EP.WE.485An Audit to Investigate the Incidence of Face-to-Face Patient Review by GPs Prior to Referral to Surgical Assessment Unit

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hannah Murray
Keyword(s):  
Hospital Setting ◽  
Electronic System ◽  
Patient Risk ◽  
Face To Face ◽  
Increased Risk ◽  
Assessment Unit

Abstract Aims Since COVID-19, GP’s have been encouraged to do fewer face-to-face consultations to prevent unnecessary patient contact1. Anecdotally, this initially resulted in many patients being referred to SAU who had not been seen by a GP, and then being discharged back to the community the same day, causing potentially increased risk of contracting COVID-19 through hospital attendance. The aim of this audit was to investigate the incidence of patients referred to SAU not seen by a GP and discharged the same day. Methods GP referrals were identified over a 7 day period through the surgical take electronic system Aramis©. The case notes and GP documentation were reviewed to identify whether a face-to-face GP consultation occurred, and then whether the patient was admitted to SAU or discharged the same day. Results During a 7 day period, there were 24 (n = 24) GP referrals of which only 3 (12.5%) were not seen by the GP, all of whom were admitted for at least one night. However, of the patients referred and seen by GP, 7 (29%) were discharged the same day. Conclusions This demonstrates that during this 7-day period, there was no incidence of inappropriate GP referral to SAU of patients not seen by a GP, and the majority of GP referrals warranted admission. This suggests that in most cases, GPs are avoiding unnecessary emergency surgical referrals and attempt to review patients face-to-face prior to referral, thus reducing patient risk of contact with COVID-19 in the hospital setting.

scholarly journals Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045356
Author(s):  
Nick A Francis ◽  
Beth Stuart ◽  
Matthew Knight ◽  
Rama Vancheeswaran ◽  
Charles Oliver ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Hospital Setting ◽  
Health Problems ◽  
Clinical Deterioration ◽  
Care Services ◽  
Increased Risk ◽  
Remote Assessment ◽  
History Of

ObjectiveIdentify predictors of clinical deterioration in a virtual hospital (VH) setting for COVID-19.DesignReal-world prospective observational study.SettingVH remote assessment service in West Hertfordshire NHS Trust, UK.ParticipantsPatients with suspected COVID-19 illness enrolled directly from the community (postaccident and emergency (A&E) or medical intake assessment) or postinpatient admission.Main outcome measureDeath or (re-)admission to inpatient hospital care during VH follow-up and for 2 weeks post-VH discharge.Results900 patients with a clinical diagnosis of COVID-19 (455 referred from A&E or medical intake and 445 postinpatient) were included in the analysis. 76 (8.4%) of these experienced clinical deterioration (15 deaths in admitted patients, 3 deaths in patients not admitted and 58 additional inpatient admissions). Predictors of clinical deterioration were increase in age (OR 1.04 (95% CI 1.02 to 1.06) per year of age), history of cancer (OR 2.87 (95% CI 1.41 to 5.82)), history of mental health problems (OR 1.76 (95% CI 1.02 to 3.04)), severely impaired renal function (OR for eGFR <30=9.09 (95% CI 2.01 to 41.09)) and having a positive SARS-CoV-2 PCR result (OR 2.0 (95% CI 1.11 to 3.60)).ConclusionsThese predictors may help direct intensity of monitoring for patients with suspected or confirmed COVID-19 who are being remotely monitored by primary or secondary care services. Further research is needed to confirm our findings and identify the reasons for increased risk of clinical deterioration associated with cancer and mental health problems.

scholarly journals Increase in the Risk of Respiratory Disorders in Adults and Children Related to Crop-Growing in Niger

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Ali Mamane ◽  
Jean-François Tessier ◽  
Ghislaine Bouvier ◽  
Roger Salamon ◽  
Pierre Lebailly ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Environmental Factors ◽  
Respiratory Symptoms ◽  
Respiratory Health ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Face To Face ◽  
Increased Risk ◽  
Adults And Children ◽  
Agricultural Areas

