scholarly journals AB0817 CAN RHEUMATIC CONDITIONS ASSOCIATED INTERSTITIAL LUNG DISEASES BE MANAGED IN A DISTRICT GENERAL HOSPITAL – RESULTS FROM A LONGITUDINAL OUTCOMES SURVEY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1432.1-1433
Author(s):  
A. Francioni ◽  
J. Gnanapragasam ◽  
N. Ramsundar ◽  
V. Joshi ◽  
M. K. Nisar
Keyword(s):  
General Hospital ◽  
Rheumatic Diseases ◽  
Care Pathway ◽  
Treatment Options ◽  
Tertiary Care ◽  
District General Hospital ◽  
Interstitial Lung Diseases ◽  
Specialist Service ◽  
Hub And Spoke ◽  
Tertiary Centre

Background:Interstitial lung disease is a well described extra-articular manifestation in a range of rheumatic diseases. It carries significant morbidity and mortality. Management of rheumatic diseases associated ILD (r-ILD) requires expertise as the needs of such patients are complex and treatment options limited. Historically, such complex ILD has been managed in tertiary referral centres. We set up a combined service incorporating both rheumatology and respiratory domains in a district general hospital (DGH) to help patients avoid long journeys and improve their experience whilst focusing on an integrated care pathway.Objectives:We evaluated the outcomes of all patients managed over three years in this pilot service model.Methods:Referrals were accepted from any hospital specialist involved in the management r-ILD. They were triaged by lead ILD pulmonologist to monthly ILD MDT comprising a rheumatologist, respiratory physician, a radiologist and ILD specialist nurse. Appropriate patients were booked into combined clinic, run by the respective rheumatology and chest specialists with ILD interest, attracting a multi-speciality tariff. All the data was recorded electronically with full access to demographics, disease parameters, investigations and drug management.Results:111 consecutive patients were included in this evaluation. Mean age was 66.4 yrs (19-92 yrs) and 36% (n=40) were male. 34 (30%) had RA, 31 (28%) had CTD, 20 (18%) had IPAF and 26 others. Most predominant HRCT pattern was NSIP (n=40,36%) followed by UIP (n=31, 28%). Mean FVC was 2.59 L/min (1.93-4.13) with DLCOc of 52.7% (28.9-90.1%) predicted. Only two patients had all antibodies negative whilst 109 had at least one antibody positive with ANA being the most common (n=38).Most (83%) patients were treated with immunomodulators including 11 with rituximab. 49 (44.1%) patients had significant improvement in clinical, imaging and pulmonary parameters with DLCOc improving to 56.57% and FVC to 2.70 L/min. There were similar improvements in six minute walk test. 21 patients died and 23 patients required long term oxygen therapy.Conclusion:This pilot real world study confirms the utility of a combined specialist service in a district general hospital. Nearly half of this complex and resource intensive patient cohort had good clinical outcomes and derived benefit from the expertise in one room. Feedback from both patients and referrers was unanimously positive. No patient required tertiary centre referral and all could be managed adequately in the clinical setting.Our report confirms that r-ILD can be managed in a DGH setting with a stream-lined service offering clear benefits to patients. We would argue that r-ILD service, congruent to satellite pulmonary hypertension clinics in secondary care with hub-and-spoke model liaison with tertiary centre, can be established on similar principles and could help over-stretched tertiary care with repatriation of services whilst helping develop local expertise in the management of chronic ILD.Disclosure of Interests:None declared

scholarly journals AB1181 SHOULD A COMBINED RHEUMATOLOGY-PULMONOLOGY INTERSTITIAL LUNG DISEASE SERVICE BE CONFINED TO TERTIARY CENTRES - A SERVICE EVALUATION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1881.1-1881
Author(s):  
K. Salama ◽  
N. Ramsundar ◽  
V. Joshi ◽  
M. K. Nisar
Keyword(s):  
Clinical Trials ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
General Hospital ◽  
Rheumatic Diseases ◽  
Care Pathway ◽  
Tertiary Care ◽  
District General Hospital ◽  
Proof Of Concept ◽  
Tertiary Centre

