The beauty of sleep

Sleep is a critical plank of our physical and mental wellbeing. But for those working in veterinary medicine – with its long and unpredictable hours – it is something that can be as difficult to acquire as it is precious. Claire Read speaks to Michael Farquhar, a hospital consultant in sleep medicine, about why sleep is so important and what individuals and managers can do to improve it.

The elusive spleen

Introduction The aim of this study was to review the experience of general surgeons performing splenectomy in a district general hospital. The outcomes are discussed together with potential reasons for the increasing rarity of the procedure. Methods A retrospective cohort study was carried out of all patients undergoing splenectomy (as identified by a single trust pathology department on receipt of splenic samples) between 1 January 2000 and 1 May 2017. Case notes and computer systems were interrogated for data on operating surgeon, patient demographics, diagnosis, surgical approach (laparoscopic/open/converted to open), critical care admission and 30-day mortality. Results During the study period, 170 consecutive splenectomies were undertaken by 24 different operating surgeons. There were on average 5.8 planned and 4.2 unplanned splenectomies per year. The 30-day mortality rate for all splenectomies was 8.8%, with an elective 30-day mortality rate of 2.0%. Only 3 of the current consultant surgeons had undertaken more than 6 cases over the 17-year study period. Some senior consultants had not performed any splenectomies (either planned or unplanned) during the 17-year study period. Conclusions Splenectomy is required ever more rarely and experience as a district general hospital consultant is limited. Possible reasons for this include improvements in medical management of haematological diseases, the increasing use of conservative and radiological management for traumatic splenic injury, and a reduction in trauma cases and diversion of such cases to major trauma centres. Trainees and consultants must seek experience during specialty training or via cadaveric training in order to demonstrate competence.

Non-Attendance Rates in ENT Clinics Following the Implementation of 'Choose and Book'

Traditionally, general practitioners (GPs) would write a referral letter to a hospital consultant requesting an appointment. The choice of hospital and specific consultant was left to the expertise of the GP. This referral would be vetted by the consultant and prioritised into a routine or urgent appointment. However, in 2005 a new system, called 'Choose and Book', was introduced. Once the patient and GP had agreed that a hospital consultation was required, the GP completed a referral letter and provided the patient with a code to access a telephone or internet booking system. This allowed patients to choose both the hospital they would attend and the consultant by whom they would be seen. Booking rules were constructed to ensure that appropriate consultations were offered.

An Audit of Orthopaedic Referrals via Multi-Professional Triage Teams

INTRODUCTION Multi-Professional Triage Teams (MPTTs) were created to reduce the caseload of hospital orthopaedic clinics and this prospective study evaluated referrals made to a district general hospital orthopaedic department from a lower limb MPTT clinic. PATIENTS AND METHODS Over 9 months, 277 referrals to a lower limb hospital orthopaedic clinic were assessed. The temporal delay to hospital clinic review between patients seen at the MPTT clinic and those referred directly by their general practitioner (GP) was analysed using an ANOVA test. A qualitative assessment of diagnoses given to patients reviewed at the MPTT clinic was performed. RESULTS The 132 patients initially reviewed at the MPTT clinic and subsequently referred to a hospital consultant waited significantly longer (140 days compared to 62 days by direct GP referral; P < 0.05) to see an orthopaedic consultant. Over three-quarters of this patient cohort incorrectly identified the healthcare professional conducting their consultation at the MPTT clinic. One-third of cases (31%) had no diagnosis made and 22% were assessed as having an incorrect diagnosis. CONCLUSIONS Time delays, patient confusion regarding professional roles and diagnostic indecision are significant problems for patients referred to hospital orthopaedic clinics from MPTT clinics. This risks sub-optimal patient care and may lead to future medicolegal implications.