star surg uk presentation
DESCRIPTION
Presentation slides from our first meeting, held on Tuesday 10th September 2013 at the Royal College of Surgeons. Find us on Twitter @STARSurgUK Facebook.com/STARSurgUK Email: [email protected]TRANSCRIPT
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STARSurgUKSTUDENT AUDIT AND RESEARCH IN SURGERY
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Introduction• Who we are.
Aneel, Chetan, Dmitri, Ed, James, Mike, Steve.
• How we met.
• Our aim.
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Blank canvas
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Collaborative Research
Aneel BhanguGeneral Surgery Registrar, West Midlands
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Trainee collaboration• Difficult to do alone!
• Frustration at small projects
• Natural network.
• Requirement.
• Interest and enthusiasm.
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Team leading& working
Team leading& working
Enhance CVEnhance CVWrite papersWrite papers
Publications & Presentations
Publications & Presentations
Transferableskills
Transferableskills
Data Collection & analysis
Data Collection & analysis
Project Methodology
& design
Project Methodology
& design
Trainee
Quality ofResearch
Patients
Region
Benefits of Research
Collaborative
More clinical surgical trialsMore clinical surgical trials
MulticentreTrials
MulticentreTrials
Better recruitment
Better recruitment
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Benefits• Medical school network.
• All centres represented.
• Auditable & useful questions.
• PubMed citable co-authorship.
• Local, on-going networks.
• Participation in audit.
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Factors leading to success
• Enthusiastic network.
• Communications.
• Leaders.
• Supporters.
• Ideas:
- simple, broadly applicable, common.
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First project• Simple.
• Broadly applicable to every hospital.
• To establish network.
• Test the network.
• Final outcome not reliant on result.
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The future1. First project > committee > annual
report.
2. Align support > RCS, ASGBI, surgical societies
3. Pan-European.
4. Strengthen local links > Sepsis.
5. Global study 2014.
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Surgical AuditDmitri Nepogodiev
FY2, Norfolk & Norwich University Hospital
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Clinical audit
“A quality improvement process that seeks to improve patient care and outcomes through
systematic review of care against explicit criteria and the implementation of change”.
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Audit versus research
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Audit cycle
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Gold standard
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Common audits• Venous thrombo-embolism prophylaxis.
• Fluid management.
• Medical record keeping.
• Anastomotic leaks.
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Interventions• Present at department/ MDT meeting.
• Create an induction for new doctors.
• Change documentation.
• Change procedures.
• Then re-audit!
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Surgeon level data
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STARSurgUK• Gold standard.
• No change to patient management.
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HRA decision tool
http://www.hra-decisiontools.org.uk/research/
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STARSurgUK
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STARSurgUK thanks RCSE for their support
http://www.rcseng.ac.ukhttp://
surgicalcareers.rcseng.ac.uk
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STARSurgUK Protocol
Chetan KhatriImperial College London Medical School
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NSAIDs
1Gotissen, BJS, 2012, 2Klein, BMJ, 2012
• Regularly used as post-operative analgesics as part of ERAS, WHO pain ladder.
• Increasing evidence1,2 emerging that NSAIDs may have a detrimental effect on post-operative adverse events.
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Aim
“To audit the safety profile of post-operative NSAIDs in current British surgical
practice.”
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Primary questions• Are post-operative NSAIDs associated
with an increase in the rate of post-operative adverse effects
• What are the other risk factors for poor outcome following bowel resection?
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Inclusion criteria• Consecutive patients undergoing bowel
resection.
• Elective or emergency patients.
• Open, laparoscopic or lap assisted procedures.
• Age 18 years or over.
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Exclusion criteria• Appendicecotomy for acute
appendicitis.
• Bowel repair without resection.
• Wedge resection.
• Trauma laparotomy.
• Gynaecological primary indication.
• Urological primary indication.
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Patient identification• Daily review of:
• Elective theatre lists.
• Theatre logbooks.
• Handover sheets (emergency/ ward lists).
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STARSurgUK Protocol
Michael KellyLiverpool Medical School
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Data quality is key!• Become familiar with the Clavien-Dindo
classification.
• Complete the e-learning module!http://quizstar.4teachers.org/index.jsp
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Pilot period• Should take place post-audit approval.
• All team members should be involved.
• Get familiar with how to access/ record necessary patient data .
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Audit periods• Period 1: 0800 Tuesday 24th September
to 0759 Monday 14th October
• Period 2: 0800 Tuesday 1st October to 0759 Monday 14th October
• Period 3: 0800 Tuesday 8th October to 0759 Monday 21st October
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Data sources• Patient Notes/ nursing notes.
• Computer-based electronic records.
• Anaesthetic/ recovery notes.
• Operation notes.
• Outpatient records.
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The Clavien-Dindo Classification
James GlasbeyCardiff University Medical School
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Overview• What it is.
• Why it’s good.
• Why it’s important to STARSurgUK.
• How we can make sure it is used accurately.
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“any deviation from the normal postoperative course”
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Why is it good?• Measure of MORBIDITY.
• Classification via therapeutic consequence.
• Validated.
• Internationally reproducible.
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Data sources• Patient Notes/ nursing notes.
• Computer-based electronic records.
• Anaesthetic/ recovery notes.
• Operation notes.
• Outpatient records.
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Dindo et al., 2004, Annals of Surgery
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Definitions
IAny deviation from the normal postoperative course without the need for pharmacological treatment [other than the “allowed therapeutic regimens”], surgical, endoscopic or radiological interventions.
IIRequiring pharmacological treatment with drugs other than the allowed therapeutic regimens. Includes transfusions and TPN.
IIIRequiring surgical, endoscopic or radiological intervention.
IVLife-threatening complications requiring critical care management and CNS complications.
VDeath of a patient
The Clavien-Dindo classification
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Case 1
Eligible? Classification?
A 52 year old man underwent gastrectomy for malignancy. Six days post-operatively he had left sided facial and limb weakness. His CT head scan showed no acute changes. He was not thrombolysed. Several hours later the weakness resolved spontaneously. A diagnosis of TIA was made and aspirin
75mg OD was started.
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Case 2
Eligible? Classification?
A 76 year old lady who underwent emergency sigmoid colectomy for an
obstructing tumour failed to mobilise post-operatively. She developed a chest
infection. Despite intravenous antibitiotics, physio and nebulisers she deteriorated and
developed respiratory failure. She was taken for ventilation in ITU. Eventually she
was discharged.
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Case 3
Eligible? Classification?
A 41 year old man underwent anterior resection for a rectal tumour. On the first
post-operative night he spiked a temperature and was given intravenous
paracetamol. On day 2 he was hypokalaemic and was administered oral
potassium supplementation.
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Take home messages!
• Internationally validated classification of morbidity via therapeutic consequence.
• Primary outcome measure for the STARSurgUK audit this September/October.
• Quality assurance – please complete the online e-learning module prior to commencing your data collection.
http://quizstar.4teachers.org/index.jsp
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James GlasbeyAssociation of Surgeons in
Traininghttp://
www.asit.org
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Any questions?