bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increasing the Efficiency Of Community Mental Health Team (CMHT) MDT Meetings in Birmingham & Solihull Mental Health NHS Foundation Trust (BSMFT)
Authors: Menon Anannya , Sain Kallol 
Published: July 2023

AimsMultidisciplinary team (MDT) meetings provide a timely opportunity per week where a range of professionals involved in the service user's care come together to discuss patients and make an informed decisions as a team. With an increase in psychiatry community mental health team (CMHT) caseload (referrals in March 2021 were +5%), it is paramount we think of more efficient ways of running routine CMHT practises. Our aim was to identify the inefficiencies that surround the Aston & Nechelle's weekly MDT meetings & derive feasible modifications to make the protected team discussion time more efficient.MethodsThe PDSA (Plan-Do-Study-Act) cycle quality improvement methodology was used. A mixed qualitative & quantitative methodology was utilised. An observational study was carried out pre-intervention by two new members over 20 MDT meetings. Qualitative data were collected by identifying the key delays in MDT. Comparison of pre-intervention & post-intervention efficiency was established by quantifying the percentage of MDTs overrunning their allocated time. Satisfaction of the MDT members (n=10) with the new practise was also recorded via a questionnaire post-intervention. Our data collectors identified three main primary drivers: Systems, process & documentation.ResultsThe interventions under process included a structured agenda, table of patients for discussion & allocating designated roles within MDT. The primary driver of System, focused on creating AccurX proformas as a way to ease the use of AccurX (an integrated software program in Rio for securely contacting patients) during MDT. MDT members were trained informally to use AccurX & Smartcard (NHS spine search for patient demographic details). Finally, a standardised documentation style was trialled by creating proformas with a streamlined set of options under each agenda.Pre-intervention showed that >90% of MDTs were starting late & >50% were running over the allocated time. Post QI implementations, 80% of MDTs ran within allocated time. 90% of people found the MDT has increased efficiency, with 30% rating it as ‘very efficient’.ConclusionThe current CMHT MDT meetings have scope for more efficient practises. We should consider feasible modifications in the realm of system, process & documentation as a stepping stone to increase efficiency. This QI project suggests benefits for the wider implementation of such interventions to other CMHTs within the area.
Remembering Your Memory Appointment! a Quality Improvement Project Looking to Improve the Attendance of Memory Assessment Service (MAS) Appointments in the East North East Older Peoples Services (ENE-OPS) of Leeds, Through the Formalisation of a Pathway
Authors: Michael Gabriel , Williams Jordan , Nightingale Sharon 
Published: July 2023

AimsAfter experiencing disappointment due to numerous patients not turning up to their memory assessment service (MAS) appointments as well as the effect of losing man-hours due to this we decided to investigate how best to improve the attendance rates of our MAS patients. The initial frustration occurred when several patients for multiple team members were not attending their appointments. When followed up they stated that they had not received the required letters or follow up telephone calls prompting them to attend their appointments. This led to the initial hypotheses that a formal structure was required in part to aid in the delivery of this service and improve attendance.MethodsWe initially investigated the percentage of patient's that did not attend their appointments from the period of August 2022 to December 2022. This was achieved utilising the trust's data collection team. From these initial raw data we processed and calculated the delay between appointment allocation and a letter being sent out as well as basic percentages of patients not attending each month. What we realised was that there was no strict average and our admin team were not aware of any pathway that they could utilise as a guideline for the management of patient appointments. We therefore outlined the overall process of the appointment pathway and formed this. Upon this foundation we subsequently ironed out the optimal points of contact between our admin team and patients and when this could be accomplished and documented. The aims of these points of contact overall was to improve the rates of patients not attending their appointments and improving our target of appointment attendance. We subsequently re-evaluated our patient attendance five months after the formation of the posters, which were affixed in the admin and memory nurse rooms at our base.ResultsThe results overall were quite promising and did appear to show a change based upon the formalisation of the MAS appointment pathway.ConclusionThe results showed a positive improvement to the attendance rate of the MAS patients and also demonstrated the empowerment that a team can have when a formal pathway is in place. This fully completed audit cycle demonstrated the importance of such a pathway and how to address what is often a multi-faceted problem for many community based services. Our conclusion appears to support our hypotheses that a formal pathway can often improve the provision of a service.
Increasing the Interval Between Anti-Psychotic Depot Injections for Service Users on 3-Weekly Injections: A Quality Improvement Project
Authors: Pandey Aditi , Hussain Parisah , Perumal Ruben , Khoury Marc El , Smith Clare 
Published: July 2023

