Abstracts, Annual Scientific Sessions of the College of Surgeons of Sri Lanka, 2009
The Sri Lanka Journal of Surgery
The accident service of NHSL serves as the centre of trauma care for the nation and provides round the clock service. While a large number are cared for as inward patients, the quality of care provided has not been evaluated to date. A i m To ascertain the adequacy and promptness of pain relief, waiting times prior to surgery, duration of fasting for fluids, and methods of inward accommodation which contribute to the quality of care, and identify areas for improvement. Patients and methods 220
... onsecutive admissions to the accident service were evaluated with regard to pain score on admission, type of injury, type and dosage of analgesia, delay prior to administration of analgesics, pre and post op periods of fasting for fluids in relation to the type of anesthesia, and the method of inward patient accommodation. Results Mean duration between admission and administration of analgesia was 6.14 hrs, mean pain score of 7.45 dropped to 3.47 following analgesic medication. For lower limb fractures, 19.6% received Paracetamol alone, Opioids alone in 22.1% and a combination of Paracetamol and DiclofenacNa in 52.2%. Of the non ambulant patient population, 63.9% were accommodated in beds, 25% in trolleys without mattresses and 11.1% in trolleys with mattresses. The mean duration of fasting for procedures under LA were 7.45 hrs preoperatively and 4.35 hrs postoperatively while for GA it was 7.05 hrs and 9.54 hrs respectively. Conclusions There is room for improvement in the quality of care provided to inward patients of the accident service, NHSL. Introduction During preoperative preparation patients undergo "routine" investigations to detect asymptomatic diseases. The probability of finding an abnormality on such "routine" investigations is small, increasing the cost of perio-perative care. We evaluated the compliance with guidelines and costs of preoperative investigations at NHSL. Material and methods Records of 367 patients undergoing elective surgery at the general surgical units of the NHSL from January-February 2009 were evaluated using NICE-UK guidelines on pre-operative investigation as the standard. Data were collected using an expert validated pretested interviewer administered questionnaire. Results Mean age was 45.7 (SD±15.8) years and 46.9% were males. Majority underwent intermediate grade surgery (56.7%) and belonged to ASA Class I (68.7%) and. Out of 2046 investigations in all patients the mean number of investigations requested per patient was 4.58(SD±2.00). Requests for urinalysis and ABG demonstrated good adherence to guidelines (70-100%). ECG, FBC, Renal profile and blood grouping demonstrated moderate adherence (40-70%) while CXR, PT/INR, FBS/RBS, Lung function tests, AST/ALT and 2D-Echo demonstrated poor adherence (<40%) to guidelines. Surgery was not cancelled/deferred in any patient due to abnormal preoperative investigations. Excess cost due to non-adherence to guidelines during the study period was Rs. 241,300-375,270. Minimal utilization and lack of awareness about guidelines and performing investigations requested by all team members without supervision also contributed towards unnecessary investigations. Discussion and conclusion Unnecessary testing during preoperative preparation is com-mon at our institution resulting in an excess cost. There is opportunity to rationalize practices and decrease related costs.