944 ‘A Series of Unfortunate Fractures’: Utilising Opportunities Brought About By COVID-19 To Create A National Online Educational Series

Background

The Covid-19 pandemic has disrupted the training and education of Junior Doctors. Physical restrictions have highlighted the potential use of remote online platforms to deliver teaching. We aimed to create and deliver a free educational series for Junior Doctors, delivered by Orthopaedic Registrars and Consultants through an interactive online platform.

Method

Teaching material, learning aims, and advertisement tools including mailing lists were developed. Advertisement was arranged on national scale via the British Orthopaedic Association (BOA) and the British Orthopaedic Trainees Association (BOTA). Six sessions were delivered via the ‘Blackboard Collaborate’ platform.

Results

Six sessions were held over six weeks with 546 total attendees, averaging 92 per session. Foundation Doctors and Medical Students accounted for 39.7% and 54.0% of attendees respectively. Attendees were primarily from the UK (90.1%). Average attendee rating for ‘enjoyment of session’ and ‘relevance to education’ was 9.11/10 and 8.66/10 respectively. Of those surveyed, 100% of attendees reported they would recommend this series to a colleague.

Discussion:

This lecture series was created in response to the restrictions on physical meetings and reduced teaching opportunities during the Covid-19 pandemic. High attendance and overwhelmingly positive feedback from this series supports the use of online teaching for the future of Post-graduate education.

441 Intravenous Tranexamic Acid Given at Femoral Fragility Fracture Surgery Reduces Blood Transfusion Requirements Four-Fold

Introduction

Tranexamic acid (TXA) is proven to reduce blood loss in several surgical fields, but its use in femoral fragility fracture (FFF) management is ill defined. This study examined the effect of intraoperative TXA on the rate of postoperative blood transfusion following FFF.

Method

A prospective non-randomized case-control study of 361 consecutive patients admitted to the study centre with FFFs over a 4-month period was performed. Intravenous TXA 1g was administered intraoperatively at the discretion of the operating team: 178 patients received TXA and 183 did not.

Results

Patients given TXA required fewer blood transfusions: 15/178 (8.4%) vs controls 58/183 (31.7%), (p < 0.001). Calculated blood loss (mean difference -222ml (-337 to -106, 95%CI), p < 0.001) and percentage drop in Hb (mean difference -4.3% (-6.3 to -2.3, 95%CI), p < 0.001) were significantly lower in the TXA group. The difference in CBL was greatest following intramedullary nail (n = 49: mean difference -394ml, p = 0.030) and DHS (n = 101, mean difference -216ml, p = 0.032). There was no significant difference in complication rates: venous thromboembolism TXA 2/178 vs control 1/182 (p = 0.620); MI/stroke/TIA 2/178 vs 0/182 (p = 0.244)

Conclusions

Intraoperative intravenous TXA significantly reduced calculated blood loss and blood transfusion requirements following femoral fragility fracture surgery without increasing the rate of complications.

83 Closed Loop Audit Examining Documentation of Advanced Trauma and Life Support (ATLS) Secondary Survey in Polytrauma Cases at The Royal Infirmary of Edinburgh (RIE)

Introduction

Secondary survey is a key aspect of the ATLS guidelines in avoiding missed injuries in polytrauma patients. Aim: Evaluate the documentation of secondary survey in polytrauma cases admitted to the RIE A+E department.

Method

Standard audit protocol, retrospective data collection. Polytrauma patients and patients requiring Trauma CT were identified from the local trauma database. Primary outcome was successful completion and documentation of secondary survey. Cycle 1: All patients from 01/01/2015-01/09/2015. Local policy change included an A+E trauma booklet and policy of secondary survey on admission to Intensive Care. Cycle 2 was completed post-intervention for patients presenting between 11/01/2019-29/05/2019.

Results

Cycle 1 (N = 20, N Secondary survey documented=10, mean=50%). Mean time to secondary survey was 8 hours (range 3-49). Cycle 2 (N = 28, N Secondary survey documented=24, mean=87.5%). Mean time to a secondary survey was 4 hours 30 minutes (range=1-21hrs). Significant improvement in documentation (Fisher’s Exact Test, P = 0.017).

Conclusions

Implementation of the secondary survey protocol and trauma booklet significantly improved documentation of secondary survey in the polytrauma patient. Evidence also suggests improved time to secondary survey. However, documentation of secondary survey is not universal indicating further improvement is required in trauma care, as the RIE moves towards becoming a National Major Trauma Centre.

989 Improving the Completion of Hospital Anticipatory Care Plans in Orthopaedic Trauma Wards During The COVID-19 Pandemic

Background

The COVID-19 pandemic has highlighted the importance of the Hospital Anticipatory Care Plan (HACP). New guidance recommends all patients admitted acutely to hospital should have a HACP completed within 24 hours. We aimed to assess how many orthopaedic trauma patients admitted to the study centre had HACP completed within 24 hours of admission.

Method

Departmental Quality Improvement Project (QIP) permission was granted, and standard audit protocol was utilised. Data were collected in a retrospective manner using our trauma database and online patient record system. Educational interventions including staff teaching sessions and dissemination of infographic posters were implemented. Cycle two was repeated in similar fashion.

Results

Cycle one (50 patients): 37/50(74%) had HACPs completed. Of those with HACPs, 18/37(49%) were completed within 24 hours. Median time to completion was 45.3 hours (range 0.4-275.1 hours). Cycle two (58 patients): HACP completion significantly improved (56/58, 97%; p < 0.01), with more completed within 24 hours (50/56, 89%; p < 0.01). The median time to completion was decreased to 4.92 hours (range 0.27-60.6; p < 0.01).

Conclusions

Unit compliance was initially poor however significantly improved with educational measures. Failing to identify ceilings of care early can result in difficult decisions having to be made in critical situations, risking suboptimal patient care.

66 Cycle 1: Time for Peripherally Inserted Central Catheter (PICC) Insertion for Patients with Complex Infections in The Trauma and Orthopaedic Department at The Royal Infirmary of Edinburgh (RIE)

Introduction

Bone, joint and soft tissue infections often require long term antibiotic therapy alongside operative management. Intravenous (IV) access is essential for antibiotic administration and monitoring. ‘Long-lines’ such as PICC provide reliable long-term IV access. Aim: analyse time to insertion of ‘Long-lines’ and effects on patient outcomes.

Method

Standard audit protocol. Data tool was developed, trialled, and tested. Data was collected retrospectively from departmental database and TRAK (Online patient record system) for patients admitted with suspected bone, joint or soft tissues infection from 01/11/19- 29/2/20.

Results

91 patients admitted with presumed infection. PICC requested in 30 patients. Mean time to PICC request from admission was 8.7 days (1-33). 23 patients received PICC. Mean time to PICC following request was 6.7 days (1-15). Mean time to PICC from admission was 15.9 days (4-39). 10 of 30(33.3%) patients had documented missed antibiotics due to lack of IV access.

Conclusions

Large variation in time for patients receiving PICC from admission and from time of request. A significant proportion of patients are missing IV antibiotics due to poor IV access. Improvement in time to ‘longlines’ would reduce incidence of venepuncture in patients requiring IV access in addition to reducing missed IV antibiotics due to lack of access.