2033. A Systematic Review of Systematic Reviews: Procalcitonin in the ICU to Guide Antibiotic Therapy

Abstract Background Antimicrobial resistance is an emerging global health crisis with overall antimicrobial use a key contributor. Strategies to safely reduce antibiotic course length are important. Procalcitonin (PCT) is a serum biomarker produced in the presence of bacterial infection. There have been many systematic reviews (SRs) evaluating PCT in various populations but its use remains controversial. The aim of this SR of SRs was to evaluate the extent to which PCT in critical care (ICU) impacts antibiotic duration and other reported outcomes. Methods A systematic search of major databases using an “a priori” strategy and protocol was performed. SRs were included if one of the reported outcomes related to antibiotic duration or initiation in the ICU. Data were extracted by an author, checked and corrected independently by another author. The quality of SRs was assessed by 2 authors independently using AMSTAR II. Disagreements were resolved by consensus with a third author. Results are presented narratively and in tabular format (Table 1). Results Figure 1 shows the PRISMA diagram. 19 SRs were included. The number of patients included ranged from 308 to 6,037 (median = 1,316) across SRs. Overall, there was a consistent finding of a statistically significant (sf) reduction in antibiotic duration in study groups using PCT cessation protocols (all studies in Table 1). 3 SRs did not contain suitable statistics for inclusion in Table 1. SRs that presented the antibiotic duration outcome as a mean or median difference in exposure days (N = 16) showed a median reduction of 2.10 days (range −1.19 to -5) with PCT use. 1 SR found an sf decrease in mortality with PCT use. 4 SRs included antibiotic initiation as an outcome: 2 found an sf decrease in antibiotic prescription rate with PCT; 2 found no difference. Conclusion SRs have found that PCT use in ICU leads to an sf reduction in antibiotic duration without impacting mortality. There are no data presented in the SRs about the impact of this on antimicrobial resistance. Few SRs detail the infections included; thus the applicability of these findings to a single ICU remains challenging. Other outcomes, such as length of stay, are not affected by PCT use in ICU. Disclosures All authors: No reported disclosures.

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119. Procalcitonin to Guide Antibiotic Therapy for Respiratory Infection: A Systematic Review of Systematic Reviews

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.164 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S73-S73

Author(s):

Joshua A York ◽

Maithili Varadarajan ◽

Joseph R Yates ◽

Gavin Barlow

Keyword(s):

Antimicrobial Resistance ◽

Antibiotic Therapy ◽

Respiratory Infection ◽

Systematic Reviews ◽

Data Extraction ◽

Control Group ◽

Consistent Finding ◽

Antibiotic Duration ◽

Course Length ◽

The Impact

Abstract Background Antimicrobial resistance is an international calamity; closely linked to antibiotic use. Safely reducing antibiotic course length and overall use are imperative. Procalcitonin (PCT) is a biomarker expressed in serum in response to bacterial infection. Systematic reviews (SRs) evaluating PCT as an adjunct to guide antibiotic therapy have been performed but its use remains contentious. The aim of this SR of SRs was to evaluate the extent to which PCT impacts the likelihood of antibiotic initiation and antibiotic duration in cases of respiratory infection. Methods A systematic search of databases using an a priori strategy was conducted. SRs which reported an outcome related to antibiotic initiation and/or duration in the context of respiratory infection were included. Data extraction was performed by the first author and checked independently by a second author. The quality of SRs was assessed by two authors independently using ROBIS criteria. Disagreements were resolved by consensus with a third author. Results are presented narratively and in tabular format (Table 1 and Table 2). Results 13 SRs were included (see PRISMA diagram). The number of respiratory patients included in these SRs ranged from 308 to 6708 (median = 3457). There was a consistent finding of a statistically significant reduction in antibiotic initiation in the PCT study group compared to the control group (Table 1). SRs that meta-analysed antibiotic duration (n = 9) as a difference in days showed a median reduction of 2.15 days (reduction range 0.80 to 3.83 days) with PCT use. PRISMA Diagram Table 1: Summary of odds ratios/ risk ratios in antibiotic initiation with the use of PCT Conclusion PCT use leads to a reduction in antibiotic initiation for respiratory diseases. It also results in a decrease in antibiotic duration, but this finding was not consistently statistically significant. There are no data presented in the SRs about the impact of this on antimicrobial resistance. Disclosures All Authors: No reported disclosures

