bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change From 24-Hour Off-Site On-Calls to 12-Hour On-Site Shifts for Psychiatry SHOs Was Near-Unanimously Welcomed by SHOs, Senior Doctors and Allied Health Professionals in Cardiff
Authors: Little Charlotte , Majumder Vivek , Pope Charles 
Published: August 2024

AimsIn January 2023, the rota for psychiatry SHOs within Cardiff and Vale UHB changed from 24-hour off-site on-call to 12-hour on-site shifts. This change occurred after rota gaps from sickness, increasing clinical pressures, and poor GMC survey feedback. We hypothesised that this would likely be received positively by SHOs, senior psychiatrists and other staff who work with the on-call SHO, and surveyed attitudes to the new rota. Our aim was to inform decisions about the rota going forward, and gather a baseline set of data for future comparison.MethodsData were collected retrospectively, via three questionnaires created on Microsoft Forms and distributed by email to: junior doctors on the on-call rota (“SHOs”), registrars and consultant psychiatrists (“seniors”), and nurses and allied healthcare professionals (“AHPs”). We used a mixture of Likert scales and free-answer sections, surveying staff attitudes of the impact of the change in rota on Patient Safety, Workload, Training Impact, Working Relationships and Welfare. Questions were altered to suit the group being surveyed (e.g. AHPs were not asked to comment on welfare of SHOs).Data were collected between the dates of 23/3/23 and 5/5/23.ResultsA total of 63 respondents (17 SHOs, 12 seniors, 34 AHPs) completed the questionnaire.Overall results were very positive in favour of the new rota, with a final overall question concluding that 100% SHOs preferred the new rota, as did 92% seniors and 92% AHPs. Other highlights include:
•92% of all staff felt the on-call SHO could provide safer patient care, particularly at night.•82% SHOs and 83% seniors felt workload had improved or stayed the same.•71% SHOs had more training opportunities on-call (e.g. observing MHA assessments).•82% AHPs felt working relationships with SHOs had improved.•88% SHOs felt positive impact on their mental or physical wellbeing.ConclusionThe new rota was near-unanimously positively welcomed by each group of staff surveyed, in all domains studied.These findings were presented to members of the clinical board, and used to justify continuing the rota in future. It has remained in-person since.With baseline data gathered, we will repeat the survey in February 2024 to gain more data on current attitudes to the new rota, one year on from its implementation.
Psychiatric Admissions in NHS Lothian – What Can We Do Better?
Authors: Allen Ruairidh , Dissanayake Konal , Green Milly , Murphy Kenneth , Murdie Douglas 
Published: August 2024

AimsPsychiatric services are under increasing pressure to provide effective patient care with diminishing resources. In NHS Lothian, there is a sector-based model and chronic issues with lack of inpatient beds.We aim to examine the admission to discharge process at the Royal Edinburgh Hospital (REH) for patients within the North-West sector of Edinburgh (NW) to identify areas for improvement.MethodsWe collected data for NW admissions and discharges from the five General Adult Psychiatry wards in REH in 2023, two of which are allocated NW wards.Admissions to the Intensive Psychiatric Care Unit were excluded as they indicated differing severity, and discharges via the ‘long-stay’ ward were excluded due to other factors delaying discharge.Data was collected from NHS Lothian Analytical Services and anonymised in line with NHS Information Governance Policy.Qualitative data was collected anonymously from staff within NHS Lothian in the form of an online questionnaire to identify strengths and weaknesses of the current processes.ResultsIn 2023 there were 133 discharges of NW patients in REH. The average age was 39 years old and most common diagnosis was a psychotic illness (36%).Qualitative data identified that admitting patients to hospital is increasingly challenging due to capacity issues and the lack of a community transfer plan.53% of NW patients were admitted to NW wards. 27% of patients were moved between wards during their admission.Length of stay (LOS) and readmission rates were used as proxy measures to examine patient outcomes. Patients who remained on the same ward during their admission had an average LOS of 28 days. 22% were re-admitted within the calendar year. Outcomes were no better when patients remained on their sector ward.Patients who moved ward during their admission to hospital had an average LOS of 47 days. 45% were re-admitted.ConclusionA lack of bed capacity is having a negative impact on patient care in NHS Lothian. Staff expressed concerns about the admission process and patients are moving wards during acute episodes of care to accommodate a sector-based model and chronic lack of capacity. Lack of continuity during admissions may be contributing to longer admissions and more re-admissions, further impacting on capacity.A review of the strategic planning of NHS Lothian Psychiatric care is required, including capacity planning, admission protocols and policies on boarding patients. We will disseminate these results to support this process and any future work into this topic.
Monitoring Antipsychotic Adherence in a Community Depot Clinic
Authors: Behbahani Ayoub , Willis Catherine , Naidoo Kuben 
Published: August 2024