Background and Objective. Environmental factors are an increasing concern for respiratory health in developing countries. The objective of this study was to investigate whether Nigerien people living in cultivated areas have more respiratory symptoms than those living in pastoral areas. Method. A cross-sectional study was conducted in 2013 in two populations during the rainy season when land is cultivated. Environmental factors including pesticide use and respiratory symptoms were collected in adults and children during face-to-face interviews. Multivariate analysis between exposures and symptoms was performed in children and in adults separately. Results. The study included 471 adults and 229 children. Overall, none of the households reported the use of pesticides for agricultural purposes. However, 87.2% reported the use of insecticides at home. Multivariate analysis showed that people living in agricultural areas compared to those in pastoral areas had an increased risk of respiratory symptoms in adults (wheezing, dyspnea, sudden shortness of breath, and cough without fever) and in children (cough without fever). The use of insecticides showed no effect on respiratory symptoms after adjustment. Conclusion. This first epidemiological study on the environment and respiratory health conducted in Niger demonstrates a significant relationship between respiratory manifestations and the agricultural characteristics of the living area. However only the effect of insecticides in the home on respiratory health was observed.

scholarly journals Evaluation of an Electronic Module for Reconciling Medications in Home Health Plans of Care

2016 ◽  
Vol 07 (02) ◽  
pp. 412-424 ◽  
Author(s):  
Bryan Gibson ◽  
Yarden Livnat ◽  
Iona Thraen ◽  
Abraham Brody ◽  
Randall Rupper ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Medication Reconciliation ◽  
Confidence Score ◽  
Electronic System ◽  
Home Health ◽  
Home Healthcare ◽  
Medication Discrepancies ◽  
Increased Risk ◽  
Perceived Usability ◽  
Improved Accuracy

SummaryTransitions in patient care pose an increased risk to patient safety. One way to reduce this risk is to ensure accurate medication reconciliation during the transition. Here we present an evaluation of an electronic medication reconciliation module we developed to reduce the transition risk in patients referred for home healthcare.Nineteen physicians with experience in managing home health referrals were recruited to participate in this within-subjects experiment. Participants completed medication reconciliation for three clinical cases in each of two conditions. The first condition (paper-based) simulated current practice – reconciling medication discrepancies between a paper plan of care (CMS 485) and a simulated Electronic Health Record (EHR). For the second condition (electronic) participants used our medication reconciliation module, which we integrated into the simulated EHR.To evaluate the effectiveness of our medication reconciliation module, we employed repeated measures ANOVA to test the hypotheses that the module will: 1) Improve accuracy by reducing the number of unaddressed medication discrepancies, 2) Improve efficiency by reducing the reconciliation time, 3) have good perceived usability.The improved accuracy hypothesis is supported. Participants left more discrepancies unaddressed in the paper-based condition than the electronic condition, F (1,1) = 22.3, p < 0.0001 (Paper Mean = 1.55, SD = 1.20; Electronic Mean = 0.45, SD = 0.65). However, contrary to our efficiency hypothesis, participants took the same amount of time to complete cases in the two conditions, F (1, 1) =0.007, p = 0.93 (Paper Mean = 258.7 seconds, SD = 124.4; Electronic Mean = 260.4 seconds, SD = 158.9). The usability hypothesis is supported by a composite mean ability and confidence score of 6.41 on a 7-point scale, 17 of 19 participants preferring the electronic system and an SUS rating of 86.5.We present the evaluation of an electronic medication reconciliation module that increases detection and resolution of medication discrepancies compared to a paper-based process. Further work to integrate medication reconciliation within an electronic medical record is warranted.

507 Outcomes After the Administration of Hydroxocobalamin

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S90-S90
Author(s):  
Kaitlin A Pruskowski ◽  
Leopoldo C Cancio
Keyword(s):  
Hospital Mortality ◽  
Hospital Stay ◽  
Hospital Setting ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Lactate Clearance ◽  
Inhalation Injury ◽  
Icu Admission ◽  
Increased Risk ◽  
Lactate Levels

