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Audit of Surgeon's activity in emergency laparotomies

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May 29. 2011
Nebil Behar

Hello everyone, just joined this network after coming across it at ASGBI Bournemouth this month.

I am an emergency surgeon in London. As a consultant I lead and train juniors in emergency surgery at Chelsea & Westminster Hospital and therefore run the cepod list every morning. I have started looking at ways of auditing my work beyond the monthly M&M meetings;

1. Trying to assess the optimum ratio of laparoscopy vs laparotomy

2. Emergency Surgical Decision Making by Juniors and Consultants

are two areas we started here which are relevant to outcomes in emergency laparotomy.

I was wondering if anyone else had any audit ideas involving training and surgical practice in emergency surgery similar to above they have used successfully?

Nebil Behar

October 19. 2011
Alistair Myers

I am a colorectal/emergency surgeon at Hillingdon, and have been wondering about the same things. Did you ever get any answers? We have been trying to work a thing to measure, equivalent to the #NOF pathway.

October 19. 2011
Nebil Behar

Hello Alistair, we got some interesting data on both projects. The optimum ratio of laparoscopy has become an interesting tool for expanding a surgeons laparoscopic practice overtime with reduced conversion rates by encouraging post op reflection. i have presented this at the recent St Marks Laparoscopy in Emergency Surgery Course and it was well recieved. As for the decision making proforma that we developed here, it is in its early stages but improvement in basic decision making appears possible at least for FY1's and SHO's in the same cohort over 4 months by getting them to commit to decisions on paper and the ensuing discussion facilitated by the decision. Although ofcourse they could progress during their attachment even without such exercise, it is nevertheless nice to demonstrate improvement if for nothing else but for their formative assessment and appraisal. This latter will be established once the exercise is validated over time.

How are you using the #NOF pathway?

Nebil

November 02. 2011
Alistair Myers

I'm not involved with the NOFs but I believe that the time delays in operating have all but gone with the adoption of all day trauma lists, and there is some financial benefit to the trust for doing this which outweighs the loss in elective activity, even if at times the trauma theatre is standing idle.

We were interested in an equivalent metric for gen surg, and had started looking at management of ? appendicitis, with the aim being to avoid principally female pts lying around waiting for ultrasounds which never change management. We then found this network, and became more focused on our sickest pts, working out the reasons in delays getting them to theatre. We think its better now with dedicated emergency consultant sessions, but its such a heterogenous group of pts that its difficult to prove.

Your decision making proforma sounds interesting. Would you be able to send me a copy?

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