scholarly journals Improving risk assessments for CAMHS admissions at Great Ormond Street Hospital

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S107-S107
Author(s):  
Lisanne Stock ◽  
Sacha Evans
Keyword(s):  
Risk Assessment ◽  
Risk Assessments ◽  
Junior Doctors ◽  
List Type ◽  
Street Hospital ◽  
Great Ormond Street Hospital ◽  
Early Risk ◽  
Audit Cycle ◽  
Working Day ◽  
The Impact

AimsDuring the COVID-19 pandemic, admissions to the Mildred Creek Unit (MCU), an Inpatient CAMHS Ward at Great Ormond Street Hospital (GOSH) changed.The MCU is a 7–10 bed unit for children aged 7–15 years based on therapeutic milieu principles. The ward accepts patients via a planned national referral pathway, however, during the COVID-19 pandemic, patients were admitted as emergencies and consequently risk assessments were missed. Risk assessment is important in all admissions and as the MCU is not a locked unit, early risk assessment is particularly important.We aimed to review whether risk assessment occurred within one working day of admission, as suggested by the ward risk assessment policy, and if this was not the case, our aim was to ensure that all risk assessments took place within this period via our audit interventions.MethodWe collated data looking at the time between admission to GOSH and the date at which first risk assessments took place. We then put in place three interventions. 1)Posters prompting doctors who were providing on-call liaison input to perform a risk assessment within one working day of admission.2)New junior doctors were provided with written and verbal information to emphasise the importance of early risk assessment.3)Guidelines also highlight that assessment of risk may need to be on-going. We therefore added a prompt section in the weekly ward round proforma with the aim of reducing the interval between risk assessments during admission.The first audit cycle was conducted on the 3/8/2020 and the second on the 28/11/21 to allow for a comparative number of inpatients between the first and second audit cycle.ResultWe found these interventions significantly reduced delays in risk assessments. Prior to the audit's first cycle the average delay between admission to GOSH/MCU and a risk assessment was 2 weeks. After the interventions there were no patients whose risk assessment was delayed outside the next working day parameters.ConclusionThis full cycle audit demonstrates the impact that prompts to clinical practice can make on patient care. It is important to recognise the need for flexible risk assessment with regular review, especially at times of clinical change. We hope that this continued trend for early risk assessment leads to improved clinical care and timely discussion of risk for all new CAMHS inpatients at GOSH.

scholarly journals Psychiatric admission booking: audit of the impact of a standardised admission form

2006 ◽  
Vol 30 (9) ◽  
pp. 334-336 ◽  
Author(s):  
Stephen Dinniss ◽  
Jocelyn Dawe ◽  
Michael Cooper
Keyword(s):  
Physical Examination ◽  
Risk Assessments ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Educational Tool ◽  
Psychiatric Admission ◽  
Data History ◽  
Audit Cycle ◽  
Almost All ◽  
The Impact

Aims and MethodWe used a complete audit cycle to assess the quality and completeness of current admission bookings by junior doctors and whether the introduction of a standardised admission form led to improvements.ResultsFollowing the introduction of the standardised form significant improvements were found in almost all areas, including the recording of basic data, history, mental state, physical examination, risk assessments and diagnosis.Clinical ImplicationsThe introduction of a standardised admission form improved the completeness of information obtained. The form may also be used as an educational tool and to assist trainees preparing for examinations.

Applying the risk principle to optimize accuracy and equity in correctional risk assessment: Results From a Simulation

2021 ◽  
pp. 0306624X2098652
Author(s):  
Grant Duwe
Keyword(s):  
Risk Assessment ◽  
Predictive Accuracy ◽  
Ethnic Disparities ◽  
Simulated Data ◽  
Risk Assessments ◽  
Risk Level ◽  
Risk Levels ◽  
Risk Principle ◽  
Changes In Risk ◽  
The Impact

