Cholecystectomy Surgery - Case Study Example

Contents 1.0 Introduction 1 2.0 Background and Literature Review 1 2.1 Curtin Hospital 1 2.2 Gallstones 2 2.3 Types of Cholecystectomy 3 2.4 Benefits 4 2.5 Information about Use of Audits 4 3.0 Rationale 5 4.0 Objectives of Study 5 5.0 Criteria of Audit 5 6.0 Scope and Methodology 6 7.0 References 16 8.0 Appendix 1 1 1.0 Introduction Quality of service in a healthcare facility is imperative as it guarantees the adherence of safety measures pertaining to the health of the patient. In this regard, it is important that the quality of laparoscopic Cholecystectomy be gauged with respect to the set guidelines. Although laparoscopic Cholecystectomy is considered as a safe practice in healthcare centres with adequate facilities, its associated feasibility and quality of service offered has not received adequate review. Quality assurance, health authorities and surgeons working in developed countries may be subject to subjecting patients to low-quality services, as such affecting the patient’s experience at the healthcare facilities. In the majority of healthcare facilities, laparoscopic Cholecystectomy is considered as a gold standard; essential for treating gall stone related problems. The introduction of these techniques has imposed the evolution of the practice, as well as, new interest in the field. As the practice is received by patients, its safety and quality is imperative in realizing the proffered procedures. This report will cover the results of a clinical audit on 100 patients undergoing cholecystectomy surgery at Curtin Hospital from 2003-2009. Moreover, it will state some details of the study such as, rational, the objectives of the study, and criteria of the audit, scope and methodology. Finally, the discussion and recommendation will be discussed below. 2.0 Background and Literature Review 2.1 Curtin Hospital Since the beginning of the hospital, the staff has championed its healthcare services and focussed on the patient’s experience. Considered as a high standard and proficient healthcare facility, it has effectively offered various practices ranging from medical, diagnostics and surgical specialties. The facility aims to provide improved quality of service to its patients, given its recent advancement in laparoscopic Cholecystectomy. The healthcare facility employs about 1600 staff member of which 300 are dedicated surgeons in this profession. The hospital has aggressively excelled in its field of operation. Some of the vital information of the hospital is shown below: Indicators. Total Bed number. 800 A&E. 50000 Average length of day. 6 Surgical operations 9000 Kidney transplantation 90 Liver transplantation 80 Heart transplantation 30 Bone marrow transplantation 250 Cholecystectomy is the surgery of choice for symptomatic gall-stones, since it effectively removes the organ where gallstones are formed (Miller, 2013). As such, this is a surgery that pertain the removal of the gall bladder. The gall bladder is a small sac located in the right side of the human upper abdomen (Miller, 2013). It is linked to the bile ducts which originates from the liver and is tasked with carrying bile into the intestine. The production of bile is fundamental for digestion of food. Nonetheless, the gall bladder is not essential in maintaining human health hence after its removal, bile flows into the liver directly. 2.2 Gallstones More often than not the gall bladder may be subject for removal, upon residual discovery in the bile. Simply put, gallstones are minute solid substance, resembling debris in the bile. Accordingly, stones may be found in the duct that leads from the gallbladder. Gallstones are found in various sizes, colour and shapes, but is fundamentally made up of excess cholesterol (Casillas, 2008). They are associated with diseased gallbladders. Stones may result in tremendous swelling of the affected organ, resulting in detrimental health to the affected persons. Stones are very common and may affect two of every 11 persons (Casillas, 2008). They are mostly experienced among the elderly and women associated with the use of contraceptive pills, obesity and pregnancies. Over time they gradually increase in size but the small stones are major causes of pain, in this regard. 