scholarly journals Mental health in South East London general hospitals: using electronic patient records to explore associations between psychiatric diagnoses and length of stay in a patient cohort receiving liaison psychiatry input

BJPsych Open ◽  
2019 ◽  
Vol 5 (6) ◽  
Author(s):  
Abbeygail Jones ◽  
Helen Todman ◽  
Mujtaba Husain
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Research Centre ◽  
Psychiatric Diagnoses ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Liaison Psychiatry ◽  
General Hospitals ◽  
Bipolar Affective Disorders ◽  
The Impact

Background Psychiatric illnesses are prevalent in general hospitals and associated with length of stay (LOS). Liaison psychiatry teams provide psychiatric care in acute hospitals and can improve mental health-related outcomes but, to achieve ambitious policy targets, services must understand local need. Aims Using electronic patient records, we investigate associations between psychiatric diagnoses and LOS in South East London hospitals. Method Patient records were extracted using the South London and Maudsley NHS Foundation Trust Biomedical Research Centre Case Register Interactive Search system. There were 6378 admissions seen by liaison psychiatry aged <65 years between 2011 and 2016. Linear mixed-effects models investigated the impact of psychiatric diagnoses on LOS. Potential confounders included medical diagnoses, gender, age, ethnicity, social deprivation, hospital site and investment per admission. Results According to marginal means, longer LOS is associated with primary diagnoses of organic disorders (mean: 23 days, 95% CI 20.39–25.61), depressive disorders (mean: 11.03 days, 95% CI 9.74–25.61) and psychotic disorders (mean: 10.63 days, 95% CI 8.75–12.51). Shorter LOS is associated with personality disorders (mean: 6.28 days, 95% CI 4.12–8.45), bipolar affective disorders (mean 6.81 days, 95% CI 3.49–10.14) and substance-related problems (mean 7.53 days, 95% CI 6.01–9.05). Conclusions Psychiatric diagnoses have differential associations with in-patient LOS. Liaison psychiatry teams aim to mitigate the impact of psychiatric illness on patient and hospital outcomes but understanding local need and the wider context of care provision is needed to maximise potential benefits. Declaration of interest M.H. is a consultant liaison psychiatrist for King's College Hospital adult liaison psychiatry team. At the time of writing, H.T. was senior business manager at SLaM psychological medicine and integrated care clinical academic group. These may be considered financial and/or non-financial interests given the implications of findings for service funding.

Using electronic patient records to assess the impact of swine flu (influenza H1N1) on mental health patients

2011 ◽  
Vol 20 (1) ◽  
pp. 60-69 ◽  
Author(s):  
Lisa A. Page ◽  
Seeta Seetharaman ◽  
Imran Suhail ◽  
Simon Wessely ◽  
Jerson Pereira ◽  
...  
Keyword(s):  
Mental Health ◽  
Swine Flu ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Mental Health Patients ◽  
The Impact ◽  
Influenza H1n1

The impact of electronic patient records on workflow in general practice

2007 ◽  
Vol 13 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Matthew R. Cauldwell ◽  
Caroline E. Beattie ◽  
Benita M. Cox ◽  
William J. Denby ◽  
Jessica A. Ede-Golightly ◽  
...  
Keyword(s):  
General Practice ◽  
Patient Records ◽  
Electronic Patient Records ◽  
The Impact

scholarly journals The impact of first COVID-19 peak on patient referrals to Liaison Psychiatry Service and staff perception about service provision in Birmingham and Solihull Mental Health Trust Birmingham - a service evaluation project

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S329-S329
Author(s):  
Saima Jehanzeb ◽  
Muhammad Suleman ◽  
Ella Tumelty ◽  
Joanne Okusanya ◽  
Laxsan Karunanithy ◽  
...  
Keyword(s):  
Mental Health ◽  
Focus Groups ◽  
Quantitative Methods ◽  
Service Evaluation ◽  
Psychotic Symptoms ◽  
Healthcare Provision ◽  
Liaison Psychiatry ◽  
Clinical Databases ◽  
The Impact ◽  
Health Trust

