BACKGROUND:Prior to all surgical procedures, possible risks are outlined to patients during an informed consent discussion, and they are invited to ask questions. Written consent records this discussion and signals a patient's willingness to proceed with surgery. This study aims to improve the documentation of complications discussed during laparoscopic cholecystectomy consent through the introduction of a procedure-specific consent form.METHODS:Phase 1 included a retrospective analysis of possible complications documented on standard consent forms for laparoscopic cholecystectomy. Phase 2 was a prospective randomized comparison of existing standard consent forms versus procedure-specific consent forms measuring the documentation of significant complications as identified from the Royal Australasian College of Surgeons brochure for laparoscopic cholecystectomy. These include bile duct injury, bile leak, bleeding, infection, conversion and damage to other organs. The proportion of participants in each cohort with the documentation of specific complications was assessed using the two-sample test of differences in proportions.RESULTS:Phase 1 of the study found that the possible risk of bleeding was documented in 82.1% of cases, while damage to other organs was only documented in 7.7%. Phase 2 of the study showed significant improvements in the documentation of specific complications for both standard and procedure-specific consent cohorts; 76.5% of participants in the procedure-specific consent cohort had all complications documented, while no participants in the phase 1 cohort had all complications documented.CONCLUSION:Introduction of a procedure-specific consent form for laparoscopic cholecystectomy has improved the documentation of a standard set of complications.

word count: 247 Manuscript word count: 3,387 This article is protected by copyright. All rights reserved. This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/ans.13888 2 Figures: 2 Tables: 3 Abstract Introduction: Prior to all surgical procedures possible risks are outlined to patients during an informed consent discussion and they are invited to ask questions. Written consent records this discussion and signals a patient’s willingness to proceed with surgery. This study aims to improve documentation of complications discussed during laparoscopic cholecystectomy consent through the introduction of a procedure specific consent form.Introduction: Prior to all surgical procedures possible risks are outlined to patients during an informed consent discussion and they are invited to ask questions. Written consent records this discussion and signals a patient’s willingness to proceed with surgery. This study aims to improve documentation of complications discussed during laparoscopic cholecystectomy consent through the introduction of a procedure specific consent form. Methods: Phase 1 included a retrospective analysis of possible complications documented on standard consent forms for laparoscopic cholecystectomy. Phase 2 was a prospective randomized comparison of existing standard consent forms vs. procedure specific consent forms measuring the documentation of significant complications as identified from the Royal Australian College of Surgeons (RACS) brochure for laparoscopic cholecystectomy. These include bile duct injury, bile leak, bleeding, infection, conversion and damage to other organs. The proportion of participants in each cohort with documentation of specific complications was assessed using the two-sample test of differences in proportions. This article is protected by copyright. All rights reserved.

BACKGROUND:Key aspects of care may be overlooked on a busy surgical ward round. This study assessed the use of a checklist to correct these omissions. Its use as the basis of structured ward round documentation was then measured.METHODS:Using a structured checklist, key aspects of surgical care were observed and recorded during ward rounds. Initially, members of the surgical team were unaware of the checklist. Subsequently, rounds were performed with a designated member of the team acting as 'prompter' if aspects of care were not considered per the checklist. A structured ward round progress form was developed and its completion assessed before and after specific education in its use. Changes in the use of checklist and documentation using the structured form were analysed for statistical significance.RESULTS:Following the use of a checklist and prompting during ward rounds, significant improvement occurred in the consideration of the majority of criteria included in the checklist, all of which reached statistical significance (P < 0.05). Provision of a structured progress form did not initially improve documentation but this was substantially improved with specific education (P < 0.05).CONCLUSION:The use of a checklist during surgical ward rounds makes significant improvement in the consideration of most key aspects of care and education in the completion of a structured progress form substantially improved documentation.

