The Relationship between Kitwood's Model of Needs and a Student's Music Therapy Practice in an Acute Assessment Unit for People Living with Dementia and Mental Health Issues

<p>This study focused on reviewing a student's music therapy practice at an acute assessment unit for people living with dementia and mental health issues, finding links between the placement philosophy, and new ideas about practice. Kitwood's (1997) book on personhood and the needs of people who are living with dementia and other mental health issues appeared to resonate with the student music therapists' practice. This was supported by the active use of his model of needs by nursing staff at the placement. Investigations looked specifically at Kitwood's model of needs; how music therapy links with his philosophy and how interventions during practice connected to those needs. The data was draw from descriptive clinical notes using secondary analysis. The rich qualitative data was analysed using deductive and inductive methods. Findings are presented under Kitwood's model of needs, forming the five categories for the study. The main themes within these categories were then summarised and explanations given under both Kitwood's model of needs and music therapy interventions used to meet them. Though the findings are qualitative, specific to this study and not necessarily generalisable, several links within music therapy practice, and nursing practice revealed the importance and need for more person-centred individualised care programmes for patients in mental health settings.</p>

P-EGS09 The Introduction of an Ambulatory Surgical Pathway

Background Since the publication of the Emergency General Surgery Commissioning Guide by ASGBI in 2014, there has been a drive to develop ambulatory pathways for acute surgical patients, saving inpatient stays and reducing the risk of hospital-acquired infections. Many units, like ours, had a large workload increased by seeing next day returns as well as acute presentations. In October 2020 an Institute of Emergency General Surgery was formed who developed an ambulatory pathway to ameliorate some of these issues and provide a point of contact for primary care referrals, for one the busiest emergency general surgical takes in the UK. Methods A retrospective analysis was undertaken to identify all acute referrals to general surgery over a 14-day period in February 2019 prior to (Pre-ASC) and 2021 after (Post-ASC) the introduction of an Ambulatory Surgical Clinic (ASC). All patient episodes were reviewed, and descriptive statistics on overall attendance to the surgical assessment unit (SAU), admissions to inpatient wards and referrals to ASC were analysed. Patients presenting to the acute urology take were used as a control to compare the number patients attending the surgical assessment unit both before and during the COVID-19 pandemic. Results 830 patients presented over the 28-day study period (426 pre-ACS vs 404 post-ACS; 5% reduction), totalling 992 patient encounters including planned returns (525 vs 467; 11% reduction). After the introduction of the ASC total attendance to SAU was reduced by 42% (525 vs 306); next day return attendances were reduced by 87% (99 vs 13) and attendances from primary care were reduced by 68% (208 vs 67). The proportion of patients admitted was similar (46% vs 50%). 146 patients attended the ASC, and 15 patients received telephone advice alone. The control group saw attendance increase by 25% (178 vs 223). Conclusions The results clearly show that the introduction of the ASC has decreased attendance to SAU, freeing clinicians to dedicate more time to those acutely unwell. The similar proportion of admissions after the introduction of the ASC suggests that the ambulatory pathway correctly identifies those who are well enough to be managed as outpatients. The increased attendance in the control group suggests that the data were not the results of a decrease in referrals due to COVID-19. The results shared here should encourage other large units to consider developing ambulatory pathways.

Reactivation of IgA vasculitis following COVID-19 vaccination

A 23-year-old man presented to the acute assessment unit with acute-onset haematuria within 24 hours of receiving his second dose of the Pfizer-BioNTech COVID-19 vaccine. He had been diagnosed with IgA vasculitis 8 months previously. IgA vasculitis is an autoimmune condition characterised by palpable purpura affecting the lower limbs, abdominal pain, arthralgia and renal disease. He was diagnosed with an acute exacerbation of IgA vasculitis and was discharged with oral prednisolone. Reactivation or first presentation of IgA vasculitis is a rare but increasingly recognised complication of COVID-19 vaccination. This is an important new differential in the assessment of patients with haematuria following COVID-19 vaccination.

EP.WE.485An Audit to Investigate the Incidence of Face-to-Face Patient Review by GPs Prior to Referral to Surgical Assessment Unit

Aims Since COVID-19, GP’s have been encouraged to do fewer face-to-face consultations to prevent unnecessary patient contact1. Anecdotally, this initially resulted in many patients being referred to SAU who had not been seen by a GP, and then being discharged back to the community the same day, causing potentially increased risk of contracting COVID-19 through hospital attendance. The aim of this audit was to investigate the incidence of patients referred to SAU not seen by a GP and discharged the same day. Methods GP referrals were identified over a 7 day period through the surgical take electronic system Aramis©. The case notes and GP documentation were reviewed to identify whether a face-to-face GP consultation occurred, and then whether the patient was admitted to SAU or discharged the same day. Results During a 7 day period, there were 24 (n = 24) GP referrals of which only 3 (12.5%) were not seen by the GP, all of whom were admitted for at least one night. However, of the patients referred and seen by GP, 7 (29%) were discharged the same day. Conclusions This demonstrates that during this 7-day period, there was no incidence of inappropriate GP referral to SAU of patients not seen by a GP, and the majority of GP referrals warranted admission. This suggests that in most cases, GPs are avoiding unnecessary emergency surgical referrals and attempt to review patients face-to-face prior to referral, thus reducing patient risk of contact with COVID-19 in the hospital setting.