AimsIn conditions such as schizophrenia insight may be limited, leading to partial adherence to antipsychotic medication. This can result in lower remission rates in this group and increased disease burden. Depot injections allow close monitoring of treatment adherence and early intervention where needed.We aimed to determine the treatment adherence of patients attending the outpatient depot clinic at the South Sefton Neighbourhood Centre (SSNC) for antipsychotic injections and compare adherence between depot medication administered at 1, 2, 3 and 4 weekly intervals.MethodsWe identified patients attending the depot clinic at the SSNC using depot cards. The RIO patient electronic record was used to find previous depot cards and to record the number of doses given each month and calculate the number of failed encounters over a twelve-month period.We excluded patients receiving the injection at home and those where 12 months of data could not be collected.Results42 (12 female, 30 male) patients were included. 18 had full adherence and 24 had partial adherence. Average adherence was 93%; 90% in the female group and 94% in the male group. We compared adherence to weekly (7 patients), 2 weekly (15 patients), 3 weekly (8 patients) and 4 weekly (12 patients) depot injections. Weekly and 2 weekly had an average adherence of 89%, while 3 and 4 weekly had an average adherence of 96% and 99% respectively. The average number of failed encounters was highest with the 2 weekly group and lowest in the 3 and 4 weekly group.ConclusionAdherence to antipsychotic depot treatment at SSNC is good with nearly half of the patients included having full adherence. 4 weekly depot injections showed the best adherence with an average of 99%. Following on from this study we would like to explore the reasons for partial adherence in the two weekly group as well as the impact this has had on this group of patients, looking specifically at relapse and readmission rates.
Advice and Guidance in Mental Health: A Transformational Approach
Authors: Ngwompo Viviane Nzouonta , Maddock Paul , Harris Rebecca 
Published: August 2024

Aims- To strengthen shared decision making between psychiatrists and general practitioners (GPs) while avoiding needless outpatient activity.- To promote a seamless partnership between GPs and psychiatrists that will improve efficiency and effectiveness for better patient health outcomes.- To improve patient journey whilst responding to operational pressures.- To test GPs engagement and satisfaction.MethodsFollowing GPs engagement sessions, a 12 weeks pilot was conducted with the Bath and North East Somerset (BaNES) Primary Care Liaison Service (PCLS) and the 6 Primary Care Networks (PCNs) in BaNES. 22 GP surgeries were allowed access to Advice and Guidance (A&G) system using a digital platform. The pilot ran from 3rd April to 25th June 2023, focussing on answering non-urgent queries related to: psychotropic medications, mental health presentations, and the wider mental health system signposting and awareness.One Consultant Psychiatrist and One Associate Specialist in Psychiatry were involved. The asynchronous system (eOpinion) with an expected response time of 3–5 working days was used.To allay any governance risks and to act as a backup should the A&G system process fail to record appropriately, a dual recording of the A&G given – both in the A&G digital platform and the patient electronic record was implemented. Further governance structures were built into the project to establish that actions undertaken by the psychiatrists were effective and justifiable.Results82 requests received over the 12 weeks period.20 out of 22 surgeries took part.The Psychiatrists spent on average of 3.5 hours per week answering A&G requests. The administrative team spent on average one hour and three quarter per week processing A&G responses.Although no significant impact on total referrals was noted, there was indication that demand was moving from the referral to A&G request.All requests were responded within 2 working days.Requests from GPs were largely appropriate with 88% resulting in advice and guidance, indicating an improved patient journey.Minimal impact on the operational processes.Positive feedback from GPs with 91% finding the A&G system useful or very useful. They were keen for the offer to continue.ConclusionEffective inter-professional collaboration between GPs and psychiatrists is essential in enhancing patients' overall health outcomes and experiences. For mental health services, this transformational approach should continue to enhance the existing offer. However, we should remain mindful of the potential risk of increased workload burden in General Practices, and the implications of this new clinical model on staff based in specialist services.
One Stop; Addiction, Obstetrics & Perinatal Mental Health Pathway in North East Essex
Authors: Immadisetty Vyasa , Oshingbesan Opeyemi , Sarafudheen Sheeba , Gurney Shelley 
Published: August 2024

