107 Improving Frailty Screening and Accuracy in the Emergency Department (Ed) of A Busy District General Hospital

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
H Dowell ◽  
R Mallinson ◽  
D Cartmell ◽  
K Mellstrom ◽  
G Pettigrew ◽  
...  
Keyword(s):  
Nursing Staff ◽  
Screening Tool ◽  
Early Recognition ◽  
District General Hospital ◽  
Accurate Estimation ◽  
Electronic Screening ◽  
Teaching Interventions ◽  
Screening Frequency ◽  
Routine Assessment ◽  
Routine Measure

Abstract Background Over 20,000 75+ years attendances annually in ED with frailty screening in introduced in ED in 2016. Early recognition of frailty is recommended. Accurate estimation of frailty level is important as it contributes to clinical pathway and management. Introduction Screening rates had fallen and there were concerns about the accuracy.. Our aim was increased frequency and accuracy of screening at triage. Method Frailty screening rates for patients aged 75+ years attending the ED (routine measure) reviewed with ED Frailty Lead. Stakeholder engagement with ED staff and Frailty and Interface Team (FIT). Frailty screening tool revised. Data review March 2020 focused on CFS accuracy (CFS at triage v CFS by FIT in routine assessment). Sampling approach to CFS accuracy during June 2020. Interventions Small group sessions with ED nursing staff (Jan 2020). Revised electronic screening tool introduced (February 2020). Education sessions (x2) for ED nursing staff (June 2020) focused on CFS. Results Frailty screening increased significantly following revised screening tool introduction from 60% to >80%. In March 2020 agreement of CFS at triage and FIT review in 22% (76/341). The CFS reliability for 10 consecutive patients per day was measured in June 2020 before and following 2 education sessions held on CFS. The reliability of CFS was 0.23 prior to teaching in June and rose to an average of 0.31 following the teaching intervention. Conclusions Frailty screening frequency and the reliability of the CFS improved following teaching interventions but remains low. Work is continuing to focus on improving this further. Although CFS has been found to be reliable between raters in other hospitals we have found this difficult to replicate. It is not known if this is due to local factors or to more common challenges that others may face in CFS estimation by ED staff.

scholarly journals A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital

2010 ◽  
Vol 104 (5) ◽  
pp. 751-756 ◽  
Author(s):  
Konstantinos Gerasimidis ◽  
Orla Keane ◽  
Isobel Macleod ◽  
Diana M. Flynn ◽  
Charlotte M. Wright
Keyword(s):  
High Risk ◽  
General Hospital ◽  
Nursing Staff ◽  
Screening Tool ◽  
Nutritional Assessment ◽  
District General Hospital ◽  
Screening Tools ◽  
Lower Sensitivity ◽  
Tertiary Referral Hospital ◽  
Rater Reliability

Paediatric in-patients are at high risk of malnutrition but validated paediatric screening tools suitable for use by nursing staff are scarce. The present study aimed to assess the diagnostic accuracy of the new Paediatric Yorkhill Malnutrition Score (PYMS). During a pilot introduction in a tertiary referral hospital and a district general hospital, two research dietitians assessed the validity of the PYMS by comparing the nursing screening outcome with a full dietetic assessment, anthropometry and body composition measurements. An additional PYMS form was completed by the research dietitians to assess its inter-rater reliability with the nursing staff and for comparison with the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the Paediatric Subjective Global Nutritional Assessment (SGNA). Of the 247 children studied, the nurse-rated PYMS identified 59 % of those rated at high risk by full dietetic assessment. Of those rated at high risk by the nursing PYMS, 47 % were confirmed as high risk on full assessment. The PYMS showed moderate agreement with the full assessment (κ = 0·46) and inter-rater reliability (κ = 0·53) with the research dietitians. Children who screened as high risk for malnutrition had significantly lower lean mass index than those at moderate or low risk, but no difference in fat. When completed by the research dietitians, the PYMS showed similar sensitivity to the STAMP, but a higher positive predictive value. The SGNA had higher specificity than the PYMS but much lower sensitivity. The PYMS screening tool is an acceptable screening tool for identifying children at risk of malnutrition without producing unmanageable numbers of false-positive cases.

