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Hello my name is grace and I am one of the final years and I'm also the data collection lead for the student healthcare Audit Society um So I just want to apologize again for that fleet disaster um Data collection information even where my internet crashed, I am so sorry, um so we just decided to do a completely new recording um and hopefully this explains everything for everyone. So again thank you for signing up to be data collectors As well, we really really appreciate that as well, so we are a student led audit society um and we were only found it this year um So just a quick reminder of who we are we have Reagan or Presidente georgia, Isabel, need dr ola, myself and then beth, so we are all finally your medical students, so duerr on your data collection period, you will see some of us about the hospitals um. So if you have any questions at all just grab us, um we won't mind at all beth is actually um ninja clayton students, so you'll see her but the rest of us you will so what is the audit, so the audit is looking at theater turnaround times in Northern Ireland hospitals, so we want to see how we can reduce um the time between procedures um and hopefully maybe implement some change or give some advice, so we have a really broad range of hospitals involved, so there's about 10 or 11 hospitals that will be data collection centers, so it is a regional audit um as well which looks great on your c. V. So this side is really important. This slide outlines all the leads for your hospital, so the data collection lead um If you haven't already been added to a Whatsapp group chat, you should be in the next few days or the next week or so and they are your first point of contact. So if you have any questions at all about the process you go straight to them and if they can't answer their questions um, then the leads will come to the committee, um so the data collection early. They may give you some information about some of the theater lists, um but that is your responsibility to go and look for a list of surgical procedures that are on, but again, if you have any questions at all, please don't hesitate to go to them, so just a quick reminder of the data collection periods Quite a few people have signed up to more than one data collection period, which is great um We would encourage you to sign up to more if you want um and also encourage friends to sign up the more people you have for data collection. The easier it is for you because it means the less time you'll have to spend in theater, so this is our inclusion and exclusion criteria, so this will help to break down into what what operations are suitable for inclusion and what needs to be ex, excluded, so it can only be a planned operation, so that means if it's an elective or a day case procedure. If it's an emergency don't include it at all all procedures that fall under general surgery or gain so general that we mean like boil um gall bladder's hernia, um appendix, um anything to do with urology or breast. We want to exclude that and then my knee surgery as well, but not including cesarean sections, so the approach can either be open, laproscopic, laproscopic assisted, laproscopic, converted to open robotic robotic converted, so there's only one robot in Northern Ireland and that is in the City Hospital, and it's only I think used for urology, so it's highly unlikely that you'll be including any procedure um with a robot unless they start to use a robot for general surgical procedures, and I can't say that happen. Um. So, then any procedure as well, that is a general anesthetic, so the patient is asleep, if it's a local and epidural or a spinal don't include it, so again our exclusion criteria anything that is unplanned or is an emergency procedure. Um We want excluded again no cesarean sections and anything that is a local anesthetic, spinal, or an epidural, and if you're unsure about anything, just ask your hospital lead um and they can direct any queries to us, so I know especially for third years, this might be your first time in theater um on your surgical placement um and some of these terms can be quite new, so please don't hesitate to ask any of us so we just want to give you a brief overview of what your day will look like um so a few key points before you actually start data collection and then what will happen during data collection, So before you start to collect your data on the thursday or the friday evening. You have spoken to you, the Anesthetic secretary or the theater sister, and we want you to get a theater timetable for what is on for general and guy knee surgery and when you have that timetable, we then want you to coordinate as a group like everyone who's in that data collection period and you will decide who will go to what theater and what days you will go there. Um So data collection we would ideally want you to be in from morning right until the end of the day or the end of the theater list, however, you can maybe decide to do half a day, but make sure that someone else covers you for the second half of the day, so we want you to arrive in theater before the first patient, so usually the patient arrives between eight and 9 a.m. but it all depends on what hospital it is, so I know in the Belfast Hospital, sometimes it's closer to eight o'clock um some neural hospitals like Enniskillen, it might be closer to nine, but just go and speak to the surgeon um or theater nurses the day before, and they're usually very good, um but being able to answer your questions, so data collection will start from when the patient arrives in theater right through until the theater cleaning is complete, and after that then you will finish your form your data collection form and then you will start a new one, so it's one form for patient, it's really important as well that you time your breaks well, so I would say the ideal time for your break is probably between um like a knife to skin when the first incision is made and the procedure starts um and then before they close up, it's really important that your back before they close up um So if you want to know like how long the procedure is going to last usually. Um during the time might be given, estimated time like procedure two hours or um the nurse can even give you quite a good indication as well um Also, maybe you could ask the nurse you know after theater cleaning is complete before the next patient arrives. Sometimes, there might be a