bluuebunny/crossref_metadata_2025_split huggingface dataset:
Introducing an Equality, Diversity and Inclusion (EDI) Champion to Address Unconscious Bias Within the Clinical Intake Meeting Selection Process in a Community Psychotherapy Adolescent Department
Authors: Simione Silvia , Dean Andrew , Habel Sheva 
Published: July 2023

AimsIt is widely recognised that the performance of the health care system falls far short of its potential on a wide range of quality indicators, particularly for racial and ethnic minorities and other disadvantaged groups. Within the Adolescent and Young Adult Service, data from the clinical intake meeting have been previously collected and stratified, identifying disparity conditions and populations based on gender (accepted females to males ratio = 7:1); ethnicity (low proportion of Black/Asian/Mixed background represented within the service); age (vast majority of accepted being in their 17s); disability (low proportion of disabled seen). Primary aim for this project was to evaluate whether the introduction of an EDI champion plus an EDI discussion within the intake clinical meeting could improve our department performance in terms of Equality, Diversity and Inclusion (EDI) quality indicators comparing to historical data.MethodsA comprehensive Excel spreadsheet has been designed. All new referrals from November 22 till January 23 were included (N=29). Data collection included: non identifiable patients details, gender, date of birth, occupation, ethnicity, language, disability, outcome of the meeting, details of outcome, reason if outcome being negative. A further column on EDI comments.ResultsFollowing the introduction of the EDI champion for this cohort of patients, a decreased percentage of females (73.9% vs 69.2%) and increased percentage of transgender males (4.3% vs 15.4%) were offered an assessment. In terms of ethnicity, the number of Black/Asians/Mixed rejected for an assessment decreased. Respectively, 36.4% vs 11.1% (chi-square = 4.14, p-value = 0.47); 18.2% vs 11.1% (chi-square = 0.08, p-value ≈ 0 being statistically significant); 18.2% vs 0% (chi-square = 2.47, p-value = 0.26). An increased number of White people were rejected for an assessment which was also statistically significant (27.3% vs 66.7%; chi-square=1.96, p-value ≈ 0). Reasons for rejection have been recorded. More age groups (19, 20, 22 years old) were more widely represented in the new cohort of patients.ConclusionThe introduction of an EDI champion and an EDI discussion, within the clinic intake meeting selection process, seems a valuable instrument to tailor intervention for disparity groups (e.g. ethnicity), assessing both quality and disparities at the same time aiming for a Culturally Competent Quality Improvement within the service. This findings can be easily applied to other departments and implemented more broadly.
Medical Emergency Drills: An Essential Component of Inpatient Psychiatric Care
Authors: Stammeijer Roelof Joe , Boyle Ainslie , Khalid Osman 
Published: July 2023

AimsAt Farmfield Hospital, medical emergency drills are conducted monthly, as well as at all other Elysium Healthcare sites. Managing medical emergencies is an expected component of inpatient care, though without regular practice of Immediate Life Support (ILS) skills they can degrade rapidly. We propose that medical emergency drills should be considered an essential component of inpatient care, and explore how we have used them to create targeted teaching and to build skills after significant events.MethodsWe reviewed all medical emergency drills at Farmfield Hospital over the previous 12 months, looking through standardised event reports and feedback on quality and timing of response. We explore and compare qualitative feedback from involved staff members, and detail methods by which medical emergency drills can be used to create targeted teaching and training where skill gaps are noted.ResultsStaff fed back that these drills are key to building their confidence in managing medical emergencies. Core reports include that without these drills, for some staff the only regular practice would be at annual ILS recertification, and reports that they would feel considerably less confident to manage medical emergencies without regular practice and feedback. We use a case study exploring human factors and leadership skills being highlighted in one emergency drill as needing improvement, and how through targeted training and reassessment through subsequent drills we improved this skill gap and enabled staff to become more confident leaders in emergency situations as measured by direct feedback and assessment in subsequent drills.ConclusionMedical emergency drills are not currently standard practice across psychiatric inpatient services, and this creates several challenges. While ILS recertification is annual, these are perishable skills, and without regular practice confidence falls rapidly. Moreover, specific skill gaps such as leadership or even technical competencies such as familiarity with specific emergency equipment may go unnoticed until needed in a live medical emergency call. Organising these drills does not require a significant time investment, and we have found the increase in quality of response and staff confidence in managing emergencies makes these drills an essential part of our standard practice. We propose a simple structure for drill design and assessment as part of an ongoing Quality Improvement architecture.
Expeditious multipronged Interventions strike down Geriatric Memory Clinic No Shows in the Department of Geriatrics -a Value Enhancing Initiative via Memory Outreach Program and Telephone Triaging
Authors: Hamad Hanadi Al , Chandran Mani , Manikoth Pravija Talapan , Refaee Mahmoud , Orabbi Marwa El , Hussein Zakia , Gad-Elseed Mashrig , Ramadan Nabila , Babu Parvathy Chandra , Moldez Mancha Maraeh Angela 
Published: July 2023

