bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing a Tool for Cognitive Screening in an Older Adult Psychiatric Rehabilitation Ward
Authors: Newton Elle , Ramesh Yathooshan , Carney Omar , Bhattacharya Aroop , Popescu Ioana 
Published: August 2024

AimsCognitive disorders, such as dementia, are a possible comorbidity and an important differential diagnosis to consider in older adults admitted to psychiatric wards with a functional disorder. Whilst cognitive assessment tools (e.g. ACE-III) and neuroimaging (e.g. MRI scans) are well established, there is significant variability in how and when they are used, which can result in inconsistences in their use. The aim was to identify the types of inconsistencies that may occur, and to provide a standardised framework in order for these tools to be used consistently on our functional rehabilitation ward.MethodsThis QIP retrospectively assessed data for all patients discharged over a 7-month period between October 2022 and May 2023, from an older adult functional rehabilitation ward. Clinical notes were reviewed to determine whether a cognitive assessment and neuroimaging had been considered, and if so, whether the assessment or investigation was appropriate and completed without delay. Correspondence to the GP or CMHT was reviewed to determine whether this had appropriate information about the relevant cognitive screening completed, and had included an appropriate follow-up plan. Data collected was checked for accuracy through screening by a second clinician, after which a consensus meeting was held to account for discrepancies.Results25 patients were discharged during the 7-month period. 52% were identified as having an issue or delay in their cognitive screening and correspondence; 32% had a delay in completing a cognitive assessment; 32% did not have an appropriate follow-up plan communicated in their discharge summary regarding future monitoring of their cognition; and 8% had a delay in considering or requesting neuroimaging.ConclusionTeam discussion identified that staff uncertainty relating to the use of cognitive tools and neuroimaging was a significant contributing factor to the issues identified in our results. We subsequently delivered training using a flowchart for doctors, nurses and allied healthcare professionals on the ward, which included information about the benefits and disadvantages of different screening tools and imaging modalities, in order to assist selection of the most appropriate tools on a case-by-case basis. The flowchart included the need for MDT discussion and senior psychiatrist involvement, but aimed to improve team confidence in understanding the rationale for these decisions. Based on the results of our post-intervention data, we will consider adapting the training and flowchart delivered to meet the needs of other older adult services in the trust.
Gaming the Mind – Improving Access to Recreational Gaming Activities Within an Inpatient CAMHS Unit
Authors: Osman Adam , Morrin Hamilton 
Published: August 2024

Aims1.To assess the current video gaming provisions on an inpatient CAMHS ward.2.To gather feedback from young people on the ward on the current provisions and gather suggestions for improvements.3.To implement any suggestions of improvements.4.To organise regular group gaming sessions for groups and to allow access for individual use.5.To gather feedback following implementation on how to improve further.MethodsUsing surveys, we gathered feedback on attitudes to recreational gaming, interest in gaming social events, preference for individual gaming and on thoughts of the current gaming facilities in a London inpatient CAMHS unit, from a cohort of young people admitted to the ward.Based on this feedback we sourced funding for a Nintendo Switch from Gaming the Mind Charity and purchased a Nintendo Switch for the Unit along with preferred games.Regular group gaming sessions were integrated into the ward activity schedule. Additionally, access for individual use was also facilitated.Further feedback on implementation was gathered from the young people.ResultsBased on initial survey feedback, a majority of young people on the ward indicated that they enjoyed gaming and that it was a good way to “have fun, relax or socialise”.Feedback suggested the current provisions on the ward (consoles and games) were outdated and not used frequently.Nintendo Switch received most suggestions for best new addition to the ward.Game suggestions included: Mario Kart 8 deluxe, Wii sports, Splatoon 3, Mario super smash bros and Minecraft.After implementation of social gaming events into ward timetable, follow up feedback was positive, suggesting that the majority of young people who engaged in recreational gaming activities on the ward benefited from this. Feedback suggested it was beneficial in terms of mood, socialising, and as a distraction from difficult emotions.ConclusionImproving access to recreational video gaming consoles and games within inpatient settings is a valuable way to offer activities to improve mood and social interactions between young people in an inpatient CAMHS setting. Follow up research into efficacy would be of benefit.
Of Course, Breaking Bad News Is Not Just for Patients: A Quality Improvement Project Survey to Explore How Staff Are Informed of Patient Deaths
Authors: Davies Sian , Pankhania Kishan , Waheed Imran 
Published: August 2024