As the use of risk assessments for correctional populations has grown, so has concern that these instruments exacerbate existing racial and ethnic disparities. While much of the attention arising from this concern has focused on how algorithms are designed, relatively little consideration has been given to how risk assessments are used. To this end, the present study tests whether application of the risk principle would help preserve predictive accuracy while, at the same time, mitigate disparities. Using a sample of 9,529 inmates released from Minnesota prisons who had been assessed multiple times during their confinement on a fully-automated risk assessment, this study relies on both actual and simulated data to examine the impact of program assignment decisions on changes in risk level from intake to release. The findings showed that while the risk principle was used in practice to some extent, the simulated results showed that greater adherence to the risk principle would increase reductions in risk levels and minimize the disparities observed at intake. The simulated data further revealed the most favorable outcomes would be achieved by not only applying the risk principle, but also by expanding program capacity for the higher-risk inmates in order to adequately reduce their risk.

scholarly journals The belief that politics drive scientific research & its impact on COVID-19 risk assessment

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249937
Author(s):  
Danielle M. McLaughlin ◽  
Jack Mewhirter ◽  
Rebecca Sanders
Keyword(s):  
Risk Assessment ◽  
Survey Data ◽  
Scientific Research ◽  
Risk Assessments ◽  
Negatively Associated ◽  
Health Measures ◽  
Preventative Health ◽  
The Impact

We use survey data collected from 12,037 US respondents to examine the extent to which the American public believes that political motives drive the manner in which scientific research is conducted and assess the impact that such beliefs have on COVID-19 risk assessments. We find that this is a commonly held belief and that it is negatively associated with risk assessments. Public distrust in scientists could complicate efforts to combat COVID-19, given that risk assessments are strongly associated with one’s propensity to adopt preventative health measures.

Hormesis - Implications for risk assessment caloric intake (body weight) as an exemplar

1998 ◽  
Vol 17 (8) ◽  
pp. 454-459 ◽  
Author(s):  
Angelo Turturro ◽  
Bruce Hass ◽  
Ronald W Hart
Keyword(s):  
Risk Assessment ◽  
Caloric Intake ◽  
Toxicity Testing ◽  
Risk Assessments ◽  
Specific Information ◽  
Response Curves ◽  
Hormetic Effect ◽  
The Impact ◽  
Hormetic Response

Hormesis can be considered as a parameter which has a non-monotonic relationship with some endpoint. Since caloric intake is such a parameter, and the impact of this parameter on risk assessment has been fairly well characterized, it can provide clues as to how to integrate the information from a hormetic parameter into risk assessments for toxicants. Based on the work with caloric intake, one could: (a) define a biomarker for hormetic effect; (b) integrate specific information on when in the animals lifespan the parameter is active to influence parameters such as survival; (c) evaluate component effects of the overall hormetic response; and (d) address the consequences of a non-monotonic relationship between the hormetic parameter and endpoints critical for risk assessment. These impacts on risk assessments have been characterized for chronic tests, but are also true for short-term tests. A priority is the characterization of the dose-response curves for hormetic parameters. This quantification will be critical in utilizing them in risk assessment. With this information, one could better quantitatively address the changes one expects to result from the hormetic parameter, and limit the uncertainty and variability which occurs in toxicity testing.

11 Filling the void: preparing future junior doctors for challenging conversations

2018 ◽  
Vol 8 (3) ◽  
pp. 363.3-364
Author(s):  
Hannah Costelloe ◽  
Alice Copley ◽  
Andrew Greenhalgh ◽  
Andrew Foster ◽  
Pratik Solanki
Keyword(s):  
Palliative Care ◽  
Medical Education ◽  
Medical Students ◽  
Small Group ◽  
End Of Life ◽  
Communication Skills ◽  
Skills Training ◽  
Junior Doctors ◽  
List Type ◽  
The Impact

