scholarly journals A quality improvement project to improve attendance to the physical health clinic at Southwark team for early psychosis

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S194-S195
Author(s):  
Christina Huggins ◽  
Joanna Cranshaw ◽  
Lucy Pauli ◽  
Beate Haege
Keyword(s):  
Physical Health ◽  
Absolute Number ◽  
Early Psychosis ◽  
Health Clinic ◽  
First Episode ◽  
Post Intervention ◽  
Improvement Project ◽  
Intervention Service ◽  
Number Of Patients ◽  
The Absolute

AimsThe aim of this project was to improve the booking and attendance of patients under Southwark Team for Early Psychosis (STEP) into the physical health clinic.BackgroundSTEP is an Early Intervention Service which provides treatment to 230 adults (18-65 years) with first episode psychosis in the community. In line with national and trust guidance, physical health checks are completed at baseline, 3 months, 6 months and annually, through a weekly physical health clinic run by the core trainee (CT). This is an essential opportunity to assess and monitor patients’ physical health and aid decisions regarding psychotropic medications, which is particularly important given the increased morbidity and mortality in this group and their reduced engagement with health services. It was noted that attendance to the clinic was poor and there was no guidance about how to communicate the results to the General Practitioner (GP).MethodData on the number of clinic appointments booked and attended were collected over 3 defined 9 week intervals between 17/09/18 and 29/07/19. The interventions were implemented prior to the third round of data collection and included an educational session to the STEP team and a protocol for booking and running the clinic to be used by the CT. We devised a physical health questionnaire to be completed by patients on arrival, which includes a summary of the Maudsley guidelines for antipsychotic monitoring. Finally, we created a template letter to communicate the results to the GP.ResultFollowing the interventions, the percentage of available clinic slots booked increased from an average of 27.8% to 100%. The proportion of slots attended reduced from an average of 80% to 50%. However, the absolute number of patients booked into clinic increased from an average of 10 patients over 9 weeks pre-intervention, of which an average of 8 patients attended, to 36 patients post-intervention, of which 18 attended.ConclusionWe observed full utilisation of available clinic slots post-intervention and an increase in the absolute number of patients attending. Given the ongoing use of the protocols developed, we expect these changes to be sustainable. The number of patients attending could be further increased by training additional staff to run the clinic more often and more flexibly. The number of Did-Not-Attends could be reduced by care-coordinators sending reminder texts prior to the appointments.

scholarly journals Improving access to the physical health clinic in a community first-episode psychosis service

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S224-S224
Author(s):  
Zena Tansley-Ahmed ◽  
Wei Han Lim
Keyword(s):  
Health Outcomes ◽  
Physical Health ◽  
Health Clinic ◽  
First Episode ◽  
Successful Implementation ◽  
Trainee Doctor ◽  
Improvement Project ◽  
User Input ◽  
Physical Health Outcomes ◽  
Early Intervention In Psychosis

AimsPhysical health outcomes are poor for patients with severe mental illness as demonstrated by the significant mortality gap present globally.[1] Access to and engagement with care is a key factor underpinning this disparity.[2] The Early Intervention in Psychosis service works with young people from 14-35 experiencing a first episode of psychosis in the community. Within the service, difficulties in engagement have been reflected in the high ‘no-show’ rates observed in the Foundation Year 2 trainee doctor-led physical health clinic. This quality improvement project aimed to reduce the ‘did not attend’ (DNA) rate in the physical health clinic by 20% in order to improve patient outcomes, particularly in the context of their physical health.MethodThe project took place between September and November 2020, over the course of 10 weeks. A driver diagram was constructed to identify key influencing factors and subsequent change ideas. In order to implement each of these changes, three cycles within the Plan, Do, Study, Act (PDSA) ramp framework were completed. These consisted of phone reminders within 48 hours of appointments, a teaching session for staff alongside the distribution of an accompanying information leaflet and increased flexibility in clinic times with opportunistic appointments. The change ideas were cumulative with each cycle lasting a duration of seventeen days.ResultThe baseline DNA rate was calculated based on the preceding month and found to be 55%. Following cycle one of the project, there was a significant reduction in DNA rates to 30% although this remained relatively stable at 33% after cycle two. By the end of cycle three when all interventions had been introduced, the DNA rate had dropped to 22%. As such, a total drop in DNA rate of over 30% was achieved which surpassed the initial aim of the project.ConclusionThe outcomes of this project demonstrate that the introduction of even simple measures can lead to positive change. Successful implementation of these changes requires teamwork and a culture of openness and flexibility. Feedback from team members, particularly care coordinators, also indicated better resulting engagement of clients with the service overall, suggesting potential for both improved mental and physical health outcomes. Next steps for this project may involve not only continued implementation of established changes but also service user input and scope for virtual consultations particularly in light of current COVID-19 restrictions.