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Impact of heterogeneity and effect size on the estimation of the optimal information size: analysis of recently published meta-analyses

BMJ Open ◽

10.1136/bmjopen-2017-015888 ◽

2017 ◽

Vol 7 (11) ◽

pp. e015888 ◽

Cited By ~ 7

Author(s):

Josep M Garcia-Alamino ◽

Clare Bankhead ◽

Carl Heneghan ◽

Nicola Pidduck ◽

Rafael Perera

Keyword(s):

Systematic Reviews ◽

Effect Size ◽

Sequential Analysis ◽

Trial Sequential Analysis ◽

Size Analysis ◽

Cochrane Reviews ◽

Number Of Patients ◽

Optimal Information ◽

Meta Analyses ◽

The Impact

ObjectiveTo estimate the proportion of systematic reviews that meet the optimal information size (OIS) and assess the impact heterogeneity and effect size have on the OIS estimate by type of outcome (eg, mortality, semiobjective or subjective).MethodsWe carried out searches of Medline and Cochrane to retrieve meta-analyses published in systematic reviews from 2010 to 2012. We estimated the OIS usingTrial Sequential Analysissoftware (TSA V.0.9) and based on several heterogeneity and effect size scenarios, stratifying by type of outcome (mortality/semiobjective/subjective) and by Cochrane/non-Cochrane reviews.ResultsWe included 137 meta-analyses out of 218 (63%) potential systematic reviews (one meta-analysis from each systematic review). Of these reviews, 83 (61%) were Cochrane and 54 (39%) non-Cochrane. The Cochrane reviews included a mean of 6.5 (SD 6.1) studies and the non-Cochrane included a mean of 13.2 (SD 10.2) studies. The mean number of patients was 2619.1 (SD 6245.8 or median 586.0) for the Cochrane and 19 888.5 (SD 32 925.7 or median 6566.5) patients for the non-Cochrane reviews. The percentage of systematic reviews that achieved the OIS for all-cause mortality outcome were 0% Cochrane and 25% for non-Cochrane reviews; for semiobjective outcome 17% for Cochrane and 46% for non-Cochrane reviews and for subjective outcome 45% for Cochrane and 72% for non-Cochrane reviews.ConclusionsThe number of systematic reviews that meet an optimal information size is low and varies depending on the type of outcome and the type of publication. Less than half of primary outcomes synthesised in systematic reviews achieve the OIS, and therefore the conclusions are subject to substantial uncertainty.

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Susceptibility to Fraud in Systematic Reviews

Anesthesiology ◽

10.1097/aln.0b013e3181c14c3d ◽

2009 ◽

Vol 111 (6) ◽

pp. 1279-1289 ◽

Cited By ~ 32

Author(s):

Emmanuel Marret ◽

Nadia Elia ◽

Jørgen B. Dahl ◽

Henry J. McQuay ◽

Steen Møiniche ◽

...

Keyword(s):

Systematic Reviews ◽

Surgical Patients ◽

Relevant Difference ◽

Number Of Patients ◽

Subgroup Analyses ◽

Current Article ◽

Web Of Knowledge ◽

Meta Analyses ◽

The Impact

Background Dr. Scott Reuben allegedly fabricated data. The authors of the current article examined the impact of Reuben reports on conclusions of systematic reviews. Methods The authors searched in ISI Web of Knowledge systematic reviews citing Reuben reports. Systematic reviews were grouped into one of three categories: I, only cited but did not include Reuben reports; II, retrieved and considered, but eventually excluded Reuben reports; III, included Reuben reports. For quantitative systematic reviews (i.e., meta-analyses), a relevant difference was defined as a significant result becoming nonsignificant (or vice versa) by excluding Reuben reports. For qualitative systematic reviews, each author decided independently whether noninclusion of Reuben reports would have changed conclusions. Results Twenty-five systematic reviews (5 category I, 6 category II, 14 category III) cited 27 Reuben reports (published 1994-2007). Most tested analgesics in surgical patients. One of 6 quantitative category III reviews would have reached different conclusions without Reuben reports. In all 6 (30 subgroup analyses involving Reuben reports), exclusion of Reuben reports never made any difference when the number of patients from Reuben reports was less than 30% of all patients included in the analysis. Of 8 qualitative category III reviews, all authors agreed that one would certainly have reached different conclusions without Reuben reports. For another 4, the authors' judgment was not unanimous. Conclusions Carefully performed systematic reviews proved robust against the impact of Reuben reports. Quantitative systematic reviews were vulnerable if the fraudulent data were more than 30% of the total. Qualitative systematic reviews seemed at greater risk than quantitative.

