Introduction The COVID-19 pandemic has led to changes in NHS surgical service provision, including reduced elective surgical and endoscopic activity, with only essential emergency surgery being undertaken. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. The aim of this study was to investigate a possible ‘lockdown’ effect on the volume and severity of surgical admissions and their outcomes. Methods Two separate cohorts of adult emergency general surgery inpatient admissions 30 days immediately before (16 th February 2020 to 15 th March 2020), and after UK government advice (16 th March 2020 to 15 th April 2020). Data were collected relating to patient characteristics, severity of disease, clinical outcomes, and compared between these groups. Results Following lockdown, a significant reduction in median daily admissions from 7 to 3 per day (p<0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of acute kidney injury, and also were significantly more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p=0.001), all cause 30-day mortality (8.5% vs. 2.9%, p=0.028), but no significant difference was observed in operative 30-day mortality. Conclusion There appears to be a “lockdown” effect on general surgical admissions with a profound impact; fewer surgical admissions, more acutely unwell surgical patients, and an increase in all cause 30-day mortality. Patients should be advised to present promptly with gastrointestinal symptoms, and this should be reinforced for future lockdowns during the pandemic.

Background The situation of coronavirus disease 2019 (COVID-19) pandemic in the Indian subcontinent is worsening. In Bangladesh, rate of new infection has been on the rise despite limited testing facility. Constraint of resources in the health care sector makes the fight against COVID-19 more challenging for a developing country like Bangladesh. Vascular surgeons find themselves in a precarious situation while delivering professional services during this crisis. With the limited number of dedicated vascular surgeons in Bangladesh, it is important to safeguard these professionals without compromising emergency vascular care services in the long term. To this end, we at the National Institute of Cardiovascular Diseases and Hospital, Dhaka, have developed a working guideline for our vascular surgeons to follow during the COVID-19 pandemic. The guideline takes into account high vascular work volume against limited resources in the country. Methods A total of 307 emergency vascular patients were dealt with in the first 4 COVID-19 months (March through June 2020) according to the working guideline, and the results were compared with the 4 pre–COVID-19 months. Vascular trauma, dialysis access complications, and chronic limb-threatening ischemia formed the main bulk of the patient population. Vascular health care workers were regularly screened for COVID-19 infection. Results There was a 38% decrease in the number of patients in the COVID-19 period. Treatment outcome in COVID-19 months were comparable with that in the pre–COVID-19 months except that limb loss in the chronic limb-threatening ischemia patients was higher. COVID-19 infection among the vascular health care professionals was low. Conclusions Vascular surgery practice guidelines customized for the high work volume and limited resources of the National Institute of Cardiovascular Diseases and Hospital, Dhaka were effective in delivering emergency care during COVID-19 pandemic, ensuring safety of the caregivers. Despite the fact that similar guidelines exist in different parts of the world, we believe that the present one is still relevant on the premises of a deepening COVID-19 crisis in a developing country like Bangladesh.

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Short term changes in outcome measures are correlated with longer term changes; outcome changes are correlated across domains independently of the type of treatment.

Introduction Documentation of clinical assessment and care plans is integral to patient safety, continuity of care and has medico legal implications. Methods A retrospective study of the quality of documentation of post take ward rounds (PTWR) by the on-call surgical team was performed. Results Among the key factors reviewed (18 randomly selected emergency admissions), history of presenting complaints, past history and medical history were recorded in 66%, 72% and 44% of the records respectively. National early warning score (NEWS) was recorded in 66% notes and clinical findings in 88% of patients. The key lab and imaging findings were entered in a subset of patients only (27% and 33% respectively). Based on the initial audit, the PTWR quality could be improved with increased compliance of NEWS score entry, medical history, key lab and imaging results. A standardised ward round template was designed and circulated. This was disseminated to the surgical team by email. Posters were displayed in the surgery office. A presentation was made during teaching session for the junior doctors. The re-audit (34 emergency admissions) showed that the quality had improved based improvement noted in all the key parameters. Documentation of presenting history improved from 66% to 100%. Similarly medical history (44% to 85%), vital signs (66% to 79%), key lab results (27% to 55%), and key imaging (33% to 78%), the management plan was documented in all patients (94% to 100%). Conclusion In summary, a standardised PTWR entry ensures better quality and compliance; this should be reiterated during junior doctor change over phase. Take-home message Standardised post take ward round entry ensures quality and better compliance during a busy surgical ward round.