little break and that's quite a good time to time or breaks as well, but just make sure you speak to the nurses um and ask them whether the next patient will be coming down, it's important as well to discuss the audit with the doctors urine placement with so they understand what you're doing and can help you um to time your breaks as well and just remember for the data collection, you will have your full night because it is a google form. So you need to just tell people what you're doing unless it looks really rude um and it just it doesn't look good at all if you stand with your phone out in theater and you have no explanation as to why you're doing it, So just make sure people are aware of that, so the data collection form will consist of 52 questions um So this may seem daunting at first, but the more you do it you will find it will become more familiar to you and you'll find that many of the questions are simple, yes or no, so always be gorgeous and polite. The nurses in the surgical team introduce yourself to the nurse in charge and to one of the surgeons, I would say, probably make friends with the theater nurses. That's probably the one of the best pieces of advice. I can give you um they will inform me about you know when you can take your break um and they're even really good for you know, answering questions about things that maybe you don't know you know um like what does it mean what is the surgical scrub they can just help you with those things or where can. I find this piece of data explain that you are collecting data and it's for an audit. Um Looking at theater turnaround times have some background knowledge as well, so in case they ask you questions about the audit like here you collecting data for or you know what are you collecting to know. It's a Student Health Care Audit society know that you're looking at theater turnaround times because there's nothing worse. If you're asked what you're doing an audit on and you just don't know so if you are challenged by a nurse or a doctor about collecting data inform them that the society has approval um so a consultant and trust level and no patient identifiable data will be included. So a really common question I thought that you might have is should I scrub, so I know that many of you will be on your poem attachment Obscene Guy in a General Surgery, so when you become familiar with the process, If asked, scrub never pass up this opportunity, um it's always a really good opportunity if any consultant asks you or let you scrub I would say on the first couple of attempts. You know when you're trying to complete the um google form, just don't scrub stay out of it, um just so you get familiar with it and you get your bearings for it, and if you do scrub, it's really important to remember that you need to describe before they start closing just to make sure that you can complete all your data collection, so it's really important to include 90% of the eligible procedures. If this target is not met, then the center cannot be included um as a data collection center, which is really sad and you'll probably think about how are we going to new. Um If like how will we check if all of the procedures have been included um well, we actually have to validate the data the data and just verify it, but it's all okay, so we will appoint a data validator in each collection period, so in some of the documents that we send out your name will be highlighted in bold and you will never be asked to um verify the data for your own data collection period, so usually it will be the data period before your own data collection period, so you will be sent a spreadsheet with all the operations that were audited during the previous data collection period, and then you will have to go to theater and cross check them with the theater log book um So the log book is Captain theater, um So it should only take about 15 minutes um and you just go when you just check off, so I would go and like ask one of the theater nurses or the sister If you can just have the log book. Again, just explain why you're asking for so. When you do go through all those um procedures, you need to record any procedures that were missed um and we would also expect that the hospital lead will be overseeing this and they will just make sure that someone is doing it and it is so important if you think that you're not hitting the target and you're not going to get all the procedures covered. You need to let the committee know um because we may be running around Northern Ireland, just trying to mop up any off the procedures that just happens been included, just to make sure that the centers do hit the 90% target, so what I want you to do now is to take your phone um and scan this barcode, so this is a barcode that takes you to the google form um So it is expected that when you're in theater, you will have some form of wifi or hospital um internet connection. Um If you don't uh that's okay, I would just advise that you print off the form or have it downloaded maybe on an ipad where you can like right over um and bring it with you um to use When you're collecting the data. These m barcodes should be in most of the theaters across northern Ireland um and if you can't find it that's okay, just use um this web link, so we will send you the web link to use if you can't find it, so you may be looking through. Um The questions I, there's 52 questions and you might think okay, but what if I do understand all the questions that the data collection for him is answering, asking me, so I have actually gone through and created a data dictionary um So if we just move on, um each question number on your google form is actually mapped to the number um in the data dictionary, so it's in three columns I split it into data fails, which is basically um the question repeated in the first column. Then the second column is the required data, so that is basically a definition or or a comment about what the question is asking you what data you need to collect and then the final column If it's relevant, I've included some places and some sources where you might be able to find this information, so we will send you out the data dictionary, I would say keep it to hand it's really really good um and it can just be a really useful resource for helping you with some of those questions that maybe you're not sure of so what I'm gonna do now is I'm just gonna take you three um each question and um just to explain away bit more and hopefully