Wellbeing Wednesdays: nurse-led clinic for improving physical health care in a general adolescent inpatient unit

2020 ◽  
Vol 29 (4) ◽  
pp. 230-235
Author(s):  
Catriona Mellor ◽  
Jonathan Blackman ◽  
Emily Barker ◽  
Zaakirah Bhula ◽  
Evelyn Sibanda ◽  
...  
Keyword(s):  
Physical Health ◽  
Inpatient Unit ◽  
National Standards ◽  
Health Clinic ◽  
Post Intervention ◽  
Improvement Project ◽  
People With Mental Illness ◽  
Health Domains ◽  
Adolescent Inpatient ◽  
Improved Performance

Background: Young people with mental illness are at high risk of physical health complications. Physical healthcare on a general adolescent inpatient unit is complex. Aim: To establish a wellbeing clinic to improve efficiency and quality of the physical healthcare offered and increase health promotion. Methods: Plan, Do, Study, Act (PDSA) cycles were used to drive this quality-improvement project. The authors audited 12 records before establishing the clinic and 12 at three further time points (6, 18 and 30 months post-intervention) to guide changes. Results: Results progressively improved over PDSA cycles. Time taken for initial investigations dropped. Compliance with medication monitoring and management of important physical health domains rose from zero in some cases to 100% in all but one area. Conclusions: Establishing a dedicated physical health clinic in this setting is feasible and leads to improved performance against local and national standards. Mental health teams need to ensure physical health is prioritised.

scholarly journals The psychiatric, psychosocial and physical health profile of young people with early psychosis: Data from an early psychosis intervention service

2019 ◽  
Vol 40 (1) ◽  
pp. 93-115 ◽  
Author(s):  
Dominiek Coates ◽  
Leeanna Wright ◽  
Tim Moore ◽  
Susan Pinnell ◽  
Catherine Merillo ◽  
...  
Keyword(s):  
Young People ◽  
Physical Health ◽  
Early Psychosis ◽  
Health Profile ◽  
Intervention Service

scholarly journals COVID and early intervention: the impact of COVID-19 on referrals to an early intervention service

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S112-S112
Author(s):  
Adam Whyte ◽  
Alastair Reid
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Mental Health Services ◽  
Health Services ◽  
First Episode Psychosis ◽  
First Episode ◽  
Intervention Service ◽  
Number Of Patients ◽  
Episode Psychosis ◽  
The Impact

AimsCOVID-19 has a demonstratable impact on the population's mental health and is associated with an increased incidence of psychiatric disorders, including patients experiencing psychotic presentations. The aim of this study was to explore whether referral rates within a county-wide Early Intervention (EI) service changed in response to the COVID-19 pandemic. The EI service provides NICE approved treatments and support for patients experiencing a First Episode Psychosis (FEP).MethodData were collected from all referrals to the EI service between March–December 2019 and March–December 2020. Clinical notes were reviewed to ascertain whether the referred patient was assessed and if they were subsequently accepted on to the team's caseload.ResultDuring the March–December 2019 period 147 referrals were made to the EI service, with 66 patients being accepted for treatment by the service (44.9% of referrals). In March–December 2020, 127 referrals were made, a 13.6% reduction compared to the same period in 2019, however 70 referrals were accepted (55.1% of referrals).Whilst the overall referrals declined during the COVID-19 period, there were notable increases in both April and August 2020, by 25.0% and 70.0% respectively.ConclusionAlthough overall referrals to the EI service reduced during the COVID-19 pandemic compared similarly to the previous year, there was a noteworthy increase in the proportion of patients accepted onto the team's caseload.Potential explanations for this finding include the possibility of an increased incidence of first episode psychosis during this period, or that restrictions in accessing primary care and secondary mental health services during the COVID-19 pandemic reduced the number of patients being referred whose symptoms were not representative of First Episode Psychosis (FEP).This study highlights that mental health services, such as EI teams, have experienced a persistent level of need over the past year and that ongoing investment in psychiatric services is warranted to meet this sustained requirement for support and interventions.

High-needs hematology/oncology patients: A quality improvement project.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 197-197
Author(s):  
Swanee Tobin ◽  
Joyce Fenuta ◽  
Julie Kruchowski ◽  
Lisa K. Hicks
Keyword(s):  
Hospital Admissions ◽  
City Hospital ◽  
Post Intervention ◽  
Improvement Project ◽  
Targeted Interventions ◽  
Admission Rates ◽  
Higher Ed ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

