform meta-analyses and modeling studies to adjust the reported risk estimates for the use of thromboprophylaxis and length of follow up. We will derive the estimates of risk from the median estimates of studies rated at the lowest risk of bias. The primary outcomes are the risk estimates of symptomatic VTE and major bleeding at 4 weeks post-operatively for each procedure stratified by patient risk factors. We will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate evidence certainty. Discussion This series of systematic reviews, modeling studies, and meta-analyses will inform clinicians and patients regarding the trade-off between VTE prevention and bleeding in general and gynecologic surgeries. Our work advances the standards in systematic reviews of surgical complications, including assessment of risk of bias, criteria for arriving at the best estimates of risk (including modeling of the timing of events and dealing with suboptimal data reporting), dealing with subgroups at higher and lower risk of bias, and use of the GRADE approach. Systematic review registration PROSPERO CRD42021234119

EP.WE.485An Audit to Investigate the Incidence of Face-to-Face Patient Review by GPs Prior to Referral to Surgical Assessment Unit

Aims Since COVID-19, GP’s have been encouraged to do fewer face-to-face consultations to prevent unnecessary patient contact1. Anecdotally, this initially resulted in many patients being referred to SAU who had not been seen by a GP, and then being discharged back to the community the same day, causing potentially increased risk of contracting COVID-19 through hospital attendance. The aim of this audit was to investigate the incidence of patients referred to SAU not seen by a GP and discharged the same day. Methods GP referrals were identified over a 7 day period through the surgical take electronic system Aramis©. The case notes and GP documentation were reviewed to identify whether a face-to-face GP consultation occurred, and then whether the patient was admitted to SAU or discharged the same day. Results During a 7 day period, there were 24 (n = 24) GP referrals of which only 3 (12.5%) were not seen by the GP, all of whom were admitted for at least one night. However, of the patients referred and seen by GP, 7 (29%) were discharged the same day. Conclusions This demonstrates that during this 7-day period, there was no incidence of inappropriate GP referral to SAU of patients not seen by a GP, and the majority of GP referrals warranted admission. This suggests that in most cases, GPs are avoiding unnecessary emergency surgical referrals and attempt to review patients face-to-face prior to referral, thus reducing patient risk of contact with COVID-19 in the hospital setting.