bluuebunny/crossref_metadata_2025_split huggingface dataset:
105 Beyond the Bleep: Exploring Alternate Methods of Communication in the Multidisciplinary Team to Facilitate Efficient Discharge
Authors: Harcourt H , Hewertson E 
Published: March 2021

Abstract

Introduction
On the surface discharging a patient seems a simple a simple process, but delays due to coordination and communication in preparing medication, transport and discharge summaries are all to common. This results in delayed discharge, which is unfair on patients and their families, adds to the risk of hospital acquired infection and increases NHS expenditure and bed pressures. This quality improvement project investigates alternate systems for coordinating this process to make it more efficient and easier for the relevant stakeholders, with the added advantage of being “bleep free” as is the Health Secretary’s target for 2021.

Method
We started with process mapping and summarising the challenges faced by stakeholders in the current system, which uses bleeps for communication across six older people medical wards and ten medical teams. We progressed to iterative PDSA cycles using Medxnote for one medical team across all wards and then Microsoft Teams on one ward with ten medical teams. New process maps for each were created and circulated to stakeholders to explain the roles and responsibilities of each team.

Results
Both Medxnote and Microsoft teams subjectively made communication easier. However, Medxnote was hampered by the inability to have a three-person conversation and the required use of personal phones. Microsoft teams overcame these obstacles and was able to demonstrate objective improvements with a 42% increase in medication screened before 1 pm and 72% increase in medications prepared on the day of discharge, suggesting better prioritisation. Team feedback was that it decreased workload, made team members more accessible and minimised interruptions to working day.

Conclusions
The initial PDSA cycle suggests Microsoft teams is a promising tool for improving the discharge process and aiding bleep free communication amongst members of the multidisciplinary team. The next step will be a trial across all wards with all teams.
109 Improving Escalation and Treatment Plans in the Borders General Hospital (BGH) During COVID-19
Authors: Ralston K , Campbell A , Alcorn G 
Published: March 2021

Abstract

Topic
Clear escalation and treatment plans created in discussion with patients are crucial to managing patients safely and appropriately. Our goal was to introduce a standardised, easily identifiable document for this purpose, with an aim of 90% of medical inpatients having a clear escalation plan discussed and documented.

Intervention
We developed a Treatment Escalation Plan (TEP), raised awareness via different platforms and delivered teaching for staff. For baseline and subsequent data collections following interventions, we reviewed the notes of twenty random medical inpatients for decisions regarding escalation, patient involvement in decision making including capacity and specific interventions considered. We also included time taken to find information; documented patient/family discussions and whether a TEP was present. We collected qualitative feedback from staff.

Improvement
After introduction, TEP was present in 35/60 patients (58%). Improvement was demonstrated across all measured domains when a TEP form was present: escalation decision (no TEP 80%, TEP 100%), discussion with patient/relative (no TEP 4%, TEP 85%), capacity decision regarding escalation (no TEP 52%, TEP 91%), decision on specific interventions (no TEP 12%, TEP 94%), mean time taken to find information (no TEP 84 seconds, TEP 34 seconds). Qualitative feedback from staff was positive, particularly the inclusion of specific care decisions beyond “DNACPR”.

Discussion
We felt it was critical to develop a TEP to ensure appropriate decisions are made and clearly documented for medical inpatients, especially in light of COVID-19. In patients with a TEP completed, we observed improvements in all domains, particularly in the involvement of patients/relatives in escalation decisions, which is key to delivering patient-centered care. Implementing a new system in a pandemic had challenges, such as continuity of staffing, however feedback was uniformly positive. This is an ongoing project that will continue to promote TEPs to improve patient care.
110 A Single Centre Study on the Thirty-Day Hospital Reattendance and Readmission of Older Patients During the SARS-CoV-2 Pandemic
Authors: Mooney C J , Hone L , Majid M , Cai J , Mieiro L , Fink D L 
Published: March 2021

Abstract

Introduction
Hospital and social care suffered major alterations during the SARS-CoV-2 pandemic in the UK. Older adults were disproportionally affected by routine care disruption. To our knowledge, no data has been published so far on the impact of service disruption on 30-day readmission.

