bluuebunny/crossref_metadata_2025_split huggingface dataset:
Establishing a Diagnostic Autism Assessment Clinic in a Primary Healthcare Setting to Reduce Waiting Times, Increase Efficiencies and to Improve the Patient Journey and Clinical Outcomes
Authors: Dabbagh Nadia , Dhuhair Baraa 
Published: June 2022

AimsTo establish a multidisciplinary diagnostic autism assessment clinic in primary healthcare so as to reduce lengthening waiting lists for specialist hospital based services, to increase efficiencies and improve the patient journey and clinical outcome. Timely diagnosis and early access to community based early intervention services optimizes outcomes.MethodsWaiting time for specialist hospital based services were increasing in number. Analysis of the data revealed that 42.9% of all referrals were autism related and 75.5% of these referrals were for autism assessments in under six-year-olds. Bottlenecks were found in the current system. In collaboration with primary healthcare colleagues, a new pathway was developed with paediatricians, social workers and primary healthcare physicians completing a comprehensive initial assessment including conducting a Childhood Autism Rating Scale (CARS). Each of the three hospital based child psychiatrists then ran a diagnostic autism clinic in the primary healthcare setting once a month (so three clinics in total) to review the initial assessment, meet the child and family/carers and then to confirm the diagnosis and write a medical report for community based services as appropriate. Follow-up care remained in primary healthcare unless there was diagnostic uncertainty, significant behavioural difficulties or comorbidities requiring medication. The project timeline started with one and gradually increased to four diagnostic assessments in each clinic, that is, twelve per month.Results57 diagnostic assessments were completed in first eight month period. Waiting times for diagnostic assessments in under six-year-olds were reduced from two to four months to only one to two weeks. Medical reports were issued within five working days. Under six-year-olds and their parents no longer had to attend busy, less child friendly hospital settings but rather were able to attend a purpose build early intervention centre within the primary healthcare setting.ConclusionIn conclusion, this is an example of a successful quality improvement project embracing the efficiencies of integrated models of care between primary, secondary and tertiary services. Critical success factors included strong leadership support, compelling rationale and purpose, clear clinical pathways and clear roles and responsibilities. It was presented as part of the hospital wide quality meetings in November 2021.
Implementing a Physical Health Clinic on an Acute Adult Inpatient Psychiatric Ward
Authors: De Souza Rowan , Patel Alisha 
Published: June 2022

AimsAcute Inpatient Psychiatric Wards present the challenge of a high turnover of patients who have multiple physical health comorbidities that both contribute to patients’ overall morbidity and may exacerbate any mental illness. Furthermore, there are a number of physical health parameters which must be checked and monitored in the initiation of psychiatric treatments. It is therefore important that patients receive physical examination, blood tests and Electrocardiograms (ECGs). The busy environment of inpatient units and the acute presentation of patients, who often decline interventions, lack capacity or cannot communicate their physical health problems, mean these assessments are often missed when offered in an ad hoc fashion. This Quality Improvement Project looked at implementing a Physical Health Clinic to look at whether this structured environment would provide better coverage of these physical health assessments.MethodsThe number of physical examinations, blood tests and ECGs both offered but declined and successfully obtained was measured on an Inpatient Ward with 20 patients and 2 junior doctors over 2 weeks with assessments being offered in an ad hoc fashion. Following this, a structured clinic run by a doctor and nurse with three 20 minute appointments three times a week was implemented and the same data collected over 2 weeks. A paired T-test was used to evaluate the results.ResultsThere was a statistically significant increase in the number of successfully obtained physical examinations, bloods tests and ECGs when the Physical Health Clinic was implemented (Mean difference = 7.33, Two tailed P value = 0.0480,95% confidence interval 0.16–14.50, t = 4.4, df = 2, standard error of difference = 1.667). However, there was no difference between the number of bloods, examinations and ECGs offered but declined (Mean difference = 4.83, Two tailed P value = 0.2495, 95% confidence interval −3.92–8.58, t = 1.6059, df = 2, standard error of difference = 1.453).ConclusionThe clinic led to a statistically significant increase in the number of examinations, blood tests and ECGs successfully obtained. The reasons for this are hypothesized that having a structured clinic prepares the patient to have a physical assessment and ensures their availability, provides motivation for staff and increases the efficiency of assessments with appropriate teamwork between doctors and nurses. Issues with the Clinic are limited availability of junior doctor and nursing staff and emergencies disrupting the functioning of the clinic. Implementing the clinic on a wider scale is required to assess its effectiveness.
Missing Person Protocol: Rapid Risk Assessment Re-Audit 2021
Authors: Fowler Juliette 
Published: June 2022

