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Ten Years of Inspiration and Impact : The RANZCP Psychiatry Interest ForumAims To illustrate the scale and impact of the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) Psychiatry Interest Forum (PIF) ten years since its inception. Methods Member data from 2013–2023 was analysed alongside recent event and engagement activity survey results, as well as qualitative feedback from medical students and prevocational doctors who took part in PIF engagement activities. Results PIF attracts and inspires the next generation of Australian and New Zealand psychiatrists. It is a stepping stone into the RANZCP Fellowship program, and has a particular focus on increasing interest in rural careers and supporting more First Nations medical students and prevocational doctors into psychiatry. PIF events, sponsorships, scholarships and information achieves this by: • providing a starting point for learning and exploring the specialty of psychiatry • fostering interest in psychiatry among medical students and junior doctors • creating a safe and enabling environment to explore the specialty, create networks, and build connections • challenging common misconceptions about psychiatry and reduce associated stigma • increasing applications to the RANZCP Fellowship program. Established in September 2013 the program now has over 5,100 members. In 2023, the program achieved its highest annual number of new members joining to date, with 1,056 medical students and junior doctors choosing to join PIF. That year, 77% of all new trainees that joined the Fellowship pathway were former PIF members. Survey data from PIF members who took part in the PIF program hosted at the Perth Congress in 2023 demonstrated that: • 100% reported an increase in psychiatry knowledge following Congress. • 82% reported their likelihood of pursuing psychiatry had increased following Congress, and 18% reported ‘no change’, as they reported strong certainty prior to the Congress attendance. • 75% reported that the PIF networking sessions helped clarify misconceptions or stigmas that they previously held about psychiatry following Congress. The voices of PIF members best illustrates the influence that inspirational experiences like these can have on future career directions: ‘My favourite part of the PIF Congress was the ability to interact with likeminded PIF peers and psychiatrists and trainees from all over Australia and New Zealand. Another PIF member had said “I feel like I've found my tribe” which is a comment I particularly resonated with. Conclusion Ten years on, PIF continues to expand its reach and impact to increase the pipeline of psychiatry trainees in Australia and Aotearoa New Zealand.
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Understanding patients' perspectives of clinical communication within a Major Trauma CentreClinical communication between major trauma patients (MTP) and healthcare professionals is extremely complex. Multiple demands are placed on specialist multi-disciplinary teams (MDT) and patients in all stages of treatment. Patient-staff clinical communication has an integral role in MTP healthcare experiences, supporting them with a range of physical and psychological difficulties post-injury. This study aimed to understand MTP perspectives of clinical communication within a MTC through qualitative semi-structured interviews. Twenty participants were purposively sampled from an outpatient follow-up clinic and interviews were analysed using a pluralistic qualitative approach. Three themes were conceptualised from the data; "Challenges to speaking up" "Conversations left me feeling" and "Strategies need to be clinical but tailored". Patients often found it challenging to speak up due to feelings of vulnerability, confusion, and challenges navigating medical terminology. Patients spoke of not wanting to burden staff and family members playing a role in patient-staff communication, but these challenges require further exploration. Patients highlighted the positive (feel reassured, cared for, and human again) and negative (feeling like an object, angry, confused, and dependent) emotional impact of staff communication. Patients also described the benefits of being provided with written information, clear explanations of injuries and person-centred communication. MTP require multiple options to communicate and address psychological difficulties. Greater training on the emotional impact of conversations, skills to respond to psychological distress and communication guidance for staff, is needed to improve clinical communication with MTP.
