Improving Surgical Triage Documentation Through Implementation of a Care of the Critically Ill Surgical Patient (CCrISP)-Based Proforma: A Quality Improvement Project

Abstract

Aims/background Timely assessment and accurate documentation of acutely unwell surgical patients are important for safe clinical decision-making and effective multidisciplinary communication. This quality improvement project was conducted at a rural district general hospital in the north of Scotland, where acute surgical referrals are assessed by clinicians of varying grades and experience, and the surgical team provides cross-cover for related specialties. Variation in documentation prompted the development of a standardised Surgical Take Proforma based on the Royal College of Surgeons of England Care of the Critically Ill Surgical Patient (CCrISP) framework. This project evaluated whether introduction of the proforma was associated with improved completeness and consistency of surgical triage documentation. Methods A two-cycle, closed-loop audit was undertaken within the Department of General Surgery at NHS Grampian. Cycle 1 reviewed 30 consecutive acute surgical referrals documented using existing clerking methods between 15 and 30 December 2024. At the start of Cycle 2, the CCrISP-based Surgical Take Proforma was introduced, and staff education was provided through a Microsoft Teams meeting and face-to-face discussions. Cycle 2 reviewed a further 30 consecutive acute surgical referrals documented using the proforma between 1 and 30 January 2025. Documentation was assessed against five predefined criteria: A-E assessment, sepsis-related assessment or score, patient stability, blood gas or lactate documentation, and a definitive or daily management plan. Descriptive statistics and exploratory two-sided Fisher’s exact tests were used to compare the two cycles. Results Documentation of an A-E assessment increased from 0% in Cycle 1 to 80% in Cycle 2, while documentation of patient stability increased from 26.7% to 93.3%. Documentation of a definitive or daily management plan increased from 60% to 100%, and documentation of a sepsis-related assessment or score increased from 0% to 46.7%. Blood gas or lactate documentation increased from 73.3% to 86.7%. Exploratory Fisher’s exact testing demonstrated statistically significant differences for A-E assessment, sepsis-related assessment or score, patient stability, and definitive or daily management planning, with p<0.001 for each comparison. The difference in blood gas or lactate documentation was not statistically significant (p=0.333). Conclusion Introduction of a standardised CCrISP-based Surgical Take Proforma was associated with improved completeness of surgical triage documentation across the five audited criteria. The proforma was subsequently incorporated into a Patient Management Record template, demonstrating local institutional uptake. The project did not directly assess clinical assessment accuracy, clinical decision-making, communication, patient outcomes, educational effects, or documentation burden. Further evaluation is required to determine the sustainability of these improvements and their relationship to clinical and educational outcomes.