237 Audit of Operative Note Quality in HPB Surgery: Adherence to RCS Good Surgical Practice Guidelines

Abstract Aim To assess adherence to the RCS Good Surgical Practice (2025) standards in HPB operative note documentation and additionally evaluate documentation of intraoperative adjuncts—Pringle’s manoeuvre, ICG fluorescence, intraoperative ultrasound (IOUS), and frozen section—in liver procedures. Method A prospective audit of 75 HPB operations was conducted. Operative notes were reviewed for compliance with RCS 2025 documentation standards, including key parameters such as incision, findings, complications, closure, estimated blood loss (EBL), prophylaxis, and postoperative instructions. Intraoperative adjunct documentation was analysed for liver procedures specifically. Results High adherence was observed for core parameters including incision (93%), findings (100%), closure (100%), postoperative instructions (100%), and surgeon signature (100%). Lower compliance was noted in the documentation of EBL (20%), specimen details (71%), and extra procedures (13%). Among 9 laparoscopic liver resections, ICG usage was documented in 2 cases (22%). Pringle’s manoeuvre was recorded in all applicable liver resections. IOUS and frozen section documentation were present in 25% and 30% of relevant cases, respectively. Conclusions This preliminary audit demonstrates strong compliance with core RCS documentation standards in HPB surgery. However, documentation of intraoperative adjuncts in liver procedures remains inconsistent. Planned interventions include implementing a standardised electronic operative note template, delivering educational sessions, and placing visual reminders in theatres. A second-cycle audit will be conducted in August, with loop closure planned by September.