INTRODUCTION:Suprapubic catheter (SPC) insertion is a basic skill required of surgical trainees. It is likely a trainee's first attempt at the procedure, will be undertaken without direct supervision at night and without access to aids of catheterization. Unfortunately, lack of simulation models and unpredictability of when SPCs are required, make it difficult to acquire this skill. Therefore, junior doctors frequently persist with urethral catheterization, with an increased risk of urethral injury. Improper catheterization has been cited as the causative factor for urethral strictures. The aim of this study was to develop an SPC model and assess its influence on a trainee's confidence in this procedure.TECHNICAL CONSIDERATIONS:An SPC model needs to fulfill a number of criteria. It should have anatomic characteristics of a bladder and provide realistic visual and sensory feedback. Cost effective copies of the model, which are able to be rapidly cycled through simulations are needed for effective clinical workshops. Finally, a trainee's understanding and confidence in performing the procedure should increase after using it. This prototype model has 3 anatomic parts: the bladder, the anterior abdominal wall, and the housing abdominal box. The most crucial component is the bladder, which is a balloon with Mefix tape that prevents leaking and "popping" on trocar insertion.CONCLUSION:This SPC model can be readily replicated by most clinical school and easily added to surgical workshops to ensure that trainees have hands on experience with this procedure before being required to perform it on patients.

ANZ Journal of SurgeryVolume 83, Issue 11 p. 892-892 LETTER TO THE EDITOR Orientation of junior surgical staff to a surgical service Graeme Thompson FRACS, Graeme Thompson FRACS Surgery, Western Health, Footscray, Victoria, AustraliaSearch for more papers by this authorJohn Mulder FRACP, FCICM, John Mulder FRACP, FCICM Intensive Care Unit, Western Health, Footscray, Victoria, AustraliaSearch for more papers by this authorJanet Beer RN, CCRN, GradCert (Education and Training), Janet Beer RN, CCRN, GradCert (Education and Training) Simulation Centre, Western Health, Footscray, Victoria, AustraliaSearch for more papers by this authorMatthew Croxford FRACS, Matthew Croxford FRACS Surgery, Western Health, Footscray, Victoria, AustraliaSearch for more papers by this authorDavid Mai MBBS, David Mai MBBS Simulation Centre, Western Health, Footscray, Victoria, AustraliaSearch for more papers by this authorTodd Mason, Todd Mason Simulation Centre, Western Health, Footscray, Victoria, AustraliaSearch for more papers by this author Graeme Thompson FRACS, Graeme Thompson FRACS Surgery, Western Health, Footscray, Victoria, AustraliaSearch for more papers by this authorJohn Mulder FRACP, FCICM, John Mulder FRACP, FCICM Intensive Care Unit, Western Health, Footscray, Victoria, AustraliaSearch for more papers by this authorJanet Beer RN, CCRN, GradCert (Education and Training), Janet Beer RN, CCRN, GradCert (Education and Training) Simulation Centre, Western Health, Footscray, Victoria, AustraliaSearch for more papers by this authorMatthew Croxford FRACS, Matthew Croxford FRACS Surgery, Western Health, Footscray, Victoria, AustraliaSearch for more papers by this authorDavid Mai MBBS, David Mai MBBS Simulation Centre, Western Health, Footscray, Victoria, AustraliaSearch for more papers by this authorTodd Mason, Todd Mason Simulation Centre, Western Health, Footscray, Victoria, AustraliaSearch for more papers by this author First published: 29 October 2013 https://doi.org/10.1111/ans.12376Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume83, Issue11November 2013Pages 892-892 RelatedInformation

BACKGROUND:Surgical audit on management of mild acute gallstone pancreatitis at Western Health showed that non-compliance of carrying out laparoscopic cholecystectomy or endoscopic retrograde cholangiopancreatography and sphincterectomy within 4 weeks had resulted in a high readmission rate. Modification of management was then instituted and audit cycle repeated to assess the outcome.METHODS:Medical records of patients with mild acute gallstone pancreatitis between January 2000 and February 2002 were audited. The pathology results and medical imaging suggestive of acute gallstone pancreatitis were analysed. Patients with less than three positive Ranson's criteria were included in the surgical audit. Information on the course of treatment, including method (laparoscopic cholecystectomy or endoscopic retrograde cholangiopancreatography and sphincterectomy), timing, reason of non-operation and outcome were recorded. Reasons for failing to remove stones in a timely fashion were identified and strategies to improve compliance with the guidelines were implemented. An audit was repeated 10 months later to assess changes in practice.RESULTS:The rate of carrying out timely stone removal has improved from 57 to 82% at the follow-up audit. The readmission rate has also significantly decreased. Nevertheless, the rate of carrying out laparoscopic cholecystectomy during the original admission for suitable candidates was still at 39%.CONCLUSION:Surgical audit has identified a need to improve in the management of mild acute gallstone pancreatitis in the Western Health system. By complying with guidelines, outcomes of patient care have improved.