bluuebunny/crossref_metadata_2025_split huggingface dataset:
Training the Trainers of Tomorrow Today - driving excellence in medical education
Authors: Fellow-Smith Elizabeth , Beveridge Ed , Hogben Katy , Wilson Graeme , Lowe John , Abraham Rachel , Ingle Digby , Bennett Danielle , Hernandez Carol 
Published: October 2013

AbstractTraining the Trainers of Tomorrow Today (T4) is a new way to deliver "Training for Trainers". Responding to local dissatisfaction with existing arrangements, T4 builds on 3 essential requirements for a future shape of training:1. Clinical Leadership and a Collaborative Approach2. Cross-Specialty Design and Participation3. Local Delivery and Governance NetworksDesign principles also included: 3 levels of training to reflect differing needs of clinical supervisors, educational supervisors and medical education leader, mapping to GMC requirements and the London Deanery's Professional Development Framework; alignment of service, educational theory and research; recognition of challenges in delivering and ensuring attendance in busy acute and mental health settings, and the development of a faculty network.The delivery plan took into account census of professional development uptake and GMC Trainee Surveys. Strong engagement and uptake from the 11 Trusts in NW London has been achieved, with powerful penetration into all specialties. Attendance has exceeded expectations. Against an initial 12 month target of 350 attendances, 693 were achieved in the first 8 months.Evaluation of content demonstrates modules are pitched appropriately to attendees needs, with positive feedback from trainers new to the role. Delivery style has attracted high ratings of satisfaction: 87% attendees rating delivery as "good\excellent". External evaluation of impact demonstrated improved training experiences through changes in supervision, the learning environment and understanding of learning styles.We have addressed sustainability of the programme by advertising and recruiting Local Faculty Development Trainers. Volunteer consultants and higher trainees are trained to deliver the programme on a cascade model, supported by the Specialty Tutors, individual coaching and educational bursaries. The Trainers are local champions for excellence in training, provide a communication between the programme and local providers, are a repository of expertise in their service, and trouble shoot local barriers to engagement.
Implementing a Patient Safety Team to reduce serious incidents
Authors: Dowell Louise 
Published: October 2013

AbstractThe Division were experiencing a high number of serious incidents, and the Team felt that a good safety strategy would improve the quality of care given. Through multidisciplinary engagement they wanted to learn from these, encourage reporting and focus on a fair blame culture. The ultimate aim was to increase incident reporting, decrease serious incidents and improve quality. The key aim of the project was to improve the quality of care for the woman and their babies, we reduced the incidence of serious incidents and increased the incident reporting of less serious incidents, this was based on the theory of the Heinrich Ratio which theorises that for every serious incident there will be 300 less serious / near miss incidents. The Team wanted to ensure that the multidisciplinary team were engaged and felt confident to report incidents, and would receive the appropriate feedback and support. In addition all staff involved in the incident would be involved in the investigation and be at the heart of the decision making. The key measure for improvement was the increase in incident reporting (44% increase 2011 â 2012) and the decrease in serious incidents. The figures support the theory that the increase in minor incidents being reported and managed has reduced the incidence of serious incidents. Staff engagement in the process was paramount, and this was driven by a passion to ensure the woman was at the centre of every decision or safety improvement that was made. Women and their families would be involved in the quality improvement process.
Improving the management of Staphylococcus aureus bacteraemia, including MRSA
Authors: Meyer Claudia , Pett Eleanor 
Published: October 2013

AbstractStaphylococcus aureus bacteraemia is a serious infection associated with significant complications, including recurrence of bacteraemia, endocarditis and metastatic foci of infection. The management of these patients is often complex, involving appropriate source control, a thorough review and investigations to exclude metastatic foci and infective endocarditis. Additionally, a prolonged course of intravenous antibiotics is often required.As part of our quality improvement project, the following five aspects were evaluated in 56 patients with S. aureus bacteraemia at two District General Hospitals: 1) adequate and timely removal of the source of bacteraemia, 2) echocardiography to exclude endocarditis, 3) repeat blood culture to prove clearance of bacteraemia, 4) adequate duration and choice of antibiotics and 5) documentation of bacteraemia in the discharge summary.After an initial review revealed several areas for improvement, we instituted five Plan-Do-Study-Act learning cycles which involved: teaching microbiology trainees and junior doctors, improving clinical liaison and communication between the microbiology team and clinicians, as well as a clinical review of patients by the microbiology team where appropriate.The post-intervention review evaluated 24 patients with S. aureus bacteraemia between November 2012 and May 2013. The proportion of patients undergoing an echocardiogram improved from 49% to 88%. Another marked improvement was seen in the timely obtaining of clearance blood cultures, with 88% of patients having clearance blood cultures within the 2-4 day window, compared to 56% pre-intervention. 70% of patients with uncomplicated S. aureus bacteraemia received an appropriate antibiotic course post-intervention, compared with 59% pre-intervention. Documentation of the S. aureus bacteraemia in the discharge summary improved from 65% to 75%. The support of the entire microbiology team was pivotal in the successful outcome of the quality improvement project.
Admission avoidance using intramuscular antibiotics for the treatment of borderline foot infections in people with diabetes in a tertiary care foot clinic
Authors: Dhatariya Ketan 
Published: October 2013