AimsAddiction services in Essex are provided as a collaborative by NHS run Essex STaRS, Open Roads, SHARP and ARC provide psychosocial care. YPDAS supports the young people.Observed gap: Pregnant women with addiction problems were running from pillar to post to receive care and support needed during this challenging phase of their life.The one stop clinic provided an all-encompassing care pathway to fill the above need and improving outcomes for mothers and babies.MethodsDescription:The new pathway was setup in 2019 on a hub & spoke model. The one stop clinic was at centre, comprising Substance Misuse, Midwifery and Obstetrics. The spokes included Perinatal-mental health, Neonatal, Adult, Child Social services, CMHTS, Police, Criminal Justice and primary care.Simple entry criteria: 1. Substance Dependence 2. Positive pregnancy test with referral taken from any service. Patients receive comprehensive initial assessment covering addictions, mental health, social circumstances, obstetric history and physical health evaluation including foetal US scanning. Led by a team of psychiatrist, midwife, obstetrician and substance worker.Evaluation identifies risks from mental, physical health, safeguarding, support needs and formulates an initial engagement and management plan. Referral into all necessary organisations. A staggered follow up plan per every trimester agreed.Commencement or planned reduction of Opiate Substitution Therapy (OST), medication rationalisation, nutritional advice, enhanced antenatal monitoring. The regular follow-up via fortnightly midwife, drugs worker review. Monthly medial review in the clinic.The support from perinatal psychiatry teams, CMHTS, Social services, Criminal Justice safeguarding teams is roped in when needed. Child protection, safeguarding issues are addressed. Clear multi-directional communication is maintained at all times. A safe delivery plan along good neonatal management ensured with appropriate outcomes for mother & baby are achieved.ResultsSince 2019, this initiated 16 patients with various complexities. 12 women left hospital with their baby in their care. 1 left the area during the pregnancy. 2 babies were removed into care. 1 had a miscarriage, 1 had a false positive test. All women received contraceptive advice, one got tubectomy and many on long-term contraception. No significant mental health relapses or admissions. All managed to stabilize or reduce their opiates issues.ConclusionThis One Stop Clinic has effectively addressed the complex needs of perinatal addiction patients. Centralised provision of care, duplication avoided, clear communication was a welcome relief for patients. Clinic has won a quality award.
Treating Unmet Needs in Psychiatry (TUNE-UP): Developing a Novel Service for Individuals With Psychosis With Refractory Cognitive, Negative, and Positive Symptoms
Authors: Varvari Ioana , Mancini Valentina , Zauchenberger Chambrez , McGuire Phillip , McCutcheon Robert 
Published: August 2024