it'll make it easier. Um. The only thing is I know you never really fully pick up and what you're doing until you actually have to go into theater. You actually have to collect the data and that is probably the best way for learning actually doing it, um but just have the data dictionary to hand on those first few days, so question 126 those are all pretty basic um So I'm just going to start a question seven, so the patient number on the list, So if the patient is number one of four on the list, that's why they're patient number one of four, but say for example if the second patient was canceled, um the third patient will still remain as patient three or four on the list um And that's okay because that actually lets us see that there was a cancellation um and one of the procedures didn't happen, so just be mindful of that, so any on day cancellations, you'll be able to find this. Usually in theater, there will be a list of the procedures, and there used to be a big line through anything that was cancelled um so specialty to which the operation belongs to again. Guy Near general, you should be able to understand that, but again just check with one of the nurses or one of the surgeons, if you're not sure, so, it is not remember that anything that is purely diagnostic, should not be included. So that means if it's just a scope, or if it's just like a camera being put in, but they're not doing anything. If there's no therapeutic procedure um don't include it either so the name of the procedure, um So this can be found on the operative note um. This would usually be written by the surgeon at the end, um. However, sometimes it can be a really good way you know just when you go in um talk to the surgeon um to say so what is the name of the procedure, it actually looks really good. It shows that you're interested um and you can get the exact details that you need for your for your collection form, So the urgency of the procedure is an elective or is it a decade case procedure. Again, this will probably be on the theater lists um from the operative note or again, just ask the nurse, so the patient arrival in the anesthetic room, So this is really important because it's different patient arrival in the theater room in the operating theater, so the anaesthetic room is you most hospitals usually have a separate anaesthetic room, so the patient is brought in their first and then they will be brought into the operating room after, but they're usually adjoined. So again please record all your times in 24 hour o'clock, so then we want you to record the time that the patient actually arrives in the operating theater. Then question 14 was the pre op completed, so usually the preop will have been completed up in the wards and the very odd occasion it hasn't been and it will happen in the anesthetic room, but if you're there with the patient, you will see it happening and you will know that it has happened, so then we want to just record if the preop wasn't completed how long it actually took to complete it in the anesthetic cream, then just look again how many times was patient information checked, so um we want to to record you know did they check the patient um like wristband when they come into the anesthetic room, then when they moved into the operating theater how many times was it checked, so just record the number of times um so 17 their covid swab wasn't completed um before theater time. Usually, it will have been very rarely it hasn't, but if the covid swab hasn't been completed, you will know about it and um they will say well, there's a delay because the covid swab hadn't been done and has to be fast tracked and usually it takes about 30 minutes or so before it's back and someone has to do it sergeant, arrival time, so that is the time that the first surgeon arrives, it doesn't have to be the consultant. Um It just needs to be the first member of the surgical team, so the surgical scrub so that is when um the surgeon like just as they're full scrubbing, they put on their gown and gloves, so again record how long that takes, I would record it from the time when the first surgeon starts to scrub and then until the last surgeon is fully scrubbed and then did anything else happen when the surgical scrub was, was taking place, so when the surgeons were scrubbing, what was happening with the patient was the patient being anesthetized or was the patient already anesthetized before they went to scrub, and then patient transfer onto the operating tables um usually shouldn't take long at all is. If the patient is mobile, they will easily get up of the bed and just walk and get up on the operating table themselves, however, sometimes um it may take longer if the patient is quite a mobile um and they might have to you know, log roll the patient across that will require maybe like 4 to 6 people to do that um So, sometimes it just takes a little bit of time to get those people gathered, get them there and get the patient transferred, so was the who checklist completed yes or new um who checklist is usually um it's a little green sheet and it's usually carried out by one of the theater nurses, so it's split into three sections. Your sign in your time out and your sign out the most important part for you to remember as a medical student is the time out, so that happens immediately before the incision of the skin is made and that is the one time as a medical student you get to speak in theater, um So you will introduce yourself and you'll say my name is grace, I'm finally a medical student, so I'm just record was that done and the next question is was the time I completed, so that is the part that you were actively involved in as a medical student, so the induction of anesthesia, so I have actually just put a small classification here. Goodell's classification, which explains three yeah, just by three stages off anesthesia, I don't think you'd be going to stage for that would be an overdose um so I hope that wouldn't be included, um but the induction of anesthesia is when they start to give the patient um some oxygen and they start to inject usually something in through their cannula um to the point where they are fully unconscious um So when you see that happen in the anything a student you record from how long it took, but hopefully that classification system will give you guidance from where you start to stop recording. It was that time so was there a delay starting the procedure yes or no, so just record what that was, I'm