AimsThe Rapid Risk Assessment (RRA) has been a part of the Missing Person's Protocol since 2017 following a ward level intervention to try and provide as much information in as succinct a way as possible to the Police when a patient goes missing from the ward. This tool allows for rapid evaluation of a person's risk level on admission to hospital allowing consistent decisions to be made around risk to self and others, including physical risk and states why the risk level has been so set. In line with the National Framework for Missing Persons, a Return to Ward Interview is undertaken when a patient returns to the ward. The document is reviewed on a weekly basis at MDTs. The aim is to re-audit the extent to which the RRA within all wards at Royal Cornhill Hospital has been completed within the patients’ notes.Methods•All General Adult (GAP), Older Adult (OAP) and Learning Disability Wards were audited for the level of completion of the RRA proforma.•10 sets of notes were audited in each ward (where possible).•Data were gathered on a proforma for consistency looking at each area of the RRA: Patient Details, Brief Admission Details, Risk Level, Police Contact.Results58 sets of patient notes were checked. 100% of notes contained the RRA proforma.The average completion of all sections was 87.5%.There has been a 21% improvement in completion of the RRA since the first audit in 2017. There was variability across the wards, but there has been a 14.5% improvement in completion of sections compared to the previous audit.The Patient Details section of the RRA was the most fully completed area, The Brief Admission Details section was poorly completed and it is important to be able to give this information to the Police when they are contacted about a missing person.ConclusionAcross the wards, the data were less well completed by General Adult Psychiatry and best within Learning Disabilities. This is perhaps because of the higher turnover of patients but it would be interesting to consider the reasons for the disparity in data.Improvement seems to have been driven by the teaching around the RRA and weekly review of the RRA at MDTNone of the wards audited had completed the Return to Ward Questionnaire. The ward staff made comment that the questions within this document are asked but more informally.
Alcohol Screening on Admission to an Acute Mental Health Ward
Authors: Gesell Sutapa , Tsitsiou Yvonne , Prochazka Josef 
Published: June 2022

AimsAlcohol misuse is estimated to cost the NHS £3.5 billion/year. Only 6% of people suffering from alcohol dependence in England, receive treatment per year, highlighting that alcohol misuse is under-identified. During the COVID-19 pandemic, people have significantly changed their drinking habits, evidenced by government tax receipt data, suggesting alcohol sales increased by 3% to 5% in the UK compared to 2019. Problems associated with harmful alcohol consumption were intensified by the crisis, even though the long-term impacts of COVID-19 on alcohol consumption are uncertain. There was a notable increase of patients with dual diagnosis of mental illness and alcohol misuse on our ward, which is a general adult inpatient psychiatric ward. As such, the aim was to assess and improve alcohol screening on admission to an acute mental health ward.MethodsThrough a System One review, we assessed whether alcohol consumption is documented on admission (within 72 hours) in units, and a validated screening tool is used (AUDIT-C), which was expected in all patients. Their notes were initially retrospectively analysed and subsequently reviewed approximately six weeks following the implementation of interventions.Interventions included presenting the findings of the primary survey to our colleagues during a multidisciplinary team meeting on the ward and a trust-wide audit meeting attended by both junior and senior doctors. Additional interventions included posters outlining the importance of alcohol screening in the interview rooms of the acute wards (including a QR code link to our presentation and findings).ResultsOut of the 17 patients on the ward, 47% (8/17) were not appropriately screened for alcohol misuse during their first 72 hours of admission. 47% (8/17) had no documented alcohol history on admission clerking. Only 12% (2/17) had partially quantifiable alcohol intake, both drinking above the recommended weekly amount. None of the ‘Current Drinker’ patients had AUDIT-C screening. Improvement was noted following the interventions during the secondary survey.ConclusionAlthough alcohol screening in acute psychiatric admissions is often vague or incomplete, simple reminders and education can improve screening. If the alcohol history cannot be obtained from the patient on admission, which is often the case, the clinician should clearly document review of notes for historical alcohol use, to avoid potential complications, such as alcohol withdrawal, delirium tremens or seizures.This project raises further questions on how effective brief interventions for excessive alcohol consumption in acutely unwell/psychotic patients are, encouraging a further area of research.
Outcomes of a Quality Improvement Project to Reduce Unnecessary Blood Tests in Beechcroft Regional Child & Adolescent Mental Health Unit, Belfast Trust
Authors: Gillanders Catherine , Doherty Francess , Fitzsimmons Sarah 
Published: June 2022

