E-Posters

This is an audit regarding the emergency operational notes and how far they are from the Royal College of Surgeons guidelines (RCS). Notes from 50 patients from the emergency operation book were retrieved, analysed and compared to the RCS guidelines. Results were presented. Aims: The goal is to compare the existing operational notes of the emergency operations with the guidelines that have been set by the RCS. This aims to improve the way notes are kept, to improve communication and information sharing in order to endure patient safety. Methods: Data were collected by the emergency theatre book, 50 recent patients’ notes were included and data were put on an excel sheet. The data were analysed and two charts were created. Data were presented in the audit meeting. Results: Results showed that RCS guidelines are followed partially in writing good operational notes but improvement is needed. Conclusions: A template of operational notes needs to be introduced to ensure 100% compatibility with RCS guidelines. P Th A.4A Review of the Congenital Causes of Large Bowel Obstruction Talisa Ross1,2, Nicholas Farkas1, Ted Welman1, Sarah Brown1, Jason Smith1, Nihkil Pawa1 1West Middlesex University Hospital, 2Imperial College London Aims: Large bowel obstruction (LBO) is a surgical emergency where a mechanical interruption occludes the flow of intestinal contents. The common causes of malignancy, volvulus and herniae are well known. This review aimed to highlight the less commonly seen congenital causes of LBO described in the literature. Methods: A thorough search of PubMed, Google Scholar, Medline and Embase was performed and all pertinent causes identified in the literature were discussed. Symptoms, aetiology, diagnosis and management of each cause were described. Results: In neonates, important differentials for causes of LBO include meconium ileus (which leads to a microcolon), meconium plug syndrome (inability of the colon to propel meconium through the intestine), colonic atresia (due to a vascular insult on the mesentery), Hirschprung’s disease (failure of development of the Meissner’s and Auerbach’s plexuses) and malrotation (failure of the midgut to rotate around the superior mesenteric artery). Other less common causes reported in paediatric and adult patients include congenital anomalous bands and Ladd’s bands (both treated with band lysis), solitary intestinal fibromatosis (mesenchymal spindle cell tumours), stenosis secondary to Meckel’s diverticulum and congenital diaphragmatic herniae (reports of herniae of both Bochdalek and Morgagni). Conclusions: Overall, congenital causes of LBO are an infrequent finding, however they should be considered in the symptomatic neonatal and paediatric population. Congenital causes of LBO can be broadly classified into neonatal, paediatric and adult, and differentials can be identified accordingly. P Th A.5A cost improvement programme for new policies in pre-operative blood transfusion Mikolaj Kowal1,2, Damir Kosutic2, Eva Myriokefalitaki2, Maurice Lau2, Abudeeb Haytham2, Vijay Sangar2 1Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom, 2Department of Surgery, the Christie NHS Foundation Trust, Manchester, United Kingdom Aims: The NHS faces unprecedented financial pressures. Unnecessary pre-operative blood transfusion testing generates large costs and puts strain on blood transfusion services. A cost improvement programme (CIP) at a large NHS cancer treatment centre was developed to evaluate the cost savings of new pre-operative blood transfusion guidelines. Methods: The pre-operative blood transfusion tests ordered were compared with new guidelines retrospectively over a two-month period. Patients that underwent surgical procedures in Colorectal Surgery, Gynaecological Surgery, Plastic Surgery and Urological Surgery were included. The data was then analysed to calculate the estimated cost savings per patient and department, total study period cost savings and an annual forecast for Trust cost savings. Results: 389 patients underwent surgical procedures. The predicted savings were: £1788 for Plastic Surgery, £2006 for Gynaecological Surgery, £1369 for Urological Surgery, £2406 for Colorectal Surgery, £7569 in total and £40,192 forecast per annum. Conclusions: The new guidelines are forecast to generate large savings within the Trust. CIP projects on pre-operative blood transfusion guidelines are encouraged in NHS trusts. Utilisation of similar guidelines nationwide could generate large annual savings for NHS England. P Th A.6Patient Involvement in Choice of Surgical Approach to Inguinal Hernia Repair Anne Macleod, Mike Kipling City Hospital Sunderland Aims: NICE guideline TA83 recommends all individuals undergoing inguinal hernia repair should be offered open or laparoscopic approach. They must be fully informed of the risks and benefits associated with each; as part of the informed consent process. This should be reflected in out-patient clinic documentation. The aim of this audit is to assess current practice in our trust against NICE guideline. Methods: Data was collected retrospectively for elective inguinal hernia repairs (April 2016April 2017). Letters were reviewed for documentation of discussion with patient regarding surgical approach. Initial results were presented at clinical governance meeting. Following this, a re-audit was completed over a 2-month period to assess for evidence of improvement. Results: Initial data was collected for 348 patients. Documentation of surgical approach discussion was found in 21% of cases. © 2019 The Authors www.bjs.co.uk BJS 2019; 106 (S5): 85–128 BJS © 2019 BJS Society Ltd