AimsMental health professionals are very likely to experience a patient death at least once in their careers. The Royal College of Psychiatrists published a framework for supporting mental health staff following the death of a patient by suicide. It states that ‘how the news about a patient's suicide is imparted influences the emotional impact of the death and is therefore very important'. We sought to explore how healthcare professionals are informed about patient deaths within Birmingham and Solihull Mental Health NHS Foundation Trust.MethodsA 25-question survey was devised to explore how staff have been informed about patient deaths and the impact it had on them. This was emailed to all grades of doctors, nurses and allied healthcare professionals within the trust and results were collected over 11 days.Results83 healthcare professionals completed the survey.72 respondents had experienced a patient death within the trust. Of 72, 48.6% of respondents felt they had not been informed about their most recent patient death in a sensitive manner. There was wide variability in the method by which staff were first informed. 27.8% of respondents first learned of the patient's death via an email from the trust lawyers, patient safety team or another party. Of these 20, 17 felt they had not been informed in a sensitive manner. 63.9% (n = 46) reported that they had not been signposted to any support. Qualitative data suggested that the way in which people were informed had a wide-ranging impact. Many respondents felt shocked and upset. With hindsight, people would have appreciated being informed face to face and being given time to reflect. Of the total 83 responses, 82% (n = 68) felt that there should be a specific policy about how staff are informed about patient deaths.ConclusionResults from this survey demonstrate a large scope for improvement in the way that staff are informed of patient deaths. Using these results, we will generate change ideas for a quality improvement project which aims to inform staff more sensitively about patient deaths. Feedback suggested implementation of a new protocol to guide team managers and consultants on how to inform staff; it may help to standardise the process and the support provided. Patient deaths have a significant impact on the mental health of staff; communicating this matter compassionately may help to alleviate immediate feelings of distress and mediate the long-term impact on staff wellbeing and satisfaction.
Improving Quality and Satisfaction With Handover at the Riverside Centre, Hillingdon
Authors: Bernstein Gabriella , Puri Avani , Padayatchi Mellisha 
Published: August 2024

AimsThis project was launched in January 2022 to improve handover between on-call teams and wards, following GMC concerns in 2020 with the out-of-hours handover process. In 2021, a ‘Hospital At Night’ Microsoft Teams evening meeting was successfully introduced. However there remained low satisfaction with other areas of the handover process, including use of paper forms to handover between shifts. The aims of the project were to review the current handover process and improve quality and satisfaction of handover. The target was to improve baseline satisfaction with the handover process by 20% (6 months after change implementation).MethodsA driver diagram was built to identify factors contributing to quality and satisfaction with handover and develop change ideas.Qualitative surveys using Likert rating scales were sent to all doctors to explore satisfaction with handover format and quality of information received. Opinions of doctors and the wider MDT were used to develop ideas and evaluate support for change. Surveys were repeated following each cycle.From July 2022, interventions were introduced and monitored over four QIP cycles. This included an electronic handover in the form of a twice-daily email handover list, which was updated following feedback. Microsoft Teams morning weekend meetings were then introduced and modelled on the existing ‘Hospital At Night' protocol.ResultsFollowing interventions, the percentage satisfaction with handover format improved from a baseline of 14% and was maintained at an average of 81% across 15 months.The satisfaction with the quality of handover improved from 36% and was maintained at an average of 97%.The weekend virtual handover has also been well received with 71% satisfaction. This maintains the satisfaction levels achieved with the ‘Hospital At Night' virtual handover. The involvement of the MDT has been high with 71% of doctors satisfied that the necessary team members are attending.ConclusionIntroducing a standardised electronic twice-daily handover has improved satisfaction with and quality of handover. It has also improved communication between on-call teams and wards.The introduction of additional virtual handover meetings at the weekend has also been well received. It allows another opportunity to strengthen clinical leadership and the MDT to work more effectively out-of-hours. Future intervention will be targeted at standardising the content of these meetings and attendance in line with the ‘Hospital At Night' protocol.We aim to monitor local benefit from these changes, and expand this project to other hospital sites which are not yet using an electronic handover system.
Thematic Review of Serious Incidents in a Liaison Psychiatry Service
Authors: Puttaroo Imrana , Bunton Natasha , Yousif Michael , O'Halloran Aideen 
Published: August 2024