AimsBased on recommendations from the Royal College of Psychiatrists, this project aimed to evaluate the impact of the first peak of the COVID-19 pandemic on referral patterns to the Queen Elizabeth Hospital Birmingham (QEHB) Liaison Psychiatry (LP) service. Additionally, we aimed to explore staff experiences in LP services across Birmingham and Solihull Mental Health Trust (BSMHFT) in order to generate Trust recommendations promoting optimal healthcare provision amidst the on-going pandemic.MethodA mixed method service evaluation was conducted using quantitative and qualitative analysis. Quantitative methods involved reviewing referrals made to the QEHB LP service from March to June 2020, compared with the equivalent time period in 2019. Data were retrospectively extracted from the electronic clinical databases RIO and PICS, and subsequently analysed using Microsoft Office. The number of, and reasons for referrals to LP were identified, whilst focus groups were conducted to explore the subjective experiences of staff working across BSMHFT LP services.ResultBetween 1st March and 30th June 2020, 984 referrals were made to the QEHB LP service, compared to 1020 referrals in 2019, representing a 3.5% reduction. From 2019 to 2020, referrals due to psychotic symptoms and deliberate self-harm rose by 12.8% and 14.1% respectively, whilst referrals for drug and alcohol-related causes reduced by 28.3%. A significant increase (150%) in referrals for medication or management advice was seen. Focus groups indicated that staff perceived an initial reduction in number of referrals, but an increase in the acuity of patient presentations.Staff reported anxiety around contracting and transmitting SARS-Cov-2, exacerbated by uncertainty around patients’ COVID-19 status. In QEHB, sixty-five of the 984 referrals (7%) had a positive SARS-Cov-2 PCR swab, with the remaining 919 referrals being either negative (68%) or unknown (25%). Ninety-six percent of consultations were conducted face-to-face in QEHB. There were conflicting views amongst staff regarding whether more consultations could have been conducted remotely. Furthermore, varying perceptions of support and communication from both the physical and mental health trust were reported.ConclusionQuantitative data indicates that COVID-19 impacted LP healthcare provision in BSMHFT. Whilst referral numbers remained similar between the equivalent period in 2019 and 2020, a change in the nature of referrals to LP at QEHB was seen. This was corroborated by qualitative data which highlighted a perceived change in acuity of referrals. These findings have been disseminated across the Trust and subsequent recommendations are being implemented during the on-going pandemic.

scholarly journals The impact of COVID-19 on an inpatient mother and baby unit: a service evaluation

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S316-S316
Author(s):  
Joanna Cranshaw ◽  
Gertrude Seneviratne ◽  
Ranga Rao ◽  
Julia Ogunmuyiwa ◽  
Rebecca McMillin ◽  
...  
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Social Services ◽  
Unit Length ◽  
Perinatal Period ◽  
Service Evaluation ◽  
Psychotic Illness ◽  
Mental Health Act ◽  
Mother And Baby Unit ◽  
The Impact

AimsUnique challenges have been faced by women in the perinatal period during the COVID-19 pandemic and the impact of this is compounded for women suffering from mental illness. This service evaluation looked at different aspects of the treatment pathway on a specialist inpatient psychiatric Mother and Baby Unit during the pandemic to identify what changes occurred.MethodData were collected for all admissions to the unit between January 2019 and October 2020, with the beginning of the pandemic being defined as on or after 1st March 2020. Information was collected retrospectively from electronic clinical notes on ethnicity, length of stay, diagnosis, mental health act use and restrictive practice, medication, psychology, occupational therapy and social services involvement.ResultThere were 114 admissions to the MBU during the study period. 4 were parenting assessments rather than acute psychiatric admissions and were excluded from the analysis, giving a sample of 110 women. 58% (62/110) were classed as “pre-pandemic” and 43.6% (48/110) were “during pandemic”. 95.45% (105/110) of women were postpartum 4.55% (5/110) were pregnant. Mean length of stay was shorter during the pandemic at 44 days, compared to 61 pre-pandemic. There was greater use of the mental health act during the pandemic: only 43.75% of patients were informal throughout admission, compared to 70.97% pre-pandemic. Mean duration of detention was shorter at 25 days (32 pre-pandemic). Psychotic illness made up a greater proportion of diagnoses during the pandemic: 56% (27/48) compared to 44% (27/62) pre-pandemic. The next most common diagnostic group was mood and anxiety disorders, which made up 29% (14/48) of diagnoses during the pandemic, but 43% (27/62) pre-pandemic. Outcomes as measured using the Health of the Nation Outcome Scale showed a mean improvement between admission and discharge of 6.65, compared to 5.15 pre-pandemic. HONOS scores were higher on admission during the pandemic (12.83, vs 10.88), suggesting a higher level of acuity.ConclusionDuring the COVID-19 pandemic on this Mother and Baby Unit, length of stay was shorter, a greater proportion of patients were detained under the mental health act (although length of detention was shorter) and psychotic illness was more prevalent. This study demonstrates that there were differences in this perinatal inpatient population during the pandemic and this may be a reflection on the wider impact of COVID-19 on perinatal mental health.

scholarly journals 91 Management and Outcomes of Appendicitis in The Pre-COVID-19, COVID-19 And Post-COVID-19 Periods

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Abeywickrema ◽  
C Patel ◽  
A K Ghumman ◽  
A Krishan ◽  
P Puventhiranathan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Lower Proportion ◽  
Surgical Approaches ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Readmission Rates ◽  
Surgical Guidance

