bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation of Heart Rate Variability and Subjective Withdrawal Symptoms in Patients With Opioid Dependence, and Its Comparison in Patients Undergoing Detoxification With Patients Maintained on Opioid Agonist Treatment
Authors: Verma Adit , Sarkar Siddharth , Kochhar Kanwal Preet , Sood Esha , Chandran Dinu
Published: August 2024

Aims

Patients with opioid dependence seek treatment for the discomforting withdrawal symptoms. Accurate clinical assessment is essential as medications are optimized based on these withdrawal symptoms. However, subjective reporting can present challenges. Heart rate variability (HRV) can enhance clinical assessment and has taxonomic and therapeutic implications. This study aimed to explore the correlation between HRV and subjective withdrawal in patients with opioid dependence and to compare the HRV parameters in patients undergoing detoxification to those maintained on opioid agonist treatment and healthy controls.

Methods

3 groups of adult male participants were included. Group 1 included 40 patients with opioid dependence undergoing inpatient detoxification. Group 2 included 40 patients with opioid dependence receiving stable doses of buprenorphine on outpatient basis. Group 3 included 49 healthy controls. The Subjective Opiate Withdrawal Scale (SOWS) was used for withdrawal symptoms. For Group 1 and Group 2, HRV was assessed twice – before administration of morning dose of buprenorphine, and then 2 hours post administration. For Group 3 HRV was assessed once.

Results

At baseline, resting heart rate differed significantly between the 3 groups (p < 0.001), it was highest for Group 2 (92.4) and lowest for Group 3 (79.4). In time domain parameters of HRV, the beat-to-beat variability was highest for Group 1 with standard deviation of all normal RR intervals (SDNN) = 134.8, root mean square of successive differences between normal heartbeats (RMSSD) = 181.7 and RR tri index = 8.9 (p < 0.005). In frequency domain parameters of HRV, total power was highest for Group 1 (98334.1, p < 0.001) while relative power did not differ significantly among the groups. The SOWS had a weak negative correlation with RMSSD in Group 2 (r = -0.312, p < 0.05) but did not have any correlation with HRV parameters in Group 1. Post administration of morning buprenorphine, the HRV parameters did not show a significant change in either of the groups (except reduction in very low frequency percentage in Group 1 from 12.013 to 7.196, p < 0.05).

Conclusion

A higher degree of subjective withdrawal is associated with lower beat-to-beat variability in patients on stable doses of buprenorphine. However, this exploratory study did not find a robust relationship between HRV and subjective withdrawal symptoms. Higher RMSSD (representative of higher vagal tone) in patients undergoing detoxification may suggest greater physiological adaptation to withdrawal symptoms. This study provides additional insights into HRV in patients with opioid dependence.
Associations Between Pathways Into Care and Service Use and Involuntary Hospitalisation Among Children and Young People
Authors: Walker Susan , Freitas Daniela Fonseca , Downs Johnny , Nyikavaranda Patrick , Johnson Sonia
Published: August 2024

Aims

There is evidence that children and young people (CYP) of Black ethnicity are more likely to experience involuntary hospital admission. This is not explained by clinical and sociodemographic factors. One possible explanation are differences in pathways into, and/or use of mental health services (MHS). This study investigates the associations between ethnicity, pathways into MHS, MHS use and involuntary hospitalisation in CYP.

Methods

Using data from the Clinical Record Interactive Search (CRIS) system for (South London and the Maudsley) SLaM services we identified 652 CYP under 18 years admitted to inpatient units between 2008 and 2021 living within the SLaM catchment; 458 (70.2%) were admitted informally and 194 (29.7%) were detained. We conducted univariable logistic regression to investigate the association between pathways into MHS (referral source, S.136 presentation), MHS use (time known to services, recent appointment prior to admission, and presence of a care plan), clinical factors (diagnosis, severity, risk) and social factors (gender, age, ethnicity, deprivation) with the outcome i.e. involuntary admission. We then conducted multivariable logistic regression to investigate the association between the clinical and social factors and involuntary admission.

Results

In multivariable analyses we found evidence that adverse pathways into MHS such as S.136 presentation (OR 6.25, 95%CI 2.06-19.01, p = 0.001), and referrals from social services (OR 4.92, 95%CI 1.49-16.19, p = 0.009) and police/legal services (OR 4.22, 95%CI 1.03-17.31, p = 0.045) were associated with involuntary hospitalisation. There was no evidence that the duration of contact with MHS, having had an appointment in the 28 days prior to admission or a care plan in the 12 months prior to admission were associated with involuntary hospitalisation after adjusting for other factors. There was evidence that being of Black ethnicity (OR 2.04, 95%CI 1.19-3.50, p = 0.010), older age (13–15 years: OR 4.46, 95%CI 1.57-12.72, p = 0.005; age 16–17 years: OR 8.67, 95%CI 3.08-24.41, p < 0.001) and having a diagnosis of a psychotic disorder (OR 4.21, 95%CI 2.21-8.02, p < 0.001) were associated with involuntary admission after accounting for pathways into and use of MHS.

