EP.FRI.178 Audit of rejected radiological referrals at Ninewells Hospital, Dundee: Reasons and outcomes

Background Rejected radiology requests in emergency-settings can be time-consuming for clinical and radiological staff; and can delay or even affect patient management plans and outcomes. Inappropriate or duplicate radiological requests additionally can be resource-wasting (according to data from Fairfield Independent Hospital, BUPA, St. Helen’s) - the approximate costs / scan are £160 for Ultrasound, £450-£675 for CT, £350- £525 for MRI. Methods Results Commonest reasons for rejection: Conclusions

515 Patient Satisfaction on Drainless Outpatient Parotidectomy

Background Parotidectomy is commonly performed as an inpatient procedure due to drain insertion. However recent evidence suggests that drainless outpatient parotidectomy is a safe option with comparable postoperative complication and hospital readmission rates to inpatient parotidectomies. Aim Patient satisfaction on outpatient parotidectomy is unclear and this study aims to report patients’ perspective and satisfaction on drainless outpatient parotidectomy. Method Anonymous ‘Core questionnaire for the assessment of Patient Satisfaction’ (COPS) for general Day care (COPS-D) questionnaire survey was completed by patients who underwent drainless same day parotidectomy at Ninewells Hospital, Dundee from June 2018 to October 2020. Patient satisfaction on different aspects of their outpatient parotidectomy journey (e.g., pre-admission, admission on ward, in-theatre experience, nursing care, pain control and overall satisfaction) were scored using a five-point Likert scale. Results A total of 31 drainless outpatient parotidectomies were performed and 28 patients completed the patient satisfaction survey. The majority of patients were highly satisfied (i.e., scored 5/5) with their preadmission visit (79.5%), admission on the ward (84.5%), operating room experience (96.4%), nursing care (83.9%), medical care (87.5%), information received (75.0%), autonomy (79.8%) and discharge and after care (61.9%). Despite preferring drainless parotidectomy, 16/28 (57.1%) patients either stayed for less than 23 hours or preferred to stay overnight stay in the hospital for non-surgical reasons. Conclusions Outpatient parotidectomy is well received by patients and the majority of patients preferred drainless parotidectomy over inpatient parotidectomy with drains.

Improving accessebility to psychiatry in NHS Tayside

AimsOur aim is to improve the accessibility of Psychiatry to other specialties when being contacted for review and advice, both in hours and out of hours.BackgroundFrom clinical contact and informal conversations, other specialties sometimes have difficulties contacting psychiatry for advice/review. The aim of this is quality improvement project is to determine how accessible we are to other specialties and work on improving how we communicate with the general hospital.MethodWe created a questionnaire for colleagues from other specialties to fill in from 26/9/19 for 6 weeks. We gathered information regarding their grade, work site, previous contact with psychiatry, whether they knew where to find our contact information and if they could identify the correct method to ask for advice from general adult psychiatry (GAP), Psychiatry of old age (POA) , and out of hours psychiatry (OOH). We also asked colleagues to put in free text comments regarding their experience in contacting psychiatry. We also asked if our colleagues were aware of how to perform an Emergency Detention Certificate as this is advice we sometimes give which does not always need our input immediately.ResultThere was a total of 39 responses, 29 from Ninewells Hospital (NW) and 10 from Perth Royal Infirmary (PRI). There was a mixture of staff grades from Foundation Doctors to Consultants. 23/39 colleagues knew where to find contact information for Psychiatry, 14/39 colleagues correctly answered how to contact GAP (Phone), 15/39 colleagues correctly answered how to contact POA (Email), 15/39 colleagues correctly identified who to contact OOH, and 16/34 colleagues who could do emergency detentions (FY2+) knew how to do one. Free text comments often referred back to the difficulty of finding the right grade of staff first try, Feedback from PRI where there was no dedicated Liaison Service and relies on a duty doctor system was less positive, with terms ‘tricky’, ‘difficulty’, ‘awkward’ used in majority of responses.ConclusionFrom our results we can conclude that contacting Psychiatry in NHS Tayside can be confusing for other specialties. Taking this forward, we will utilize the ‘referral finder’ system in NHS Tayside and review the existing information available, and to update the contact information for our subspecialties to make contact ourselves more streamlined and accessible. We will also review appropriate clinical protocols that we can link to our page on referral finder to help save time for our colleagues as well.