Aims/backgroundOne of the biggest challenges faced by the healthcare sector is devising ways of tackling No shows in the Clinics. Patients are classed as no-shows when they fail to attend scheduled appointments without prior notification to the Health Care Provider. Some factors contributing to clinic No shows amongst frail Older Adults include lack of transportation and non-availability of family members to bring them to the clinic. Along with this, forgetfulness and poor insight into their condition also can contribute to No shows. Memory clinics in Rumailah Hospital under Hamad Medical Corporation in Qatar are the leading specialized multidisciplinary clinics that carry out an assessment, diagnosis, and management of people presenting with Memory Concerns.Implementation of Quality Improvement projects to tackle the No shows in the Geriatric Memory Clinics in Rumailah Hospital under Hamad Medical Corporation in the State of Qatar.MethodsVarious process improvement initiative based on LEAN methodology got implemented from January 2022 to reshape the service and reduce No shows
1.Initial nurse triage contacts with the patients or their family members to identify any inappropriate referrals are signposted to the right service and offer appointments for the appropriate referrals at a date and time convenient for them2.Telephone triage by the Physician and Case manager of new cases offered a clinic appointment and conduct a brief assessment to agrees risk and order investigations prior to the initial appointment . Patient's requesting rescheduling and cancellations are dealt with immediately. In addition, any new slots which becomes available during this process are offered to other patients and their appointments are brought forward3.Nurses contact with the patient caregiver of the person with Dementia and remind them of the appointment a day before the appointment.4.Geriatric Memory Outreach Service to carry out home visits for patients who are unable to attend clinic appointments because of frailty, significant cognitive impairment, and mobility issues.ResultsThe No shows rates were as follows2019 -26%.2020 -13% (COVID-19 impact).2021 -13%Intervention was implemented in January 2022 and No Show reduced to 9% in 2022. This indirectly reduced the waiting time (from referral to Consultation) from three months to 5 weeks.ConclusionInnovative alternative Outpatient Service delivery balances the elimination of No Shows with enhanced outcomes by continuously improving all the workflow process
Quality Improvement Project: Increasing the Proportion of Inpatients Being Re-Offered and Receiving Baseline Physical Investigations
Authors: Thompson Bethany 
Published: July 2023

AimsThe Greater Manchester Mental Health trust standard on admitting patients states that “The patient will receive a comprehensive mental health & physical health assessment (including electrocardiogram (ECG) and routine admission bloods) commenced within 4 hours of admission”. It was observed that patients commonly do not receive admission blood tests or ECG. It was also identified that there is no current system for keeping track of those who have not received admission investigations or any guidance on re-offering them. The aims were therefore to: 1) Increase the proportion of patients being re-offered baseline physical investigations (blood tests and an ECG) after not receiving them on admission. 2) Increase the total proportion of patients receiving baseline physical investigationsMethodsThe patients included were any male inpatients (n=41) across two wards between 23/05/22 and 17/06/22.A list was created of all the patients who had not received admission investigations. Each patient had their notes searched to find out whether they had undergone blood tests and an ECG on admission. If they had not, their notes were searched to see if there was any evidence of them having been reoffered and/or done later. As patients were admitted, they were added to the list if they had not received admission investigations.The list was taken to ward reviews with the intention of prompting a reoffer of investigations to the appropriate patients. Following the creation of the list, it was reviewed and updated weekly. After 4 weeks, percentages were calculated to determine if there had been an improvement in the proportion of patients being reoffered/receiving baseline investigations.Results85.14% patients did not receive admission bloods. 83.79% did not receive admission ECG.Prior to the introduction of the list, 90% of patients who did not have admission bloods were reoffered. 55.77% patients had baseline (admission or on reoffer) bloods taken. 85.72% patients who did not have admission ECG were reoffered. 78.85% patients had a baseline ECG.During the 4 weeks following the introduction of the list, 97.5% patients who did not have admission bloods were reoffered. After 4 weeks, 85.14% of all patients had baseline bloods taken. 95% patients who did not have an ECG were reoffered. After 4 weeks, 86.49% of all had a baseline ECG.ConclusionFollowing the introduction of the list, the proportion of patients being reoffered baseline blood tests and ECGs increased.The proportion of patients receiving baseline blood tests and an ECG also increased.
Improving the Assessment and Management of Acute Alcohol Withdrawal on General and Older Adult Mental Health Inpatient Wards – Baseline Data and Proposed Interventions
Authors: Pope Emma , Turner Charlotte , George James , Soe Myo Min , Westwood Lucy , Nguyen Jenny , Hopwood Beth 
Published: July 2023