AimsOur aim was to improve service user satisfaction by increasing the interval between their depot injections where clinically feasible. By doing this, we aimed to reduce attendance at the South Kensington and Chelsea Community Mental Health Team (SK&C CMHT) depot clinic by 25% over a period of 3 months, improving the workload for nurses running the clinic.MethodsOur first baseline measure was data gathered about service user satisfaction with their depot. Our second baseline measure was the average number of service users attending the depot clinic per week between May and November 2022. The balance measure was a medical review 3 months post-interval change to ensure there were no negative impacts from this change.10 service users on 3-weekly anti-psychotic depots were identified. Our team devised criteria to select service users who were appropriate for our project. This included: a stable mental state, minimal side effects on the current dose, no breakthrough symptoms, good engagement with the depot clinic, and scope to increase the current dose. These service users were discussed with their care coordinator, consultant and depot clinic nurse. If the criteria were met, the dose and interval change was discussed with our pharmacist. Finally, service users were consented and their depot charts were amended.ResultsThe interval between depot injections for 2 service users was increased from 3 to 4 weeks on December 5th, 2022. The other 8 service users failed to meet the criteria set out in our methodology.These 2 service users were asked to fill in a questionnaire on January 23rd, 2023. They reported that “it was not comfortable having an injection” and that “having it every 4 weeks was better” and “less hassle”. Their first medical review did not raise any safety concerns.On average, 20 service users attend the SK&C CMHT depot clinic every week. There was no change in the average number of patients attending the depot clinic in the last two months as only 2 service users had their depot interval successfully altered.ConclusionService users on depot injections can benefit from increasing the interval between their injections where clinically feasible. We would like to repeat this project for service users on 2-weekly depots and reassess if that makes an impact on satisfaction levels and attendance numbers at our depot clinic.
Community Mental Health Team (CMHT) Book Club: A Staff Well-being Improvement Project
Authors: Perumal Ruben , Hussain Parisah , Pandey Aditi , Smith Clare , Marriott Sarah 
Published: July 2023

AimsCOVID-19 lockdown had reduced face-to-face interaction amongst staff with work-from-home and hybrid models adapted by most NHS organisations which had impacted team morale and reduced learning opportunities within the team. Book clubs are an effective way to enhance social process of learning especially in mental health. Our aims were to improve face-to-face interaction to boost morale within the Community Mental Health Team (CMHT) and increase the reading habit within the team around mental health fiction.MethodsA questionnaire was sent initially to gauge interest on the idea of a book club and how it should be conducted. Next, we digitalised the book club with a WhatsApp group to facilitate discussion on selection of books and the first book was selected via polling (The Fat Lady Sings by Jacqueline Roy). After 4 weeks reading time, we gathered on a selected day (30th September 2022) for moderated discussions with potluck-style lunch. Anonymous feedback was collected via surveys. The cycle was repeated on 28th October 2022 (second book was Inheritance of Loss by Kiran Desai).ResultsQuestionnaire to gauge interest and how the book club should be conducted revealed that the majority preferred a once-a-month discussion during working hours on a mental health and/or social care-related fiction of about 200-300 pages in length. The 8 respondents were made up of 6 doctors, 1 nurse and 1 social worker.Feedback surveys on the impact of the book club on interaction with colleagues showed 30% improvement after the first book club (50% to 80%) and was 100% after the second cycle. Respondents also noted 60% improvement in interest in mental health-related fiction and 60% felt that the book club and discussions generated would help them in their day-to-day work in psychiatry (this figure rose to 100% after the second cycle).ConclusionStaff well-being is paramount to ensure staff satisfaction and reduce burnout. Initiatives to address this must be tailored to specific teams. It is also essential to encourage medical education in informal settings to create a culture of learning and improvement from healthcare professionals of diverse backgrounds.
Increasing Early Cardiac Screening in an Inpatient Psychiatric Setting Using the KardiaMobile 6 Lead Device
Authors: Pierscionek Tomasz , Urban Gavin , Loubser Ignatius 
Published: July 2023