AimsWhile dopamine antagonists are an effective treatment for positive psychotic symptoms, they are rarely effective when it comes to treating the cognitive (memory, learning, planning, etc.) and negative (avolition and social withdrawal) symptoms of the disorder. Furthermore, for a sizeable proportion, standard dopamine antagonists are not effective for positive symptoms either. As such, refractory symptoms are a major burden for patients, carers, and clinical services.MethodsTo address this, The TUNE-UP (Treating Unmet Needs in Psychiatry) clinic in Oxford was established in September 2023 as an innovative solution aiming to: (A) Undertake an in-depth assessment of cognitive, negative, and positive symptoms; (B) Identify potentially modifiable causative factors contributing to refractory symptoms (e.g., cholinergic burden, sleep disturbances, physical comorbidities, affective symptoms); and (C) Implement management plans including community clozapine initiation where appropriate. We have analysed data from the clinic's initial five months of operation to establish a baseline understanding of our patient population and identify trends in symptoms.ResultsIn the first five months of operations, 21 referrals were accepted comprising 80.9% males (mean age 43.3 years, SD 13.7). 3 were referred for cognitive symptoms, 1 for negative and cognitive symptoms, 11 for positive symptoms, 3 for medication optimisation, and 3 for clozapine re-titration. Of those fully assessed (N = 17), mean total symptom scores measured using the Positive and Negative Syndrome Scale (PANSS) were of mild/moderate severity (70.5, SD 18.4). Objective cognitive testing via the Screen for Cognitive Impairment in Psychiatry (SCIP) demonstrated a total mean score of 54.1 (SD 12.1), markedly below what would be expected in a matched control population (76.3). Cognitive scores were lower in those of older age (r = −0.62, p = 0.01). Subjective experience of cognitive impairment was measured using the Subjective Scale to Investigate Cognition in Schizophrenia, poor subjective cognition was associated with more severe negative symptoms (r = 0.57, p = 0.03), but not objective SCIP results (r = 0.12, p = 0.85).ConclusionRefractory positive symptoms remain a priority for clinicians, but cognitive and negative symptoms are highly prevalent reinforcing the need for a comprehensive approach. Routine structured assessment of all symptom domains is feasible in clinical practice. Future work should examine the longitudinal impact of various interventions on different symptom domains.
A Survey on the Electronic Discharge Summary Process in an Acute Inpatient Ward
Authors: Akani Ruth 
Published: August 2024

AimsThe study aimed to assess staff understanding of the discharge process in an Elmdale ward, Halifax and improve the promptness of discharge reports to other primary care professionals.MethodsInitially, the discharge process was reviewed in March 2023 to establish a baseline, focusing on completion time and personnel involved in the process. An online survey was conducted using Survey Monkey with 20 responses from the staff, including nurses, pharmacists, and doctors, to gather insights into their comprehension of the discharge process.Electronic data for EPMA (electronic prescribing and medication administration) discharge form from SystmOne was analyzed to determine the percentage of completed discharge summaries and identify any incomplete or absent summaries among patients discharged from Elmdale ward (an acute inpatient ward) between March 1st and March 31st, 2023.ResultsThe data showed that 76.9% of discharges were completed within 24 hours, with weekend discharge completion at 4 and only 25% after 5 pm. Half of the discharge summaries were closed by nurses, 46% by doctors, and one by the ward clerk.The median time taken to complete the discharge process was 25.83 hours, slightly exceeding the 24-hour target. Survey results indicated that 60% of staff were aware of the 24-hour timeline, but there were gaps in communication between staff members. Additionally, only 40% of staff had received formal EPMA discharge summary training, with nursing staff being the majority.Eighty percent of survey respondents expressed challenges with the discharge summary process, particularly regarding communication with the pharmacy team and closing the discharge summary. Weekend discharge data revealed gaps in responsibilities when the ward clerk was unavailable to send letters.Overall, the findings suggest a need for improved communication and training to enhance the efficiency and effectiveness of the discharge process, ensuring timely and accurate transmission of discharge reports to primary care physicians and other professionals.ConclusionMore than half of the staff understood the discharge process however communication between staff in regard to the discharge process impacted on the timeliness of the summaries completed.
Audit of Psychotropic Polypharmacy Amongst Inpatients in East Suffolk
Authors: Ruhi Shamim , Alase Anne , Aregbesola Motolani , Khan Quratulain , Rizvi Fariha 
Published: August 2024

