scholarly journals Improving quality and assessment of referrals to the Enfield Crisis Resolution and Home Treatment Team (ECRHTT)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S202-S202
Author(s):  
Margarita Kousteni ◽  
John Cousins ◽  
Ajay Mansingh ◽  
Maja Elia ◽  
Yumnah Ras ◽  
...  
Keyword(s):  
Home Treatment ◽  
Absolute Difference ◽  
List Type ◽  
Treatment Team ◽  
Crisis Resolution ◽  
Post Intervention ◽  
Improvement Project ◽  
Consultant Psychiatrist ◽  
The Impact

AimsTriaging referrals to crisis resolution and home treatment teams is a significant undertaking requiring experienced and dedicated staff. We observed that the volume of inappropriate referrals to ECRHTT was high, and that staff processing these often felt inexperienced or lacking in confidence to discharge them back to the referrers and signpost them to appropriate services.The aims of this quality improvement project (QIP) were: a)to reduce the number of inappropriate referrals received by the teamb)to reduce the number of inappropriate referrals accepted by the teamThis would significantly improve access and flow to the service and facilitate better patient care.MethodA pilot study was first completed of the quality (appropriateness/ inappropriateness) and source of all referrals to ECRHTT in January 2019 (n = 177).Subsequently, the consultant psychiatrist for ECRHTT based himself within the assessment team. He was able to closely monitor the referrals, at the same time as providing medical input to patients at their first point of contact. To evaluate the impact of this intervention, the percentage of inappropriate referrals accepted pre- and post-change was compared by re-auditing all referrals received in February 2019 (n = 175).Further interventions were instigated to improve referral quality. These included continuation of psychiatric medical input to the assessment team, teaching sessions for GPs and the crisis telephone service, and weekly meetings with psychiatric liaison and community mental health teams (CMHTs). Change was measured by reassessing the quality of all referrals made to ECRHTT in February 2020 (n = 215).Result46.9% of inappropriate referrals to ECRHTT were accepted in January 2019 compared to 16.9% in February 2019 following the addition of medical input to the assessment team. The absolute difference was 30% (95% CI: 14%–44%, p < 0.001).71% of referrals from GPs were inappropriate in January 2019 compared to 36% in February 2020 post-intervention (difference 35%, 95% CI: 8.84%–55.4%, p < 0.05). Inappropriate referrals from CMHTs decreased from 55.5% to 12% (difference 43.5%, 95% CI: 9.5%–70.3%, p < 0.05). Overall, the percentage of inappropriate referrals fell from 38% to 27.4%, a difference of 10.6% (95% CI: 1.3%–19.8%, p < 0.05). The percentage of inappropriate referrals from liaison teams did not change significantly.ConclusionThis piece of work shows that better engagement with referral sources significantly improved the quality of referrals made to ECRHTT. Interventions included medical input at the point of referral, teaching sessions for general practitioners as well as ongoing liaison with referring teams.

scholarly journals 49 A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Sadiq ◽  
M Tahir ◽  
I Nur ◽  
S Elerian ◽  
A Malik
Keyword(s):  
Categorical Variables ◽  
Next Of Kin ◽  
Chi Square ◽  
Neck Of Femur ◽  
Improvement Project ◽  
Handover Process ◽  
Neck Of Femur Fracture ◽  
The Impact ◽  
Standard Operating Protocol

Abstract Introduction Poor handover between shifts can result in patient harm. This study was designed to evaluate the impact of implementing a handover protocol on the quality of information exchanged in the trauma handover meetings in a UK hospital. Method A prospective single-centre observational study was performed at an NHS Trust. Ten consecutive weekday trauma meetings, involving 43 patients, were observed to identify poor practices in handover. This data was used in conjunction with the Royal College of Surgeons’ recommendations for effective handover (2007) to create and implement a standard operating protocol (SOP). Following its implementation, a further 8 consecutive meetings, involving a further 47 patients, were observed. The data was analysed using t-test for quantitative variables and chi-square or Fisher’s exact tests for categorical variables. Results An improvement was demonstrated in multiple aspects of trauma handover including past medical history, injury date, results, diagnosis, consent, mark, and starvation status (all p &lt; 0.001). Subgroup analyses showed that handover of neck-of-femur fracture patients including information on baseline mobility (p = 0.04), Nottingham-Hip-Fracture Score (p = 0.01), next-of-kin discussion (p = 0.075) and resuscitation status (p = 0.001) all improved following the intervention. Conclusions These results demonstrate that the implementation of a well-structured handover protocol can improve the transmission of critical information in trauma meetings.