AbstractSeveral international guidelines exist to help decision making for the infected 'diabetic foot'. However, none consider admissions avoidance. We wanted to develop an antibiotic foot formulary for the empirical treatment of diabetes related foot infections presenting to our service and subsequently to asses the costs associated with the introduction of our protocol. We rationalised our antibiotic protocol. The introduction of our formulary changed the average antibiotic prescribing costs for a 3 week course of treatment from £17.12 to £16.42. In addition, we adapted the Infectious Disease Society of America (IDSA) guideline by introducing a category of ‘moderate infection – borderline admission’ to our classification. This enabled the administration of outpatient intramuscular antibiotics. Over 22 months of follow up, 26 episodes were eligible for treatment with intramuscular antibiotics. Over the same time period, 121 people were admitted directly from the foot clinic. The costs saved as a result of avoided or delayed admission for those 26 episodes was over £76,000. For 12 people who required subsequent admission, their length of hospital stay was significantly shorter than those admitted directly (9.25 days [range 2-25] vs. 16.11 [2-64] p=0.045). In summary, by modifying the IDSA classification and adopting a protocol to administer outpatient oral and intramuscular antibiotics we have led to substantial cost savings, shorter hospital admissions and also have developed a successful admissions avoidance strategy.
Improving e-discharge letters for Permanent pacemaker insertions at Wansbeck General Hospital
Authors: Taylor Christopher 
Published: October 2013

Abstract670 patients attend Wansbeck General Hospital each year for elective and emergency permanent pacemaker insertion or modification. Elective patients for new devices attend the cardiology department on the day of procedure and are clerked onto the cardiology ward after insertion. Patients are discharged home the following day with a letter typed by a junior doctor.Prior to October 2011, junior doctors were unaware of any guidelines regarding content of discharge letters due to poor accessibility. Vital information such as pacemaker model and indication for implantation were frequently absent from the typed summaries. In October 2011, the cardiology department reviewed the guidelines establishing the information required in all discharge summaries for pacemaker implantation and these guidelines were published on the ward in an easy to follow proforma for any junior doctor typing letters.Eight essential criteria should be included in each letter; date and indication for insertion, pacemaker type, make and model, access route, complications, chest x-ray and device check results, and follow-up details. Finally, a copy of the letter was to be sent to the cardiology department for clinic follow-up.Ten letters were audited prior to the proforma being issued. 0 letters contained 100% of the required information. Main criteria missing in most letters included indication for insertion (50%), make of device (0%), the route of access (10%) and cc to cardiology department (0%). 70 letters were audited in October 2012, one year following introduction of the discharge proforma.100% of letters contained all of the eight essential criteria required by the departmental guidelines. 53% of the letters were also received by the cardiology department.In conclusion, a set of easy to follow guidelines in the form of a published document on the cardiology ward has produced dramatic improvement in the quality of e-discharge letters for patients undergoing permanent pacemaker implantation.
Development of an Integrated Subspecialist Multidisciplinary Neuro-oncology Service
Authors: Price Stephen J , Guilfoyle Mathew , J Jefferies Sarah , Harris Fiona , Oberg Ingela , G Burnet Neil , Santarius Thomas , Watts Colin 
Published: October 2013

AbstractTraditionally, the poor outcome for patients with malignant brain tumours led to therapeutic nihilism. In turn, this resulted in lack of interest in neurosurgical oncology subspecialisation, and less than ideal patient pathways. One problem of concern was the low rate of tumour resection.Between 1997 and 2006, 685 treated glioblastomas were identified. In the first four years only 40% of patients underwent tumour resection, rising to 55% in the last four years. Before revision of the pathway, the median length of hospital stay was 8 days, and 35% of patients received the results of their histology outside of a clinic setting.A pathway of care was established, in which all patients were discussed pre-operatively in an MDT meeting and then directed into a new surgical neuro-oncology clinic providing first point of contact. This limited the number of surgeons operating on adult glioma patients and aided recruitment into research studies.Now, three consultant neurosurgeons run this service, easily fulfilling IOG requirement to spend >50% of programmed activities in neuro-oncology. Nursing support has been critical to provide an integrated service. This model has allowed increased recruitment to clinical trials.The introduction of this service led to an increase in patients discussed pre-operatively in an MDT (66% rising to 87%; P=0.027), an increase in the rate of surgical resection (from 40% to 80%) and more patients being admitted electively (from 25% to 80%; P<0.001). There was a reduction in the median length of stay (8 days reduced to 4.5 days; P<0.001). For the cohort of GBM patients that went on to have chemoradiotherapy we improved median survival to 18 months, with 35% of patients alive at two years, comparable to international outcomes.Implementing a specialist neurosurgical oncology service begins with understanding the patient care pathway. Our patients have benefitted from the culture of subspecialisation and the excellent inter-disciplinary working relationships that have been developed.
From Zero to Hero, the rise of the Trauma and Orthopaedic discharge summary
Authors: Evans Jonathan , Armstrong Alexander 
Published: October 2013