pretty sure there is a box to explain what it was. Um I can't fully remember um so like that could have been anything um then knife to skin time again record in 24 o'clock, so the time of the um surgeon makes the first incision on the skin and then the time that the dressing was applied, so again they're nice white dressings, what time are those proof of the winds. So again, I mentioned that a good time to take the break would usually be from knife to skin time to the dressing applications, so remember between 0.27 28 you could maybe factor in a break, so the operation time should then be recorded using the 24 hour clock um that will be from the knife to skin time to addressing application, so just record that and usually in theater, there is a clock up um where it gives the time that the procedure has been going on for, so then the time of the drape removal from the patient, so that those are the blue drapes um that are around the patient um during the procedure and then 31 so transfer of the patient back onto the hospital bed, um so just record at what time that happened. So was the patient woken up in theater or did they remain unconscious and were, they resuscitated later on, Perhaps when they were back in, I see you're on the board, but most of the time it will happen in theater unless the patient is quite unstable, um So the patient was actually being it how long does that take how long did it take for them to fully come around after and they need it as starting um the activation process and to resuscitate them, Then what time did the patient leave the operating theater again just 24 o'clock um and so the time theater sterilization has been completed. So what time was the theater fully sterile, everything was clean, ready to go for the next patient, so the preparation of equipment how long did that take. Sometimes that usually happens occasionally when theater cleaning is happening or after theater cleaning just before the patient the next patient arrives, so how long did that take for them to prep and get ready and then at what time was the next patient sent for um so how did they send for the patient. This can be a variety of ways did they phone for the patient. They actually physically go up to the ward to get the patient um so when you hear someone say call for the next patient just look how did they do it um did someone actually get the phone or did they just run up, so who collected the patient from the ward when they come down just look does it is it a porter who's well in the bed, is it a theater staff member or is it a nurse from the border, is it someone else so it was theater sterile, I'm ready for the patient arriving. It was retired delay, and how long did this delay take so the presence of the designated cleaning team, so some hospitals actually have a theater cleaning team, specifically for theaters, um but some of the more rurales hospitals, there isn't a theater cleaning team and it's just um the theater nurses who actually clean so again that can cause a real delay um So if you see a cleaning team, please record it um. And then is there a designated anaesthetic room. Some hospitals, I knew actually don't have an anaesthetic room to the patient as well directly into theater um I think most places do, but again it's just interesting to record if there's no anesthetic room and if there was an anesthetic room was this used or not so the surgical approach. Again, I mentioned them earlier open laparoscopic laparoscopic assisted laproscopic converted robotic robotic converted, um So we just have a read I moves um different terms just become familiar with them Again, it should say in theater or the operative note what the what approach has been taken, and then what stage of training was the lead operating surgeon, so the lead surgeon doesn't actually have to be the consultant yes, the consultant must be present for the procedure to happen, um but it quite often it might be as an s. T. Who is completing something like a gallbladder or hernia, so just try and find out at what stage they are again, it should say in the operative note or just simply ask one of the nurses, they'll know or um get down to some of the doctors who are scrubbed in so the stage of training of the lead anesthetist. Again, there does have to be um a consultant anaesthetist, but you'll usually find if there's two anesthetists in theater, then one is a is a treatment level or training stage, um so just try and find out who's the lead um and what stage they are, so is there a permanent or temporary theater team. So sometimes um there might be like luke um theater nurses in or might be nurses who have been taken from. I see if there's a real shortage. I know during Covid, you know everyone was moved around and everyone was doing different jobs um Hopefully, things are back to normal now, but just try and find out from one of the nurses like is this the normal team um or they temporary. Um You know do they usually do this job and how many people were in the theater team, So the number of members that includes um surgeons, nurses um beneath us. As well, um So how many anesthetist are in the room, Again, just if there's two means there's like a training grade there as well and how did the surgeon record the POSTOP note, so was it handwritten, was it um computerized or was it another way so um usually it will be handwritten. There'll be something in the notes, but I know quite a lot of places are now moving towards the computerized and note and just record any other factors that may have affected the patient turn around time. So I know that there's strikes on going at the minute. So you know if the porters are on strike well, it's going to take a while to get the patient down from um from the board to theater, so just be mindful about those uh you know, try and find out if anything like that is going on. If there's a medical student quite often, if um one of the surgeons, it's taken time to teach them, it will take longer or if there's a medical student in for poem um. Then again it can take longer um just to city at the patient, if the anesthetist is teaching, so that is me and if you have any questions um just let us know, um you can email the audit society um or just send us a message on one of our social media platforms, um but I hope that has been helpful and I said you have any questions and you see it's about just grab us um and we really really encourage you to get as many people involved as well. Thank you.