Abstract Introduction Hydroxocobalamin is administered to patients after injures sustained during structure fires or fires in enclosed spaces. It is unknown how the administration of hydroxocobalamin affects patient outcomes, however, there have been reports of increased risk of acute kidney injury (AKI). The purpose of this study was to determine the population in which hydroxocobalamin is administered and to assess outcomes in patients who receive this medication in the ICU setting. Methods This was a retrospective chart review that included all patients admitted to the burn ICU between July 2016 and April 2019. Patients were included if they received hydroxocobalamin after ICU admission. Patients who received hydroxocobalamin in the pre-ICU or pre-hospital setting were not included in this analysis. Data collected included demographic information, number of hydroxocobalamin doses administered, burn size (% TBSA), presence of inhalation injury (II), lactate levels during the first 72 hours of hospitalization, carboxyhemoglobin levels, need for continuous renal replacement therapy (CRRT), and in-hospital mortality. Results Thirty-five patients received hydroxocobalamin after ICU admission. Patients were, on average, 48 ± 19 years old with a 25.5 ± 24.8% TBSA burn. Twenty-nine patients (82.9%) who received hydroxocobalamin in the ICU were diagnosed with II via bronchoscopy. The median 24-hour fluid resuscitation requirement was 7.4 mL/kg/% TBSA (IQR 4.6, 12.7). Twenty-two patients (63%) who received hydroxocobalamin developed AKI during the first 72 hours of admission. Twenty-one patients (60%) required CRRT during their hospital stay; 42.8% of patients were started on CRRT during the resuscitation period. The mean admission lactate level was 4.4 ± 2.3 mmol/L. On average, lactate clearance occurred in 34.6 hours; 11 (31.4%) patients did not clear lactate within 72 hours. One patient had a carboxyhemoglobin level greater than 10% on admission. Ten (28.9%) patients died during their hospital stay. Conclusions Most patients who receive hydroxocobalamin after ICU admission developed AKI within the first 72 hours. Further studies on the relationship between the administration of hydroxocobalamin and the development of AKI and in-hospital mortality are warranted. Applicability of Research to Practice The use of hydroxocobalamin may carry an increased risk of AKI. Providers should be aware of this risk when prescribing this medication.

scholarly journals Quantitative examination of the bone health status of older adults with intellectual and developmental disability in Ireland: a cross-sectional nationwide study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026939 ◽  
Author(s):  
Éilish Burke ◽  
Rachael Carroll ◽  
Máire O’Dwyer ◽  
James Bernard Walsh ◽  
Philip McCallion ◽  
...  
Keyword(s):  
Bone Health ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Intellectual And Developmental Disability ◽  
Face To Face ◽  
Objective Health ◽  
Increased Risk ◽  
Quantitative Examination ◽  
Adults With Intellectual Disabilities ◽  
Skeletal Integrity

Objectives(1) To investigate the prevalence of osteopenia and osteoporosis among adults with intellectual disabilities (IDs) and (2) to examine alternative optimal bone screening techniques.DesignObservational cross-sectional study.SettingWave 2 (2013–2106) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing.ParticipantsA national representative sample of 604 male and female persons with ID aged 43 years and over. In total, 575 participants completed quantitative ultrasound (QUS) measurements for one or both feet.Outcome measuresParticipants underwent health assessments consisting of eight objective health measures including the standardised QUS of the calcaneus bone using a GE Lunar Achilles. A preinterview questionnaire and face-to-face interview were also completed.ResultsObjectively QUS identified poorer rates of bone health in people with ID overall with 74% indicating evidence of osteopenia (33.2%) or osteoporosis (41%). Females scored lower than males in the QUS t-scores −2.208 (±1.77) versus −1.78(±1.734). Bone status was stratified by gender (p=0.114), age (p=0.003), level of ID (p<0.0001) and living circumstance (p<0.0001).ConclusionsThis study has shown the prevalence of poor bone health in people with ID is substantial implying an increased risk of fracture due to reduced skeletal integrity. QUS screening has been shown to be useful when combined with clinical risk factors.

scholarly journals The performance of the EMS triage (RETTS-p) and the agreement between the field assessment and final hospital diagnosis: a prospective observational study among children < 16 years

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Carl Magnusson ◽  
Johan Herlitz ◽  
Thomas Karlsson ◽  
Maria Jiménez-Herrera ◽  
Christer Axelsson
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Hospital Setting ◽  
Risk Of Death ◽  
Computerised Decision Support System ◽  
Field Assessment ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Life Threatening ◽  
Triage Level