Conclusion

In this cohort of child and adolescent inpatients living in South East London, we found that CYP who experience adverse pathways into MHS are more likely to experience involuntary hospitalisation. Prior contact with MHS did not appear to influence involuntary admission. We found that Black CYP remained more than twice as likely to be admitted involuntarily after accounting for MHS use and pathways into MHS as well as social and clinical factors.
Psychiatry Residents' Views on Quality of Psychotherapy Training in Pakistan: A Cross-Sectional Survey
Authors: Khan Aazeen , Ahmed Raja Adnan
Published: August 2024

Aims

Several modalities of psychotherapies have an established therapeutic evidence base for many psychiatric disorders. Stakeholders around the world including the Royal College of Psychiatrists, recommend training of psychiatry trainees in psychotherapy as part of Psychiatry training. However, the quality and quantity of training in psychotherapy differ across different regions. Psychiatry training programmes in high-income countries are regularly audited to ensure minimum standards of training in psychotherapies among psychiatry trainees. There is a lack of reporting regarding psychotherapy training in low- and middle-income countries such as Pakistan. This study explores the experiences of Pakistan-based psychiatry residents regarding their psychotherapy training within the fellowship programme of the College of Physicians and Surgeons (FCPS) Pakistan.

Methods

This study employs a mixed-method survey approach, targeting psychiatry trainees registered with College of Physicians and Surgeons (CPSP) four-year training programme (FCPS) across different cities of Pakistan. Utilising a convenience sampling strategy supplemented by the snowball sampling method, an electronic survey was disseminated using social media platform over a 4-week period. The survey was anonymous and structured into three sections; essential demographic data of the participants, experiences with psychotherapy training, and open-ended questions allowing participants to freely express their thoughts and insights on improving psychotherapy training in Pakistan.

Results

Out of the 41 responses received, the majority were female respondents, totalling 27 (65%). All participants were FCPS trainees at various stages of their training, hailing from ten different cities across Pakistan. Findings indicated that 61% of respondents reported insufficient time to learn, understand, and apply psychotherapy techniques, while 53% identified a deficiency in supervision.

In terms of therapeutic exposure, a predominant 34 participants (82%) encountered Cognitive Behavioural Therapy during their training. Mindfulness, Dialectical Behaviour Therapy, and Family Therapy each were reported by 12 respondents (30%). Interestingly, 34 of the respondents (82%) noted an increased interest in psychotherapy since starting their psychiatric training. However, only 20 respondents (48%), felt confident in delivering psychotherapy independently.

A recurring theme emerged from the feedback: participants advocated for a more structured psychotherapy training program, emphasising the need for dedicated time specifically allocated for supervision and practical learning opportunities.

Conclusion

This survey highlights that FCPS Psychiatry Residents in Pakistan are keen to learn more about psychotherapy. However, identified shortcomings in delivery, structure, and supervision suggest a need for comprehensive reforms. The findings emphasise on refining the psychotherapy training in low- and middle-income countries.
Implementation and Evaluation of a Local CBT Teaching Programme for Core Psychiatry Trainees
Authors: Bloomfield James , Leyden Eimear , Vaida Alina
Published: August 2024

Aims

Core Psychiatry Trainees (CTs) are required to complete two psychotherapy cases, utilising different therapeutic modalities as part of their training. During supervision sessions, CTs in Coventry and Warwickshire reported feeling underprepared to start their psychotherapy cases. Locally, the most frequently used modality for short cases is Cognitive Behavioural Therapy (CBT). Here we evaluate a local CBT teaching program implemented to prepare CTs, delivered by the trust Psychotherapy Tutor in conjunction with a CT, Dr Bloomfield, who has experience delivering CBT in a talking therapies service.

Methods

We implemented a teaching programme which consisted of 30-minute teaching sessions occurring immediately after Balint groups, which are usually well attended. Dr Bloomfield designed a teaching plan, with separate CBT teaching topics divided into 12 sessions. Each session focused on a CBT concept with practical examples. The effectiveness of psychotherapy teaching was evaluated with pre- and post-teaching online surveys assessing preparedness, confidence in formulation, and knowledge of specific techniques. The survey consisted of Likert scales ranging from 1–10 with lower numbers indicating a negative response. Trainees were also surveyed about Psychodynamic Psychotherapy in the absence of specific teaching, as a comparator.