scholarly journals Operating Rooms efficiency: leveraging data to improve management of elective surgery

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Quercioli ◽  
G A Carta ◽  
G Cevenini ◽  
G Messina ◽  
N Nante ◽  
...  
Keyword(s):  
Historical Data ◽  
Elective Surgery ◽  
District General Hospital ◽  
Operating Rooms ◽  
Accurate Estimation ◽  
Surgical Time ◽  
Accurate Analysis ◽  
Management Efficiency ◽  
Scheduling Model ◽  
The Mean

Abstract Background Careful scheduling of elective surgery Operating Rooms (ORs) is crucial for their efficient use, to avoid low/over utilization and staff overtime. Accurate estimation of procedures duration is essential to improve ORs scheduling. Therefore analysis of historical data about surgical times is fundamental to ORs management. We analyzed the effect, in a real setting, of an ORs scheduling model based on estimated optimum surgical time in improving ORs efficiency and decreasing the risk of overtime. Methods We studied all the 2014-2019 elective surgery sessions (3,758 sessions, 12,449 interventions) of a district general hospital in Siena's Province, Italy. The hospital had3 ORs open 5 days/week 08:00-14:00. Surgery specialties were general surgery, orthopedics, gynecology and urology. Based on a pilot study conducted in 2016, which estimated a 5 times greater risk of having an OR overtime for sessions with a surgical time (incision-suture)>200 minutes, from 2017 all the ORs were scheduled using a maximum surgical time of 200 minutes calculated summing the mean surgical times for intervention and surgeon (obtained from 2014-2016 data). We carried out multivariate logistic regression to calculate the probability of ORs overtime (of 15 and 30 minutes) for the periods 2014-2016 and 2017-2019adjusting for raw ORs utilization. Results The 2017-2019 risk of an OR overtime of 15 minutes decreased by 25% compared to the 2014-2016 period (OR = 0.75, 95%CI=0.618-0.902, p = 0.003); the risk of a OR overtime of 30 minutes decreased by 33% (OR = 0.67, 95%CI= 0.543-0.831, p < 0.001). Mean raw OR utilization increase from 62% to 66% (p < 0.001). Mean number of interventions per surgery sessions increased from 3.1 to 3.5 (p < 0.001). Conclusions This study has shown that an analysis of historical data and an estimate of the optimal surgical time per surgical session could be helpful to avoid both a low and excessive use of the ORs and therefore to increase the efficiency of the ORs. Key messages An accurate analysis of surgical procedures duration is crucial to optimize operating room utilization. A data-based approach can improve OR management efficiency without extra resources.

scholarly journals Communications and Screening for 2019 Novel Coronavirus at a Tertiary-Care Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s84-s84
Author(s):  
Lorinda Sheeler ◽  
Mary Kukla ◽  
Oluchi Abosi ◽  
Holly Meacham ◽  
Stephanie Holley ◽  
...  
Keyword(s):  
Screening Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The United States ◽  
World Health ◽  
Communication Campaign ◽  
Electronic Screening ◽  
Novel Coronavirus ◽  
The Impact