Methods
We performed a retrospective observational study of all patients admitted to a single east London hospital with laboratory-confirmed or clinical diagnosis of COVID-19 between 16th March and 6th April 2020. Older patients were defined as aged 80 years and over. Readmission was captured within 30 days of discharge. Comparator defined as the same period in 2019. Descriptive statistics were used.

Results
Three hundred and ninety-three patients were included. The majority survived to discharge (69.7%). Positive laboratory testing was similar between older and younger patients (85.7% vs 84.7%, p = NS). Mortality was significantly higher for older patients on index presentation (60.2% vs 20.3%, p &lt; 0.001). Length of stay was also significantly longer for these patients (median 9 vs 7 days, p = 0.00694). The readmission rate for the 274 individuals discharged after index admission was 11.3% (n = 31). Amongst older patients, readmission rate during the study period was slightly higher than the same period in 2019 (17.9% vs 14.8%, p = 0.36). The median time interval between discharge and re-attendance was 8 [1–29]days. All re-attending older patients were re-admitted, whereas 54.2% of younger patients were sent home directly from the emergency department. Only 1 of the 31 patients re-attended because of insufficient social care.

Conclusions
Our data shows that readmission rates in the older population of East London during the SARS-CoV-2 pandemic were largely similar to non-pandemic periods. During this period, readmission rates appear to have been driven by clinical rather than social imperatives. This suggests that adapted social care services performed well and should be reinforced for future surges.
111 Tripper: Trying to Reduce Inappropriate Prescribing in Patients Who are Elderly and At Risk of Falls
Authors: O'Kane A , McGarry N , Baillie J , Plumb R 
Published: March 2021

Abstract

Background
Falls in older adults are common, and a major cause of mortality and morbidity. Polypharmacy is associated with a greater number of falls and is prevalent but preventable. The American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults are used worldwide. This project focused on Table 3 of the 2019 Beers Criteria which recommends an explicit list of PIMs to be avoided in older adults with a history of falls.

Aims
To increase documented discussion about PIMs on discharge letters for elderly patients at risk of falls over a 6-week period.

Method
A retrospective review was undertaken to define baseline data on falls, PIMs and documented discussion of PIMs on discharge letters. Stickers for Kardexes were introduced to highlight PIMs for review. A table documenting discussion of PIMs was incorporated to discharge letter templates. Data was then collected on falls, PIMs and documented discussion of PIMs on discharge letters over a 6-week period. Results: Of patients discharged over 10 weeks, 44% had a history of falls. Of patients with a history of falls, 73% were taking at least one PIM pre-admission. Following intervention, the median percentage of discharge letters with documented discussion of PIMs increased from 4% to 30%. Following intervention, there was a greater average reduction in prescribed PIMs on discharge in patients with a history of falls.

Discussion
We confirmed a significant burden of falls and PIMs in our patient population. QIP intervention increased documentation of PIM discussion and reduced the volume of PIMs prescribed on discharge. Communicating PIM discussion on discharge letters encourages deprescribing; informs primary care and future admissions; and promotes patient centred decision-making in this important risk area. Further work includes collecting feedback from primary care and introducing a PIMs review table to discharge letter templates throughout the hospital.
112 Outcomes and Clinical Characteristics of COVID-19 Disease in the Frail, Elderly Population of Tayside
Authors: Shedden R , McCulloch A , Laidlaw S , Love S , McLuckie S , Jones W , Taylor J , Pennington R , Tipton C 
Published: March 2021

Abstract

Introduction
With advancing age, frailty, multi-morbidity and need for care, elderly patients are some of the most vulnerable to Covid-19 disease. In NHS Tayside, a dedicated Covid-19 Medicine for the Elderly (MFE) Team was formed to care for patients identified as frail and likely to benefit from comprehensive geriatric assessment.

Methods
All Covid-19 patients meeting frailty criteria1, cared for by the Covid-19 MFE Team were identified. Data on outcomes and clinical characteristics for all (140) patients admitted during the first pandemic wave (March–July 2020) was collected using electronic patient records and analysed.

