Colonoscopies can be used for both interventional and dialogistic purposes. The use of colonoscopies is not without risk and an awareness of these risks, as well as the clinical presentation of these risks / adverse effects, is vital to ensure optimal patient care is achieved both throughout and after the procedure. We present a case of a 49-year-old patient who presented to a district general hospital within the National Health Service (NHS) with diffuse abdominal pain and haemodynamic instability following a colonoscopy. A splenic artery injury was identified following a computerized tomography (CT) scan with contrast, of the abdomen and pelvis of the patient. The patient was resuscitated and managed without the need of surgical intervention in the form of targeted splenic artery embolization. This case highlights that a high index of suspicion of splenic injury should be held by the clinical in any patient who presents with abdominal pain with or without haemodynamic instability as early intervention is key to good patient outcomes.

Aim: Increasing pressures within the National Health Service has led to busier ward rounds. Documentation of information can be sacrificed to accommodate the pace of (ward) rounds. This quality improvement project aims to implement a user-friendly proforma for surgical ward rounds, with the view both improving patient safety via directing documentation and supporting the junior doctor. Methods: Plan, Do, Study, Act (PDSA) method was used for this quality improvement project. Primary and secondary parameters were established, and baseline assessment undertaken 1 month prior to intervention with repeat data collection 1 month and 6 months after introduction of a pre-printed ward round proforma. Results: A total of 106 entries were reviewed within the 6-month study period. Pre-printed ward round proforma led to an improvement in all assessed parameters. 80% of junior doctors (n=10) and 75% nursing staff (n=8) found the pre- printed proforma standardised documentation, improving communication of plans to the wider team. Antibiotic stewardship improved from 0% (N=50) to 98% (N=30) over the 6-month period. 100% of junior doctors (n = 10) and nursing staff (n = 8) found coloured paper facilitated and bettered identification of last consultant review. Conclusion: The introduction of a pre-printed proforma allowed for standardisation of documented information for ongoing ward rounds, improved antibiotic stewardship and was received positively by junior doctors. Colour paper allowed for quicker identification of the last ward round entry which makes reviews of an unwell patient more efficient. Further work is needed to optimise and incorporate proforma within other surgical specialities.