Background: In December of 2019, the World Health Organization reported a novel coronavirus (severe acute respiratory coronavirus virus 2 [SARS-CoV-2)]) causing severe respiratory illness originating in Wuhan, China. Since then, an increasing number of cases and the confirmation of human-to-human transmission has led to the need to develop a communication campaign at our institution. We describe the impact of the communication campaign on the number of calls received and describe patterns of calls during the early stages of our response to this emerging infection. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center with >200 outpatient clinics. In response to the coronavirus disease 2019 (COVID-19) outbreak, we launched a communications campaign on January 17, 2020. Initial communications included email updates to staff and a dedicated COVID-19 webpage with up-to-date information. Subsequently, we developed an electronic screening tool to guide a risk assessment during patient check in. The screening tool identifies travel to China in the past 14 days and the presence of symptoms defined as fever >37.7°C plus cough or difficulty breathing. The screening tool was activated on January 24, 2020. In addition, university staff contacted each student whose primary residence record included Hubei Province, China. Students were provided with medical contact information, signs and symptoms to monitor for, and a thermometer. Results: During the first 5 days of the campaign, 3 calls were related to COVID-19. The number of calls increased to 18 in the 5 days following the implementation of the electronic screening tool. Of the 21 calls received to date, 8 calls (38%) were generated due to the electronic travel screen, 4 calls (19%) were due to a positive coronavirus result in a multiplex respiratory panel, 4 calls (19%) were related to provider assessment only (without an electronic screening trigger), and 2 calls (10%) sought additional information following the viewing of the web-based communication campaign. Moreover, 3 calls (14%) were for people without travel history but with respiratory symptoms and contact with a person with recent travel to China. Among those reporting symptoms after travel to China, mean time since arrival to the United States was 2.7 days (range, 0–11 days). Conclusion: The COVID-19 outbreak is evolving, and providing up to date information is challenging. Implementing an electronic screening tool helped providers assess patients and direct questions to infection prevention professionals. Analyzing the types of calls received helped tailor messaging to frontline staff.Funding: NoneDisclosures: None

scholarly journals Discriminating levels of alcohol use associated with self-harm in individuals presenting to a district general hospital

2010 ◽  
Vol 34 (6) ◽  
pp. 226-230 ◽  
Author(s):  
Nicholas Holdsworth ◽  
Hugh Griffiths ◽  
David Crawford
Keyword(s):  
Alcohol Use ◽  
General Hospital ◽  
Screening Tool ◽  
District General Hospital ◽  
Alcohol Screening ◽  
Screening Tools ◽  
Psychosocial Assessment ◽  
Different Types ◽  
Self Harm ◽  
Problematic Alcohol Use

Aims and methodAlthough alcohol is reported as commonly associated with self-harm, there is nothing in the literature that bases the association on validated screening tools. We sought to discern the different types of alcohol use as discriminated by the Alcohol Use Disorders Identification Test (AUDIT). Completed AUDITs from a 2-year period were analysed, all relating to people who had presented to a district general hospital in Northumberland following self-harm.ResultsThe proportion of dependent, harmful and hazardous drinkers identified using AUDIT was many times higher than previously estimated in similar studies that had not used a validated alcohol screening tool.Clinical implicationsThe routine use of an alcohol screening tool should be part of any standard psychosocial assessment of self-harm, to guide appropriate interventions for problematic alcohol use that might otherwise be overlooked.

scholarly journals P007: A comparative analysis of qSOFA, SIRS and Early Warning Scores Criteria to identify sepsis in the prehospital setting

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S79-S80 ◽  
Author(s):  
S. AlQahtani ◽  
P. Menzies ◽  
B. Bigham ◽  
M. Welsford
Keyword(s):  
Severe Sepsis ◽  
Screening Tool ◽  
Early Recognition ◽  
Capture Rate ◽  
Data Capture ◽  
Prehospital Setting ◽  
Life Saving ◽  
Data Points ◽  
And Performance ◽  
Definition Of