Impact of Training on Livestock Technology Transfer for Rural Poor Farmers Livelihood Improvement in Bangladesh

2021 ◽  
Vol 19 (1) ◽  
pp. 223-235
Author(s):  
MA Hossain ◽  
MS Islam ◽  
A Akhter ◽  
M Rashiduzzaman
Keyword(s):  
Baseline Survey ◽  
Rural Poor ◽  
Flock Size ◽  
Improvement Project ◽  
Feeding Management ◽  
Livelihood Improvement ◽  
Logistic Support ◽  
The Impact ◽  
Farming Households

The study was conducted to evaluate the impact of training facilitated by Nuton Jibon Livelihood Improvement Project (NJLIP) under Social Development Foundation (SDF) for transfer livestock technologies and livelihood improvement for rural poor farmers in Bangladesh. A total of 650 farming households were selected by baseline survey during January 2018 to June 2018.The training and non-training beneficiaries were primary level educated and their family size (4.52) was little lower than the national average (4.9). Average age was 36.73 and 35.12 years for training and non-training farmers, respectively. The rate and amount of loan was found higher with respondent received training than without training. Adoption rate of technologies was higher than the level of idea on the concept of housing, feeding, breeding and marketing. The training beneficiaries improved knowledge and skill on feeding, management and health care of livestock and poultry. Training and demonstration are considered two strong tools for adoption and dissemination of livestock technology. Herd and flock size was increased by training beneficiaries than non-training beneficiaries. Beneficiaries having training on various IGAs have expanded their land and asset possession to a greater extent compared to non-training beneficiaries. Housing and sanitation condition of training beneficiaries were higher than non-training beneficiaries. Increased annual income of training and non-training households was 19.43% and 13.30% where income from different IGAs of livestock was 32.19% and 14.53%, respectively. Livestock were not extremely price sensitive but more sensitive on non-price factors logistic support like institutional support, quality of input and availability of input. Thus, training was treated as vital tools for transfer livestock technologies to influence the poor farmer’s livelihood improvement of training household than non-training household. SAARC J. Agric., 19(1): 223-235 (2021)

scholarly journals The impact of music on health-related quality of life, as quantified by the SF-36: A systematic review and meta-analysis

2021 ◽  
Author(s):  
J. Matt McCrary ◽  
Eckart Altenmuller ◽  
Clara Kretschmer ◽  
Daniel S. Scholz
Keyword(s):  
Standard Treatment ◽  
Meta Analysis ◽  
Music Listening ◽  
Health Related Quality ◽  
Post Intervention ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related ◽  
The Impact

Background/Objectives: Increasing evidence supports the ability of music to broadly promote wellbeing and health-related quality of life (HRQOL). However, the magnitude of music effects on HRQOL is still unclear, particularly relative to established interventions, limiting inclusion of music interventions in health policy and care. The SF-36 is the most widely used instrument to evaluate HRQOL, with broad validity in evaluating the effects of a range of interventions. This study aims to synthesize and contextualize the impact of music interventions on HRQOL, as assessed by the SF-36. Methods: MEDLINE; EMBASE; Web of Science; PsycINFO, clinicaltrials.gov, and ICTRP databases were searched on 30 July 2021. Randomized and single-group studies of music interventions which reported SF-36 data at pre- and post-intervention timepoints were included. Observational studies were excluded. The quality and certainty of evidence provided by included articles and meta-analysis results was appraised using GRADE. Inverse variance random effects meta-analyses quantified changes in SF-36 mental and physical component summary scores (respectively, MCS and PCS) pre- to post-intervention and vs. common control groups. Results: Analyses included 764 participants from 25 studies. Music interventions (music listening, 10 studies; music therapy, 7 studies; singing, 7 studies; gospel music, 1 study) significantly improved MCS (Mean difference (MD) [95% confidence interval]=3.0 [1.4, 4.6]; p<.001) and PCS (MD=1.0 [0.1, 2.0; p<.04) scores. In a subgroup (8 studies; music group, N=254; control, N=257) addition of music to standard treatment for a range of conditions significantly improved MCS scores vs. standard treatment alone (MD=3.7 [0.4, 7.1; p<.03). Effects did not vary between music listening, therapy and singing intervention types or doses (p>.12); no evidence of small study or publication biases was present in any analysis (p>.31). Music impact on MCS scores meets SF-36 minimum important difference thresholds (MD>/=3) and is within the range of established interventions. Conclusions: This study provides Moderate quality evidence that music interventions can generally be used to provide clinically meaningful improvements in HRQOL. Further study is needed to determine optimal music interventions and doses for distinct clinical and public health scenarios. Funding: Alexander von Humboldt Foundation Registration: PROSPERO (ID: CRD42021276204)