AbstractDischarge summaries document key information after an in-patient care episode and hand back care to the GP. Locally our orthopaedic department used carbon-copy paper as a discharge document. Anecdotally, these were thought to be inaccurate, illegible and of poor quality. Complaints from GPs became a catalyst in assessing the accuracy and presenting it to the department.A baseline dataset of inaccuracies was collected. This became a good starting point to develop a new improved system of discharging orthopaedic patients. We proposed to develop a bespoke, electronic, patient centred discharge document. Our aims were to improve patient safety, quality and develop an adaptable document, which could be updated to be in line with local CQUINs. The initial challenges of the resistance to change within the department were overcome by presenting data in an open forum with an agreed trial period.A multidisciplinary team was formed, including managers, consultants, junior doctors, allied health professionals and IT personnel. This facilitated live decision making, streamlining the processes. We created an adaptable online document, which enabled regular updates. This in-turn improved the overall accuracy of the document, improved prescription of key medications and ensured we were able to fulfil local CQUINs. We highly recommend the use of subspecialty specific electronic discharge summaries.
Making the ward a more efficient place: a qualitative evaluation of the impact of the Vista 90 trolley
Authors: Ahluwalia Nikhil 
Published: October 2013

AbstractA significant amount of professional time is wasted during a medical ward round retrieving patient notes from the ward trolley. If the efficiency of this non-clinical, non-functional interaction could be improved it would save time, maintain continuity and have financial implications.One identified constraint was the structure of the traditional ward trolley; a stationary filing tray with vertical sleeves. During ward round, time is spent returning and retrieving each patients notes from outside the patient bay and additional time may be wasted if the notes are misplaced or in use elsewhere. To resolve this, the ‘Vista 90’ trolley with horizontal, transparent trays, is portable and has an ergonomic writing surface was selected as a potential second generation replacement.An assessment of the impact of the Vista 90 trolley over the traditional trolley in the clinical setting was carried out on Erringham (medical) Ward, Worthing Hospital, West Sussex Hospital Trust, UK. This was by way of qualitative analysis performed by semi-structured interview of 12 doctors and other healthcare professionals who regularly interacted with the Vista 90 and traditional trolley in December 2012.The audit found that those interviewed preferred using the Vista 90 trolley over its predecessor as it improved the efficiency of the ward round and subsequent clinical work. It’s mobility allowed it to be easily transported with the ward round, reducing disruption during a consultation and between consecutives ones. The ergonomic writing surface was noted to improve legibility of documentation due to greater comfort and if placed appropriately, did not interfere with the doctor-patient interaction. The financial savings of this greater efficiency was found to be of significance and justify the cost of the Vista 90 within two weeks.
Improving Peripherally Inserted Central Catheter (PICC) care on a Trauma and Orthopaedics ward
Authors: Piorkowska Marta , Al-Raweshidy Zahra , Yeong Keefai 
Published: October 2013

AbstractPeripherally Inserted Central Catheter (PICC) blockage rate was audited over a two month period on the Trauma & Orthopaedics ward at our District General Hospital. A 70% (five out of seven) PICC blockage rate was observed. High blockage rates lead to potential treatment complications, delays in delivery of treatment, increase in costs, and reduction in patient satisfaction. The factors contributing to the significant blockage rate include, long and contradictory PICC care guidelines, no information sheets in the patient notes, lack of training and awareness about care of, and flushing of, PICC lines, and lack of accountability for PICC flushing. Our project aimed to achieve a greater rate of PICC patency. We produced one succinct and comprehensive PICC care guideline, carried out staff training sessions, introduced a sticker reminding staff to flush the PICC line after use, and introduced a prescription of weekly heparin saline and PRN saline flushes (for monitoring and accountability). We used questionnaires to assess competency of hospital staff pre-teaching (doctors 6%, nurses 0%), and post-teaching (doctors 70%, nurses 38%). Blockage rate data post-intervention is pending. Education improved awareness of guidelines amongst staff and we anticipate that the proposed interventions will translate into reduced blockage rates, improving patient outcomes and reducing costs.
Strengthening surgical handover: Developing and evaluating the effectiveness of a handover tool to improve patient safety.
Authors: Din Nizar , Ghaderi Shahrzad , O'Connell Rachel , Johnson Tayo 
Published: October 2013