Results

13 CTs responded to the pre-teaching survey and 16 CTs to the post teaching survey, with near-equal weighting across the training grades. Responses indicated a median increase across all areas for CBT, with trainees reporting higher confidence in formulation (7 to 8.5), improved knowledge of CBT techniques (5 to 8) and increased preparedness to start seeing patients (5 to 7). By comparison, there was a modest increase in preparedness (5 to 6) and confidence in psychodynamic formulation (3 to 3.5), with knowledge of specific aspects of Psychodynamic Psychotherapy unchanged (6 and 6).

Conclusion

Regional teaching alone may not be sufficient in preparing trainees to start seeing psychotherapy patients. The CBT learning needs of CTs in Coventry and Warwickshire were effectively met by providing a series of short, tailored sessions covering the different aspects of CBT, resulting in improved confidence, preparedness, and knowledge of CBT techniques. The same increases were not seen in trainees’ responses regarding Psychodynamic Psychotherapy, though small increases were seen in preparedness and confidence in formulation. Our next phase of the teaching will focus on Psychodynamic Psychotherapy teaching, with further repetition of the survey.
Dealing With Discrimination, Harassment and Bullying in Mental Health Settings: A Qualitative Evaluation of Training
Authors: Fotheringham Lachlan , Munro Katie
Published: August 2024

Aims

This is a qualitative evaluation of a simulation/debrief based training session to address discrimination in an NHS workplace, delivered to psychiatry trainees. Videos portraying discrimination acted as the simulation, followed by a diamond model informed debrief.

This evaluation aimed to:

•

assess the effectiveness of this training session in terms raising awareness of discrimination, problematising discrimination, empowerment to act and skills building

•

explore the extent to which these stated aims are relevant to participants’ experience of discrimination, harassment and bullying at work

•

establish if this is a meaningful and acceptable training model for this topic

•

establish if there are more relevant themes that this training session should be focusing on and if so, what these are?

Methods

A total of 8 trainees were interviewed between December 2022 and May 2023, having recently completed the training. A thematic analysis was undertaken by two researchers following established recommendations, seeking to bring out latent themes with an inductive, interpretative approach within a constructionist paradigm.

Results

Trainees attended with existing knowledge, skills and attitudes about discrimination, harassment and bullying, and about the training session itself.

Both the simulation and debrief were valued by trainees. The debrief was more than just a discussion. Portrayals of discrimination in the videos/simulation could have been more subtle, and tackled a more diverse range of examples such as LGBTQ+.

The learning objectives were largely met, and related to real challenges that trainees face. Trainees took away more than this, citing learning related to team cohesion and developing their sense in which discrimination in the context of mental illness requires special consideration.

Conclusion

This model of training is providing good value in addressing a topic of strategic importance in a novel way. The impact on empowerment and skills development is likely to be particularly valuable in impacting real world responses to workplace experiences of discrimination. Promoting team cohesion and a space to thoughtfully consider the special case of discrimination in the context of mental illness are important additional benefits. The simulation/debrief model is likely to be crucial, providing learning which would be inaccessible to didactic or e-learning based modes of delivery. The simulation materials may be improved by depicting LGBTQ+ issues, and a more subtle portrayal of discrimination. While this evaluation was situated in a psychiatric context, it could have wide applicability to tackling similar challenges throughout NHS workplaces.
Physical Issues in Mental Health Settings – Implementation of a New Immersive Course for Core Psychiatry Trainees
Authors: Mishra Vatsala , Winston Ian
Published: August 2024

Aims

This team of simulation fellows at a London teaching hospital created an immersive simulation course for core psychiatry trainees to explore the intersection between physical and mental health and impact on provision of care. The course was fully mapped to the updated Royal College Core Training Curriculum as well as Crisis Resource Management principles, and focusses on the integration of care across mental and physical health provisions. Scenarios are set in a range of inpatient and community environments to allow participants to consider differences in delivery of holistic care, prioritisation, ethical and legal considerations across settings. This would be particularly relevant for participants early in training with limited prior exposure who may be unfamiliar with handling emergencies on psychiatric wards and the nuanced limitations in providing medical care.

Methods

Scenarios were written in consultation with speciality experts and allied health professionals including mental health nursing, dietetics, and pharmacy. The course is written to enable participants to explore the intersection between physical and mental health, and the practical and social implications of an individual's mental and physical condition on provision of care. Alongside debriefing technical and non-technical learning objectives, participants reflected upon the wider determinants of each patient's current physical and mental state and discussed ethicolegal considerations such as patients’ legal status, capacity to consent, and practicalities of transferring patients between services and facilitating holistic care.