Evidence demonstrates that medical students have limited experience in developing ‘higher-order communication skills’ (Kaufman et al. 2000). Anecdotally many do not feel confident in their ability to conduct difficult conversations often due to a lack of exposure to such scenarios in practice or a pervasive notion that these scenarios are inappropriate for students and beyond the scope of a junior doctor’s role and thus not a focus of curriculums (Noble et al. 2007). There is however a correlation between level of clinical experience and improved confidence for medical students (Morgan and Cleave-Hogg 2002).We surveyed a group of final year medical students to assess their confidence using a 10-point Likert scale in tackling common palliative and end of life care scenarios. Our intervention comprised a study day of 10 practical small-group teaching simulation and OSCE-style stations designed to provide exposure to common experiences in a controlled setting. We reassessed the confidence of students after delivery and objectively explored the impact of the day by asking participants to complete a validated assessment before and after the course. All results showed significant improvement on t-testing: confidence in end of life communication in an OSCE setting improved by 42.2% and assessment marks improved by 24.7% (p=0.039).Palliative care is an area in which students approaching the end of undergraduate training feel underprepared. Our findings demonstrate that small group sessions improve confidence by facilitating communication practice in a controlled environment and providing crucial exposure to common palliative care scenarios they will face as doctors.References. Kaufman D, Laidlaw T, Macleod H. Communication skills in medical school: Exposure confidence and performance. Academic Medicine [online] 2000;75(10):S90–S92. Available at https://journals.lww.com/academicmedicine/Fulltext/2000/10001/Communication_Skills_in_Medical_School__Exposure.29.aspx [Accessed: 30 May 2018]. Morgan P, Cleave-Hogg D. Comparison between medical students’ experience confidence and competence. Medical Education [online] 2002;36(6):534–539. Available at https://doi.org/10.1046/j.1365-2923.2002.01228.x [Accessed: 30 May 2018]. Noble L, Kubacki A, Martin J, Lloyd M. The effect of professional skills training on patient-centredness and confidence in communicating with patients. Medical Education [online] 2007;41(5):432–440. Available at https://doi.org/10.1111/j.1365-2929.2007.02704.x [Accessed: 30 May 2018]

Unjust Disparities? The Impact of Race on Juvenile Risk Assessment Outcomes

2016 ◽  
Vol 29 (5) ◽  
pp. 423-442 ◽  
Author(s):  
James T. McCafferty
Keyword(s):  
Risk Assessment ◽  
Black Youth ◽  
Attorney General ◽  
Assessment System ◽  
Risk Assessments ◽  
Prediction Errors ◽  
Racial Biases ◽  
Actuarial Risk ◽  
Robust Prediction ◽  
The Impact

Research on risk assessments has illustrated many utilitarian purposes of these tools, including the robust prediction of recidivism and uniformity in correctional decision making. Recently, however, Former U.S. Attorney General Eric Holder vocalized his position that actuarial risk assessments could be unintentionally contributing to disproportionate minority contact in the correctional system. This study used data from approximately 2,600 juvenile delinquents assessed with the Ohio Youth Assessment System–Disposition Instrument to examine these claims across subsamples of White and Black youth. Bivariate and multivariate analyses indicated that the instrument predicted recidivism similarly across the two groups. There were slightly more prediction errors for Black youth than White youth; however, these differences may be the result of methodological factors rather than empirical realities. The article concluded with a discussion of the implications that potential racial biases have on risk assessment research and practice.

scholarly journals Improving venous thromboembolism risk assessments on an older age psychiatric ward – a complete audit cycle

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S86-S86
Author(s):  
Syazana JD ◽  
Edward Hart ◽  
Ranjit Mahanta ◽  
Alison Marshall
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Older Adult ◽  
Psychiatric Patients ◽  
Physical Restraint ◽  
Risk Assessments ◽  
Hydration Status ◽  
Common Disease ◽  
Junior Doctors