scholarly journals Impact of low vision services on the quality of life of low vision patients in Ghana

2016 ◽  
Vol 75 (1) ◽  
Author(s):  
Godwin O. Ovenseri-Ogbomo ◽  
Harriette Osafo-Agyei ◽  
Ralph E.U. Akpalaba ◽  
James Addy ◽  
Elizabeth O. Ovenseri
Keyword(s):  
Quality Of Life ◽  
Visual Acuity ◽  
Positive Impact ◽  
Low Vision ◽  
Care Quality ◽  
Eastern Region ◽  
Post Intervention ◽  
Low Vision Clinic ◽  
The Impact

Patients’ perspectives on the impact of clinical interventions have been recognised as critical elements in patient care. Quality-of-life instruments are designed to measure these perspectives. We used the National Eye Institute’s 25-item Visual Function Questionnaire (NEI VFQ) to measure the impact of optical low vision devices on the quality of life of 22 low vision patients who obtained and were using low vision devices from a secondary low vision clinic in the Eastern Region, Ghana. The study employed a pre- and post-intervention technique. We found statistically significant improvements in measured visual acuity and NEI VFQ scores in 8 of the 10 domains evaluated. We conclude that optical low vision devices have a positive impact on the quality of life of low vision patients in Ghana.Keywords: low vision; quality of life; visual acuity; visual impairment; Ghana

Abstract WP266: EMS/Hospital Combined Education Decreased Primary Stroke Center Bypass

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jason P Stopyra ◽  
Myron Waddell ◽  
Emily B Parks
Keyword(s):  
North Carolina ◽  
Quality Improvement ◽  
Service Area ◽  
Education Intervention ◽  
Post Intervention ◽  
Intervention Phase ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
The Impact

Introduction: Historically, community hospitals have had few options for meaningful treatment of patients presenting with acute stroke. As expertise grows in the administration of thrombolytics, primary stroke centers (PSC) fulfill an important role in the reduction of morbidity and mortality related to stroke. It is important for the PSC to partner with Emergency Medical Services (EMS) to change historical perceptions of the quality of PSC care. Education may improve teamwork and increase awareness of the PSC, thereby increasing their utilization in EMS disposition decisions. Objective: The objective of this study is to report the impact of an education intervention on PSC bypass decisions. Methods: The electronic patient care record database from a North Carolina county EMS system was queried as a quality improvement analysis from January 1, 2012 to February 28, 2016. This included 19 months prior to the education intervention, the year during the education intervention, and 19 months after the education intervention. All primary patient transports with Stroke/CVA, or suspected TIA as the primary or secondary impression were included. Interfacility transports were excluded. The recorded call location was determined to either be inside or outside the PSC service area. The hospital the patient was transported to was also recorded. Results: During the pre-intervention phase 222 patients were identified, 48 of which originated in the PSC service area. Of those 48 patients, 16 bypassed the PSC (33.3%). In the post-intervention phase, 94 of 269 total patients were in PSC service area. Only 12 bypasses occurred (12.8%) which is a reduction of 61.7% in PSC bypass compared to the pre-intervention phase. Conclusion: The period following a combined hospital/EMS educational intervention showed significant reduction in PSC bypass.

scholarly journals 008 Associations between comorbidities and adverse events of antiepileptic drugs and quality of life: a survey of epilepsy patients in australia

2019 ◽  
Vol 90 (e7) ◽  
pp. A3.2-A3
Author(s):  
Jeremy M Welton ◽  
Christine Walker ◽  
Kate Riney ◽  
Alvin Ng ◽  
Lisa M Todd ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adverse Events ◽  
Antiepileptic Drugs ◽  
List Type ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Stepwise Selection ◽  
Memory Problems ◽  
The Impact