Results

The pilot course took place on July 4th following consultation with stakeholders including senior simulation and education leads within the Trust, and deanery Training Programme Directors, to ensure the course was formally endorsed to allow participants to apply for study leave to attend. Post-course feedback was collected through use of Likert-scales and white space questions; the response was highly positive and showed the programme met its aims and filled a training need. Feedback showed increased confidence managing integrated physical and mental health issues and balancing conflicting priorities with increased understanding of practical and social implications of mental and physical condition on provision of care.

Conclusion

Next steps involve collaboration with service users to allow accurate representation of the unique needs of a diverse population, and potential use of actors to sensitively and ethically portray simulated patients. Local psychiatry training schools could be approached to consider formal implementation of the course within academic programmes, in addition to potential reformulation of scenarios for use in established courses at the host site such as Undergraduate or Foundation training days.
Live the Experience: Mental Health Simulation Training for New Starters to Psychiatry in East London NHS Foundation Trust (ELFT)
Authors: Patel Alisha , Ismail Haitham , Valdearenas Lorena
Published: August 2024

Aims

This project aimed to create and deliver a simulation-based course to improve trainees’ knowledge, practical skills and confidence as well as leadership and multidisciplinary-team working. We evaluated the effectiveness of this training and simulation as a learning experience. Simulation in psychiatry is a relatively new field compared with other specialities. Literature shows that experiential learning in psychiatry is effective for developing clinical and communication skills for doctors, and confidence in leadership. It is vital we work towards the National Health Service Long Term Plan for improving mental health care for those with serious mental illness which includes better training for doctors. This course was designed to enhance the ELFT training programme focusing on applications of theoretical knowledge.

Methods

A simulation-based course was delivered to core trainees and general practitioner trainees at induction to psychiatry. This was based on the Royal College of Psychiatrists curriculum and input from our People Participation team to ensure authenticity of scenarios. We surveyed trainees to inform the development of our pilot in February 2022 and subsequently developed two half-day courses facilitated in August 2022 following feedback. The scenarios we created were: risk assessment, section 5(2) Mental Health Act (MHA) assessment, managing agitation and violence, escalating concerns to a senior, section 136 MHA assessment, seclusion review, discussion with medical registrar for physical health concerns, collateral history and information-giving in child psychiatry. We used a structured debrief model (what went well, what could you have done differently, what was the ‘golden moment'?) and provided relevant teaching. Service users joined the debrief to share their perspectives and lived experiences. We collected and analysed quantitative and qualitative feedback.

Results

Ten trainees attended the pilot course, followed by eleven on day 1 and nine on day 2 in August 2022. Results from questionnaires revealed post-course, 100% of participants felt more confident in their psychiatric skills and found this experience to be valuable for clinical practice. 100% would recommend this simulation to others. Qualitative data showed participants thought scenarios were realistic, the environment was supportive and feedback was comprehensive. They also appreciated the service user involvement.

Conclusion

Trainees reported simulation provided a safe and engaging environment to learn practical skills which better prepared them for work. This course is now embedded into the ELFT induction programme and enables doctors to develop their confidence and have a better understanding of service user perspectives. Future development of this course will involve allied health professionals.
Tailored CAMHS Educational Sessions for Primary Care Staff
Authors: Sherratt Anna , Foster Michael
Published: August 2024

Aims

To develop and evaluate a tailored teaching session for local non-medical primary care staff on common CAMHS (Child and Adolescent Mental Health) conditions. It was hypothesised that quizzes administered before and after the educational session would evidence an improvement in clinician's knowledge of these clinical presentations.

Methods

Invitations were extended to all local PCNs to attend educational sessions held on four separate occasions in December 2022 and January 2023. Multiple choice quizzes were administered before and after a presentation on four common CAMHS conditions. The presentation and quizzes covered the presentation, diagnosis, and management of autism, eating disorders, depression and emotional dysregulation. Quizzes were scored out of a maximum 16 points with four questions per clinical condition. A paired T-test (following tests for normal variance) was performed using JASP software to compare the before and after scores.

Results

A total of 22 non-medical clinical staff attended the sessions. This included physician associates (n = 1), allied health professionals (n = 5), practice nurse (n = 3), care coordinator (n = 3), health care assistant (n = 4), social prescriber (n = 1), mental health practitioner (n = 3), advanced clinical practitioner (n = 1) and advanced nurse practitioner (n = 1). For the 22 pairs of quizzes, mean differences and 95% confidence intervals (CIs) were calculated between before-and-after scores. The mean difference between total score was 6.9 CI [6.1, 7.7] which was statistically significant (p < 0.001).