AimsThe use of psychotropics and polypharmacy among patients with learning disability have been widely discussed. Mental illness increases morbidity and mortality and the addition of polypharmacy potentiates these risks.It is important to determine the proportion of inpatients with psychotropic polypharmacy, highlight associated socio-demographic and clinical factors, and follow up plans for such patients at the point of discharge.MethodsA retrospective collection of data was completed using electronic records of patients 18 years and above who were discharged from inpatient psychiatric wards located in East Suffolk between 1st July and 31st December 2021.Data available in discharge medication letters, discharge summaries and inpatient clinical notes were also used in the study.ResultsAmongst 256 inpatient episodes included within the audit, polypharmacy was found in 52% cases.Of which 80% of patients were above 65 yrs and 56.3% of them were male.Out of the included episodes, 74% were on combination and 26% were on augmentation therapy.About 40% had a single diagnosis of schizophrenia/schizophrenia-like delusional disorders, while around 25% had a mood disorder.9% of episodes had a singular diagnosis of personality disorder and 8.4% of episodes had >1 psychiatric diagnosis.ConclusionDespite the increased side effect burden and risks in the presence of physical health co-morbidities, polypharmacy remained prevalent in this group of inpatients.More than a quarter of patients were on sedative augmentation without any clear plan or recommendation for deprescribing after discharge.In order to improve clinical practice, more frequent medication reviews should be recommended when there is high prevalence of psychotropic polypharmacy.
Audit of Current Vitamin D Testing on Bridge House Detoxification Unit
Authors: Ayanda Segun , Felix Francis , Braithwaite Sally , McCloud Annie 
Published: August 2024

AimsThe National Institute for Health and Care Excellence (NICE) recommends routine testing and replacing vitamin D in adults considered high risk of deficiency. Evidence suggests high prevalence of vitamin D deficiency among those with alcohol dependence and those with chronic liver disease regardless of etiological factors. These findings are particularly important for Bridge House Detoxification Unit, where patients with complex substance use disorder (SUD), and multiple physical and mental health co-morbidities, undergo detoxification. The purpose of this audit project was to establish current levels of vitamin D testing on Bridge House Detoxification Unit in comparison to the standard set by NICE guideline PH56, and to improve it.MethodsData was collected retrospectively from a total of 76 patients, through 3 rounds of data collection. In each round all the patients discharged within a 2 months period were included. The Audit tool looked at whether vitamin D was tested on admission. Vitamin D level ranges were defined according to the Royal Osteoporosis Society: <25nmol/L is deficient, 25–50nmol/L inadequate, >50nmol/L is sufficient. After the first round, an intervention in the form of pre-populated blood form including vit D testing was introduced. This was to be used on the first day of admission. The second round measured improvement while the third round measured maintenance. Microsoft Excel was used to analyse data.ResultsDuring the first round of data collection, no patient had their vitamin D tested. Following our intervention, 86.67% of our patients had their vitamin D tested suggesting significant improvement to compliance in the second round. In the third round, we were able to maintain compliance at 90%. Of the 44 patients that had their vitamin D tested after our intervention, 30 (68.18%) patients were within the deficient and inadequate thresholds, requiring vitamin D replacement.ConclusionThis audit project examined international literature and local data identifying that vitamin D is indeed low among our patient group, therefore should be regarded as a high-risk group for vitamin D deficiency. There is sufficient evidence among the international literature that people with SUD suffer through significant physical and mental health effects of low vitamin D. A simple intervention of a prepopulated blood form was able to increase our compliance and maintained this.