AimsThe Royal College of Psychiatrists' core standards include a comprehensive physical health review as a vital part of an inpatient admission.To determine whether using the KardiaMobile 6 lead (KM6L) device on an inpatient psychiatric ward would increase:
a.the percentage of patients who receive an ECG during an inpatient stayb.the percentage of patients who receive an ECG within 24 hours of admissionMethodsThe KM6L device provides a 6 lead ECG recording within 30 seconds. It enables ECGs to be performed more efficiently and less intrusively than a 12 lead ECG machine.The study aimed to offer all patients (101) admitted to an acute inpatient ward (July 2022 – Jan 2023) an ECG using the KM6L device, unless reporting chest pain, having significant cardiac history, or doctor otherwise concerned – in that event a 12L ECG would be done instead.The percentage of patients receiving an ECG during an inpatient stay and the percentage who received an ECG within 24 hours of admission were compared on the same ward when using:
a.the KM6L device between July 2022 and Jan 2023; andb.a 12L ECG between July 2021 and July 2022QT intervals were calculated manually as the automatic feature is still in developmentResultsBetween July 2021 – July 2022, using a 12L ECG:
•217 patients admitted•142 (65.4%) had a 12L ECG during their inpatient stay. Of these, 83 were done within 24 hours of admission (58.5%). Overall, 83/217 (38.2%) of patients had an ECG within 24 hours of admission.Between July 2022 – Jan 2023, when KM6L device available on ward:
•101 patients admitted•66* (65.3%) had an ECG during their inpatient stay. Of these, 46 were done within 24 hours of admission (69.7%). Overall, 46/101 (45.6%) of patients had an ECG within 24 hours of admission*Note: 15/66 patients had a 12L ECG as available clinician did not know how to operate KM6L deviceConclusionKM6L, despite being easier to use and less intrusive, did not increase the percentage of patients who received an ECG during an inpatient stay. However, there was a notable increase in the percentage of ECGs performed within 24 hours of admission. KM6L offers a cost and time saving alternative for obtaining ECGs; earlier cardiac screening may also reduce risk.Future work will consider further training of healthcare professionals in how to use the KM6L device and expand its use across healthcare settings.
A Quality Improvement Project: Improving the Presentation of Assessments Within a Liaison Psychiatry Department
Authors: Jain Shivali , Maalouf Natalie , Hassanally Khalil , Rashwany Raman , Faldu Asha , Amin Krishna 
Published: July 2023

AimsThis Quality Improvement Project (QIP) was undertaken within a Liaison Psychiatry (LP) department at a district general hospital in North West London. The current service model has LP nurses and junior doctors providing first contact with patients, and subsequently discussing assessments with the team psychiatrists. A need for effective communication when presenting clinical cases has emerged given high rates of staff turnover. The aims of this QIP were; (1) To assess the quality of presentations within the multidisciplinary team (2) to deliver a targeted teaching session focused on frameworks for assessment presentation and (3) to evaluate the effectiveness of the intervention.MethodsThe ‘SBAR: Situation, Background, Assessment, Recommendation’ communication tool already used widely within healthcare was adapted for LP by an MDT including doctors, senior nurses and pharmacist.A survey was designed with MDT input to collect data about the content of presentations using adapted Likert scales, a quantitative global score and qualitative data highlighting areas for improvement. Over two weeks, senior team members completed surveys for every patient discussion.A targeted teaching session was delivered on the adapted LP SBAR including: presenting complaint, current medical issues, referral question, psychiatric background, mental state examination, delirium/cognitive screening, risk assessment, impression and management plan. The session included breakout groups with clinical vignettes to practice presenting. All team members filled in a pre- and post-intervention surveys rating their confidence in presenting assessments and received copies of teaching materials.Data were collected over a 2-week period post-intervention using the same methodology as pre-intervention. Post-intervention data were presented to the MDT and feedback was sought for improvement in the next cycle.ResultsPre-intervention data (n=30) indicated a risk assessment, impression and plan were often missed from presentations.Following targeted teaching, team members felt more confident presenting assessments, formulating impressions, and management plans. Post-intervention data (n=22) showed an improvement in inclusion of all key information covered in the LP SBAR except management plans. The percentage of presentations with a global score ≥7 increased from 41% to 57%.ConclusionThis ‘Plan, Do, Study, Act’ cycle has modestly improved the quality of assessment presentations within LP and has identified a critical need for communication tools within LP. We will perform another cycle in February 2023 given the high turnover of staff and continue to seek feedback from the MDT on the effectiveness of this targeted teaching session to continue to improve the presentation of assessments in LP.
Improving Screening and Standardising Interventions for Patients With Above Normal Body Mass Index (BMI) Admitted to a Male Psychiatric Intensive Care Unit (PICU): A Quality Improvement Project
Authors: Holmes Ariadne , Rashid Sheween , Zabrzycki Domenic , Satisha Shantala 
Published: July 2023