Conclusion

More than 31,000 additional staff have been recruited into healthcare roles at general practices across the country since 2019 to meet soaring demand for primary care services. Since the pandemic record numbers of children and adolescents are presenting with mental health difficulties, therefore, it is likely that primary care clinicians will encounter these presentations in their practice. Our results suggest that such a tailored approach can offer effective means in improving knowledge in this growing group of professionals. Such sessions may also provide informal spaces in which to network with secondary mental health professionals, improving links between services.
Developing an Electronic Handover System for On-Call Doctors in a South London Mental Health Trust
Authors: Abdelsamie Ahmed , Alexander Laith , Wilkinson Rebecca , Dawson Olivia , Yadav Prateek
Published: August 2024

Aims

To replace pre-existing paper-based and informal handover systems with a confidential electronic handover system for on-call doctors across a large South London mental health trust, thereby improving the safety and quality of handovers.

Methods

A quality improvement project was registered within our trust. At baseline, we surveyed core trainees, GP trainees, and locum doctors about their experiences using a paper handover system for on-calls at the Bethlem Royal Hospital and Lambeth Hospital, South London and the Maudsley NHS Foundation Trust (SLaM). Their feedback guided the implantation of a confidential and secure electronic handover system integrated into the trust's Microsoft SharePoint, using the Microsoft To Do app and then Microsoft Teams. We alerted doctors to these changes via formal and informal means, such as trust inductions, emails and through communication with trust junior doctor representatives. After a period of 8 and 24 weeks, we assessed the initiative's success by collecting both qualitative and quantitative data from on-call doctors about their experience with the handover system. Based on feedback, we made multiple adjustments to improve the system, which was later adopted at Lambeth Hospital. The Microsoft To Do app was then replaced by a channel on Microsoft Teams to ensure wider access.

Results

15 doctors responded to the baseline survey. Handover practices were varied and included paper-based handovers, phone calls, and emails. Mean doctors’ ratings for the pre-existing handover systems were 3.2/5 for overall quality (1: very poor; 5: very good) and 2.7/5 for safety (1: very unsafe; 5: very safe). 60% (n = 9) of doctors said tasks would sometimes be missed in the pre-existing handover system. 21 doctors responded to 2 post-change surveys. Mean doctors’ ratings of overall quality were 4.6/5 and safety were 4.5/5. Qualitative feedback highlighted that a verbal handover was still necessary to complement the electronic system, and that locum doctors would need to have access to the system as well as consultants and registrars during periods of industrial action.

Conclusion

An electronic handover system was successfully implemented to replace a predominantly paper-based handover system at two large mental health hospitals in South London, and on-call doctors reported improvements in handover safety and handover quality. Future work aims to implement a consistent electronic handover system across other hospitals in SLaM and other trusts and transition fully to Microsoft Teams for broader accessibility.
Enhancing Well-Being: Optimizing Service Delivery in Neighbourhood Mental Health Team (NMHT) for Administrative Staff and Service users
Authors: Ali Harith , Moller Danica , Selim Amra , Meah Taz , Ali Selma
Published: August 2024

Aims

Promoting the well-being of staff is paramount within mental health services. However, a common issue arises where administrative personnel, often serving as the primary point of contact for service users, engage in mental health-related interactions without formal training. This deficiency can adversely affect their well-being, leading to diminished team morale and increased staff turnover, consequently impacting the quality of care provided by the Neighborhood Mental Health Team (NMHT). Moreover, it can contribute to dissatisfaction among service users, jeopardizing their rapport with the service. We aim to improve the wellbeing of staff and service users and to optimize service delivery at the local NMHT.

Methods

Data were gathered from a local NMHT catering to 1200 service users in the borough of Tower Hamlets in London. A pre- and post-implementation questionnaire was administered to both service users and six administrative staff members. The questionnaire highlighted several areas for improvement, including a lack of mental health understanding among administrative staff, reported low confidence when handling certain phone inquiries, and service user complaints. Change initiatives were then devised to address these concerns and evaluate their impact on enhancing the experience for both service users and administrative staff.

Results

Administrative staff uniformly expressed the need for increased mental health training prior to commencing their roles. Implementation of targeted change initiatives led to noticeable improvements in service user satisfaction and staff confidence in managing phone interactions. These enhancements culminated in an overall advancement in service delivery.

Conclusion

Through the strategic implementation of change initiatives informed by our initial findings, we not only augmented mental health literacy among administrative staff and service users but also bolstered their well-being. Consequently, this directly translated into an amelioration of local service offerings. Further research is warranted to ascertain the long-term efficacy of these innovative interventions.
Improving Quality of Multidisciplinary Team Meetings in Our Community Mental Health Team in NHS Greater Glasgow and Clyde, Scotland
Authors: Ambardar Prerna , Brown Rachel
Published: August 2024

Aims

To ensure smooth running of Multidisciplinary team (MDT) in Community mental health team (CMHT) and reviewing MDT structure for better functioning at Parkview Mental health Resource centre.