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De-escalation of antimicrobial therapy in ICU settings with high prevalence of multidrug-resistant bacteria: a multicentre prospective observational cohort study in patients with sepsis or septic shock

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa375 ◽

2020 ◽

Vol 75 (12) ◽

pp. 3665-3674 ◽

Cited By ~ 3

Author(s):

Christina Routsi ◽

Aikaterini Gkoufa ◽

Kostoula Arvaniti ◽

Stelios Kokkoris ◽

Alexandros Tourtoglou ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Antimicrobial Therapy ◽

Sofa Score ◽

Multivariate Regression Analysis ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Antibiotic Resistant ◽

Number Of Patients ◽

Observational Cohort ◽

The Impact

Abstract Background De-escalation of empirical antimicrobial therapy, a key component of antibiotic stewardship, is considered difficult in ICUs with high rates of antimicrobial resistance. Objectives To assess the feasibility and the impact of antimicrobial de-escalation in ICUs with high rates of antimicrobial resistance. Methods Multicentre, prospective, observational study in septic patients with documented infections. Patients in whom de-escalation was applied were compared with patients without de-escalation by the use of a propensity score matching by SOFA score on the day of de-escalation initiation. Results A total of 262 patients (mean age 62.2 ± 15.1 years) were included. Antibiotic-resistant pathogens comprised 62.9%, classified as MDR (12.5%), extensively drug-resistant (49%) and pandrug-resistant (1.2%). In 97 (37%) patients de-escalation was judged not feasible in view of the antibiotic susceptibility results. Of the remaining 165 patients, judged as patients with de-escalation possibility, de-escalation was applied in 60 (22.9%). These were matched to an equal number of patients without de-escalation. In this subset of 120 patients, de-escalation compared with no de-escalation was associated with lower all-cause 28 day mortality (13.3% versus 36.7%, OR 0.27, 95% CI 0.11–0.66, P = 0.006); ICU and hospital mortality were also lower. De-escalation was associated with a subsequent collateral decrease in the SOFA score. Cox multivariate regression analysis revealed de-escalation as a significant factor for 28 day survival (HR 0.31, 95% CI 0.14–0.70, P = 0.005). Conclusions In ICUs with high levels of antimicrobial resistance, feasibility of antimicrobial de-escalation was limited because of the multi-resistant pathogens isolated. However, when de-escalation was feasible and applied, it was associated with lower mortality.

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1274 Impact of Covid 19 on Urgent Suspicion of GI Cancer Referral in a District General Hospital

British Journal of Surgery ◽

10.1093/bjs/znab259.498 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S Barman ◽

H J Ng ◽

S Teo ◽

E M Blaney ◽

O Mansfield

Keyword(s):

Cancer Detection ◽

Detection Rate ◽

District General Hospital ◽

Cancer Detection Rate ◽

P Value ◽

High Grade ◽

Consistent Finding ◽

Number Of Patients ◽

The Uk ◽

The Impact

Abstract Aim Endoscopy services across United Kingdom were affected significantly since March 2020 due to Covid-19 pandemic. Services were reduced and were more selective. We aim to compare the impact on duration between referral to colonoscopy and the detection rate of pathology between February (pre- Covid) and August (Covid impacted) 2020. Method Data was analysed from a prospectively maintained database of patients referred for colonoscopy to Royal Alexandra Hospital, Scotland. Patients underwent colonoscopy in month of February and August 2020 were included. Bowel screening patients were excluded. Positive findings included diverticulosis, colitis, polyp and adenocarcinoma. P value of < 0.05 was considered significant. Results Total number of patients included was 97 (55 in February, 42 in August). Median age was 61 and 69 years, respectively. Mean duration from referral to colonoscopy were 4 weeks in February and 7 weeks in August. qFIT test were found raised in 50.9% in February and 57.1% in August with positive findings of 47.3% in February and 66.7% in August. 46.4% in February and 16.7% in August had raised qFIT but normal findings (p < 0.05). Two high grade dysplasia polyps and two adenocarcinomas were identified in February, none found in August. Conclusions Covid-19 pandemic has disrupted the endoscopic services prolonging the duration from referral to colonoscopy. qFIT test is more heavily relied to prioritise urgent colonoscopies resulting in more positive findings on colonoscopy. Cancer detection rate has reduced which is a consistent finding as the UK national endoscopy study. Massive efforts are needed to restore endoscopy services.