Does a multidisciplinary approach have a beneficial effect on the development of a structured patient handover process between acute surgical wards in one of Scotland’s largest teaching hospitals?

BackgroundEffective handover is key in preventing harm. 1 In the Acute Surgical Receiving Unit of Ninewells Hospital, Dundee, large numbers of patients are transferred daily. However, lack of medical handover during transfer means important tasks are missed. Our aim was to understand and reflect on the current system and test changes to improve medical handover.AimOur aim was to ensure that 95% of patients being transferred from the Acute Surgical Receiving Unit receive a basic medical handover within 2 months.MethodsInitially, we collated issues that were missed when patients were transferred. These data coupled with questionnaire data from members of the team fed into the creation of a handover tool. We proposed to link our tool with the nursing handover, hence creating one unified handover tool. We completed six full Plan-Do-Study-Act (PDSA) cycles (two on communication to aide handover and four on the tool itself) to assess and develop our tool.ResultsBy our final PDSA cycle, 84% (33/39) of the patients had a handover, meaning no tasks were missed during transfer. After 4 months, 9 out of 10 staff felt that the introduction of the handover sheet made the handover process smoother and 8 out of 10 felt that the handover sheet improved patient safety and quality of care.ConclusionsImproving handover can be challenging. However, we have shown that a relatively simple intervention can help promote better practice. Challenges are still present as uptake was only 84%, so work still has to be done to improve this. A wider cultural change involving communication and education would be required to implement this tool more widely.

Secure provision of unconsented radiological imaging for research

ABSTRACT Objectives Design and implement an architecture for managing unconsented DICOM imaging Maintain sufficient data to define research cohorts when data quality is unknown Perform project-level linkage and extraction into a Safe Haven (SH) environment Extract large image volumes for multiple projects with limited storage constraints Provide applications for an imaging research workflow within the SH environment Serve as a prototype for the Farr/NHS Scotland project to create a research dataset from Scotland’s national PACS ApproachThe software architecture builds on the Research Data Management Platform (RDMP) developed at Dundee’s Health Informatics Centre (HIC) within Farr@Dundee. The RDMP provides core services common to loading any dataset, with configuration and extensibility points for dataset-specific implementations. This architecture augments the RDMP with scalable micro-services performing peripheral functions. Images are sourced from the local PACS server in Ninewells Hospital and cached securely within HIC using an implementation for the RDMP with a custom server to query/retrieve data. Data stored in the catalogue should be anonymous, according to the Scottish SH model. The imaging dataset is poorly understood, with several potentially identifiable free-text fields which may contain information required for defining suitable research cohorts. The load process only permits verified metadata fields into the anonymised catalogue; a Mongo database stores other data for later analysis, should a field subsequently be required for cohort definition. A DICOM extraction implementation is provided, using DICOM Confidential for anonymisation and a project-specific remapping of DICOM GUIDs. Two provisioning methods have been designed. A basic copy when sufficient storage is available, and a more sophisticated method using a custom filesystem to provide separate project-specific views onto shared image files. ResultsA full end-to-end solution has been developed, from initial caching through to provisioning anonymised images. Two imaging cohorts have been loaded, one with over 5000 studies. NHS Tayside CT and MR data since 2008 is currently being loaded. Two projects have had anonymised extracts released using the ‘copy’ method. The custom filesystem method has been developed and tested with limited amounts of data. This work has highlighted anonymisation, cohort creation and SH issues which require further exploration. ConclusionA production system for securely providing linked DICOM imaging to researchers has been implemented, serving as a testbed for a national system which will provide a unique population-level resource for researchers.