AimsThe management of alcohol withdrawal has become a national focus amongst psychiatry with recent POMH-UK audit data suggesting many aspects for improvement, whilst alcohol competencies have been reintroduced into the core training curriculum. The first part of this project was to evaluate the current standards of assessing and managing alcohol withdrawal on acute inpatient wards within Livewell South West and to survey doctors’ confidence levels in this area.MethodsAll admissions to the acute adult and older adult inpatient wards at Livewell SW between March and July 2022 were included in the initial data collection. An audit tool was designed to evaluate the initial assessment of alcohol use, the withdrawal risk and subsequent management. Guidance was provided to the authors assessing the records.A survey to all doctors was conducted during a CPD session about this project which assessed confidence levels in the assessment and management of alcohol withdrawal.ResultsOn initiation of this project, it was noted there was no trust guideline or policy to manage those presenting with possible alcohol withdrawal symptoms.120 patient admissions were assessed against the audit tool. Half of these (53%) had alcohol intake documented on admission.11 patients (9%) were found to be at risk of alcohol withdrawal symptoms (n.b 46% too little data). 5 (45%) of these were identified promptly and 4 (36%) were given thiamine (1 parental, 3 oral). Only 4 out of the 11 (36%) were prescribed benzodiazepines, these 4 patients were also considered for referral to alcohol services. Relapse medications were not considered for any patients. No significant incidents were noted.Generally, trainee doctors feel confident in recognising and managing alcohol withdrawal in acute hospital settings but have difficulties on psychiatric inpatient wards. A major reason stated for this was the difficulty distinguishing between psychiatric and alcohol withdrawal symptoms and also concerns surrounding prescribing benzodiazepinesConclusionThis project identified a need for a trust policy which has subsequently been developed and is currently being ratified.The initial baseline results show poor assessment of alcohol use and low confidence amongst doctors in assessing and managing alcohol withdrawal in this population. Several interventions have been identified that could be trialled to improve these results. Further training has been given to junior doctors involved in initial assessment and other interventions planned include posters, electronic prompts, nursing survey and education. Furthermore, patient focus groups are planned to understand patients’ perspective and help guide further training.
Blood Tests in Psychiatric Patients-Evaluation and Improving the Process
Authors: Usman Mehr , Afloarei Daniel 
Published: July 2023

Aims/backgroundThe aim of this project is to assess which specific laboratory tests where being requested to psychiatric patients in our trust prior to developing a new local guideline to help standardise the blood testing to improve quality of patient care and reduce wastage in NHS due to inappropriate blood tests. It also assessed financial implication of unnecessary blood tests.There are several reasons for the purpose of blood tests:
•To identify medical conditions that might be causing or contributing to a psychiatric presentation•Provide baseline for safer initiation of psychotropic medication that can cause adverse effects•To screen for medical problems who are less likely to attend primary care. Requesting blood tests is a clinical responsibility .Currently there is no formal guidance on which specific lab tests should be ordered for psychiatric patients and was felt a new local guideline was essential to rationalise blood testingMethodsA survey was circulated to all wards and community mental health teams within our trust to get a clear insight about current practice.The survey questions included:
•Place of work?•What is included in routine blood tests list?•Who created and approved the blood list?•Where is the blood list kept?•When was it reviewed?ResultsResults showed
•Significant variation in blood test requesting within our trust emphasising need for standardization using evidence based methods.•Unnecessary repetition of blood tests like thyroid function and vitamin D levels against guidelines•Unwarranted blood test request when clinically not indicated like including Troponin and Creatine kinase in routine tests. The results were shared to all staff through meetings.ConclusionRecommendations were drawn to improve optimisation of resource use, communication between health professionals and the need for standardisation in requesting blood tests.
Re-Audit of Physical Examination and Blood Tests Completed Within 24 Hours of Admission to Psychiatric Ward
Authors: Wilson Kirstin 
Published: July 2023