2.3 Types of Cholecystectomy Although they can be treated, Cholecystectomy surgery may be advised in certain cases. The gallbladder may be surgically removed after substantial swelling in the gallbladder. This operation is imperative in relieving pain during gallbladder swelling. There are two ways through which this surgery may be achieved. i. Laparoscopic Cholecystectomy Otherwise known as keyhole “Surgery”, laparoscopy facilitates the inspection of the abdomen’s interior - without making major incisions on the abdomen. The surgeon makes an incision of about 2 to 3 cm long at the navel of the abdomen (Miller, 2013). After a small incision at the navel, the surgeon inserts the laparoscope machine; a long, narrow telescope that is attached to a video camera. Thereafter, the abdomen is inflated by using carbon dioxide gas; a harmless gas that creates room for the operation. Two cuts of about 0.5 to 1 cm in size are made just below the rib margin. Consequently, a fourth incision is made at the upper abdomen, next to the breastbone; used for the insertion of the instruments like forceps and scissors. Surgical clips are used in securing these arteries and duct in preventing leakage of excessive bleeding. Accordingly, the gallbladder can be removed through one of the incisions. In most cases the surgery last about 30- 90 minutes, with respect to the size of inflammation and difficulty of operation. ii. Open Gall Bladder Surgery This surgery is achieved through making a big and open surgical incision just below the rib, at the right side of the abdomen. A large incision is made, and through direct site, the doctor operates to remove the inflated gall bladder (Teoh, 2007). 2.4 Benefits There are many benefits realized through the laparoscopic process. Most of the patients have significantly reduced postoperative pain (Teoh, 2007). Consequently, they heal faster as opposed to open surgery. Thirdly, the patient can resume to his normal activities faster as opposed to the traditional surgery. What are the common complications of cholecystectomy surgery? 2.5 Information about Use of Audits Audit and feedback is a cumulative summary in any clinical performance over a given duration that offers provision of information to healthcare professionals. Essentially, the information allows the healthcare professionals to adjust on their performance (Haynes, 2008). Simply put, healthcare practitioners receive feedback on their performance through a reflection of the derived data. Despite the intuitive nature of the audit, it is imperative to gauge their performance and consistency at acceptable levels (Powell, 2008). The healthcare sector has to have a sensitive approach as it governs ways through which human treatment can be achieved. In this regard, the inception of audit on the same has championed the quality of healthcare services offered at various institutions. Information obtained from audits is indispensable in improving the quality of service offered (Haynes, 2008). Thus, it is important that audits are sufficiently conducted and information obtained be used effectively throughout the management practice (Kodner, 2009). In most cases feedback can be presented from a variety of ways ranging from recipients to content. Examples of cholecystectomy audits and their results would add to this section 3.0 Rationale Nursing practitioners, together with surgeons play an essential role in sustaining quality and safe procedures for the patients. In this regards, an audit was conducted on one hundred patients at Curtin Hospital in 2007 to ascertain the quality of service offered. Consequently, findings and probable recommendations were discussed in this regard. 4.0 Objectives of Study This study aims at conducting a retrospective audit on the quality of Cholecystectomy surgery, pre, intra and post operatively. Essentially, the analysis is imperative for the clinical experts and to better understand the variations in the clinical practice at Curtin Hospital. An analysis on the extent to which the variations affects the clinical quality outcomes is ultimately conducted. 5.0 Criteria of Audit The following criterion was used; Figure 1 Criterion No. Criterion Expected Rate (%) Exceptions 1 Do the signs, symptoms and investigations pre-cholecystectomy justify the surgery? 100% None 2 Was the pathology report positive? 100% None 3 (a)Was there surgical exploration of the common bile duct? 100% No common bile duct exploration (b) If so, is there evidence of disease of the common bile duct? 100% No common bile duct exploration 4 Is the admission free of unplanned additional surgery? 100% Unplanned additional surgery not related to the cholecystectomy 5 Has the patient been given antibiotic prophylaxis in accordance to the given protocol? 100% Patient does not fall into prophylaxis protocol category 6 Is the admission free of intraoperative or postoperative blood transfusion? 100% None 7 Was the result of the procedure non-fatal? 100% None 8 Was the length of stay Read More