Results
Patients were predominantly male (58.6%). Ages ranged from 65–99 years, with 43.6% aged ≥85 years. 82.1% had one or more of cough, fever and anosmia on admission fitting Covid-19 case definition 2. Lymphopenia was present in 92.1%. Of note, 26.5% of patients had a normal or unchanged chest x-ray report, with only 10.2% showing bilateral peripheral infiltrates. 28-day mortality was 37.1% with Covid-19 Disease listed as primary cause of death in 90.4%.

Conclusion(s)
Entering further “waves” of infection, it is vital that we understand the clinical presentation and course of Covid-19 disease in elderly patients. Our data highlights that any Covid-19 symptom, even in isolation, should raise suspicion of disease. Chest x-rays should not be used alone as a diagnostic tool. The presence of lymphopenia should raise suspicion of Covid-19 infection. In developing an understanding of how elderly patients with Covid-19 present, we can ensure early identification and initiation of appropriate infection control measures.

References
1. Healthcare Improvement Scotland. Think Frailty. 2014. http://www.healthcareimprovementscotland.org/his/idoc.ashx?docid=8abd8530-48f3-4152-bbfb-d0918b870ec9&version=-1
2. Scottish Government. Update to Coronavirus Symptoms 2020. https://www.gov.scot/news/update-to-coronavirus-symptoms
113 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Elderly Hip Fracture Patients
Authors: McCann C , Hall A , Leow J Min , Harris A , Hafiz N , Myers K , Amin A , MacLullich A 
Published: March 2021

Abstract

Background
Acute kidney injury (AKI) in hip fracture patients is associated with morbidity, mortality, and increased length of stay. To avoid this our unit policy recommends maintenance crystalloid IV fluids of &gt;62.5 mL/Hr for hip fracture patients. However, audits have shown that many patients still receive inadequate IV fluids.

Methods
Three prospective audits, each including 100 consecutive acute hip fracture patients aged &gt;55, were completed with interventional measures employed between each cycle. Data collection points included details of IV fluid administration and pre/post-operative presence of AKI. Interventions between cycles included a revised checklist for admissions with a structured ward round tool for post-take ward round and various educational measures for Emergency Department, nursing and admitting team staff with dissemination of infographic posters, respectively.

Results
Cycle 1: 64/100 (64%) patients received adequate fluids. No significant difference in developing AKI post operatively was seen in patients given adequate fluids (2/64, 3.1%) compared to inadequate fluids (4/36, 11.1%; p = 0.107). More patients with pre-operative AKI demonstrated resolution of AKI with appropriate fluid prescription (5/6, 83.3%, vs 0/4, 0%, p &lt; 0.05) Cycle 2: Fewer patients were prescribed adequate fluids (54/100, 54%). There was no significant difference in terms of developing AKI post operatively between patients with adequate fluids (4/54, 7.4%) or inadequate fluids (2/46, 4.3%; p = 0.52). Resolution of pre-operative AKI was similar in patients with adequate or inadequate fluid administration (4/6, 67% vs 2/2, 100%). Cycle 3: More patients received adequate fluids (79/100, 79%, p &lt; 0.05). Patients prescribed adequate fluids were less likely to develop post-operative AKI than those receiving inadequate fluids (2/79, 2.5% vs 3/21, 14.3%; p &lt; 0.05).

Discussion
This audit demonstrates the importance of administering appropriate IV fluid in hip fracture patients to avoid AKI. Improving coordination with Emergency Department and ward nursing/medical ward staff was a critical step in improving our unit’s adherence to policy.
114 Tackling Noise Pollution in Hospitals: A Pre-Feasibility Study
Authors: Paul N , Xyrichis A 
Published: March 2021

Abstract

This study aimed to better understand appropriate interventions aimed at reducing hospital ward noise and the subsequent impact this would have on inpatient experience. Service users consistently reported that noise pollution was the most detrimental factor in their recovery in hospital, principally due to its effects on sleep.

Methods
To aid usability and data collection the Richards- Campbell Sleep Questionnaire (RCSQ) was adapted into an electronic format with a sliding Likert scale using QuestionPro Software3. Qualitative patient interviews, the RCSQ and ward decibel measurements were recorded on Henry and Anne wards at St. Thomas’ Hospital, London. 20 patients were interviewed (12F, 8 M), with 3 being ultimately discounted due to severe cognitive impairment.