197 Background: St. Michael’s Hospital (SMH) is an academic, inner-city hospital in Toronto, Canada. In the hematology/oncology (hem/onc) program, a small number of patients appeared to contribute disproportionately to hospital admissions and emergency department (ED) visits. We hypothesized that high needs hem/onc patients could be recognized early in their care and that ED visit and admission rates among these patients could be decreased through targeted interventions. Methods: Members of the hem/onc team were interviewed regarding characteristics, which they felt predicted higher needs and greater liklihood for hospital admission/ED visit. A list of high risk features was generated. ED visit and admission rates for a prospectively identified high needs cohort were compared to rates for the entire hem/onc clinic. An intervention targeting high needs hem/onc patients is on-going. Pre and post-intervention ED visit and admission rates will be compared. Results: Interviews with 3 nurses, 1 social worker, 1 discharge planner, and 4 physicians identified 10 factors that the hem/onc team believed were predictive of higher needs and subsequent higher ED visit and admission rates. Between December 1, 2012, and February 28, 2013, 42 high needs hem/onc out-patients were prospectively identified. The ED visit and admission rates for this cohort were retrospectively compared to those of the entire hem/onc clinic and found to be dramatically higher (Table). Begininng in June 2013, hem/onc patients identified as “high needs” were offered enrollment in a NP-based program offering telephone assessments following ED visits, hospital admissions or discharges. Assessment of the impact of this intervention is ongoing. Conclusions: It is possible to prospectively identify hem/onc patients who are at risk of higher than usual ED visit and admission rates. Identifying this population may provide an opportunity to decrease their ED visit and admission rates. An evaluation of an intervention targeting high needs hem/onc patients is ongoing. Preliminary data will be presented. [Table: see text]

scholarly journals Emergency department utilization during the COVID-19 pandemic

2020 ◽  
Vol 9 (6) ◽  
pp. 25
Author(s):  
Regina K. Saylor ◽  
Andrea Blome ◽  
Derek Isenberg ◽  
Daniel A. DelPortal ◽  
Wayne A. Satz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Absolute Number ◽  
Emergency Department Utilization ◽  
Patient Acuity ◽  
Admission Rates ◽  
Use Of Resources ◽  
Time Period ◽  
Number Of Patients ◽  
The Absolute ◽  
Time Of Presentation

Objective: Optimizing resource utilization is critical to reducing healthcare costs. Our study aims to review trends in overall patient volume, acuity, time of presentation, and use of resources in the emergency department (ED) during the COVID-19 pandemic.Methods: We compared ED utilization from a 30-day period during the height of the COVID-19 pandemic (April 1, 2020-April 30, 2020) to the same 30-day period in the preceding calendar year (April 1, 2019-April 30-2019). Data were grouped into outcome measures focusing on ED throughput and utilization of ancillary ED services.Results: While the absolute number of patients in or arriving to the ED at any given time was significantly lower during the COVID-19 pandemic (p < .01), the hourly patterns of patient census, arrivals, and admissions all aligned with pre-pandemic values. Also, patient acuity, as measured by ESI level, did not significantly change. The absolute number of admissions for bothsites was similar to the pre-pandemic time period, but the percentage of patients admitted over the 30-day period increased. The absolute number of radiographic and laboratory studies ordered in the ED also changed significantly (p < .05), but the hourly pattern did not.Conclusions: Our study shows significantly lower patient volumes, increased admission rates, and no significant change in the hourly throughput of the ED. Thus, our analysis suggests that shift times should not be adjusted, nor should the number or composition of providers on each shift in academic and community ED sites during the COVID national lockdown.

scholarly journals A Quality Improvement Project to Improve Influenza Vaccination Rates Among Employees at an Onsite Employer-Based Health Clinic

2021 ◽  
pp. 216507992110169
Author(s):  
Karen Landwehr ◽  
W. Jeff Trees ◽  
Susan Reutman
Keyword(s):  
Quality Improvement ◽  
The United States ◽  
Quality Improvement Project ◽  
Vaccine Uptake ◽  
Health Clinic ◽  
Full Time ◽  
Improvement Project ◽  
Vaccination Rates ◽  
Number Of Patients ◽  
Flu Vaccine

Background In the United States, millions of people contract the flu each year. Immunization has been shown to provide the best protection against the flu. Increasing flu vaccination rates can reduce the number of patients who get the flu and seek care for non-specific symptoms thus making detection of the coronavirus more efficient. Method A quality improvement project was implemented to increase the number of influenza vaccines received by employees at an onsite employer-based health clinic. Anonymous pre- and post-surveys were used to assess the flu knowledge of employees. Employees from a large financial group, who voluntarily participated, received an educational handout at the onsite health fair or at a lunch and learn. Full-time employees who carried their employer’s health insurance were eligible to participate, whereas, dependents and contract employees were excluded. Findings The number of employees who received the vaccination increased during the fall of 2019 ( n = 406) when compared with the previous year ( n = 337). Nineteen percent ( n = 170) of employees completed surveys. There were statistically significantly more post- than pre-survey responses reflecting the participants’ perceived knowledge of influenza and the flu vaccine. The majority of participants in both the pre- and post-surveys reported that they learned “a lot” about both influenza and the flu vaccine. Conclusion Providing education and access to the vaccine in the workplace may improve flu knowledge, reduce barriers, and increase flu vaccine uptake among employees.

