1231 A Full-Cycle Audit Of ‘Safe’ Surgical Handovers in A Tertiary Centre

Aim 1. Assess performance in surgical handovers at Southampton General Hospital (SGH) against RCS ‘Safe Handover’ guidelines Identify any areas for improvement to ensure safe and effective handover of surgical patients Method 10 evening surgical handovers were anonymously audited In October 2019 against RCS ‘safe handover’ guidelines. The results were subsequently analysed and circulated amongst the surgical department. Handovers were then led consistently by surgical registrars and advanced nurse practitioners (ANPs). A prompt including the RCS handover guidelines was made and distributed to all members of the surgical team and included in departmental inductions. Following this, a further 10 evening handovers were anonymously audited between July and August 2020. Results Many aspects of handover performance descriptors described by the RCS in the re-audit improved following the circulation of our prompt including RCS handover guidelines and examples of minimum or good standards of practice for handover. Specifically, handover timeliness, the briefings provided (100% from 70%), the audibility of a single speaker (70% from 30%), the number of educational discussions held during handovers (100% from 50%) and awareness of the on-call overnight consultant (100% from 80%) all vastly improved. Conclusions Emphasis on undertaking effective handovers needs to continue as ‘safe' handovers between shifts can protect both patient and doctor safety. This is especially true following the implementation of the European Working Time Directive (EWTD) and a move to full shift working. Handovers are also proposed as opportunities for training which may be helpful especially in an era of reduced hours of surgical training.

WED 240 An audit of unplanned admissions in myasthenia gravis patients

BackgroundUnplanned admissions of neuromuscular patients adversely affect patients and NHS. Muscular dystrophy UK designed an audit of unplanned admissions of neuromuscular patients in 2012 and 2017.AimWe aimed to compare unplanned admissions amongst myasthenia gravis (MG) patients, in two different hospitals in Wessex, Southampton general hospital (SGH) and Queen Alexandra service (QAH).MethodsData was collected from patients attending neurology clinics in conjunction with hospital database.Results240 adult patients were included in the audit. 60 unplanned hospital admissions were identified, but only 22 (37%) were judged to be potentially avoidable. 8 admissions were due to myasthenia relapse, 8 occurred in patients with severe myasthenia on dual immunosuppression. 9 admissions were due to pneumonia in elderly patients with multiple comorbidities but well controlled myasthenia. 2 admissions were anxiety related and 3 were due to falls and fracture despite appropriate bone protection.ConclusionOur preventable admission rate for MG patients is less compared to MDUK data (37% vs 68.7% and 59.4% in 2012 and 2017). Pneumonia is common in elderly myasthenic patients who have other comorbidities. Fragility fractures can occur despite bone protection and falls advice is necessary during consultation.

CFD Challenge: Solutions Using the Mesher, Harpoon, and the Finite Volume Solver, Fluent

The Bressloff group has focused on cardiovascular disease and its treatment for the last ten years. Possessing close ties with Southampton General Hospital, much of the work has sought understanding and/or solutions to clinically relevant problems, including the design of vascular stents. For the CFD Challenge, preliminary verification studies were performed by Masters student Ahsan Hameed using a fast hex-dominant mesher, Harpoon (Sharc Ltd) and V12.1.4 of the ANSYS Fluent solver (ANSYS, Inc.).

The workload of stroke thrombolysis: A prospective study in a district general hospital setting

Many hospitals are still setting up acute stroke thrombolysis services, often delayed by fears over workload. However, there are few data on how many patients require urgent assessment before one is treated. We prospectively studied all referrals to the 24-hour stroke thrombolysis service, February 2009 – January 2010, in Southampton General Hospital. 128 patients were referred to the thrombolysis team and 20 received thrombolysis. The most common reasons for treatment exclusion were: stroke severity (37%), time from onset (26%) or CT findings (15%). Approximately six patients required urgent assessment by the thrombolysis team for every one treated. These data are crucial to inform service planning.

The GH-2004 project: the response of IGF1 and type III pro-collagen to the administration of exogenous GH in non-Caucasian amateur athletes

ContextThe GH-2000 team proposed a method based on IGF1 and type III pro-collagen (P-III-P) to detect exogenously administered GH. As previous studies involved predominantly white European athletes, it is important to assess whether the response of these markers to recombinant human GH (rhGH) differs with ethnicity.ObjectiveTo examine the response of serum IGF1 and P-III-P and GH-2000 score to rhGH in non-Caucasian amateur athletes.DesignDouble-blind placebo-controlled rhGH administration study.SettingWellcome Trust Clinical Research Facility, Southampton General Hospital.SubjectsThe study included 31 male and 14 female amateur athletes of different ethnicities.InterventionThe subjects were assigned to treatment with placebo or 0.1 IU/kg per day (low dose) or 0.2 IU/kg per day (high dose) rhGH for 28 days. Blood was collected weekly during treatment and on days 35, 42 and 84 during the washout period. Serum IGF1 and P-III-P were measured, and GH-2000 score was calculated.ResultsIGF1, P-III-P and GH-2000 score rose in response to both low- and high-dose GH in both men and women. When compared with the Caucasian volunteers of the previous GH-2000 study, mean baseline and placebo-treated P-III-P and GH-2000 score were lower in GH-2004 men and women. Post-GH, however, peak IGF1 or P-III-P did not differ between studies but the peak GH-2000 score was lower in GH-2004 men. There was no difference between studies in the maximal change in IGF1, P-III-P and GH-2000 score in response to GH in either gender.ConclusionsThese data do not support a significant ethnic effect on the peak or maximal response to rhGH.