On a Friday two Multidisciplinary teams (MDTs) were running online on Microsoft teams simultaneously. The same staff was running the two MDTs, so staff input could be limited at times and staff would dip in and out of MDTs. Discussion around ways of improving this so that both MDTs run smoothly. Also, there was no formal structure to MDT meetings. It was decided that improvement in Quality of MDT needs to be addressed.

Methods

Initially numerous discussions held online with Parkview team, nursing colleagues.

CMHT Quality improvement group was set up and a meeting was arranged where everyone's ideas were considered.

A pilot project was first introduced in March 2022 and audited in July 2022. Plan, do, study, act (PDSA) cycle was carried out.

Plan

Two nursing teams to be setup which will feed back into the two MDTs on alternate weeks. This will reduce nursing teams having to come in and out of one MDT to join other MDT, hence increasing the efficacy of the MDT.

Devise a new template to provide formal structure for the MDT presentation.

Do

Trial the new setup of two nursing teams.

Study

Ask all MDT staff members for feedback on the working of MDT.

Act

Reformat the Structured template and distribute to all staff members.

Results

100% staff felt that new structure of MDT was useful.

84% staff satisfied with the new way of running of MDT.

84% staff satisfied with having designated teams for MDT.

Conclusion

Having Designated MDT teams and a structured format helped in robust functioning of the MDT in the CMHT.
Improving Trainee Doctors' Awareness on How to Refer for Routine Radiological and Cardiac Investigations at a Psychiatric Hospital in South London
Authors: Felton Annabel , Ang Trisha
Published: August 2024

Aims

Psychiatric inpatient hospital, although part of secondary care, is separate from a physical health hospital and therefore does not have access to electronic referral systems, which increases efficiency of referral processes. As part of an admission clerking for all inpatients in psychiatric hospitals, the admitting doctor takes a history of past medical issues, a physical examination, electrocardiogram and bloods. Depending on findings, further radiological and cardiac investigations may be warranted. Not having access to electronic referral systems can cause delay in delivering treatment for psychiatric inpatients, especially when referral pathways is unclear. The aim of this quality improvement project is to increase the knowledge of referrers in order to improve efficiency completing referrals and reduce incorrect referrals. With clinicians able to refer for routine imaging correctly and in an efficient manner, it is hoped that this will correlate with an improved quality of care received by patients.

Methods

Firstly we assessed the knowledge of currently employed trainee doctors, via a web-based survey, on how to refer for routine and commonly ordered radiological and cardiac investigations. Employed referrers included core trainee, GP and foundation year trainee doctors. We then created an electronic referral pack which includes a guidance and referral forms provided to clinicians when they start employment at Lambeth hospital and accessible to current trainees. A follow up survey then reassessed the knowledge of these referrers.

Results

There was a total of 11 responses received from survey prior to sending out the electronic referral guidance pack, of which 100% believed that it would be helpful to have a referral guidance pack. A total of 4 responses were received after sending out the guidance. The surveys showed that there is improved knowledge of how to refer for routine radiological and cardiac investigations after guidance was sent. Prior to sending the guidance, 9.1% referrers were made aware of the referral process, and this increased to 50% after the referral guidance pack was sent out.

Conclusion

Trainee doctors in psychiatric hospitals require more support with physical health management in psychiatric hospitals, including referring for physical health investigations, as referrers cannot access electronic referral systems used in physical health hospitals. Results need to be correlated with clinical outcomes in future. A longer term project could include linking the electronic referral systems between psychiatric and physical health hospitals.
Adherence to RCPsych Standards for Physical Health Monitoring and Health Promotion in Patients Open to the North Wales Early Intervention Psychosis (EIP) Service
Authors: Azhar Zeenish , Mendieta Javier
Published: August 2024

Aims

•

The audit aims to improve the quality of physical health monitoring and physical health interventions that the EIP service provides to people with psychosis.

•

To ensure adherence to RCPsych standards for physical health monitoring in patients with First Episode Psychosis.

•

To ensure adherence to RCPsych standards for provision of required physical health interventions and health promotion in patients with First Episode Psychosis.

Methods

•

A retrospective case note audit and re-audit was conducted for 13 patients on the caseload of the North Wales EIP service from December 2022 to December 2023.

•

The case notes were audited against RCPsych standards for physical health monitoring and physical health interventions using an adapted version of the National Clinical Audit of Psychosis (NCAP) audit tool.

Results

•

Alcohol and substance misuse screening status improved to 100% in re-audit.

•

There was significant improvement noted in Hypertension, Body Mass Index and Cholesterol screening.

•

Mental health medication review, advice or referral for diet and exercise with regards to weight gain/obesity and hypertension improved to 100%.

•

No specialist interventions were offered around health promotion and illness prevention as most of the patients were either not in the abnormal range, identified as high risk for developing the above mentioned physical health conditions or refused to have interventions for these conditions.

