scholarly journals Establishing a District Psychiatric Service without Psychiatric Trainees

1986 ◽  
Vol 10 (12) ◽  
pp. 338-340 ◽  
Author(s):  
D. G. Kingdon ◽  
T. K. Szulecka
Keyword(s):  
General Hospital ◽  
Social Services ◽  
Early Development ◽  
Royal College ◽  
Medical Staff ◽  
Psychiatric Service ◽  
District General Hospital ◽  
Short Report ◽  
House Of Commons ◽  
The Social

The Report of the Social Services Committee of the House of Commons in 1981 (the ‘Short Report’) recommended the establishment of consultant posts without the support of trainee medical staff as part of a strategy to correct the situation where too many doctors occupied training posts for the number of consultant posts available.1 The Royal College of Psychiatrists has endorsed this policy,2 and the withdrawal of approval for training from an increasing number of hospitals around the country is leading rapidly to a situation where a large number of them need to look at alternative arrangements for providing medical cover. We would like to report the establishment and early development of such an arrangement based in a district general hospital.

scholarly journals Antipsychotic prescribing in light of the consensus statement of the College

1997 ◽  
Vol 21 (7) ◽  
pp. 408-410 ◽  
Author(s):  
K. L. Newton ◽  
R. Murthy ◽  
J. Qureshi
Keyword(s):  
General Hospital ◽  
Royal College ◽  
Medical Staff ◽  
Consensus Statement ◽  
District General Hospital ◽  
Recommended Dose ◽  
High Dose ◽  
Prescribing Practices ◽  
Retrospective Survey ◽  
Antipsychotic Prescribing

A retrospective survey was undertaken to evaluate the prescribing practices of medical staff in a District General Hospital in light of the Consensus Statement by the Royal College of Psychiatrists on the use of high dose antipsychotics (1993). Two per cent of 247 patients were prescribed a higher than recommended dose of antipsychotic. None of these cases had been prescribed ‘supra-BNF doses of antipsychotic on a regular basis, but with the addition of ‘as required’ (PRN) medication the recommended dose was exceeded. In only one patient was the high dosage administered. A further analysis of these patients is made.

scholarly journals The Short Report and its Implications

1982 ◽  
Vol 6 (9) ◽  
pp. 155-157
Author(s):  
Fiona Caldicott
Keyword(s):  
Social Services ◽  
Medical Staff ◽  
White Paper ◽  
Short Report ◽  
Hospital Medical ◽  
The Social ◽  
The Government ◽  
Early Discussion ◽  
Proper Balance ◽  
Hospital Medical Staff

Members of the College will know that in the 1980–81 Parliamentary Session the Social Services Committee, chaired by Mrs Renée Short, examined the problem of achieving for hospital medical staff a proper balance between the number of doctors in training and the number in the career grades. In February 1982 the Government published its response to that Report as a White Paper, and stated its intent of seeking early discussion with the responsible bodies, which include the College, to promote action.

scholarly journals A psychiatrist with beds: evolution and evaluation of socio-therapy on an acute admission ward

1991 ◽  
Vol 15 (11) ◽  
pp. 684-686 ◽  
Author(s):  
John L. Cox
Keyword(s):  
Mental Illness ◽  
General Hospital ◽  
Clinical Experience ◽  
Mentally Ill ◽  
Community Psychiatry ◽  
Psychiatric Service ◽  
District General Hospital ◽  
Admission Ward ◽  
Current Thinking ◽  
Hospital Psychiatry

There is a serious flaw in much current thinking about the development of ‘community’ psychiatry because of the failure to consider the function of admission wards and to resource them adequately. Excessive emphasis is placed on the value of non-hospital psychiatry with an implication that psychiatrists can manage patients adequately without beds (see Dean & Gadd, 1990). Although I have not met a consultant who literally believes this to be true, the managerial consequences of this attitude leads to in-patient units being yet further under-resourced, and so becoming more disturbed and having lowered morale. Yet in Better Services for the Mentally Ill (HMSO, 1975) the District General Hospital In-patient Unit was regarded as a main component of a comprehensive psychiatric service. Clinical experience does suggest that without an effective admission ward the management of patients in the community, including those with intractable mental illness, is unsatisfactory and sometimes totally impossible.

Psychiatric In-Patients and Out-Patients

1972 ◽  
Vol 120 (557) ◽  
pp. 474-475
Author(s):  
A. G. Mezey
Keyword(s):  
General Hospital ◽  
Hospital Admissions ◽  
Psychiatric Service ◽  
Admission Rate ◽  
District General Hospital ◽  
The Elderly ◽  
Referral Rate ◽  
Official Statistics ◽  
Cent Increase ◽  
Patient Referrals

