Abstract：
OBJECTIVE:The objective of this study was to describe the impact of a 'fast-track' unit, combined with a computerised system for information collection and analysis, on the clinical practice and finance of a cardiothoracic department over the first 12 month period of its application. METHODS:Within 12 months, starting December 1996, 642 major cardiothoracic cases were performed at the Cardiothoracic Department, St Mary's Hospital, London, after the establishment of a 3-bed 'fast-track' unit, which was supported by a computerised system for admission planning and a pre-admission clinic. The main outcome measures were operating numbers, financial income, patient recovery and operative mortality. RESULTS:The 'fast-track' unit resulted in an increase of the operating numbers (11.3% increase in major cardiac cases) and income (38%), as compared with the year before. Some 525 patients out of 642 (81.8%) were scheduled for the 'fast-track' unit and 492 (93.7%) were successfully 'fast-tracked'. Coronary artery bypass grafting operations had the lowest 'fast-track' failure and mortality rates. Re-do operations and complex coronary procedures presented a high 'fast-track' failure rate of approximately 20-25%. Low cardiac output, postoperative bleeding and respiratory problems were the most frequent causes for 'fast-track' failure. CONCLUSIONS:The development of a 'fast-track' unit, supported by a computerised system for information collection and analysis and a pre-admission clinic, has resulted in a substantial improvement of operating numbers and financial income, without adversely affecting the clinical results. This task demanded close collaboration between a dedicated list manager and a designated member of the medical team. Patient selection with appropriate 'fast-track,' criteria may improve further the efficiency of 'fast-track' units in the future.
journal_name
Ann R Coll Surg Engljournal_title
Annals of the Royal College of Surgeons of Englandauthors
Hadjinikolaou L,Cohen A,Glenville B,Stanbridge RDsubject
Has Abstractpub_date
2000-01-01 00:00:00pages
53-8issue
1eissn
0035-8843issn
1478-7083journal_volume
82pub_type
杂志文章abstract：:Two years individual experience of spine and joint tuberculosis in the North West Frontier of Pakistan is summarised. The problems of treating a population that presents late in the course of the disease, and of coping with an added influx of highly affected Afghans, feature prominently in surgical practice. ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1984-03-01 00:00:00
abstract：:Introduction The aim of this study was to identify the proportion of children referred to a paediatric tertiary referral centre who required admission to the paediatric intensive care unit (PICU) following surgery for obstructive sleep apnoea (OSA) and to establish risk factors for these admissions. Methods Retrospect...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2017.0185
更新日期：2018-01-01 00:00:00
abstract：INTRODUCTION:The aim of this study was to evaluate the level of sharps injury reporting amongst surgeons. SUBJECTS AND METHODS:A total of 164 surgeons completed a questionnaire on the reporting of sharps injuries, on the reasons for not reporting and their practise of universal precautions. RESULTS:Out of 164 surgeon...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588409X432194
更新日期：2009-07-01 00:00:00
abstract：:Paragangliomas are rare lung tumours; endobronchial localisation is even more rare. This report describes the case of a 59-year-old patient with a symptomatic endobronchial paraganglioma successfully resected by means of pulmonary lobectomy. Recognition of this uncommon tumour can lead to a correct diagnosis and thera...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2016.0284
更新日期：2017-01-01 00:00:00
abstract：INTRODUCTION:International humanitarian law requires emergency medical support for both military personnel and civilians, including children. Here we present a detailed review of paediatric admissions with the pattern of injury and the resources they consume. METHODS:All paediatric admissions to the hospital at Camp B...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588412x13171221499027
更新日期：2012-01-01 00:00:00
abstract：:Extraskeletal chondrosarcomas are rare and there is only one reported case of primary pancreatic chondrosarcoma. We report the case of a 34-year-old woman with a 6-month history of abdominal pain and distention. Radiological studies indicated a mass in the pancreas, and exploratory laparotomy revealed a tumour of the ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/147870810X12659688851672
更新日期：2010-04-01 00:00:00
