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Background High quality health care is information reliant. Access to high quality information in a timely manner is imperative in provision of quality patient care. A national standard for discharge summaries has been developed by the Health Information and Quality Authority (HIQA). A standard for surgical discharge letters is needed to avoid patient readmission, unnecessary presentation to primary care and to ensure continuity of care in the community. The aim is to assess the quality of surgical discharge summaries using the HIQA national Standard. To implement quality improvement strategies recommended by current research. To reassess the quality and close the audit loop. Methods For cycle one of audit, one month of discharge summaries in 2020 were generated across four consultant surgeons at the University Hospital Limerick. 33% of those were sampled evenly across consultants. 60 patient discharge summaries were audited. Training was implemented virtually. For cycle two of audit the same methodology was used, 43 discharge summaries were audited. Results Overall performance was 49%, improved to 69% following training. The worst performing category was future management, 20%, improved to 45%. The best performing categories were auto-populated, patient details 97% and primary care details, 100%. Patient medications were compliant in 25%, improving to 59%. Admission and discharge details were complete in 36% improving to 59%. Clinical narrative was present in 37% improving to 64%. Consultants had not signed off on any letters. Conclusions Surgical discharge summaries audited remain non-compliant with the national standard however, as research shows, NCHD training has improved performance across categories.

Background Trends in healthcare have caused a shift in training towards more competency based programmes. The COVID-19 pandemic has reduced time available for direct exposure and clinical learning, necessitating incorporation of simulation in training. The objectives of this study were to develop, pilot and evaluate a four week simulation based surgical teaching programme. Methods Interns pursuing a career in surgery joined a near-peer surgical training programme delivered by NCHDs. A survey established a baseline competency. Four skills workshops were delivered. Outcomes were measured using data from pre and post course surveys as well as a surgical skills competition. Results Of the 12 trainees, 71% had scrubbed in theatre before. 50% were already confident to scrub independently, increased to 75% post training. 28% were confident gowning/gloving, increased to 75% post training. 28% were confident to place a simple suture in theatre, this did not increase despite training. 42% were confident performing an instrument tie, increased to 75% post training. 14% were confident hand tying knots, this increased to 62%. 14% of participants were comfortable performing excisional biopsy in theatre, increased to 62% post training. Preparation and administration of local anaestetic could be performed confidently by 14% before training, this increased to 87%. On completion, a surgical skills competition showed that 100% were able to satisfactorily perform basic skills. Conclusions Near-peer delivery of surgical training has enhanced the basic surgical skills of interns. Similar programmes in other sites would ensure that interns have the skills required to safely care for surgical patients.