Background:Interstitial lung disease is a well described extra-articular manifestation in a range of rheumatic diseases. It carries significant morbidity and mortality. Management of rheumatic diseases associated ILD (r-ILD) requires expertise as the needs of such patients are complex and treatment options limited. Historically, such complex ILD has been managed in tertiary referral centres.Objectives:We set up a combined service incorporating both rheumatology and respiratory domains in a district general hospital (DGH) to help patients avoid long journeys and improve their experience whilst focusing on an integrated care pathway. We evaluated the outcomes of the first set of patients managed in this proof-of-concept service model.Methods:Referrals were accepted from any hospital specialist involved in the management r-ILD. They were triaged by lead ILD pulmonologist to monthly ILD MDT comprising a rheumatologist, respiratory physician, a radiologist and ILD specialist nurse. Appropriate patients were booked into combined clinic, run by the respective rheumatology and chest specialists with ILD interest, attracting a multi-speciality tariff. All the data was recorded electronically with full access to demographics, disease parameters, investigations and drug management.Results:89 patients were included in this proof-of-concept. Mean age was 66.1 yrs (19-90 yrs) and 44% (n=39) were male. 35 (40%) had RA, 34 (39%) had CTD, eight (10%) had sarcoidosis, five had IPAF and seven others. Most predominant HRCT pattern was NSIP (n=53,60%) followed by UIP (n=23, 21%), sarcoid (n=10, 12%) and miscellaneous (LIP and mixed). Mean FVC was 2.64 L/min (1.93-4.13) with DLCOc of 52.7% (28.9-90.1%) predicted. Only two patients had all antibodies negative whilst 87 had at least one antibody positive with ANA being the most common (n=28).Most (83%) patients were treated with immunomodulators including nine with rituximab. 39 (44.3%) patients had significant improvement in clinical, imaging and pulmonary parameters with DLCOc improving to 56.57% and FVC to 2.70 L/min. There were similar improvements in six minute walk test. 17 patients died and 20 patients required long term oxygen therapy.Conclusion:This proof-of-concept real world study confirms the utility of a combined specialist service in a district general hospital. Nearly half of this complex and resource intensive patient cohort had good clinical outcomes and derived benefit from the expertise in one room. Feedback from both patients and referrers was unanimously positive. No patient required tertiary centre referral and all could be managed adequately in the clinical setting.Our report confirms that r-ILD can be managed in a DGH setting with a stream-lined service offering clear benefits to patients. We would argue that r-ILD service, congruent to satellite pulmonary hypertension clinics in secondary care with hub-and-spoke model liaison with tertiary centre, can be established on similar principles and could help over-stretched tertiary care with repatriation of services whilst helping develop local expertise in the management of chronic ILD.Disclosure of Interests:Karim Salama: None declared, Natasha Ramsundar: None declared, Vijay Joshi: None declared, Muhammad Khurram Nisar Grant/research support from: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB, Consultant of: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB, Speakers bureau: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB

178 Suspected Cauda Equina Syndrome in a District General Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Ellerton ◽  
H Benjamin-Laing ◽  
W J Harrison
Keyword(s):  
General Hospital ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
District General Hospital ◽  
Bladder Function ◽  
Mri Scan ◽  
Eligibility Criteria ◽  
Joint Project ◽  
Tertiary Centre ◽  
Patient Morbidity

Abstract Introduction Cauda Equina Syndrome (CES) is rare but when the diagnosis is delayed patient morbidity is significant. Recently, NICE Clinical Knowledge Summaries have updated their red flags on CES to be more explicit enabling earlier referral and diagnosis. A joint project between Orthopaedics and Radiology departments aimed to assess the current pathway of Cauda Equina Investigation at a District General Hospital. Method Data was collected from the local Radiology database for requests between July 2017 and August 2018. This included both direct requests to assess for CES and implied. Raw data revealed a potential of 600 patients, of which we have analysed 332 patients met the eligibility criteria. Results Only 58 patients had a documented complete bladder function assessment, of those 33% had incomplete or partial bladder emptying. Time to MRI scan ranged from 50mins – 23 hours & 52 mins. 47% had negative scans with CES or Cord compromise on MRI scan was demonstrated on 9%. 23 patients were transferred urgently to the receiving tertiary centre. Conclusions We found that nearly 90% of patients were being incompletely assessed and time to scan ranged significantly. We are producing a trust wide suspected CES pathway to improve patient assessment.

scholarly journals EP.TU.526Is a foundation interim year one post better for improving confidence in general surgery in a tertiary centre or a district general hospital?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jayan George ◽  
Alok Mathew ◽  
Edward Robinson ◽  
Edward Botsford ◽  
Rohan Ardley ◽  
...  
Keyword(s):  
General Hospital ◽  
General Surgery ◽  
District General Hospital ◽  
Hepatobiliary Disease ◽  
Surgical Patients ◽  
Microsoft Excel ◽  
Likert Scales ◽  
Google Docs ◽  
Confidence Levels ◽  
Tertiary Centre