Abstract Aim The COVID-19 pandemic resulted in an upheaval of national surgical guidance on appendicitis, which has previously favoured surgical over conservative approaches. We analysed how these guidelines altered management and outcomes of appendicitis. Method A retrospective cohort study at Heartlands Hospital, Birmingham of all appendicitis admissions around and during the first COVID-19 peak was conducted, with analysis of electronic patient records using the acute surgical worklist. Results 48 admissions for appendicitis during the two-month period from 01/02/20 to 25/03/20 prior to the COVID-19 peak and 28 admissions in the two months during the peak itself from 30/03/20 to 24/05/20 were identified. Prior to the COVID-19 peak, a lower proportion of cases was managed conservatively (18.8%) compared to the latter (67.9%, p &lt; 0.0001). This change also coincided with a switch from laparoscopic to open approaches in those managed surgically. We studied a further period post-COVID-19 peak from 01/06/20 to 26/07/20, where proportions of patients managed conservatively versus surgically did not significantly change following the COVID-19 peak, although surgical preference reverted from open to laparoscopic approaches. During the COVID-19 period, a reduced length of stay was seen in cases managed conservatively (1.65 days) compared to those managed surgically (4 days, p = 0.024). Differences in readmission rates were not statistically significant. Conclusions A reduction in numbers of appendicitis presentations as well as a switch to conservative approaches was seen during COVID-19. These findings furthermore support non-inferiority of conservative over open surgical approaches in most appendicitis cases at a time where laparoscopy was deemed unfeasible.

PP38 Rates of recording different aspects of patients’ social history on ambulance electronic patient records – a service evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A16.1-A16
Author(s):  
Chloé R Barley ◽  
Imogen M Gunson
Keyword(s):  
Social History ◽  
Median Number ◽  
Service Evaluation ◽  
Patient Records ◽  
Completion Rates ◽  
Electronic Patient Records ◽  
Minimal Impact ◽  
History Data ◽  
Qualitative Work ◽  
The Impact

BackgroundUnderstanding the impact of a patient’s social history forms part of medical assessments and wider NHS data collection. To date, there has been little work examining the extent of social history recording by ambulance clinicians. The aim of this service evaluation is to examine how frequently staff complete social history fields on electronic patient records and to identify patterns in completion rate when comparing categories of call, localities of crew, conveyance or non-conveyance, and individual fields of social history data.MethodA retrospective review of one NHS ambulance trust’s electronic patient records (attended 01/01/2019 – 31/12/2019) was conducted. 10% of the records were analysed due to software limitations (n = 134434 adult cases).ResultsVery few cases (<0.05%) had every field completed, with 28.6% of all cases having no fields completed at all. In 45% of cases, between 8 and 11 fields were completed. The mean number of fields completed per case was 5.79 and the median number was 7.‘Mobility’ and ‘Home circumstances’ were the most frequently completed and ‘Sexual Orientation’ and ‘Language’ were the least.Category of call appears to have minimal impact on completion rates. Localities and specialists had more variation, ranging from 21.3% to 49.9% with no fields completed at all.ConclusionSocial history documentation is very infrequently fully completed by frontline ambulance crews within this service. The majority of cases have a partially complete social history however, due to software limitations, it is unknown whether the same fields are consistently completed throughout these cases.Further research, including qualitative work, is recommended to understand the low rate of recording of social history data and how this information is used by ambulance staff.

scholarly journals ‘We've got another one for you!’ Liaison psychiatry's experience of stigma towards patients with mental illness and mental health professionals

2012 ◽  
Vol 36 (12) ◽  
pp. 450-454 ◽  
Author(s):  
Jim Bolton
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Patient Care ◽  
General Hospital ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Clinical Implications ◽  
Liaison Psychiatry ◽  
Clinical Communication ◽  
The Impact

Aims and methodTo assess stigmatising attitudes towards mental illness and psychiatric professionals experienced by UK liaison psychiatry staff. A questionnaire asked about the impact of these events on patient care and for suggestions for tackling stigma in the general hospital.ResultsOut of 72 multidisciplinary respondents, over three-quarters had experienced stigmatising attitudes towards mental illness by general hospital colleagues at least monthly. Two-thirds reported instances where stigmatisation had an adverse impact on patient care, and over a quarter reported stigmatising attitudes towards mental health professionals. Suggestions for combating stigma included educational initiatives, clear clinical communication, and the provision of high-quality liaison services.Clinical implicationsLiaison psychiatry is well placed to both recognise and combat stigma in the general hospital. This can help to ensure that patient care is comprehensive, safe and respectful.

Persecution complex: I am getting one over electronic patient records!

2017 ◽  
Vol 8 (2) ◽  
pp. 78-81
Author(s):  
S Misra ◽  
F Dyer ◽  
Professor P Sandler
Keyword(s):  
Information Technology ◽  
Secondary Care ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Plain Language ◽  
National Programme ◽  
Care Processes ◽  
Health And Social Care ◽  
The Impact ◽  
Blair Government

The electronic patient record (EPR) is a core organisational document in which integrated health and social care records and secondary care processes can be stored. EPR was the brain child of the NHS’ National Programme for Information Technology, under the Blair government. 1 Since then, attempts have been made to install EPR in secondary care – a typical example being the installation of specialist imaging systems in hospital trusts. 2 The primary aim of EPR was to make the NHS services efficient via digitised patient records that could be viewed, discussed and transferred electronically between clinicians and/or trusts. 1 , 3 Other anticipated uses of EPR were to provide easy patient access to services such as e-referrals and e-prescriptions, as well as appointment systems. 3 , 4 Here, we discuss EPR and information technology in plain language, and assess the impact of EPR on NHS secondary care orthodontic services.

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