22 Compliance of Post Operative Notes for Open or Laparoscopic Emergency Small Bowel Resection Surgery as per Standards of GRIFT, ACS and ACPGBI Guidelines. Data from our Centre and Actions Leading to Service Quality Change

Abstract Aim To evaluate compliance of surgical doctors including registrars and consultants in documenting post operative notes for small bowel resection surgery in emergency done either open or laparoscopically as per 2023 GRIFT, ACS and ACPGBI guidelines. Furthermore, after 1st cycle to undertake measures and reevaluate the compliance and to improve service quality. Method 2 complete closed loop cycles were undertaken with inclusion of 100 patients who underwent small bowel resection surgery done either laparoscopically or open for any indication including cancer, volvulus, obstruction or perforation from Jan 2024 to Jan 2025. 1st cycle included 50 patients, and post operative notes were evaluated retrospectively after ethical approval taking GRIFT, ACPGBI and ACS 2023 guidelines as standard. After completing 1st cycle and presentation of results in M&M teaching sessions and posters were done with constant reminders. 2nd cycle was completed including another 50 patients and results compiled. Results 28 points evaluated and crossed checked against the notes. only 10 percent of the notes mentioned maximum of 20 points while 90 percent of the notes missed important points in guidelines like local aesthetic injection, exact area of bowel, length resected, drain positioning, wash out fluid and quantity and so on. after 1st cycle and intervention like teaching 2nd cycle was completed and 98% operative notes mention at least 25/28 points. Conclusions Post operative document is integral part of safe surgical practice especially if return to theatre to guide surgeon and for medicolegal issues. Successful intervention and improvement in service provision was achieved.