A picture of health: determining the core population served by an urban NHS hospital trust and understanding the key health needs

Background NHS hospitals do not have clearly defined geographic populations to whom they provide care, with patients able to attend any hospital. Identifying a core population for a hospital trust, particularly those in urban areas where there are multiple providers and high population churn, is essential to understanding local key health needs especially given the move to integrated care systems. This can enable effective planning and delivery of preventive interventions and community engagement, rather than simply treating those presenting to services. In this article we describe a practical method for identifying a hospital’s catchment population based on where potential patients are most likely to reside, and describe that population’s size, demographic and social profile, and the key health needs. Methods A 30% proportional flow method was used to identify a catchment population using an acute hospital trust in West London as an example. Records of all hospital attendances between 1st April 2017 and 31st March 2018 were analysed using Hospital Episode Statistics. Any Lower Layer Super Output Areas where 30% or more of residents who attended any hospital for care did so at the example trust were assigned to the catchment area. Publicly available local and national datasets were then applied to identify and describe the population’s key health needs. Results A catchment comprising 617,709 people, of an equal gender-split (50.4% male) and predominantly working age (15 to 64 years) population was identified. Thirty nine point six percent of residents identified as being from Black and Minority Ethnic (BAME) groups, a similar proportion that reported being born abroad, with over 85 languages spoken. Health indicators were estimated, including: a healthy life expectancy difference of over twenty years; bowel cancer screening coverage of 48.8%; chlamydia diagnosis rates of 2,136 per 100,000; prevalence of visible dental decay among five-year-olds of 27.9%. Conclusions We define a blueprint by which a catchment can be defined for a hospital trust and demonstrate the value a hospital-view of the local population could provide in understanding local health needs and enabling population-level health improvement interventions. While an individual approach allows tailoring to local context and need, there could be an efficiency saving were such public health information made routinely and regularly available for every NHS hospital.

IT Evaluation of Foundation Healthcare Group Vanguard Project

The aim of the Foundation Healthcare Group (FHG) Vanguard model was to develop a sustainable local hospital model between two National Health Service (NHS) Trusts (a London Teaching Hospital Trust and a District General Hospital Trust) that makes best use of scarce resources and can be replicated across the NHS, UK. The aim of this study was to evaluate the provision, use and implementation of the IT infrastructure; based on qualitative interviews and focused mainly on the perspectives of the IT staff and the clinicians’ perspectives. In total 24 interview transcripts, along with ‘Acute Care Collaboration’ questionnaire responses, were analysed using a thematic framework for IT infrastructure, sharing themes across the vascular, paediatric and cardiovascular strands of the FHG programme. Findings indicated that Skype for Business had been an innovative and helpful development widely available to be used between the two Trusts. Clinicians initially reported lack of IT support and infrastructure expected at the outset for a national Vanguard project, but later appreciated that remote access to most clinical applications between the two Trusts became operational. The Local Care Record (LCR), an IT project was perceived to have been delivered successfully in South London. Shared technology reduced patient travelling time by providing locally based shared care. Spreading and scaling-up innovations from the Vanguard sites was the aspiration and challenge for system leaders.

527 Selective Approach to Gallbladder Histopathological Examination Following Cholecystectomy. Would Incidental Gallbladder Cancers Be Missed?

Background The incidental finding of gallbladder carcinoma on histopathological examination following cholecystectomy is rare and thus, a selective approach should be evaluated as it could be more cost-efficient. The primary aim of this retrospective study was to assess the incidence of gallbladder cancer in a single hospital trust. The secondary aim was to evaluate the predictive value of macroscopic changes. Method A retrospective analysis of all cholecystectomies performed at a hospital trust between November 2017-November 2019. Discharge notes, operation notes, histopathology reports were evaluated. Results In total, 966 patients were included. All gallbladder specimens had been sent for histopathological examination. The histology was normal in 21 patients (2.1%) and inflammatory changes reported in 930 cases (96.3%). Gallbladder dysplasia was found in 14 specimens (1.5%) and macroscopic abnormalities were seen in 11 of those. One case (0.1%) was reported as incidental gallbladder carcinoma and macroscopic abnormalities were observed intra-operatively. Conclusions Gallbladder carcinoma detected incidentally after cholecystectomy is rare. Gallbladder dysplasia and cancer are associated with macroscopic abnormalities and thus selective approach could potentially replace routine histopathological examination - provided all gallbladders are dissected and inspected at the time of surgery.