AimsNHS England defines serious incidents as events in health care where the consequences are so significant that they warrant a comprehensive response. Serious incidents are individually reviewed, as per national standard practice, in our liaison psychiatry service line at West London NHS Trust. The aims of these individual reviews include system wide learning, organizational accountability and to make changes to the system to prevent a repetition.There is currently no mandated requirement for thematic review of incidents. Therefore, there is a risk that long-term learning may be limited and overarching themes spanning the incidents may be missed. To improve this process, we have undertaken a thematic review of all serious incidents over a 2-year period, across the three teams in the liaison psychiatry service line.The aims of this quality improvement project therefore were:To understand persistent or recurrent systemic factors that contribute to serious incidents.To identify priority areas for system changes in order to improve the safety of liaison psychiatry services.To ensure lessons learnt from incidents are embedded within the liaison psychiatry service.MethodsThis was a joint project undertaken by liaison psychiatry clinicians and the clinical governance team. Initially an inductive analysis of ten serious incidents took place. Over six months, we combed through the serious incident reports and collated the data. We then identified and stratified the key themes.ResultsThe 5 headline themes identified were:
1.Risk assessment and risk management.2.Human factors.3.Issues with referrals.4.Triangle of care.5.Organisational factors.ConclusionThe dominant theme which occurred across all cases was risk assessment and risk management. A narrow focus when considering risk and underestimation of risk led to the creation of suboptimal safety plans for patients. Our thematic analysis found a range of organisational factors, including the excessive demand on staff and resource limitations. Human factors are usually a reflection of organisational culture or system wide approaches. The issues we found with the implementation of the Triangle of Care reflect the need for a greater focus on involving families and carers.The learning was shared with all staff in our annual development day, and this is planned to be an annual review of serious incidents across the liaison service. This approach should improve the depth of our learning and enable the service line to have an overview of the key themes which need to be addressed to deliver safer services.
Managing Comorbid Eating Disorders and Autism Spectrum Conditions: An Eden Unit Quality Improvement Project
Authors: Rai Dharmesh , Davida Lily 
Published: August 2024

AimsCurrently, there is an absence of clear guidelines or recommendations for individuals with an eating disorder (ED) and comorbid autism spectrum conditions (ASC).The Maudsley ED team has pioneered a tailored approach for comorbid ED and ASC called the PEACE pathway.Our aim is to adapt and implement a similar pathway within the Eden Unit (NHS Grampian inpatient eating disorder service).MethodsQuestionnaires targeted two key stakeholders: patients and staff.Patient questionnaires had 18 multiple-choice questions on a Likert scale, along with space for comments. The questions aimed to assess inpatient care adequacy in terms of care, routine, environment, mealtimes, and staff members. There were also specific questions related to ASC, examining whether sensory and communicative needs are being met and taken into account.Staff questionnaires had 10 ‘yes-or-no' questions, along with space for comments, and gauged attitudes toward managing comorbid ED and ASC.Results6/7 patient questionnaires were completed. 3 patients have comorbid ASC.One patient found the ward overwhelming due to ASC, while others found it suitable. All experienced distress transitioning from outpatient to inpatient services, with subsequent admissions proving less challenging when they knew what to expect. They were allowed to have safe sensory items e.g comfort toys, headphones etc.Generally, they felt well-supported during distress and felt their communication needs were met by nurses and HCSWs but not always by dietitians and clinicians due to a lack of availability. Some were frustrated with vague menu descriptions and there was some diagnostic overshadowing over dislike of certain foods.13/20 staff questionnaires were completed. It showed most staff did not have formal training in managing comorbid ASC and ED, and confidence and skills varied in proportion to time and experience in the service. All staff members expressed they would like formal training, through sessions such as monthly training, weekly huddles, or psychoeducation.ConclusionA significant proportion of inpatients have comorbid ED and ASC. Therefore, awareness of potentially greater needs around communication, environment, and sensory hyper- or hyposensitivity is important. There is a risk of diagnostic overshadowing as both ED and ASC can mimic similar symptoms: cognitive rigidity, fixation on certain things etc. So while not straightforward it is important to differentiate which symptoms are due to ASC and which are due to ED. Leveraging resources from the PEACE pathway website, both staff and patients can enhance their understanding of this complex comorbidity.
Knowing Where You Are Going: Co-Producing and Standardising Information About Child and Adolescent Mental Health Services Inpatient Units
Authors: Holland Josephine , Roe James , Sayal Kapil 
Published: August 2024