•

A definite increase was observed in frequency of interventions being reviewed and reoffered for those accepting and declining interventions at baseline.

Conclusion

•

Training for staff to complete bloods and physical health screening.

•

Increase availability of equipment to carry out physical health screening.

•

Monthly, three and six monthly prompts in the case notes for staff to discuss physical health interventions with patients.

•

Staff to use headings for physical health screening and interventions to improve documentation in case notes.
Enhancing Medical Student Experience in Psychiatry Placement in Stockport: A Quality Improvement Project
Authors: Darod Nafisa
Published: August 2024

Aims

Fourth-year medical students from Manchester University undergo a four-week Psychiatry rotation in Stockport as part of their curriculum. Placed in both community and inpatient teams within General Adult and Older Adult Psychiatry services, this placement offers a unique opportunity for students to gain clinical and educational experience in Psychiatry, potentially shaping their perception of the field. This quality improvement project aimed to enhance the overall experience of medical students during their Psychiatry placement in Stockport.

Methods

A retrospective review of quantitative and qualitative feedback from the March to April 2023 cohort (n = 4) involved a 5-point Likert scale and comments covering 10 domains. The feedback focused on aspects such as induction, orientation, learning objectives, patient assessment, procedural skills, supervisor feedback, access to resources, timetables, and the overall experience. An average total score was calculated.

Subsequently, strategies were implemented for the April to May 2023 cohort based on the feedback. Weekly check-ins, updated timetables, team introductions, additional teaching sessions, and opportunities for case presentations were among the interventions.

Quantitative and qualitative feedback from the April to May 2023 cohort (n = 4) were collected and compared with the previous cohort's feedback.

Results

The feedback scores demonstrated improvement, with the average total score increasing from 4.1/5 (82%) in March – April 2023 to 4.7/5 (94%) in April–May 2023. Students praised the helpful staff, opportunities to present cases, and the tailored and useful nature of the placement. Feedback on improvements included addressing vague timetables, unannounced cancellations of teaching sessions, and limited opportunities for case presentations.

Conclusion

This quality improvement project demonstrated that the targeted interventions helped enhance the educational experience of medical students during their psychiatry placement. The increased feedback scores underscore the positive impact of targeted interventions. The findings emphasize the importance of continuous quality improvement in medical education, ensuring a more positive and enriching experience for medical students in Psychiatry rotations.
Weight Management Quality Improvement Project in Tower Hamlets Community Learning Disability Service
Authors: Dundas Lucy , Deniz Irem , Hirsz Genevieve , Prior David , Eady Nicole
Published: August 2024

Aims

The project's aim is to record up-to-date BMI readings of 70% or more of our service users by September 2024. We have identified barriers limiting current data collection, such as challenges weighing wheelchair bound clients or limited availability of weighing scales, and will action our change idea methods to reach our target in this time period.

Significant health inequalities have been identified in the learning disability population, with men and women in our cohort dying 23 years and 27 years younger respectively compared with the general population. Furthermore, people with learning disabilities are at increased risk of being overweight or obese compared with other cohorts, which itself leads to a range of health and social complications. A recent audit of our psychiatry caseload revealed the need to improve weight monitoring and subsequent management for our service users, to help reduce health inequalities identified.

Methods

We have weekly project meetings with our MDT including psychiatrists, dietetics, occupational therapists, nurses and psychologists. We have arranged stakeholder involvement by inviting service users to these weekly meetings to contribute their own ideas to the project, and have organised focus groups for service users, carers and staff. We intend to generate change ideas by using quality improvement methodology to identify primary and secondary drivers. One of these already incorporated into the project is a machine in our waiting room monitoring our clients’ weight, height and blood pressure. Having identified obstacles in our service users obtaining their weight, we have successfully bid for funding for one of these machines.

Results

We will use Plan Do Study Act (PDSA) cycles to evaluate the effectiveness of our change ideas. Convenient sampling of our psychiatry caseload showed only 26.7% of 71 service users have an updated weight and BMI, and identified that we don't have a robust process for monitoring patients' weights (total project caseload is 1264).

Conclusion

During the development of this project, we identified a variety of approaches to improve health outcomes for our service users including educating staff on incorporating weight monitoring into consultations and how to manage the results. This project comprises one part of East London Foundation Trust's overall Triple Aim: to improve population health; improve the quality and improve value for the system. Going forward, our intention is to incorporate weight management into our routine reviews and ensure staff are educated in the importance of regular weight monitoring, the health benefits and how to refer.
A Quality Improvement Project to Improve Staff Confidence in Managing Incidences of Patient Violence and Aggression on the Neurosciences Wards
Authors: Staffurth Isabel , Hoque Rahima , Duric Bea , Rogowska Marianna , Posporelis Sotiris
Published: August 2024

Aims

Incidents involving patient violence and aggression are a common occurrence on the neurosciences wards. Many staff do not know how to de-escalate or manage such incidents, leaving them vulnerable and unsupported. This project was designed to increase mean staff confidence by at least 2 points (on a scale of 1–10) regarding confidence and satisfaction in managing patient violence during a 6-week period.