Results
were collated and will be presented as part of a pre-feasibility evaluation of the tools to measure patient sleep and experience of ward noise. Results: The mean of the responses from the 17 patients interviewed were calculated and graphically displayed. Of interest, 87.5% found the questionnaire straightforward to understand, but only 18.75% found it easy to complete (due to technological unfamiliarity).

Conclusion and discussion
Patients reported a consistently reported a less than optimal night’s sleep on the ward, with light sleep and increased time to fall asleep being key factors. Although visits were restricted to the “quietest” times on the ward, noise measurements consistently exceeded WHO recommendations of 40 dB. Subsequently excessive night-time noise created by other patients as well as staff was cited as the principal causes of poor sleep, with ward lighting being another cause. Results from this study have provided the justification for sound-masking technology to be trialled on inpatient wards, with the view of decreasing unpleasant ward noise and improving patient rest and recovery.
115 Multi-Disciplinary Simulation Training on Delirium
Authors: Varma S , Alston D , Shah B , Long S 
Published: March 2021

Abstract

Introduction
Delirium is still perceived as a “geriatric medicine competency”, despite its high prevalence across most specialties. Collective multi-disciplinary team performance in implementation of multi-component interventions is key. Simulation training incorporates the complex interplay of non-technical factors, specifically, role recognition and empowerment, inter-personal skills and teamwork that are pivotal in delivering effective delirium care.

Methods
Funding was approved by Health Education England. 2 pilot teaching sessions were arranged in the simulation ward. 3 scenarios were developed, each requiring a facilitator, an actor and three participants- a foundation-year doctor, a nurse/healthcare assistant and a therapist. Scenario 1 dealt with a patient with hypoactive delirium with focus on identification and multidisciplinary optimisation. Scenario 2 challenged participants with management of an agitated patient. Scenario 3 involved discharging a patient with resolving delirium and a reluctant relative, with emphasis on mental capacity assessment. Communication, patient risk assessment and challenging perceived role barriers were global themes. Participant feedback was captured using unstructured interviews and pre- and post-session 5-point Likert confidence scale in various learning outcomes.

Results
16 participants were included- 4 foundation year doctors, 3 therapists, 2 healthcare assistants and 7 nurses. There was an average improvement in Likert confidence scales in all measured learning outcomes. All participants would recommend the course to their colleagues (average Likert scale 4.9). Qualitative feedback appraised the course for demonstration of de-escalation communication strategies, the application of mental capacity and recognition of early discharge planning.

Conclusion
Simulation training targeted at multi-disciplinary groups is an effective way to deliver teaching on delirium. It contextualises synergistic operation of different skills and personal accountability in influencing patient management. The challenge to its potential remains its adoption as mandatory training for various disciplines involved in care of older adults and its implementation at a wider-scale, to assure cost effectiveness.
116 Impact of COVID 19 Pandemic on Hospital Care For People with Dementia—Feedback From Hospital Leads and Carers
Authors: Hood C , Morris A , Corrado O , Swanson E , Bourke L , Crawford M , Quirk A , Doxford H 
Published: March 2021

Abstract

Introduction
The National Audit of Dementia (NAD) is funded by the Healthcare Quality Improvement Partnership to collect data from acute general hospital in England and Wales. In June 2020 NAD circulated optional surveys to leads for dementia in acute hospitals and carers asking about the impact of the pandemic on the organisation and provision of hospital care.

Methods
Anonymous survey links were sent to hospital dementia leads directly and circulated to carers of people with dementia via social media and representative organisations. Dementia Leads’ questions included whether they and/or their team had been redeployed during the pandemic and whether wards had access to specialist services. Carers’ questions included whether patients’ needs were discussed, whether they were permitted to visit/how this was communicated, any measures to facilitate communication with their loved ones, and whether they were updated about progress and discharge.