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One Public Health Crisis into Many Others: The impact of COVID-19 on Upstaging of Gastric Cancer

10.21203/rs.3.rs-511003/v1 ◽

2021 ◽

Author(s):

Amirmohsen Jalaeefar ◽

Mohammad Shirkhoda ◽

Habibollah Mahmoodzadeh ◽

Ramesh Omranipour ◽

Amirhossein Poopak ◽

...

Keyword(s):

Gastric Cancer ◽

Health Care Systems ◽

Locally Advanced ◽

Study Groups ◽

Tumor Location ◽

P Value ◽

Health Crisis ◽

P Values ◽

Cancer Management ◽

The Impact

Abstract Introduction: We aimed to investigate how COVID-19 affects patients with gastric cancer (GC) and what should be expected to happen in post-CVOID-19 era.Methods: A case-control study of GC patients referring to our center in two parallel time periods of February 25th to December 25th of 2020 and 2019 was conducted. Results: Twenty six patients during COVID-19 and 54 patients during pre-COVID-19 time were recruited. Mean age, gender, tumor location and T status distribution were not statistically different between study groups (all p values > 0.05). Regarding N status, distribution of N0, N1, N2 and N3 in pre-COVID group was as follows: 2(3%), 21(39%), 26(48%) and 6 (10%). In COVID-19 group N0 was not reported and N1, N2 and N3 were 7 (27%), 7 (27%) and 13 (46%) (p value < 0.05). Among pre-COVID patients 6 (11%) patients had gross metastasis in staging laparoscopy (SL) and 10 (18.5%) patients had positive malignant cytology. In COVID-19 group positive SL and positive cytology were found in 9(35%) and 11(42%), respectively (all p values < 0.05).Conclusion: Health care systems should adopt reasonable approaches to cancer management, otherwise the upcoming pandemic is locally advanced and metastatic cancers.

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Police-related triage interventions for mental health-related incidents: a rapid evidence synthesis

Health Services and Delivery Research ◽

10.3310/hsdr07200 ◽

2019 ◽

Vol 7 (20) ◽

pp. 1-164 ◽

Cited By ~ 2

Author(s):

Mark Rodgers ◽

Sian Thomas ◽

Jane Dalton ◽

Melissa Harden ◽

Alison Eastwood

Keyword(s):