AimsVenous thromboembolism (VTE) is a common disease amongst hospital patients. Within acute hospitals, there are well established protocols for risk assessment and prevention of VTE via mechanical and pharmacological prophylaxes.In psychiatry, assessment of VTE risk is more commonly overlooked despite many inherent risk factors which are unique to acute psychiatric admissions; including antipsychotic medications, physical restraint, catatonic states, and poor nutritional and hydration status[1]. The risk is compounded in older adult psychiatric patients, in which both patient and admission-related risk factors can act synergistically.Anecdotally, it was reported that VTE assessments were not being completed and documented on the electronic patient record system. Our aim was to introduce a physical VTE risk assessment to attach to paper drug charts, which would act as a prompt for junior doctors, and serve to increase rates of completion.MethodA baseline retrospective audit of all patients admitted to the older adult inpatient ward over an 11-week period (05/08/2019~20/10/2019) was undertaken. The number of completed electronic VTE risk assessments at admission, and at 24 hours post-admission were calculated.Subsequently, a new paper VTE risk assessment proforma was developed, combining the Department of Health VTE risk assessment tool[3] with several VTE risk factors associated with psychiatric patients (catatonia, antipsychotic medication, reduced oral intake, psychomotor retardation). Education was provided to the ward doctors, and regular assessments of VTE risk was incorporated into the weekly MDT meetings.A re-audit was completed to assess the completion rates of the new paper VTE proforma. A snapshot style audit of all inpatients on the ward on Thursday 24th February 2020 was performed.ResultThe baseline audit included 23 patients admitted during the 11-week period, consisting of 21 men and two women. The mean age was 74 years. Three patients (13% of total admissions) had their VTE and bleeding risk assessed on admission.Following the implementation of a new VTE risk assessment proforma, the re-audit showed that all 19 inpatients (100% of total admissions) had a completed assessment. Although none of the patients required mechanical prophylaxis, one patient was receiving ongoing treatment for pulmonary embolism.ConclusionVTE is a preventable disease, which historically has been under-recognised by psychiatric doctors. The introduction of a paper risk assessment proforma increased completion from 13% to 100%. It also prompted regular review of VTE risk during the weekly MDT meetings. This intervention may reduce the incidence of VTE-related pathology on the ward.

scholarly journals The impact of the Covid-19 lockdown on the experiences and feeding practices of new mothers in the UK: Preliminary data from the COVID-19 New Mum Study

2020 ◽  
Author(s):  
Adriana Vazquez ◽  
Sarah Dib ◽  
Emeline Rougeaux ◽  
Jonathan Wells ◽  
Mary Fewtrell
Keyword(s):  
Mental Health ◽  
Health Professional ◽  
Research Centre ◽  
Delivery Mode ◽  
Breastfeeding Initiation ◽  
Street Hospital ◽  
Great Ormond Street Hospital ◽  
Skin Contact ◽  
The Uk ◽  
The Impact

AbstractBackgroundThe COVID-19 New Mum Study is recording maternal experiences and infant feeding during the period of UK lockdown. This report from week 1 of the survey aims to (1) provide information relevant for those supporting this population; (2) identify groups currently under-represented in the survey.MethodsWomen living in the UK aged ≥18 years with an infant ≤12 months of age completed an anonymous online survey (https://is.gd/covid19newmumstudy). Information/links are shared via websites, social media and existing contacts.ResultsBetween May 27th and June 3rd 2020, 1365 women provided data (94% white, 95% married/with partner, 66% degree/higher qualification, 86% living in house; 1049 (77%) delivered before lockdown (BL) and 316 (23%) during lockdown (DL). Delivery mode, skin-to-skin contact and breastfeeding initiation did not differ between groups. DL women had shorter hospital stays (p<0.001) and 39% reported changes to their birth plan. Reflecting younger infant age, 59% of DL infants were exclusively breast-fed or mixed fed versus 39% of BL (p<0.05). Thirteen % reported a change in feeding; often related to lack of breastfeeding support, especially with practical problems. Important sources of feeding support were the partner (60%), health professional (50%) and online groups (47%). 45% of DL women reported insufficient support with feeding. Among BL women, 57% and 69% reported decreased feeding support and childcare, respectively. 40% BL/45% DL women reported insufficient support with their own health, 8%/9% contacted a mental health professional and 11% reported their mental health was affected. 9% highlighted lack of contact and support from family and distress that they had missed seeing the baby.ConclusionLockdown has had an impact on maternal experiences, resulting in distress for many women. Survey participants are currently not representative of the population; notably, groups at greater risk are under-represented. Increasing the diversity of participants is a priority.Survey fundingNone. All research at Great Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health is made possible by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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