Results
53 dementia hospital leads completed the questionnaire. 32% had been redeployed to other clinical areas during the pandemic, 45% said the same for members of the dementia team. Specialist support for people with dementia on both Covid and Non-Covid wards was significantly compromised. 32 carers completed the questionnaire. 48% were not asked about the needs of the patient they cared for, 90% not allowed to visit, 43% were not given any explanation about visiting and 48% not given support to keep in touch with their loved one.

Conclusions
Clinical priorities inevitably meant redeployment of dementia specialist staff, and changes to visiting. However, continuation of specialist support is a requirement for people with dementia admitted to hospital. Liaison with carers/families must be a priority, including facilitating remote support. Hospitals should take note of NHS guidance permitting carer visits to support a person with dementia experiencing distress.
120 Improving Delirium Recognition and Management Through In-Situ Simulation
Authors: Cheston H , Miller E , Mufti S 
Published: March 2021

Abstract

Introduction
Delirium is a common condition that is often associated with increased morbidity and mortality, longer hospital admission, and discharge to a residential or nursing home. By improving our ability to recognise and manage these patients we can intervene early to help reduce the likelihood of these outcomes.

Method
We organised several in-situ simulation scenarios with junior staff working on the Elderly Care Unit. The research team designed a scenario to re-create a typical delirious patient on the ward. Participants had to recognise the patient was delirious and instigate a management plan. Participants completed a pre and post-intervention questionnaire to ascertain whether they felt the simulation had improved their confidence. Additionally we performed an audit to investigate whether our intervention led to an improvement in the recognition and management of delirium in patients on the ward.

Results
The questionnaires showed an increase in participants’ confidence and knowledge when managing a delirious patient on the ward. From reviewing patient notes pre-intervention we identified that 24 patients were delirious during admission,14 of which were accurately diagnosed with delirium. The remaining 10 patients were diagnosed with “Acute Confusion”. On reviewing these 10 patients’ notes, they were all likely to have a diagnosis of delirium. Post-intervention there were 14 patients identified as delirious during their admission. All these patients were correctly documented as having delirium with no inaccurate use of terminology. The data also showed increasing use of tools such as AMTS and 4AT to diagnose delirium.

Conclusions
From the data gathered, we can see participants are better at recognising and diagnosing delirium. However, our sample sizes are too small to test statistical significance between data points. To improve the project we would include a larger sample size to determine whether the simulation produces a statistically significant improvement in confidence levels.
123 Quality Improvement Project on Completion of Respect Form in the Community At Jean Bishop Integrated Care Centre (ICC)
Authors: Mon H , Kar S , Bridge L 
Published: March 2021

Abstract

Background
ReSPECT (Recommendation Summary Plan for Emergency Care and Treatment) form was designed to communicate a personalized set of recommendations for a patient’s clinical care in an emergency situation and priorities over other aspects of future care. AIMS & OBJECTIVE 1)To measure ReSPECT Form completion rates at ICC and proportion of forms uploaded on the system and this compared with the published data 2 to improve performance where possible through QI process 3) Re-auditing after interventions.

Methods
All patients who attended the ICC from 1st October 2019 to 21st October 2019 were audited. Altogether 80 patients’ notes on system 1 and Lorenzo were reviewed. After initial results, interventions such as displaying the poster of salient results and recommendations in ICC clinic rooms, giving feedback to key team members were performed by the audit team.

Results
9 patients already had ReSPECT forms. From the remaining 71 patients, 57 discussions (80%) were taken place and 29 forms (41%) were completed while 28 were not for definite reasons. ReSPECT discussion was not initiated for recorded reasons in 9 cases and without reason in 5 cases. Out of 29 completed forms, 24(82%) were uploaded on the system. After the interventions, the re-audit cycle with 16 cases in which 13(94%) had ReSPECT discussions and 6 forms were completed.

Discussion
In comparison with NHS forth valley ReSPECT report, we had a better figure in completion forms (41% Vs 39%) and the number uploaded on system (82% vs 79%). After interventions, 81% had either ReSPECT forms completed or discussion which is much improved.

Conclusion
From this study, the overall improvement in performance was seen with simple interventions but further spot check QIPs and regular training sessions to team member will be essential for sustainability.