Insights into variations in preferred selection criteria for acute stroke endovascular therapy

2017 ◽  
Vol 10 (6) ◽  
pp. 542-549 ◽  
Author(s):  
Feng Wang ◽  
Bruce C V Campbell ◽  
Leonid Churilov ◽  
Peter Mitchell ◽  
Richard Dowling ◽  
...  
Keyword(s):  
Selection Criteria ◽  
Process Analysis ◽  
Functional Independence ◽  
Absolute Number ◽  
Number Needed To Treat ◽  
Large Artery ◽  
Escape Trial ◽  
Number Of Patients ◽  
First Choice ◽  
The Absolute

BackgroundEndovascular thrombectomy (ET) is safe, effective, and cost-effective for large artery occlusion ischemic stroke, even if under different selection criteria.PurposeTo study the preferences for ET selection criteria by surveying clinicians and consumers, where number needed to treat to achieve functional independence is the only factor being considered.MethodsA survey providing visual representation of the proportion of patients treated and expected functional outcomes, based on the selection criteria in each of the recent randomized trials of ET, was distributed nationwide in Australia and New Zealand to clinicians and consumers. The preferred selection criteria were identified by the frequency of first choice and using decision-analysis techniques to assess consensus by treating respondents as a panel of experts and aggregating their preferences on selection criteria.Results104 clinicians and 107 consumer respondents (43/107 (40%) stroke survivors) took part in the study. Selection criteria of EXTEND-IA were ranked as the most preferred by the consensus process analysis and were the first choice of 64 individual clinicians (61.5%; 95% CI 52% to 71%). ESCAPE trial selection criteria were ranked as the most preferred option and chosen by 42 individual consumers (39%; 95% CI 29% to 48%). Most clinicians based their choice on the ratio of patients benefiting from ET, while consumers considered the absolute number of patients benefiting.ConclusionsConsumers favor maximization of the absolute number achieving good outcome in comparison with clinicians. This finding suggests that less restrictive criteria may be favored in clinical practice.

scholarly journals KADAR TGF-β1 PLASMA DAN LIMFOSIT-T CD4+DI PENDERITA YANG TERINFEKSI HIV STADIUM I

2018 ◽  
Vol 20 (2) ◽  
pp. 122
Author(s):  
Alberthina Alberthina ◽  
Endang R ◽  
Erwin AT
Keyword(s):  
T Lymphocytes ◽  
Hiv Infection ◽  
Plasma Levels ◽  
Absolute Number ◽  
Hiv And Aids ◽  
Stage I ◽  
Cross Sectional ◽  
Number Of Patients ◽  
The Absolute ◽  
Tgf Β1

HIV infection and AIDS have been spread throughout the world and the number of patients continues to increase from year to year.Indonesia is one of the countries with quite a high increase in the incidence of HIV and AIDS. The absolute number of CD4+T-lymphocytesand percentage in HIV-infected patients can be used to determine the stage of the disease, and progression of the disease, as well as topredict the onset of the opportunistic diseases. In certain circumstances sometimes it is difficult to determine clinically and the results ofthe absolute number of CD4+ T-lymphocytes and its percentage are still high. So the examination of TGF-β1 is necessary for predictingthe disease course in the patient, because the increase of the disease progress is also accompanied by the increased levels of TGF-β1. Thepurpose of this study is to know and to prove the existence of the correlation between plasma levels of TGF-β1 and the absolute numberpercentage of CD4+T-lymphocytes in stage I HIV-infected patients. The research was carried out by a Cross sectional observational study,the samples were derived from 41 stage I HIV-infected patients treated at the Outpatient Clinic of the Infectious Disease IntermediateCare Unit (UPIPI) in the Dr. Soetomo Hospital from January to May 2012. The examination of TGF-β1 plasma was performed by ELISAmethod, the number of absolute and percentage of CD4+T-lymphocyte were counted by immuno flowcytometry (BD FACSCalibur™). Theresults were statistically analyzed using a Pearson product moment correlation test. It was shown that the TGF-β1 plasma levels in stageI HIV-infected patients tended to increase, as well as the number and percentage of CD4+ T-lymphocytes which were also increased. Theresult of this study revealed that the number of CD4+T-lymphocytes which were less absolute and more than 200 cells /μL showed nocorrelation with the plasma levels of TGF-β1 in stage I HIV infected patients. However, there was a significant positive correlation betweenthe number of CD4+T-lymphocytes percentage with TGF-β1 plasma in stage I HIV infection.

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