AimsAn estimated 25% of blood tests are unnecessary with an annual cost to the trust of approx. £26.5 million. Aside from the huge financial impact, patients are undergoing unnecessary invasive procedures with detrimental impact on lab flow processes and inappropriate use of Doctor and Nursing Staff time. Some young people have multiple admissions to Beechcroft in a short space of time or bloods checked in A + E prior to transfer are missed and replicated. Longstanding use of blood template terms “Admission bloods” or “Eating Disorder Bloods” has added to the problem. Initial scoping exercise found one young person had 40 blood tests during their admission. AIM STATEMENT: Reduce baseline blood testing of Glucose, Lipids and TFTs by 10% by June 2021MethodsQI project commenced December 2019 using the IHI Model for Improvement Methodology was promoted by the project team through conversations with staff, unit meetings, email and posters.Outcome Measure: Total glucose, lipid and TFT blood tests recorded fortnightly for the unit over 18 monthsProcess Measures: Training as part of new nursing staff induction, reminders in daily nursing handover, number of staff attending Biochemistry liaison meetingsBalance Measures: Reduced blood test costs, reduced unnecessary staff workloadChange Ideas6 PDSA cycles were implemented
•Separate Bloods Diary for each ward – January 2020•Blood diary brought into weekly care planning meetings – July 2020•Education Posters displayed in ward clinical rooms – September 2020•MDT meeting with Clinical Biochemistry – April 2021•Junior Doctor to update bloods diary post weekly care-planning – May 2021•Bloods diary brought to daily nursing handover & dissemination of new monitoring guidelines – June 2021ResultsGlucose tests reduced by 68% with new median of 2.2 instead of 7. Lipids and TFTs median of 10 remains unchanged.ConclusionCOVID-19 has disrupted monitoring. Fundamental changes made within our service by stopping blood glucose monitoring and using BMs instead has led to significant improvements. We will continue to monitor results following 2 recent change ideas. We hope to include patient feedback moving forward.
QI: Improving Physical Healthcare Recording in a Mental Health Service for Homeless People – Working With KPI's
Authors: Hall Hugh , Ward Michael , Wicks Georgina , Sulej Katarzyna , Agyapongmaa Abena 
Published: June 2022