Mental Health ◽

Social Services ◽

Systematic Reviews ◽

Police Officers ◽

Qualitative Data ◽

Evidence Synthesis ◽

Mental Health Crisis ◽

Health Crisis ◽

Health Related ◽

The Impact

Background Police officers are often the first responders to mental health-related incidents and, consequently, can become a common gateway to care. The volume of such calls is an increasing challenge. Objective What is the evidence base for models of police-related mental health triage (often referred to as ‘street triage’) interventions? Design Rapid evidence synthesis. Participants Individuals perceived to be experiencing mental ill health or in a mental health crisis. Interventions Police officers responding to calls involving individuals experiencing perceived mental ill health or a mental health crisis, in the absence of suspected criminality or a criminal charge. Main outcome measures Inclusion was not restricted by outcome. Data sources Eleven bibliographic databases (i.e. Applied Social Sciences Index and Abstracts, Criminal Justice Abstracts, EMBASE, MEDLINE, PAIS® Index, PsycINFO, Scopus, Social Care Online, Social Policy & Practice, Social Sciences Citation Index and Social Services Abstracts) and multiple online sources were searched for relevant systematic reviews and qualitative studies from inception to November 2017. Additional primary studies reporting quantitative data published from January 2016 were also sought. Review methods The three-part rapid evidence synthesis incorporated metasynthesis of the effects of street triage-type intervention models, rapid synthesis of UK-relevant qualitative evidence on implementation and the overall synthesis. Results Five systematic reviews, eight primary studies reporting quantitative data and eight primary studies reporting qualitative data were included. Most interventions involved police officers working in partnership with mental health professionals. These interventions were generally valued by staff and showed some positive effects on procedures (such as rates of detention) and resources, although these results were not entirely consistent and not all important outcomes were measured. Most of the evidence was at risk of multiple biases caused by design flaws and/or a lack of reporting of methods, which might affect the results. Limitations All primary research was conducted in England, so may not be generalisable to the whole of the UK. Discussion of health equity issues was largely absent from the evidence. Conclusions Most published evidence that aims to describe and evaluate various models of street triage interventions is limited in scope and methodologically weak. Several systematic reviews and recent studies have called for a prospective, comprehensive and streamlined collection of a wider variety of data to evaluate the impact of these interventions. This rapid evidence synthesis expands on these recommendations to outline detailed implications for research, which includes clearer articulation of the intervention’s objectives, measurement of quantitative outcomes beyond section 136 of the Mental Health Act 1983 [Great Britain. Mental Health Act 1983. Section 136. London: The Stationery Office; 1983 URL: www.legislation.gov.uk/ukpga/1983/20/section/136 (accessed October 2017)] (i.e. rates, places of safety and processing data) and outcomes that are most important to the police, mental health and social care services and service users. Evaluations should take into consideration shorter-, medium- and longer-term effects. Whenever possible, study designs should have an appropriate concurrent comparator, for example by comparing the pragmatic implementation of collaborative street triage models with models that emphasise specialist training of police officers. The collection of qualitative data should capture dissenting views as well as the views of advocates. Any future cost-effectiveness analysis of these interventions should evaluate the impact across police, health and social services. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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EP.FRI.368Impact of Covid 19 on Urgent Suspicion of GI Cancer Referral in a District General Hospital

British Journal of Surgery ◽

10.1093/bjs/znab312.062 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Sowrav Barman ◽

Hwei Jene Ng ◽

Serene Teo ◽

Eimear Blaney ◽

Olivia Mansfield

Keyword(s):

Cancer Detection ◽

Detection Rate ◽

District General Hospital ◽

Cancer Detection Rate ◽

P Value ◽

High Grade ◽

Consistent Finding ◽

Number Of Patients ◽

The Uk ◽

The Impact

Abstract Aim Endoscopy services across United Kingdom were affected significantly since March 2020 due to Covid-19 pandemic. Services were reduced and were more selective. We aim to compare the impact on duration between referral to colonoscopy and the detection rate of pathology between February (pre- Covid) and August (Covid-impacted) 2020. Methods Data was analysed from a prospectively maintained database of patients referred for colonoscopy to Royal Alexandra Hospital, Scotland. Patients underwent colonoscopy in month of February and August 2020 were included. Bowel screening patients were excluded. Positive findings included diverticulosis, colitis, polyp and adenocarcinoma. P value of < 0.05 was considered significant. Results Total number of patients included was 97 (55 in February, 42 in August). Median age was 61 and 69 years respectively. Mean duration from referral to colonoscopy were 4 weeks in February and 7 weeks in August. qFIT test were found raised in 50.9% in February and 57.1% in August with positive findings of 47.3% in February and 66.7% in August. 46.4% in February and 16.7% in August had raised qFIT but normal findings (p < 0.05). Two high grade dysplasia polyps and two adenocarcinomas were identified in February, none found in August. Conclusion Covid-19 pandemic has disrupted the endoscopic services prolonging the duration from referral to colonoscopy. qFIT test is more heavily relied to prioritise urgent colonoscopies resulting in more positive findings on colonoscopy. Cancer detection rate has reduced which is a consistent finding as the UK national endoscopy study. Massive efforts are needed to restore endoscopy services.

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The impact of behavioural risk factors on communicable diseases: a systematic review of reviews

BMC Public Health ◽

10.1186/s12889-021-12148-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sara Wood ◽

Sophie E. Harrison ◽

Natasha Judd ◽

Mark A. Bellis ◽

Karen Hughes ◽

...