Abstract Aims 1. Understand the confidence levels in caring for general surgical patients of current foundation year one (FY1) doctors in who have had foundation interim year one (FiY1) post in a tertiary centre (TC) and a district general hospital (DGH). 2. Determine whether there is a difference in the experience of the FiY1 post in a TC or DGH. Methods FY1s doctors were surveyed throughout August – December 2020. Nine questions used Likert scales (1 to 5: not at all confident to very confident) over some common general surgical themes. Data was initially inputted using Google Docs and analysed in Microsoft Excel. Results 20% (6/30) from a DGH and 80% (24/30) from a TC Confidence levels were higher for FY1s who had a FiY1 post in a TC as opposed to a DGH in dealing with acute general surgical patients, appendicitis and scrubbing in theatre. Confidence levels were the same in both a TC and DGH for FY1s in managing those with hepatobiliary disease, prescribing fluids for resuscitation and maintenance as well as speaking to a family when a patient is dying and speaking to a patient when their diagnosis is unknown. Conclusions FY1s who had a FiY1 post in a TC had better confidence levels in more areas as opposed to a DGH. The experience of the FiY1 post should be more standardised to ensure the growth of confidence across all areas identified in the survey.

EVALUATION OF THE SHORT-TERM IMPACT OF COVID-19 IN A LARGE DISTRICT GENERAL HOSPITAL

2021 ◽  
pp. 14-15
Author(s):  
Natalie Hamer ◽  
Ashley Brown ◽  
Trisha Jha ◽  
Oladiran Olatunbode ◽  
Madan Jha
Keyword(s):  
Intensive Care ◽  
General Hospital ◽  
Service Provision ◽  
District General Hospital ◽  
Healthcare Services ◽  
Healthcare Systems ◽  
Surgical Service ◽  
Short Term ◽  
Tertiary Centre ◽  
Additional Strain

Intro: Since December 2019, SARS-CoV-2 has had a dramatic impact on the global landscape. One of the biggest challenges has been the additional strain that the virus has put on healthcare systems. Although there has been much data on the direct affects of COVID-19 on intensive care beds and ventilator availability, there has been little exploration into the wider impacts that the restrictions brought about by COVID-19 have had on the provision of other healthcare services. We designed this study to explore how Aim: COVID-19 has impacted surgical service provision at a tertiary centre. We Methods: compared the number and types of general surgeries carried out at a single hospital in the six months prior to the initial UK COVID-19 outbreak (September 2019 - February 2020) and the six months after (March 2020 - August 2020). We found that since March 2020 there has been a 70% decrease i Results: n the number of operations being carried out, with numbers dropping from a pre-COVID surgery number of 1761 to a post-COVID number of 529. This mainly affected elective procedures however, with emergency surgeries remaining relatively constant (48 pre-COVID vs 44 post-COVID). COVID-19 has Conclusion: caused a signicant decrease in the number of surgeries being undertaken. This is due to a combination of factors including stafng issues, reduced investigation, and national mandates requesting the cessation of non-urgent procedures. Although this has mainly affected elective operations, it is likely to have a larger impact in the future as surgical waiting lists continue to grow

scholarly journals Evaluation of an Emergency Treatment Unit – in a District General Hospital – Sri Lanka – A case Study

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Himali R Wijegunasekara J L
Keyword(s):  
Sri Lanka ◽  
General Hospital ◽  
Emergency Treatment ◽  
Quality Management System ◽  
Tertiary Care ◽  
Hospital Management ◽  
District General Hospital ◽  
Care Hospital ◽  
Treatment Unit ◽  
Hospital Development

Emergency Treatment Unit of a hospital is the place where, acutely unwell patients admitted to the hospital, are given the immediate treatment in the critical stage. DGH – Gampaha – Sri Lanka is a tertiary care hospital with a bed strength of 795 with a well - recognized Emergency Treatment Unit. Objective of this study was to evaluate the Emergency Treatment Unit of District General Hospital, Gampaha, Sri Lanka. Data was collected through oobservations, key informant interviews and reviewing registers and records. Findings were subjected to SWOT analysis. 1) Identified strengths included accessibility, Infrastructure, ETU concept, 24 hour service, competent staff, availability of equipment and investigation facilities and Information management. 2) Some weaknesses identified were; shortage of staff, absenteeism, gaps in competency, shortage of equipment and inadequate quality management system. 3) Receiving priority attention by the provincial, regional and the hospital management, Administration Support Team, Hospital Management Committee, Hospital Clinical Society, Hospital Development Committee, Hospital Development Foundation and regular donations were recognized as opportunities. 4) Finally, Unnecessary transfers from peripheral hospitals, by pass of peripheral hospitals by patients, frequently changing of the management and delay in procurement, repairing and condemning processes were noted as threats. TOWS analysis using a TOWS matrix was performed and strategies were developed for further improvement.

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