Aims/hypothesis1.To increase the proportion of patients having their BMI documented on admission to the PICU.2.To improve rates of standardised interventions when abnormalities in BMI found.Among patients admitted to PICU, there is lack of consistency in monitoring of BMI and in offering interventions for those with abnormal BMI. We expect an improvement in both the parameter with the quality improvement project. Background: Service users admitted to PICU have severe mental health illnesses, and are known to have several high risk cardiometabolic parameters including excessive weight. In addition, they are often treated with medications known to cause weight gain. Without effective management, this is likely to cause increased morbidity and mortalityMethodsInitial baseline data were collected by reviewing patient notes.We then tested interventions to improve weight and BMI screening process on the PICU. We used the Plan-Do-Study-Act (PDSA) methodology over 2 cycles. In the first cycle, we engaged the nursing staff to improve screening on admission, including training to overcome the glitch in the electronic form that prevented automatic BMI calculation. In the second cycle, we introduced a protocol to ensure consistent interventions were offered to patients with abnormal BMI. The interventions offered were referral to dietician, referral to PICU gym instructor and MDT discussion about lifestyle changes and medication to manage weight.Data were collected after each PDSA cycle to monitor change.ResultsBaseline: 47% of PICU patients had their BMIs recorded on admission. 69% of those patients that met the overweight criteria were offered an intervention.After the first PDSA cycle, 91% of patients had their BMIs recorded. 71% of those patients that met the overweight criteria were offered an intervention.After the second PDSA cycle, all the consenting patients had their BMIs recorded. 100% of those patients that met the overweight criteria were offered all the interventions in the protocol but not all agreed to engage with the interventions.ConclusionAs a result of this quality improvement project there has been an improvement in screening for BMI on admission to PICU and in the standardised interventions offered to those with high BMI. The next steps will be to implement this across the other wards and to improve patients’ engagement with the interventions.
Improving the Screening and Diagnosis of Delirium for Older adult Patients Admitted to Hillingdon Hospital
Authors: Selladurai Abiram , Habib Mirette , Alston Duncan 
Published: July 2023

AimsThe aim was for 80% of adults aged over 65 years to be screened for delirium at the point of admission to hospital.MethodsWe implemented multiple interventions including:
•Teaching sessions for doctors, nursing staff and healthcare assistants on delirium.•Designed a new proforma using a more specific tool for screening delirium (4AT)•Making the clerking proforma and delirium screening tool more user friendlyResultsResults have shown statistically significant improvement in the detection of delirium with a sample in October 2022 showing 68% of older adults admitted to Hillingdon Hospital having been appropriately screened for delirium.ConclusionCurrent results suggest significant improvements with our interventions, however further progress is still required to reach our aims with regular data collection being paramount.
Trans and Non-Binary Healthcare QIP: Improving GPST Knowledge and Confidence
Authors: Vieira Mariana , Barry Olivia , Shaw Fiona 
Published: July 2023

AimsTrans and non-binary people present with condition-specific health needs. General Practitioners (GPs) face increased demand to care for this population. The Royal College of General Practitioners note that “the gaps in education, guidance and training for GPs around treating gender dysphoria… and managing broader trans health issues… needs to be urgently addressed.” We are an interdisciplinary team using QI methodology to assess current self-reported knowledge and confidence amongst GP Specialty Trainees in the North-West of England (NWGPSTs) and deliver interventions targeting problem areas.MethodsFollowing engagement with Health Education England North-West, a preliminary questionnaire was distributed to all NWGPSTs to assess baseline knowledge and confidence regarding gender-diverse peoples' healthcare.Results were used to design a teaching session covering basic language and concepts; history and physical exam; gender affirming therapies; psychiatric, medical, and sexual health.Teaching was delivered in a pilot scheme at four NWGPST training locations. Data were gathered before and after each session, with 3 additional questions to assess the quality of teaching and open-text feedback.ResultsIn the preliminary questionnaire (n=150) the most common answer was the lowest amount of knowledge, confidence, or training (1 out of 6) for 11 out of 17 questions. Most reported no training during medical school or GP training programmes. Lack of knowledge in gender affirming therapies, fertility preservation, legal framework and referral pathways were identified.Using a Likert scale (1 to 5), comparison between pre (n=61) and post-teaching (n=49) questionnaires showed improvement in knowledge in all areas (CI 95%). Overall knowledge improved with a mean of 1.05 (95% CI 0.72–1.38). Teaching quality feedback achieved a total mean score of 4.18. Open-text feedback was overwhelmingly positive about teaching material, enthusiasm of presenters, and contained useful suggestions for improvement.ConclusionBaseline knowledge of trans and non-binary healthcare is generally very low. A brief educational intervention made a statistically significant improvement to self-reported knowledge and confidence.We have adapted the teaching based on participant feedback and with involvement from Experts by Experience and Experts by Training. We have enriched teaching with video submissions from Experts by Experience. We have continued to engage with stakeholders, including partners at The LGBT Foundation and Indigo (GP-based Manchester gender service). To grow further, we have trained a faculty of 10 GPSTs to provide teaching, with 11 sessions now delivered to over 300 GPSTs and 5 sessions upcoming. We are planning a nationwide virtual training day.