AimsAs a mental health team for homeless people, we are aware of poor health outcomes for our patients. They face the double-hit of chronic serious mental illness (SMI) and homelessness, reducing life expectancy. As outlined in guidance, “secondary care team should maintain… monitoring service user's physical health”. We aimed to improve recorded annual physical health checks according to Trust Key Performance Indicators (KPI) for weight; hypertension; diabetes; cholesterol; and screening for smoking, drugs and alcohol on SystmOne (e-patient record) in Westminster's Joint Homelessness Team's (JHT) caseload, with target of 90% by December 2021 set by Central and North West London (CNWL) NHS Trust.MethodsUsing monthly physical health KPI reports to target uncompleted annual health checks for JHT's 135 patients. PDSA cycles were used over a six-month period from July 2021 – January 2022.Intervention 1: Using available GP data to pull across into our records, making use of existing information.Intervention 2: Dedicated clinical session from FY2 doctor to assess patients with missing physical health checks.Intervention 3: Specific teaching to whole MDT to increase awareness and uptake.Intervention 4: Designed our own reporting to give real-time rather than monthly reporting.Outcomes were measured from monthly Physical Health reports for the active caseload.ResultsAt baseline only 26.67% of patients had completed recorded health checks. Intervention 1 more than doubled our recordings to 54.17% over a 2-month period. Our second intervention further improved recorded physical health checks.The third intervention increased our recorded physical health checks to 82.35% over a 2-month period. Notably, at the beginning of our project 7 out of 135 patients, had no engagement in physical health check monitoring, this reduced to 1 after intervention 3.At the end of our fourth cycle, we had increased our recorded physical health checks to 83.93%.Overall, results show an improvement of 57.26%, or a relative increase of 3.15 times the amount of recorded physical health checks over 6 months.ConclusionAs a result of incorporating dedicated clinical time, teaching and real-time use of data, we have improved our recorded physical health checks. There is room for improvement with 16% of patients still with incomplete health checks and approximately 10% of patients without blood tests. Some of this is due to accessibility and engagement difficulties for people with SMI and entrenched rough-sleeping, with ongoing work being done.
Junior Doctors' Enjoyment of Mental Health Placements in Derbyshire
Authors: Shahid Erum , Harlock Abigail , Ramji Abbas , Gupta Ritu , Gopal Vishnu 
Published: June 2022

AimsTo assess the job and training satisfaction of junior doctors working in Mental Health placements in Derbyshire; to highlight areas of good practice and identify areas that need improvement to enhance their working experience.MethodsThis is an ongoing Cycle of Quality Improvement to address Juniors Doctors enjoyment of work and job satisfaction. On a 25 point questionnaire we sought feedback as open response, graded response and free text. Questions were formulated using suggestions from Royal College of Psychiatrists Supported and Valued Review and BMA Fatigue and Facilities Charter. Advised areas of improvement from the previous 2017 Quality Improvement project were also reviewed and incorporated into the questionnaire design.All junior trainees (including Core Psychiatry trainees, Foundation trainees, GP trainees and junior trust grade doctors) working between December 2020 to April 2021 in Derbyshire Healthcare NHS Foundation Trust were sent the questionnaire.Official end of placement feedback from January-December 2020 was also compared to our findings.Results15 doctors completed the questionnaire.Areas of trainee-reported satisfaction included training on management of common psychiatric conditions (73%), weekly teaching sessions (100%), ability to organise leave (100%).Areas of dissatisfaction included training on management of psychiatric emergencies (40%), poor regularity of supervision (53%), inadequate access to phlebotomy services (66%), ability to take adequate breaks (66%) and ability to fulfil training requirements (40%).Discrepancies were noted in responses to similar questions in our questionnaire compared to the official end of placement feedback, with greater trainees answering with negative responses in this project.ConclusionThis project highlighted areas of high satisfaction for trainees and showed specific areas for improvement. Trainees responses have been reviewed with Educators and Trust Management for collaborative solutions, pilot schemes and future QI projects identified.Observer bias was noted, with greater numbers of doctors answering similar questions negatively when feedback was anonymous, suggesting that they may be giving more honest answers when their identity is concealed.
Transitioning of the Northwest Learning Disability (NWLD) Academic Regional Teaching Forum (HEE-NW) to a Virtual Programme With Enhancement of Medical Education for Trainees, Trainers and MDT Professionals During the COVID-19 Pandemic- a Quality Improvement Project - QIP Project Lead & Organiser -NWLD - Dr Syeda Hasan- Northwest HEE
Authors: Hasan Syeda 
Published: June 2022