AimsAt-distance and out-of-region admissions form a significant proportion of inpatient admissions in CAMHS. The recent national “Far Away from Home” study which investigated the impacts of these admissions for young people, parents/carers and services identified an inconsistent and/or lack of easily accessible information about inpatient units. Parents and young people reported that when there was a lack of easily accessible information about the unit they would be admitted to, this increased their distress and negative views about the admission before they had even arrived. In contrast, those who found useful and positive information felt more reassured about the admission, even if it was far away. Our aim was to create an expert-by-experience designed standardised template of the minimum information that all inpatient units would be required to make publicly available.MethodsWe carried out regular expert consultation meetings with young people and parents/carers with lived experience to co-design a standardised template of information that units would provide for young people and their families on their websites and in printed form.ResultsIn early meetings the information currently presented by inpatient units was reviewed and discussed. Young people and parents/carers highlighted what they found helpful and unhelpful as well as what was missing. The young people and parents/carers discussed the layout, aesthetics, and functionality that they would like to see on unit websites. They also discussed the content which would be helpful for young people and their parents individually as well as what both groups would want to know. This included realistic and practical information about the unit itself, visiting, local amenities and available funding support.ConclusionIn collaboration with young people and parents/carers we have created an expert-by-experience designed standardised template of information that all inpatient units will be asked to provide on their website. Better information provision prior to admission will reduce anxiety and uncertainty for young people and their families. We anticipate this project will also contribute towards improved staff/patient/carer relationships because of clearer expectations and understanding.
Narrowing the Gap in Differential Attainment for Psychiatry Core Trainees in East Midlands Through Mentorship Scheme
Authors: Seun-Fadipe Champion , Awhangansi Sewanu , Samad Samreen , Oluwaranti Oluwaseun , Yanson Ian 
Published: August 2024

AimsThe use of mentorship schemes may be a pragmatic approach to bridging the differential attainment gap for psychiatry trainees. There is robust evidence that mentorship improves outcomes for core trainees across several domains including exam pass rates, ARCP outcomes and clinical practice. A survey was developed to elicit core psychiatry trainees’ perspective about the need for mentoring as well as their expectations. This was an initial survey done as part of a Quality Improvement project focused on mentoring scheme for psychiatry core trainees in the East Midlands region.MethodsA 16-item self-rated questionnaire was designed to elicit information relating to respondents’ demographics, professional qualifications, UK experience prior to commencement of training, perception of mentorship as an unmet need as well as expected focus of potential mentoring relationship. These were administered to psychiatry core trainees in the East Midlands region. The data was collected in February 2023.ResultsAbout a quarter of the core trainees (n = 21) participated in the survey. Majority (47.6%) of the respondents had Black or Black British ethnic origin and 11 (52.4%) were in their second year of training. Although 13 (61.9%) had a non-UK primary medical qualification, majority had some months of UK experience before commencement of training (median = 1.4 years). Twenty (95%) of the respondents identified mentoring as an unmet need and they highlighted the areas of need.ConclusionThis survey showed a high level of acceptance of the mentoring scheme among the trainees. Their expectations and suggestions helped further the design of the mentoring scheme which is currently ongoing.
Beyond School Avoidance: Recognising, Identifying, and Addressing Autistic Burnout in Children
Authors: Siggers Georgie , Day Becky 
Published: August 2024

AimsAutistic burnout, a profound psychological state characterised by increased stress, exhaustion, and a decline in functional abilities, has begun to be documented in adults but remains under-recognised in children. This abstract aims to shed light on autistic burnout in children, particularly in the context of school avoidance, and calls for a comprehensive approach to recognition, understanding, and intervention in this area.MethodsA retrospective audit was conducted on the case notes of 20 children, all diagnosed with autism, who had been unable to attend school for at least three months. The audit involved compiling a checklist of symptoms commonly associated with autistic burnout. This checklist included: chronic exhaustion, loss of skills previously acquired, diminished interest in activities, heightened sensory sensitivities, social withdrawal, mood dysregulation, and physical complaints. The primary objective was to investigate the presence of symptoms typically associated with autistic burnout in these children. To achieve this, information regarding these symptoms was extracted from their case notes.ResultsAge: 8 to 17 years, 10 boys, 10 girls. 90% of the children had an EHCP (Education Health Care Plan). 100% of the children experienced chronic exhaustion, loss of skills & interests, increase in sensory needs, social withdrawal, mood dysregulation and physical symptoms.ConclusionThe alarming trend of school refusal among autistic children is a phenomenon that merits close scrutiny, not only for its impact on the child's education but also for the broader implications including the significant burden on families. The uniformity in the reported symptoms across the group strongly indicates a shared underlying issue. In the context of autism, these symptoms align with what is known about autistic burnout. These symptoms can significantly impact the quality of life and daily functioning, including the ability to attend school. Understanding of these symptoms as part of autistic burnout could lead to better support strategies, accommodations, and potentially improved outcomes for autistic children who are refusing school. It necessitates a shift from a potentially punitive approach to one that is compassionate and accommodative, ensuring that strategies are in place to support autistic children's return to school when they are ready and able to do so. These findings highlight an urgent need for research into autistic burnout in children, recognition of this concept by health and education and a need to re-evaluate current educational practices and support systems for autistic children in school.