EP.TH.289Diagnosis of the aetiology of acute pancreatitis at a district Hospital: A retrospective audit

Introduction The correct diagnosis of acute pancreatitis should be made in all patients within 48 hours of admission. According to recently published NICE (NG 147) guidelines for diagnosis of aetiology of acute pancreatitis should be determined in at least 80% of cases and no more than 20% should be classified as idiopathic. We aim to overview our current practice compared to guidelines. Early identification of aetiology is essential. Materials and Methods Patients diagnosed to have pancreatitis presenting to surgical assessment unit from March 1st 2019 to December 31st 2019. Sample size audited 291. The diagnosis of acute pancreatitis is made with a combination of history, physical examination and laboratory evaluation. Further investigations were done for the ethology. These patients were identified from their discharge information. They had raised amylase along with history suggestive of pancreatitis and were analysed retrospectively. Results Of all the pancreatitis patients admitted in SAU, 88 (30%) were due to biliary, 40 (16%) alcohol related, 20 (7%) other causes whereas 134 (46%) were classified as idiopathic. 3 patients self-discharged. Conclusion In our trust it seems that aetiology of acute pancreatitis is not adequately investigated. Most of other blood investigations were not performed in index admission and relevant drug history was not elicited. This failure of non-identification of gallstones could be attributed to operator dependant and they didn’t have second USS as advised. We formulated an action plan with detailed history with adequate step wise investigations which will benefit the patients.

EP.FRI.271 The impact of Surgical Assessment Unit on emergency and ambulatory surgical care in a district general hospital

Aims There has been a paradigm shift in the delivery of emergency and ambulatory surgical care necessitated by paucity of beds, improved expedited diagnostics and delayed transit in Emergency departments. The objective of a surgical assessment unit (SAU) is to reduce the number of semi-urgent admissions, provide direct access to urgent surgical admissions bypassing the ED, expeditious assessment by senior clinicians and to reduce the number of OPD follow up. In our setting, the SAU came into existence on all 5 working days at 12-hour daily schedule and its impact was evaluated retrospectively. Methods Prospectively maintained data base over a 2-month period was examined. Pre and post SAU figures were compared to judge any quantitative improvement in surgical services. Results During the audit period of 2 months there were 156 emergency patients and 190 ward attenders for follow up care. Majority of these patients were assessed within 4 hours and discharged or ambulated. Numbers being admitted overnight purely to facilitate investigations showed a decrease of 44.6% post SAU establishment. There was a reduction in post discharge outpatients appointments when compared to a similar time period pre SAU (14% difference). Conclusion The SAU, although initially conceived and designed purely to cope with increased admissions and to minimise breaching of emergency department targets, has shown quantitative and qualitative improvement in emergency and ambulatory surgical care delivery.

SP3.1.10 Surgical Emergency Assessment Unit and Emergency Surgeon of the Week’ : A Paradigm shift to providing Emergency Surgical Care

Aims Ever increasing number of A&E attendance and admissions cause immense strain on hospital beds with drainage of our finite health resources. This prompted the need for implementation and review of alternative schemes: Surgical Emergency Assessment Unit (SEAU) and ‘Emergency Surgeon of the Week’ (ESW) and its impact on our depleted health system. Patients and Method Retrospective analysis of a prospectively collected data from SEAU activity logs, patient information center and friends and family questionnaire following implementation of SEAU (November 2014) and ESW (November 2017) in a large DGH.SEAU operates on a five day policy (Monday – Friday, 0800-2000) aided by dedicated imaging pathway and ESW works on a 1:5 (Monday – Thursday, 0800-1800) rota with full complement of the surgical team. Results SEAU has attended to 16057 patients (New 9811; Follow Up 6246) from November 2014-October 2019. Emergency general surgical admission pre and post SEAU implementation was 309* and 202*/month respectively, a drop of 35% with a further reduction after introduction of ESW by another 24% to 153*/month. Thus, a total reduction of emergency admission by almost 60%. Stay in SEAU was 4* hours and re-admission rate was 6%. SEAU received 98% friends and family recommendation to others. Conclusions A paradigm shift in providing emergency surgical care is required in the face of a strained health care system; the positive outcome achieved after implementation of SEAU and ESW could be the answer to relieving bed capacity and financial pressures, possibly a solution to providing high quality and safe patient care.

Early pregnancy problems

This chapter covers the role of the early pregnancy assessment unit, the care of women with bleeding or pain in early pregnancy, the definition, causes, assessment, and treatments for miscarriage, as well as caring for the patient who experiences recurrent miscarriage. The diagnosis, assessment, and both medical and surgical management of ectopic pregnancy is explained. Nausea, vomiting, hyperemesis gravidarum, and psychological care in early pregnancy are also all covered.

EP.TH.507An Audit of Consent Documentation and Chaperone Use in Patients Presenting to Acute Settings with Breast Complaints

Aim To compare current practice of documenting consent and offering chaperones when performing breast examinations in the acute setting, with standards set by regulatory bodies (General Medical Council, Royal College of Emergency Medicine and Royal College of Surgeons). Method Data was collected retrospectively from all patients presenting with breast complaints to either the emergency department (ED) or the surgical assessment unit (SAU) over a 34-month period. From the clerk-in notes, the role (Dr/Nurse), grade (FY1 to consultant) and gender of the examiner was noted, as well as whether consent was documented and if a chaperone was offered. Results Of the 64 patients presenting in this time frame, consent was documented in 7 sets of notes (11%). Furthermore, 17 were offered a chaperone (27%), of which examiners correctly documented the name and role of the chaperone on 11 occasions. Results also demonstrated that ED trainees were most likely to offer a chaperone and GP trainees were the best at recording consent. It also revealed that although male examiners offered a chaperone 50% of the time compared to 6% of female examiners, women examiners were better at documenting consent when compared to their male counterparts. Conclusion The audit results indicate that there is significant room for improvement across all roles, grades and genders with regards to documentation of consent and the use of chaperones within the acute setting, in order to meet current standards of practice as set out by regulatory bodies.