AimsDespite the challenges posed by the pandemic, several resourceful initiatives were implemented, across the educational landscape. As the lead organiser of the academic forum the expectation was to develop a format for on-line monthly academic teachings with streamlining further innovative ideas of change to best effect. The key objective of this QIP,is to use virtual platform to establish an educational forum that is efficient, safe, reliable, easy to use and replicableMethods•A zoom based online forum was convened using QI framework to identify gaps in the programme along with new ideas of change.•The attendees experience new innovative practices within the programme format, in line with the original NWLD forum programme.•A ‘think-group’ consisting of the previous NWLD forum lead, ID training programme director and higher trainee facilitators proposed ideas towards a varied educational topic bank, in line with the ID curriculum•Qualitative feedback from the forum members collected at baseline and regular intervals.•As part of the implementation of these actions, conducted workshops evaluating the impact of COVID-19 on Educational, Psychological and Clinical landscapeResults•There were 18 virtual sessions,5 CPD hours per session, conducted monthly.•9 sessions in the first PDSA cycle from June 2020 - Feb 2021, and 9 sessions in the second PDSA from March 2021-November 2021.•Impact of COVID-19 workshops & Complex case management workshops conducted in the first and second PDSA cycle as part of the monthly academic programme.•Participants for the academic regional teaching included Consultant Psychiatrist, higher trainees, Core trainees, Foundation doctor, specialty doctors, Medical Students and MDT professionals.•New members regionally, nationally and internationally became part of the academic programme both as attendees and as speakers along with the Chair of the ID Faculty.•The academic programme helped with educational and training needs. It helped in improving social participation for our members during COVID-19 pandemic.•Qualitative feedback has been collated and analysed. The feedback contains a wealth of comprehensive information that has been used to enhance the programme and training needs for the trainees and trainers.Conclusion•The program is well-received and led to knowledge, skill, and attitude improvements.•The depth analysis of the feedback has facilitated a targeted approach that has brought a meaningful improvement, in the quality of training and education.•Audience participation and engagement remains a key area for improvement.
Complex Case Management Workshop for Trainees &Trainers - a Quality Improvement Project -to Enhance the Understanding of the Case Management and Complexity in People With Intellectual Disabilities for Senior Trainees and Early Career Consultants
Authors: Hasan Syeda , Spurrell Mark 
Published: June 2022

AimsWhilst there is always more to learn within any speciality, the particular zone of development for senior trainees and early career consultants is the management of the complex case. The factors underpinning complexity are varied, and can range from aspects of the service user such as complexity and severity of disorder and/or multi-morbidity, to aspects of their local social networks, to complexities arising from the service or care environment. The aim of this workshop was to offer a safe space for senior trainees and early career consultants to work through some principles that might be helpful, particularly where things seem to be getting into a pickle.Methods•A 60-minute slot was proposed, as part of the Northwest Learning disability academic teaching forum.•The structure of the workshop borrowed the informality and spirit of support from Balint groups.•Attendees were prepared to talk about one of their cases anonymously, and why they might be getting into a pickle.•Soundings were taken and a particular case chosen to workshop in more detail, as an exemplar for others.•Each session focused on one or two themes from the wider set of themes suggested by the CCaRM framework (Spurrell, Potts & Shaw, 2019) currently being used by Greater Manchester and Lancashire SST to expedite their work.•Each session concluded with an evaluation discussion of workshop usefulness.Results•There were 6 virtual workshops in first PDSA cycle (June 2021-Nov 2021)•Each workshop lasted approximately 100–120 minutes, with 8–12 people attended in each session.•The intention for the workshop was to include senior trainees and early career consultants who are within the NWLD forum however junior trainees, senior consultants and other MDT professional also became part of the sessions.•Each session concluded with an evaluation discussion of workshop usefulness•Qualitative feedback has been collated and analysed from the evaluation discussion.•The information derived from the qualitative analysis indicates that there is a substantial need for regular complex case discussions for the purposes of enhanced care delivery and improved patient outcomesConclusionThis approach helped in enhancing the understanding of the case management for people with intellectual disabilities among forum membersWe consider that the online workshops is a success and are planning further-PDSA 2 in order to create competent and well-rounded ID psychiatrist in the future in Northwest region.