Abstract Background The rapid triage and treatment system for paediatrics (RETTS-p) has been used by the emergency medical services (EMS) in the west of Sweden since 2014. The performance of the RETTS-p in the pre-hospital setting and the agreement between the EMS nurse’s field assessment and the hospital diagnosis is unknown. The aim of this study was to evaluate the performance of the RETTS-p in the EMS and the agreement between the EMS field assessment and the hospital diagnosis. Methods A prospective observational study was conducted among 454 patients < 16 years of age who were assessed and transported to the PED. Two instruments were used for comparison: 1) Classification of an emergent patient according to predefined criteria as compared to the RETTS-p and 2) Agreement between the EMS nurse’s field assessment and the hospital diagnosis. Results Among all children, 11% were identified as having vital signs associated with an increased risk of death and 7% were diagnosed in hospital with a potentially life-threatening condition. Of the children triaged with RETTS-p (85.9%), 149 of 390 children (38.2%) were triaged to RETTS-p red or orange (life-threatening, potentially life-threatening), of which 40 (26.8%) children were classified as emergent. The hospitalised children were triaged with the highest frequency to level yellow (can wait; 41.5%). In children with RETTS-p red or orange, the sensitivity for a defined emergent patient was 66.7%, with a corresponding specificity of 67.0%. The EMS field assessment was in agreement with the final hospital diagnosis in 80% of the cases. Conclusions The RETTS-p sensitivity in this study is considered moderate. Two thirds of the children triaged to life threatening or potentially life threatening were later identified as non-emergent. Of those, one in six was discharged from the PED without any intervention. Further, one third of the children were under triaged, the majority were found in the yellow triage level (can wait). The highest proportion of hospitalised patients was found in the yellow triage level. Our result is in agreement with previous studies using other triage instruments. A computerised decision support system might help the EMS triage to increase sensitivity and specificity.

Enhancing a culture of patient safety in an oncologic hospital setting.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 135-135
Author(s):  
Nicole Worthington ◽  
Shannon Bristow
Keyword(s):  
Patient Safety ◽  
Safety Culture ◽  
Medical Center ◽  
Hospital Setting ◽  
Patient Safety Culture ◽  
Healthcare Research ◽  
Staff Members ◽  
Increased Risk ◽  
Regional Medical Center ◽  
A Priority

135 Background: Patient safety is a priority for all hospitals and staff members. With approx. 1:10 hospitalized patients experiencing an adverse event1, healthcare lags behind other industries with regards to safety. Oncology patients have an increased risk of adverse events due to an immunocompromised status, coupled with complex treatments. Cancer Treatment Centers of America at Eastern Regional Medical Center (ERMC) recognized the need to heighten patient safety while maintaining a positive patient experience. Methods: ERMC participates in the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture to assess employee’s perception of the organization’s patient safety, conducted every 18-24 months. The most recent survey was conducted between May 11 - June 1, 2015. Interventions to enhance safety culture from 2013 to 2015 survey results included: daily safety check-ins for all hospital departments for both day and night shifts; sharing safety stories before routine meetings; leadership rounding; and enhanced transparency of safety events that occurred throughout the hospital. Routine in-servicing was also completed to educate staff members on reportable safety events for Pennsylvania and foster ongoing discussions about patient safety. Results: Survey response rate experienced a 236% increase from 2013 to 2015 (218 to 628 responses respectively). Of the 12 patient safety composites, 11 showed an increase in scores from 2013 to 2015, the outlier being “overall perceptions of patient safety” composite score which dropped by two percentage points. Furthermore, ERMC was above the national benchmark in all 12 patient safety composite categories for the 2015 survey. Conclusions: The ERMC staff considers safety a priority, as evidenced by the increase in AHRQ survey scores from 2013 to 2015. Perceptions of safety throughout the system have increased with the initiation of several safety projects. Based on raw comments from the AHRQ culture of safety survey, more work is needed to involve non-clinical staff in hospital safety. Moving forward, ERMC will investigate innovative solutions to involve all staff, clinical and non-clinical alike, to be engaged in patient safety.

Effect of education on anxiety and depression in patients with myocardial infarction

2011 ◽  
Vol 26 (S2) ◽  
pp. 133-133
Author(s):  
N. Aghakhani
Keyword(s):  
Myocardial Infarction ◽  
Medical Science ◽  
Anxiety And Depression ◽  
Control Group ◽  
Face To Face ◽  
Risk Of Death ◽  
Increased Risk ◽  
Significant Difference ◽  
Quasi Experimental ◽  
Experimental Group

IntroductionAbout 65 percent of patients with myocardial infarction experience mental and emotional problems like depression and anxiety that causes delay in the return to work, decreased quality of life and increased risk of death.The purpose of this study was to determine the effect of education on anxiety and depression in patients with myocardial infarction in Urmia hospitals in 2009.MethodsThis study was a quasi-experimental study that compares the effect of education on anxiety and depression in patients with myocardial infarction in the Urmia University of medical science hospitals. 124 patients were selected randomly and divided into two groups. The experimental group was educated through face to face training and educational booklet. Control group did not receive any intervention.Level of anxiety and depression was evaluated by using HADS questionnaire at 3 intervals after 48 hours of admission, discharge day and 2 months after discharge.ResultsThere was no significant difference between control and experimental groups before the intervention, But after the intervention, anxiety and depression in the experimental group was significantly less than controls, p < 0.05.ConclusionConsidering the beneficial results obtained from education on reducing anxiety and depression in patients with myocardial infarction, it should be one of the health care goals.