abstract：INTRODUCTION:The main barriers to short stay thyroidectomy are haemorrhage, bilateral recurrent laryngeal nerve palsy causing respiratory compromise and hypocalcaemia. This study assessed the safety and effectiveness of thyroidectomy as a 23-hour stay procedure. METHODS:All patients undergoing total or completion thyr...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588414X13814021679997
更新日期：2014-05-01 00:00:00
abstract：INTRODUCTION:Osteoarthritis of the trapeziometacarpal joint (TMJ) is a common condition causing significant disability. Conservative treatments include intra-articular steroid injections. PATIENTS AND METHODS:This clinical, observational study prospectively reviewed the longevity of benefit of steroid injections into ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 临床试验,杂志文章,评审
doi：10.1308/003588410X12699663905078
更新日期：2010-11-01 00:00:00
abstract：:There has been renewed emphasis on research following the Calman recommendations for higher training. It is often considered essential for progression in training to have participated in research projects and to have some publications to one's credit. Orthopaedic surgery is usually thought to lag behind other discipli...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588403321001417
更新日期：2003-01-01 00:00:00
abstract：:Endoscopic papillotomy without cholecystectomy has been performed in 20 elderly patients with complications of bile duct stones. Good biliary drainage was achieved in 17, and there were no complications. One cholecystectomy was subsequently required. Later deaths have been due to unrelated causes. It is concluded that...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1986-11-01 00:00:00
abstract：:A retrospective review of surgical treatment for portal hypertension during a 23-year period in a regional unit is reported and the immediate and subsequent management of patients with bleeding oesophageal varices is discussed. Fifty-four patients with recurrent varix haemorrhage uncontrolled by conservative methods h...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1975-09-01 00:00:00
abstract：INTRODUCTION:The aims of this study were to audit the outcome of elective open abdominal aortic aneurysm (AAA) repair in a district general hospital, as well as investigate the true costs for this procedure in relation to the national tariff. PATIENTS AND METHODS:A database is maintained on AAA surgery in the trust. D...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588409X12486167521037
更新日期：2009-11-01 00:00:00
abstract：:The results of a 12-month prospective study of 113 patients show that intravenous urography has no place in the management of men with acute urinary retention without haematuria. ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1989-03-01 00:00:00
abstract：INTRODUCTION:The aim of this study was to identify whether clinicians are obtaining a valid consent for surgery, and ascertain the parents' perception of parental responsibility when giving consent for their children. PATIENTS AND METHODS:Adults consenting for 100 children were questioned about the possession of paren...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588407X205332
更新日期：2007-09-01 00:00:00
abstract：:The use of preoperative intraincisional (POII) single dose antibiotic prophylaxis has the advantage of providing extremely high concentrations of antibiotic along all layers of the wound, whilst achieving adequate systemic concentrations throughout the operation. In a single blind controlled trial, 250 patients underg...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 临床试验,杂志文章,随机对照试验
doi：
更新日期：1985-07-01 00:00:00
abstract：:First reported two decades ago, isolated incisional recurrence of hepatocellular carcinoma is an extremely rare clinical entity. We present two cases of recurrence: one recurring over 10 years after initial resection, and the second presenting with a port site recurrence 3.5 years following laparoscopic radiofrequency...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2017.0097
更新日期：2017-07-01 00:00:00
abstract：:A new surgical approach to the sublingual salivary gland is described, the key feature of which is the use of a flap rather than the usual incision. The flap includes the submandibular duct and, because of the relationship of the duct and lingual nerve, allows early identification of the latter before dissection of th...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1994-03-01 00:00:00
abstract：:The increased use of day facilities for children undergoing surgery and the provision of a paediatric home nursing team has resulted in a change in overall care of surgical children in hospital in Southampton. The ratio of day patients to inpatients has fallen from 1 : 2 in 1970 to 1 : 1 in 1976 and the early discharg...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 传,历史文章,杂志文章
doi：
更新日期：1978-09-01 00:00:00