Introduction: Early recognition of sepsis is key in delivering timely life-saving interventions. The role of paramedics in recognition of these patients is understudied. It is not known if the usual prehospital information gathered is sufficient for severe sepsis recognition. We sought to: 1) evaluate the paramedic medical records (PMRs) of severe sepsis patients to describe epidemiologic characteristics; 2) determine which severe sepsis recognition and prediction scores are routinely captured by paramedics; and 3) determine how these scores perform in the prehospital setting. Methods: We performed a retrospective review of patients ≥18 years who met the definition of severe sepsis in one of two urban Emergency Departments (ED) and had arrived by ambulance over an eighteen-month period. PMRs were evaluated for demographic, physiologic and clinical variables. The information was entered into a database, which auto-filled a tool that determined SIRS criteria, shock index, prehospital critical illness score, NEWS, MEWS, HEWS, MEDS and qSOFA. Descriptive statistics were calculated. Results: We enrolled 298 eligible sepsis patients: male 50.3%, mean age 73 years, and mean prehospital transportation time 30 minutes. Hospital mortality was 37.5%. PMRs captured initial: respiratory rate 88.6%, heart rate 90%, systolic blood pressure 83.2%, oxygen saturation 59%, temperature 18.7%, and Glasgow Coma Scale 89%. Although complete MEWS and HEWS data capture rate was <17%, 98% and 68% patients met the cut-point defining “critically-unwell” (MEWS ≥3) and “trigger score” (HEWS ≥5), respectively. The qSOFA criteria were completely captured in 82% of patients; however, it was positive in only 36%. It performed similarly to SIRS, which was positive in only 34% of patients. The other scores were interim in having complete data captured and performance for sepsis recognition. Conclusion: Patients transported by ambulance with severe sepsis have high mortality. Despite the variable rate of data capture, PMRs include sufficient data points to recognize prehospital severe sepsis. A validated screening tool that can be applied by paramedics is still lacking. qSOFA does not appear to be sensitive enough to be used as a prehospital screening tool for deadly sepsis, however, MEWS or HEWS may be appropriate to evaluate in a large prospective study.

scholarly journals Performance and Utilization of an Emergency Department Electronic Screening Tool for Pneumonia

2013 ◽  
Vol 173 (8) ◽  
pp. 699 ◽  
Author(s):  
Nathan C. Dean ◽  
Barbara E. Jones ◽  
Jeffrey P. Ferraro ◽  
Caroline G. Vines ◽  
Peter J. Haug
Keyword(s):  
Emergency Department ◽  
Screening Tool ◽  
Electronic Screening

The problem with gentamicin: reducing administration and prescribing errors in neonates treated for early onset infection with gentamicin

2020 ◽  
pp. edpract-2019-318546
Author(s):  
Ashifa Trivedi ◽  
Elizabeth Lek ◽  
Sadhna Sharma ◽  
Shavindra Chellen
Keyword(s):  
Quality Improvement ◽  
General Hospital ◽  
Nursing Staff ◽  
Early Onset ◽  
District General Hospital ◽  
Moderate Level ◽  
Neonatal Unit ◽  
Prescribing Errors ◽  
Intervention Period ◽  
Low Level

We describe a quality improvement (QI) project to reduce the number of administration and prescribing errors with gentamicin on a local neonatal unit in a district general hospital, from January 2017 to August 2019. Baseline data collected showed seven errors in the first 16 months of the project (from 1999 doses). The aim of this QI project was to have no low-level, moderate-level or severe level harm errors in the intervention period. A number of interventions were carried out including a change to local guidelines and teaching sessions for staff. All Datix reports for gentamicin were reviewed as well as data collected from the pharmacy team for a further 16 months. One low harm error was reported in this period (from 1938 doses). Education of the medical and nursing staff has been a key intervention in reducing our gentamicin errors as well as changing the way we prescribe gentamicin.

scholarly journals 781. Nurse-Driven Time-of-Triage Sepsis Screening Tool Improves Timely Intervention in Ambulatory Emergency Department (ED) Patients with Suspected Sepsis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S346-S347
Author(s):  
Catalina Howland ◽  
Arthur Chang ◽  
Stephen Selvanayagam ◽  
Stacy Kim ◽  
Mark Bounthavong ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Screening Tool ◽  
Early Recognition ◽  
Average Length ◽  
Primary Outcome Measure ◽  
Medical Attention ◽  
Time Interval ◽  
Antibiotic Administration ◽  
Suspected Sepsis ◽  
Sepsis Screening