Keyword(s):

Risk Factors ◽

Systematic Reviews ◽

Physical Inactivity ◽

Communicable Disease ◽

A Priori ◽

Communicable Diseases ◽

Virus Hepatitis ◽

Behavioural Risk Factors ◽

Meta Analyses ◽

The Impact

Abstract Background The coronavirus (COVID-19) pandemic has highlighted that individuals with behavioural risk factors commonly associated with non-communicable diseases (NCDs), such as smoking, harmful alcohol use, obesity, and physical inactivity, are more likely to experience severe symptoms from COVID-19. These risk factors have been shown to increase the risk of NCDs, but less is known about their broader influence on communicable diseases. Taking a wide focus on a range of common communicable diseases, this review aimed to synthesise research examining the impact of behavioural risk factors commonly associated with NCDs on risks of contracting, or having more severe outcomes from, communicable diseases. Methods Literature searches identified systematic reviews and meta-analyses that examined the association between behavioural risk factors (alcohol, smoking, illicit drug use, physical inactivity, obesity and poor diet) and the contraction/severity of common communicable diseases, including infection or associated pathogens. An a priori, prospectively registered protocol was followed (PROSPERO; registration number CRD42020223890). Results Fifty-three systematic reviews were included, of which 36 were also meta-analyses. Reviews focused on: tuberculosis, human immunodeficiency virus, hepatitis C virus, hepatitis B virus, invasive bacterial diseases, pneumonia, influenza, and COVID-19. Twenty-one reviews examined the association between behavioural risk factors and communicable disease contraction and 35 examined their association with communicable disease outcomes (three examined their association with both contraction and outcomes). Fifty out of 53 reviews (94%) concluded that at least one of the behavioural risk factors studied increased the risk of contracting or experiencing worse health outcomes from a communicable disease. Across all reviews, effect sizes, where calculated, ranged from 0.83 to 8.22. Conclusions Behavioural risk factors play a significant role in the risk of contracting and experiencing more severe outcomes from communicable diseases. Prevention of communicable diseases is likely to be most successful if it involves the prevention of behavioural risk factors commonly associated with NCDs. These findings are important for understanding risks associated with communicable disease, and timely, given the COVID-19 pandemic and the need for improvements in future pandemic preparedness. Addressing behavioural risk factors should be an important part of work to build resilience against any emerging and future epidemics and pandemics.

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Evaluation of the Psychiatric Decisions Unit (PDU): effect on emergency department presentations and psychiatric inpatient admissions

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-135788 ◽

2019 ◽

Vol 95 (1119) ◽

pp. 6-11 ◽

Cited By ~ 2

Author(s):

Samuel P Trethewey ◽

Shantal Deepak ◽

Samuel Saad ◽

Ellen Hughes ◽

George Tadros

Keyword(s):

Mental Health ◽

Patient Satisfaction ◽

Psychiatric Inpatient ◽

Mental Health Crisis ◽

Liaison Psychiatry ◽

Optimal Care ◽

Health Crisis ◽

Psychiatric Admissions ◽

Number Of Patients ◽

The Impact

BackgroundBusy emergency departments (EDs) are not the optimum environment for assessment of patients in mental health crisis. The Psychiatric Decisions Unit (PDU) was developed by the Birmingham and Solihull Mental Health Foundation Trust as an enhanced assessment service to ensure patients in mental health crisis receive optimal care.AimsTo evaluate the activities of the PDU and its impact on the frequency of ED presentations and inpatient admissions, and to explore patient satisfaction.MethodsData were collected over a 6-month period during 2015 regarding patient demographics, referral sources, length of stay, and frequency of mental health-related ED presentations and inpatient psychiatric admissions. Comparison group data were used to evaluate the impact of the PDU. Patient satisfaction was measured using the ‘Friends and Family Test’ and structured feedback forms.ResultsIn total, 385 patients were referred to the PDU during the study period. Implementation of the PDU was associated with a 39% decrease in the number of patients taken to the ED by Street Triage and a 26% fall in inpatient psychiatric admissions via the Trusts’ in-hospital liaison psychiatry team. Ninety-eight per cent of patients surveyed felt that they were treated with respect and understanding, and 94% reported that they were likely or extremely likely to recommend the service to friends and family.ConclusionsImplementation of the PDU was associated with a reduction in the frequency of ED presentations and inpatient psychiatric admissions. This study suggests that patients are satisfied with the care provided at the PDU.

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