AbstractThe European Working Time Directive and economic challenges have led to a paradigm of shift-work becoming common, and yet the continuation of high-quality patient care remains paramount. Effective and safe transfer of clinical information is critical as emphasised by the Royal College of Surgeons document 'Safe handover: Guidance from the Working Time Directive working party (March 2007)'. The aim of this project was to design and implement a handover proforma in order to deliver a more efficient and safer system for patient care over the weekend. The surgical weekend handover proforma was designed following consultation with nursing and medical colleagues. It included a traffic light scoring system to alert the on-call team of the urgency of clinical review. An educational session was delivered to junior doctors on the surgical rotation to ensure accurate completion of the proforma. All trainee surgical doctors from Foundation Year 1 to Specialist Registrars were asked to complete a pre- and post-intervention questionnaire. Improvement was noted in all categories measured. 85% of the firms were using the new surgical weekend handover sheet. 78% of junior doctors were confident in understanding the patient's condition and executing the clinical jobs faster, with ward rounds lasting less than 3 hours. On average, 20% of patients were discharged per weekend during the trial period. Robust patient handover is vital to maintain patient safety and avoid adverse events. Our findings support the use of a surgical proforma to provide a consistent and structured approach to inpatient handover during the weekend.
Targeting the initial investigation and management in cases of acute pulmonary embolism
Authors: Moore Nicholas , Hawkins Peter 
Published: October 2013

AbstractIt was noted by consultants in our hospital that the early investigation of suspected pulmonary embolism (PE) lacked structure. This was causing delays in definitive diagnosis and early management. The resulting unnecessary use of investigation was also wasting resources. In particular, the inappropriate use of serum d-dimer tests was causing concern. The National Institute of Clinical Excellence (NICE) guidelines recommend use of the 2-level Well's score to target investigation in suspected PE. A baseline audit against the NICE guideline revealed that Well's scores were rarely used (only calculated in 12% of cases) and confirmed the suspicion that early investigation was poorly targeted.This project intervened using educational talks promoting the use of Well's scores in cases of suspected PE. Well's score proformas were placed in the emergency department and emergency assessment unit for reference. Their availability was advertised.This significantly increased the use of Well's scores (46% vs 11%, p <0.001). Fewer patients underwent unnecessary d-dimer measurements in cases of likely PE (65% vs 86%). Initial investigation was more targeted in cases where a Well's score had been calculated than in cases without a Well's score. For example, significantly fewer unnecessary d-dimer tests were performed in these cases (45% vs 100%, p < 0.05).The cost of unnecessary investigation in suspected PE is not only significant financially but also in the resulting delay in definitive diagnosis and management for the patient. The simple intervention used here was effective in addressing this problem.
Look before you LEAPP™: An interprofessional approach to bedside pediatric inpatient procedures
Authors: Botash Ann S , Jeski Michelle , Baish Cameron Colleen , K. Nelsen Elizabeth , Haines Pamela , Bennett Nicholas 
Published: October 2013

AbstractThe Golisano Children’s Hospital at Upstate Medical University is a 71 bed children’s hospital within a hospital, serving nearly two million people in Central New York. Minor procedures occur daily in all children's hospitals, yet team coordination when planning for these procedures is often overlooked. LEAPP™ is a mnemonic for: Listen, Evaluate, Anticipate, Plan, and Proceed. The “Look before You LEAPP™” program was developed by a group of nurses, child life specialists, faculty, a chief resident and a fellow. LEAPP™ is a team-based program providing consistent care to all children undergoing inpatient procedures. It improves patient satisfaction and reduces procedural distress. Through LEAPP™ steps, teams are created at point of care — at the bedside or treatment room of inpatient units. Educational goals are linked to the practical goal of cooperation for good health care.The approach uses an online educational module for residents, students and nurses to introduce an innovative protocol and a planning tool.1 Pocket cards, promotional pens, and logo door-clings, purchased through grant funds (The Foundation for Upstate Medical University) were initially used to encourage participation. Pre/post observations of procedural planning and performance of the nurse, caregiver, physician, child-life specialist and independent observer included patient and family preparation, pain and anxiety, staffing and supplies, and satisfaction. Fifty procedures were assessed pre-implementation and 28 post implementation. Although satisfaction with procedures improved between pre and post LEAPP™ implementation, there were overall differences in satisfaction with procedural management and pain/anxiety control by physicians, caregivers, and staff that remained statistically significant. Interdisciplinary bedside teamwork can be used to support interprofessional education and this education can similarly be used to support improved patient outcomes.