A multidisciplinary team (MDT) approach to managing alcohol-dependent patients with comorbid depression in an acute hospital setting

2017 ◽  
Vol 41 (S1) ◽  
pp. S393-S393
Author(s):  
L. Owens ◽  
K. Patterson ◽  
G. King ◽  
P. Richardson
Keyword(s):  
Hospital Admissions ◽  
Hospital Setting ◽  
Acute Hospital ◽  
Care Providers ◽  
Increased Risk ◽  
Future Care ◽  
Competing Interest ◽  
Fail Safe ◽  
Alcohol Dependence Treatment ◽  
Alcohol Dependent

IntroductionAlcohol-dependent patients have a significantly increased risk of depression, contributing a cycle of relapse and attendance at acute hospital services seeking help. Care is often focused on the alcohol dependence treatment with little consideration of concomitant psychiatric disorders.AimTo help bridge this gap in care planning and aim toward multidisciplinary long-term support.MethodWe collected data on all patients referred to our alcohol complex patient MDT. We investigated the range of disciplines involved in patient care. We spoke to our patients about why they had chosen to attend hospital. We then developed a referral system to our alcohol MDT where a bespoke pathways of care was developed with all current and future care providers.ResultsOur patients were often being cared for by multiple services, however much of this work was happening in isolation and was at times conflicting. Importantly, the patients were unclear where to go for what, and were utilizing the ED as a fail-safe when they were troubled.Of 15 patients referred to MDT, 7 (50%) had a diagnosis of depression (DSM-IV). These patients had an average of 5.1 hospital attendances and 2.2 hospital admissions in the 3 months prior to MDT. At 3 months post-MDT, we were able to demonstrate a reduction in hospital admissions and attendances (average 2.2 & 1.4, respectively).ConclusionsAn MDT for alcohol-dependent patients with depression facilitates effective and collaborative working for the benefit of patients and services.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Cardiovascular and all-cause mortality attributable to loneliness in older Swedish men and women.

2020 ◽  
Author(s):  
Masuma Novak ◽  
Margda waern ◽  
Lena Johansson ◽  
Anna Zettergren ◽  
Lina Ryden ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Mortality Data ◽  
Men And Women ◽  
Face To Face ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Adjusted Model

Abstract Background. This study examined whether loneliness predicts cardiovascular- and all-cause mortality in older men and women. Methods. Baseline data from the Gothenburg H70 Birth Cohort Studies, collected during 2000 on 70-year-olds born 1930 and living in Gothenburg were used for analysis (n=524). Mortality data were analyzed until 2012 through Swedish national registers. Results. Perceived loneliness was reported by 17.1% of the men and 30.9% of the women in a face-to-face interview with mental health professional. A total of 142 participants died during the 12-year follow-up period, with 5 334 person-years at risk, corresponding to 26.6 deaths/1000 person-years. Cardiovascular disease accounted for 59.2% of all deaths. The cumulative rates/1000 person-years for cardiovascular mortality were 20.8 (men) and 11.5 (women), and for all-cause mortality 33.8 (men) and 20.5 (women), respectively. In Cox regression models, no significant increased risk of mortality was seen for men with loneliness compared to men without loneliness (cardiovascular mortality HR 1.52, 95% CI 0.78 - 2.96; all-cause HR 1.32, 95% CI 0.77 - 2.28). Increased risk of cardiovascular mortality was observed in women with loneliness compared to those without (HR 2.25 95% CI 1.14 - 4.45), and the risk remained significant in a multivariable-adjusted model (HR 2.42 95% CI 1.04 - 5.65). Conclusions. Loneliness was shown to be an independent predictor of cardiovascular mortality in women. We found no evidence to indicate that loneliness was associated with an increased risk of either cardiovascular- or all-cause mortality in men.

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