AimsTo establish if the creation of a checklist of examination and investigations required within 24 hours of admission to Psychiatric ward had improved practice and patient care.MethodsThis was a snapshot audit. On 7th August 2022 I carried out a retrospective review of the case notes & results on electronic recording system to ascertain which investigations had been completed for all current in-patients on Ward 4, Dr Gray's Hospital, Elgin. I noted how soon after admission these tests had been completed.I compared these data with results from a previous audit in January 2022 which had highlighted failings in meeting the standards recommended by Royal College of Psychiatrists. The initial audit led to the creation of an Admission checklist to improve practice. The results from August 2022 demonstrated the impact of the checklist.ResultsOn 7th August 2022, there were 18 inpatients in Ward 4. Duration of admission varied from 1 day to 1,259 days.The 3 routine investigations of Physical Examination, ECG and Bloods were completed within 24 hours of admission much more reliably than the initial audit.Bloods were completed in 100% of cases compared to 52.9% in January 2022. Physical Examination was completed in 94.4% compared to 76.4% in January 2022. ECG was also completed in 94.4% compared to 58.8% in previous audit.ConclusionThere was a marked improvement in completion of examination, investigations and recording of the results since creation of a checklist. This could be due to increased awareness of the requirements aided by the visible prompt of the checklist on the ward.Staff are recognizing that mental health cannot be viewed in isolation from physical health which improves the quality of care patients receive during admission. Any health needs can be identified early allowing time for referral if required.
Can Functional Visual Loss Occur in an Older Adult Patient With a History of Stroke: A Case Report
Authors: Aldweik Abdullah , Hussain Kholod Haj , Alhaj Hamid 
Published: July 2023

AimsNonorganic visual loss, or functional blindness, is estimated to account for up to 5% of all presentations of blindness. This form of blindness can be ascribed to either a psychogenic aetiology or to malingering. Psychogenic blindness is often a manifestation of conversion disorder, in which a psychiatric condition impairs the normal physical functioning of the affected individual. This could lead to both motor and sensory defects, given that they are not better explained by an organic cause, which should be ruled out by investigations that prove an intact visual system. The individual would also commonly have an identifiable source of stress or trauma. Conversion disorders are less prevalent in older adults, and they may be missed where there are organic comorbidities.MethodsA 67-year-old male with a recent history of stroke was diagnosed with a major depressive disorder, characterized by low mood, anhedonia, insomnia, fatigue, poor appetite, poor concentration, feelings of guilt, negative feelings about life, and hopelessness. Multiple social problems and family conflicts were identified as possible precipitating factors. Sertraline led to some good initial response, although it was later discontinued. A few months later, he developed severe depression with irritability and suicidal ideation, and he was repeatedly requesting euthanasia. At this point, there was a sudden loss of his vision. Following a thorough ophthalmology evaluation, neurological assessment, and investigations including MRI of the head, cortical blindness was ruled out. As a result, he was diagnosed with visual conversion disorder. After recommencing treatment for his depression with a psychotherapeutic approach as well as vortioxetine antidepressant medication, the visual loss resolved, and the issue has not recurred since then. There was also a significant improvement in his mood. He no longer feels suicidal and appears to be brighter and more socially interactive.ResultsUncertainty regarding aetiology might initially arise if the patient has a history of trauma or a pathological condition that could cause blindness, such as diabetic retinopathy or stroke, both of which would have been differential diagnoses in the patient in this case had they not been debunked by further investigations, which included neuro-ophthalmic assessments and radiographic studies. The patient's improvement with antidepressants and counselling further supports the diagnosis of visual conversion disorder.ConclusionFunctional blindness, which is an aspect of conversion disorder, may be a representation of how detrimental undiagnosed and untreated depression could be.
Regression in Down Syndrome. Case Study of a Young Adult With Down Syndrome Who Was Referred to Brent Community Learning Disability Service With ‘Unexplained’ Changes in Behaviour
Authors: Eggleston Evelina , Purandare Kiran 
Published: July 2023

AimsThere has been growing interest in regression among adolescents and young adults with Down Syndrome. Regression can also be referred to Acute Regression, Down Syndrome Regression Disorder (DSRD), Down Syndrome Disintegrative disorder (DSDD) or Unexplained Regression in Down Syndrome (URDS) and these terms are sometimes used interchangeably. Characterised by reduction in expressive language, decreased functional skills and reduced psychomotor activity, regression can result in a significant change in the long-term needs of these individuals. Reporting this case, we wanted to highlight challenges in diagnosing, treating and supporting young people with regression in Down Syndrome.MethodsThis is Case Study of a young adult with Down Syndrome presenting with symptoms of mood disorder, apathy, new-onset vocal tics and ritualistic behaviours and profound loss of expressive language - both verbal and sign language.ResultsDiagnosis included ruling out physical causes for regression. The management remains largely symptomatic and aims to address as many as possible bio-psycho-social aspects of the concerning presentation.ConclusionMultitude of interventions and external events made it difficult to see what intervention was the most useful. Despite initial positive response to medication and behavioural strategies, a long term prognosis remains uncertain.