Methods

Using Plan-Do-Study-Act (PDSA) quality improvement methodology, we carried out a preliminary survey on 2 neurosciences wards. Multidisciplinary staff were interviewed about their confidence (on a scale of 1–10) in managing violence. The survey and interview assessed which measures were already in place on the wards, such as Datix reporting and referral pathways. The first intervention focused on preventing patient violence with informative posters on referral pathways and verbal de-escalation techniques; these were distributed throughout the wards and staff were notified via email. Follow-up surveys were collected, enquiring whether staff had seen the posters and how their confidence levels have changed. The second intervention was implemented 2 weeks later and focused on post-incident support. We distributed leaflets on Critical Incident Staff Support and sent an email link to a verbal de-escalation playlist. Follow-up surveys were collected again to track changes in staff confidence and satisfaction. Weekly electronic clinical record searches were recorded to track the number of incidences of patient aggression during the same 6-week period.

Results

Staff confidence (N = 24) in verbally de-escalating violence and aggression increased by 1.1 and 1.75 points for Wards A and B, respectively. Of the 6 staff members who were followed up, only 1 experienced a 2-point increase from baseline in confidence in verbal de-escalation; 1 staff member experienced a 1-point increase, 3 experienced no change, and 1 reported a 1-point decrease. Staff satisfaction in management of violence on their wards increased by 1.04 and 1.75 points for Wards A and B, respectively. Staff confidence in knowing which team to refer patient violence to increased by 1.167 and 1.07 points for Wards A and B. Incidences of patient violence reported on EPIC decreased by 8 episodes for Ward B and increased by 2 episodes for Ward A.

Conclusion

Low-cost, simple intervention techniques are largely ineffective in improving staff confidence in handling violence. During verbal feedback, most staff agreed that training and simulation-based days would be useful. Ward managers should seek to include well-structured training to improve staff confidence.
Improving the Management of Neuropsychiatric Presentations in Early Intervention Services (EIS)
Authors: Finn Henry , Easter Emily
Published: August 2024

Aims

Early Intervention Services (EIS) are in a unique position to assess patients presenting with their first episode of psychosis. The possibility that an organic disorder may be underlying their presentation must be ruled out, often necessitating neuroimaging and/or input from neurology and neuropsychiatry.

We aim to improve the management of neuropsychiatric presentations in EIS. We will determine the incidence of cases, from the London Boroughs of Sutton and Merton, which warrant referral to neurology, neuropsychiatry and neuroimaging. We will then review referral pathways and provide justification for community services, such as EIS, to autonomously request referrals and neuroimaging.

Methods

We retrospectively reviewed the complete caseloads of EIS for Sutton and Merton (n = 121). We considered the neurological comorbidities of patients to determine the incidence of cases which warranted a referral to neurology, neuropsychiatry and/or neuroimaging. We reviewed how requests were made and the subsequent results.

Results

15% of the EIS caseload had a neurological comorbidity. Migraine was the most common condition (8.3%), followed by traumatic brain injury (3.3%), headache (2.5%), and seizure (1.7%). There was one case each of epilepsy, stroke, transient ischaemic attack, cavernoma and cerebral venous thrombosis. 83% of patients with a neurological comorbidity had received neuroimaging and all imaging results were either normal or confirmed known pre-existing neurological disease. The 17% of patients who did not receive neuroimaging had only migraine as a neurological comorbidity. One patient was reviewed by neurology and diagnosed with psychosis presumed to be secondary to paraneoplastic syndrome. All patients that fulfilled criteria for a neuropsychiatry referral had this completed electronically. However, there was no clear pathway to request a review by neurology, and Sutton EIS had difficulties autonomously requesting and accessing the results of neuroimaging, delaying provision of appropriate care.

Conclusion

There is a small but significant burden of neurological comorbidity among EIS patients. In our brief study, we found one patient whose symptoms of psychosis were likely attributable to an organic cause. Accessible pathways to refer patients for neuroimaging, and subsequently to neurology and/or neuropsychiatry if indicated, are crucial in the assessment and management of first episode psychosis where an organic cause is suspected. Access to these resources should be efficient and autonomous for EIS. We are in the process of implementing referral guidance alongside a direct electronic referral process to request neuroimaging and further input from neurology and/or neuropsychiatry, to optimise care for patients and our service.