abstract：INTRODUCTION:The Improving Outcomes Guidance (IOG) for patients with carcinoma of the penis states that treatment should be provided supraregionally to populations of 4 million or greater who treat over 25 cases of penis cancer each year. This study assesses the impact of this guidance on the management and outcomes of...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588410X12518836439047
更新日期：2010-01-01 00:00:00
abstract：:Introduction While surgery is the cornerstone of bowel cancer treatment, it comes with significant risks. Among patients aged over 80 years, 30-day mortality is 13%-15%, and additionally 12% will not return home and go on to live in supportive care. The question for patients and clinicians is whether operative surgery...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/rcsann.2016.0146
更新日期：2016-07-01 00:00:00
abstract：:One hundred and four patients with second, third degree or thrombosed prolapsed piles, treated by cryotherapy, were studied pre- and postoperatively. A computer analysis was made of all relevant data such as pile mass, freezing time and results of treatment. The method, which is easy to perform and cost effective, is ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1983-07-01 00:00:00
abstract：:Intact parathyroid hormone (PTHi) has a relatively short half-life and levels fall significantly within 15 min of the successful excision of all the abnormal parathyroid glands during surgery for hyperparathyroidism. Monitoring this fall has been suggested as useful in decreasing the failure rate of neck explorations ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1993-01-01 00:00:00
abstract：:General anaesthesia is infrequently requested for bronchography in small children. The clinical indications, recommendations for the anaesthetic technique, and problems associated with the investigation are discussed. ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1980-05-01 00:00:00
abstract：:A patient presented with a recurrent incarcerated inguinoscrotal hernia requiring urgent surgery. The defect was through the gap in the mesh left originally for the cord structures. As a result, a modified funnel repair was performed. An innovative approach was adopted that was best suited to tackling and reducing the...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588414X13946184903081
更新日期：2014-11-01 00:00:00
abstract：:This study compares the assessment of lymph nodes by the surgeon, at the time of operation, with the pathologist's assessment on the resected specimen in 85 cases of total gastrectomy with extended lymphadenectomy for gastric carcinoma. There was correlation in 67% of cases, in 28% the disease was overstaged, and in o...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1989-09-01 00:00:00
abstract：INTRODUCTION:Septal surgery has been identified as suitable for day-surgery, but is not widely performed as such. Guidelines for day-surgery state that the unexpected admission rate should be 2-3%. Previous audits have not achieved this figure and septoplasty is not universally considered suitable for day-surgery. We h...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588406X95039
更新日期：2006-03-01 00:00:00
abstract：INTRODUCTION:The National Joint Registry (NJR) for England and Wales was launched in April 2003. The UK Department of Health (DoH) awarded the contract to run the NJR to Atomic Energy Authority (AEA) Technology in September 2002. The aim was to etablish the views of a large group of orthopaedic consultants on the new N...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/1478708051603
更新日期：2005-03-01 00:00:00
abstract：INTRODUCTION:Nosocomial MRSA infection has become an important healthcare issue. We present 6 cases of MRSA enteritis, acquired following bowel surgery and ileostomy formation. PATIENTS AND METHODS:The data set was obtained from the experience of one consultant surgeon over 6 years in one medical centre. The clinical ...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588407X179143
更新日期：2007-04-01 00:00:00
abstract：:Chemotherapy may cause oral ulceration but a thorough investigation of symptoms and signs is important to determine the underlying diagnosis accurately. We describe a case of a patient with a poorly differentiated urothelial carcinoma of the bladder developing a tongue metastasis. This is a challenging diagnosis to ma...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：10.1308/003588414X14055925060794
更新日期：2015-03-01 00:00:00
abstract：:The management of 12 patients with medullary thyroid carcinoma is reviewed. All patients underwent total thyroidectomy. Local nodal and extracapsular spread was aggressively resected, followed by radiotherapy. No patient died from uncontrolled local disease. Prolonged survival after radical treatment is demonstrated e...
journal_title：Annals of the Royal College of Surgeons of England
pub_type： 杂志文章
doi：
更新日期：1991-01-01 00:00:00