Abstract Background Sepsis is a potentially life-threatening, systemic complication of infection. Rapid intervention is critical to reduce morbidity and mortality; however, early recognition of sepsis is challenging due to a highly variable and nonspecific presentation. Recognition is particularly problematic in ambulatory (walk-in) patients who receive minimal to no medical attention prior to ED presentation. There is limited literature addressing sepsis intervention among the ambulatory population in the ED. Our organization has employed an electronic, nurse-driven sepsis screening tool into the triage process for all ambulatory patients who present to the ED. Methods This was a retrospective, quasi-experimental study conducted from November 2015 to May 2018 in three consecutive timeframes: pre-implementation (12 months), implementation (7 months), and post-implementation (12 months). Adult ambulatory ED patients were included if they had a coded diagnosis of sepsis, septic shock, or an infectious syndrome, had fever or hypothermia and systemic inflammatory response syndrome signs on presentation. The primary outcome measure was hourly time interval to antibiotic administration from time of ED registration. Results A total of 902 patients were included with 286, 208, and 408 patients in the pre-implementation, implementation and post-implementation cohorts, respectively. Baseline characteristics including comorbid conditions and infection source were similar between cohorts. The primary outcome of hourly time interval to antibiotic administration was significantly different (P = 0.044) between the three cohorts with the most substantial increase in administration specifically in the less than 1-hour interval. Between the pre-implementation, implementation, and post-implementation cohorts, significant decreases were observed in mean time to fluids (3.6, 3.0, and 2.5 hours, respectively, P = 0.003) and average length of stay (5.5, 5.8, and 4.2 days, respectively, P < 0.001) and a significant increase was observed in ED sepsis alert activations (26%, 48%, 51%, respectively, P < 0.001). Conclusion A nurse-driven electronic time-of-triage sepsis screening tool improved timely recognition and intervention in ambulatory ED patients with suspected sepsis. Disclosures All authors: No reported disclosures.

A pilot study of tele-oncology in Scotland

1998 ◽  
Vol 4 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Ian H. Kunkler ◽  
Paul Rafferty ◽  
David Foreman ◽  
David Hill ◽  
Maureen Henry
Keyword(s):  
Cost Effectiveness ◽  
Pilot Study ◽  
General Hospital ◽  
Nursing Staff ◽  
Patient Management ◽  
Pilot Trial ◽  
District General Hospital ◽  
Outpatient Services ◽  
Teleradiology System ◽  
The Uk

A pilot study of tele-oncology linking a cancer centre with a rural district general hospital was carried out; it involved patients, physicians, surgeons, radiologists and nursing staff. Its purpose was to complement the existing on-site outpatient services, providing oncological advice on non-clinic days. During the six months of the trial, 18 videoconferences were conducted. Their median duration was 17 min range 7-40 . Eight videoconferences involved patients directly. Acceptability of videoconferencing to doctors, nurses and patients was assessed by a questionnaire. Patients and staff found the technique acceptable and were satisfied with the results. The addition of a teleradiology system to teleconsultations was found to be important when decisions on patient management were taken. Following the success of this pilot trial, larger studies of tele-oncology in the UK with measures of cost-effectiveness are needed.

A new electronic screening tool for identifying risk of familial hypercholesterolaemia in general practice

Heart ◽  
2016 ◽  
Vol 102 (11) ◽  
pp. 855-861 ◽  
Author(s):  
Lakkhina Troeung ◽  
Diane Arnold-Reed ◽  
Wendy Chan She Ping-Delfos ◽  
Gerald F Watts ◽  
Jing Pang ◽  
...  
Keyword(s):  
General Practice ◽  
Screening Tool ◽  
Familial Hypercholesterolaemia ◽  
Electronic Screening
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