IntroductionThis study explored the impact of specific types of comorbidities and adverse events (AEs) from antiepileptic drugs (AEDs) on quality of life (QoL) among adult patients with epilepsy (PwE) in Australia.MethodsCross-sectional surveys were completed by PwE, or caregiver proxies, recruited via the online pharmacy application MedAdvisor and Australian PwE Facebook groups from May–August 2018 Data were collected on demographics, epilepsy severity and management, AEs, comorbidities, and QoL (using QOLIE-10-P total score).1 Multiple linear regression models were constructed to explore associations between AEs or comorbidities and QOLIE-10-P, with possible confounders determined using stepwise selection.Results978 responses were included (mean age 44.5 years, 64% female, 52% employed). 97% reported recent AED use, 47% on AED monotherapy, 35% exposed to ≤2 lifetime AEDs, and 55% seizure-free for >1 year. After stepwise selection, control variables included in both models were: time since diagnosis, employment status, seizure frequency, number of currently prescribed AEDs, and number of general practitioner visits per year. In the model for comorbidities, ‘psychiatric disorders’ was associated with the largest QOLIE-10-P decrease (-23.30, p<0.001). In the model for AEs, which additionally controlled for depression and anxiety disorder, ‘memory problems’ was associated with the largest decrease in QOLIE-10-P (-14.27, p<0.001).ConclusionsIn this survey of Australian PwE, of which many had relatively well-controlled epilepsy, psychiatric and memory problems were common and associated with the greatest detrimental impact on QoL. Further research is needed to understand causality, relationships between possibly interrelated or overlapping symptoms, and management strategies. UCB Pharma-sponsored.ReferenceCramer JA, Perrine K, Devinsky O, Meador K. A brief questionnaire to screen for quality of life in epilepsy: The QOLIE-10. Epilepsia 1996;37:577–582.

scholarly journals Impact of a Pharmacist-Driven Protocol to Improve Drug Allergy Documentation at a University Hospital

2013 ◽  
Vol 48 (4) ◽  
pp. 302-307 ◽  
Author(s):  
Christopher Burrell ◽  
Candy Tsourounis ◽  
David Quan ◽  
Vicki Jue ◽  
Eunice Tam ◽  
...  
Keyword(s):  
Drug Allergy ◽  
Age Groups ◽  
Substantial Improvement ◽  
University Hospital ◽  
Order Entry ◽  
Post Intervention ◽  
Pediatric Services ◽  
Physician Order Entry ◽  
The Impact

Background An internal evaluation of the inpatient pharmacy order entry database ( WORx) at a university hospital revealed that the nature of the reaction was documented for only 47% of patients with reported drug allergies/intolerance. Insufficient documentation of drug allergy/intolerance may result in administration of drugs that should not be prescribed. Similarly, valuable agents that should be used may not be prescribed due to an unnecessary fear of adverse drug reaction. More complete description of drug allergy/intolerance may result in more correct prescribing of medications. Objective Evaluate the impact of a pharmacist-driven protocol on the quality of drug allergy/intolerance documentation. Methods Four pre-intervention evaluations were conducted every 2 weeks documenting the completeness of drug allergy/intolerance information in the pharmacy order entry database. One week following the implementation of a pharmacist-driven protocol intended to improve the completeness of drug allergy/intolerance information, a series of 4 postintervention evaluations was repeated. Proportional analysis of pre- and postinterventional data was performed to evaluate the effectiveness of the intervention. Results A total of 1,686 allergies from 2,174 patients were reviewed pre and post intervention. The frequency of complete drug allergy/intolerance documentation pre intervention was 52% to 62%. Following implementation of the hospitalwide, pharmacist-driven protocol, this rate increased to 60% to 76%. Pediatric services demonstrated the most substantial improvement, increasing from 53% to 79% to 67% to 93%. Blank reaction fields decreased by 10% in both age groups. Conclusion A pharmacy-driven initiative intended to improve the completeness of drug allergy/intolerance documentation was associated with modest success. Other mechanisms, including electronic health record systems with computerized physician order entry and decision support, are needed to improve the completeness of drug allergy/intolerance information.

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