163 Audit cycle on the formal introduction of a standardised orthopaedic trauma patients’ admission pro-forma: the first Italian experience

An internationally recognised issue of general district hospitals is the accuracy and completeness of the admission documentation, particularly in a trauma setting. We built and formally introduced a Hospital Trust Wide admission pro-forma for orthopaedic trauma patients. An Audit looking into the quality and completeness of the admission documentation for orthopaedic trauma patients was carried out at a single Hospital Trust in December 2017. This was followed by a second round Audit with formal implementation of our new clerking pro-forma. Compliance was 94% overall. The documentation was incomplete in 7% of the cases. Delays of patients’ treatment caused by lack of documentation or written plan/instructions was recorded in only 3% of the cases. Satisfaction questionnaire: excellent 55%, good 42%, fair 7%, poor 1%. The pro-forma provides all relevant information needed to fully assess orthopaedic trauma patients and plan the appropriate management. His utilisation facilitates completeness of documentation with a standardised approach. This is a unique work on the introduction of a standardised clerking pro-forma for the admission of orthopaedic trauma patients with excellent results in terms of compliance and improvement of patients’ care. Our study seems to be a quality improvement intervention with potentials of becoming a milestone for further improvements.

A Qualitative Study Exploring the Barriers and Facilitators Associated with the Implementation of a Closed Loop Medication System in a UK Hospital Trust

Introduction Implementation of novel digital technologies into complex hospital systems, particularly within the United Kingdom’s (UKs) National Health Service, is challenging and can result in delays to the use and evaluation of innovative systems. MedEye is a bedside tool for preventing medication administration errors used as part of a closed-loop medication administration system. Aim The aim of this study was to understand the barriers and facilitators associated with implementing MedEye for the first time in a large UK Teaching Hospital Trust. Methods We used a case study approach and conducted semi-structured interviews (n=9) with key members of the project implementation team from Pharmacy (n=3), Nursing (n=2), commercial system provider(n=2), IT (n=1) and academia (n=1) and 20 hours of field observations. We explored stakeholder’s experiences about the implementation process, barriers and facilitators and any key lessons learnt according to constructs from Sittig and Singh’s Eight Dimension Sociotechnical Model.1 We analysed the data from interviews and observations using the framework approach.2 We firstly familiarised ourselves with the data, coded interviews, guided by our analytical framework, charted and then interpreted the data. All necessary ethical and organisational approvals were obtained. Results We identified themes relating to eight sociotechnical domains. Clinical Content: the format of the medication library and process for ordering medications were different to other European sites that had implemented MedEye, posing challenges for developers. Hardware and Software Computing Infrastructure: the integration of MedEye with the electronic prescribing system was one of the “biggest challenges”(P2) and contributed to delays. Human Computer Interface: the MedEye system’s user interface was described as “clean, simple and easy to use”(P2).People: nurses and senior management “absolutely wanted this [project] to work”(P1).Communication and Workflow: it was sometimes difficult to communicate effectively because the IT team had their own “set of jargon which is very technical” and the clinical team used “lots of medical jargon”(P2), resulting in misunderstandings. Internal Organisational Policies, Procedures and Culture: the hospital recognised the potential safety benefits of MedEye. However, its implementation was different to other IT products, which would “have actually gone through the development cycle”(P7).External Rules, Regulations and Pressures: the IT and informatics team’s resources were stretched with multiple projects been implemented simultaneously. System Measurement and Monitoring: the project team conducted “a lot of testing”(P3), to refine the technology. Conclusions This study sought to understand the sociotechnical challenges when implementing a novel digital technology in a UK hospital and identified themes related to eight domains. We acknowledge that our study had a few limitations: we interviewed a small number of participants who were directly involved in the implementation process, and the study was conducted in one hospital Trust, limiting the generalisability of the findings. However, use of the eight-domain sociotechnical framework strengthened our study, allowing us to derive the specific facilitators and barriers to the implementation and deployment process. This study also emphasises the importance of working closely with IT managers who can coordinate work within an organisation to anticipate delays and mitigate against project risks. References 1. Sittig, D.F. and H. Singh, A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality & safety in health care, 2010. 19 Suppl 3(Suppl 3): p. i68-i74. 2. Pope, C., S. Ziebland, and N. Mays, Qualitative research in health care. Analysing qualitative data. BMJ (Clinical research ed.), 2000. 320(7227): p. 114–116.