The reply of Morgan and Compton in this issue of the Journal (pp. 433–6), is based on a misunderstanding of our results and of the problem investigated. This leads them into a refutation of ‘claims' never made and they buttress it with a statistical exercise of great naivety. Our findings were:(a) ‘… in certain important respects in-patients and out-patients are derived from different though overlapping populations.’ The most marked differences (dismissed by Morgan and Compton as 'slight’) were found among the elderly. ‘The admission rate for the over 65s of both sexes was 4 · 90 per 1,000. In contrast, increasing age was associated with a gradual fall of out-patient referral rate to 1 · 60 for the over 65s.’ We did not claim to have demonstrated the cause of these differences, but mentioned possible reasons for them.(b) In a district general hospital-centied psychiatric service we observed a 34 per cent increase of new out-patient referrals while hospital admissions remained static; this occurred over a period of three years, when nationally hospital admissions were still rising. We quoted in illustration some extreme figures from official statistics and the figures for the Sheffield and the Liverpool regions were extreme whether one refers to Tables 3, 11 or 13 (1). This prompted the hypothesis that an increase in new out-patient referrals can prevent admission or prove an alternative to it. No ‘claim’ was made, and we advisedly used the term 'suggestion’ to emphasize that these are ‘no more than tentative and incomplete incursions into this difficult and relatively unexplored field’ (2).

Audit of psychiatric emergencies in the A & E department of an urban general hospital

1993 ◽  
Vol 10 (2) ◽  
pp. 124-127 ◽  
Author(s):  
Marcus Webb ◽  
Douglas Webb ◽  
Glenn Webb
Keyword(s):  
Patient Care ◽  
General Hospital ◽  
Social Services ◽  
Clinical Management ◽  
Psychiatric Service ◽  
Management Strategies ◽  
Special Focus ◽  
Psychiatric Emergencies ◽  
Retrospective Audit ◽  
Careful Assessment

AbstractObjectives: To ascertain the frequency and nature of emergencies referred to psychiatrists at the A & E Department of an urban teaching general hospital. Deliberate self-harm and other forms of violence were to be special foci of the study, as was substance abuse, particularly alcohol abuse. Clinical management strategies used by psychiatric emergency staff were also to be assessed. Method: A retrospective audit was made of all of the reports of emergencies written by psychiatric trainees (who were first on call to the A & E) during a six-month period (January-June, 1991). The reports were analysed according to demographic characteristics, main clinical problem, presence or absence of each special focus problem, and also clinical management strategies. Main outcome measures were recorded as percentages of relevant groupings. Mean and median ages were reported as indicated. Results: The 550 emergency psychiatric reports represented 2.2% of A & E attendances. Fifty-two percent were male and 70% were between 15 and 44 years of age. Forty-eight percent resided outside the psychiatric catchment area of St. James's Hospital. Forty-six percent of all psychiatric emergencies required careful assessment of suicidal potential; twenty percent were admitted to inpatient care, 53% were referred to out-patient or day-patient care, 7% to their general practitioner and just 3% to social services. Conclusions: 1. Emergency assessment at the A & E provides a considerable workload for the psychiatric service of an urban general hospital. 2. Careful assessment of suicidal potential still represents an important part of this emergency work. 3. Only 1 in 5 patients were referred on to in-patient care. Undue pressure should not be placed on psychiatric trainees to manage potentially suicidal patients outside hospital. 4. Few referrals were made by psychiatric trainees to general practitioners or to the social services, suggesting that more formal consultant supervision of trainees in this emergency work is warranted.

scholarly journals 684 The Standard of Emergency Operation Note Documentation at A District General Hospital Compared Against The Royal College of Surgeons of England (RCSEng) Standard

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Zuberi ◽  
Y Mushtaq ◽  
K Patel ◽  
J Joseph ◽  
R Gurprashad
Keyword(s):  
General Hospital ◽  
Royal College ◽  
Emergency Operation ◽  
District General Hospital ◽  
National Standard ◽  
Average Score ◽  
Estimated Blood Loss ◽  
Operation Note ◽  
The Impact ◽  
Current Guidelines

Abstract Introduction Meticulous operation note documentation is essential for seamless, safe continuity of care in postoperative surgical patients. This study evaluated the standard of emergency operation note documentation at a district general hospital, when compared to the Royal College of Surgeons of England (RCSEng) guidelines and assessed the impact of a new operation note proforma. Method A retrospective review of 50 emergency operation notes was conducted between December 2019 and March 2020 and compared to RCSEng guidelines. Initial findings were presented at a local clinical governance meeting and a new electronic operation note was introduced. A further 50 emergency operation notes using the new proforma were analysed between August 2020 and December 2020. Results RCSEng mentions 19 main points that all operation notes must include. A total of 100 operation notes were reviewed and each given a score out of 19. Intervention of the new proforma showed significant improvement to the average score (15.64 vs 17.94; p < 0.0001) when compared to RCSEng guidelines. In particular, there was significant improvement in the documentation of assistants involved in the procedure (58% vs 98%; p < 0.0001), estimated blood loss (2% vs 63%; p < 0.0001) and specific mention whether the operation was emergency or elective (20% vs 86%; p < 0.0001). Conclusions Implementation of the new proforma showed significant improvement in operation note documentation when compared to the RCSEng standard. Therefore, this study emphasises the need for surgeons to familiarise themselves with the current guidelines and highlights the importance of tailoring local operation note proformas to match this national standard closely.

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