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Profile, referral pathways and re-attendance of psychiatric patients attending the emergency department : focus on suicidality and self-harmAims The number of patients presenting to Emergency Departments (EDs) in the UK with acute psychiatric issues is a major concern. This project aimed to explore the outcome of patients assessed by Mental Health Liaison Services (MHLS) in a large district general hospital ED in the UK, with a focus on patients with self-harm or suicidality. Method Data were extracted from electronic patient records on 100 consecutive attendees to MHLS in July 2020. Data were collected on demographics, index of multiple deprivation (IMD) by postcode, time and reason for attendance, known ICD-10 diagnoses, self-harm history, alcohol/substance misuse at time of presentation, recent psychosocial stressors and outcome of MHLS assessment. Assessments by MHLS in the preceding 12 months and reattendance to the service within 3 months following this assessment were also recorded. Result The sample included 44 male and 56 female patients, with a mean age of 35.3 years. 80.0% of patients were Caucasian. 67.0% lived in areas classed within the top 30% most deprived in the country, whilst 2.0% had no fixed abode. The majority (79.0%) of patients self-presented; outside of normal working hours (70.0%). The most common reasons for attendance were thoughts/intent of self-harm/suicide (50.0%), overdose (29.0%) and self-harm by laceration (7.0%). The majority (73.0%) of patients had a known psychiatric diagnosis, with the most frequent being depressive disorder (36.0%) and emotionally unstable personality disorder (15.0%). Almost half (48.0%) had a history of self-harm, and 40.0% were under the influence of alcohol/illicit substances upon presentation to ED. The most common psychosocial triggers were conflict with partner (26.0%) and stress due to the COVID-19 pandemic (19.0%). Following assessment, 24.0% of patients were discharged to their General Practitioner, 18.0% to the community mental health team; and 17.0% to the Crisis & Home Treatment Team. A minority (13.0%) were admitted to a psychiatric hospital (10.0% informally, 3.0% under the Mental Health Act 1983). Approximately one in five (21.0%) patients re-attended to MHLS within 3 months. Out of 37 patients that had previously been assessed by MHLS in the preceding 12 months; 37.8% were reassessed within 3 months (p < 0.01). Conclusion In the studied sample, most (90%) of psychiatric patients attended ED for self-harm or suicide, and a significant proportion had repeat attendance. Socioeconomic deprivation, substance misuse, relationship difficulties and stress due to the COVID-19 pandemic were major issues, alongside diagnosed depression and personality disorder. Focussed support for these issues may decrease ED attendance due to self-harm/suicidality.
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ICU memories and patient outcomes in a low middle-income country : a longitudinal cohort studyOBJECTIVES: To study memories of ICU following discharge, their associations, and impact on mental health and quality of life in a low- and middle-income country. DESIGN: Prospective observational cohort; data on memories (pain, fear, nightmare, factual), clinical and demographic variables, anxiety-depression, posttraumatic stress symptoms, and quality of life were collected 0, 7, 14, 30, 90, and 180 days post discharge. Home visits for assessment minimized loss to follow-up. Linear mixed-models and regression analyses were used to estimate adjusted effects of memories controlling for age, sex, time, and severity of illness. SETTING: Twenty-five bedded ICU of a tertiary care center in East India. PATIENTS: Adult ICU survivors between January 2017 and July 2018 able to communicate their memories. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: Final sample consisted of 322 patients who completed 180 days follow-up. Pain, fear, factual, and nightmare memories dropped from 85%, 56%, 55%, and 45% at discharge to less than or equal to 5% at 180 days. Patients with gaps in ICU memory had worse anxiety-depression, posttraumatic stress symptoms, and quality of life at all follow-up points. Sedation (odds ratio, 0.54; CI, 0.4–0.7), steroids (odds ratio, 0.47; CI, 0.3–0.8), benzodiazepines (odds ratio, 1.74; CI, 1–3.04), and mechanical ventilation (odds ratio, 0.43; CI, 0.2–0.8) were independently associated with gaps in memory. Non-ICU factor such as substance addiction (odds ratio, 5.38; CI, 2–14) was associated with memories affecting mental health and quality of life. CONCLUSIONS: Gaps in memory and various memory types were common after ICU admission, whose prevalence waned over time. Compared with nightmares and fearful memories, gaps in memories were most strongly associated with poor mental health and quality of life. Identifying patients with gaps in memories might be an objective way of planning interventions to improve their long-term outcomes.
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Changing patient profile in a psychiatric hospital during COVID pandemic : a comparison with pre-COVID stateAims COVID-19 pandemic has a massively adverse mental health impact and people with pre-existing psychiatric illnesses are one of the most severely affected groups. We intended to study the changes in the patient profile in a psychiatric hospital during the COVID-19 pandemic, comparing it to the period just before the pandemic. Methods Consecutive patients (n = 210) admitted to psychiatric ward under one team during COVID-19 pandemic (February 2020 to January 2022) were compared with patients (n = 234) admitted in the immediate pre-pandemic period (January 2017 to January 2020). Demographic (age, gender, and ethnicity) and clinical variables (diagnosis, admission days, Mental Health Act status, risk to self and others) were collected from the electronic patient records and analysed. Results During the pandemic monthly admission rates have gone up by 38.1% over the base rate of 6.32/month. There was no difference in the mean age at admission; or the proportion of patients aged 18–40 years or above in the pre-pandemic and pandemic groups. Similarly the gender composition of patients in the two periods was comparable. Proportion of patients from Asian background increased from 7.7% to 16.8% during pandemic period (p < 0.05). The number of hospital days decreased from 31.97 ± 45.8 days in the pre-pandemic period to 22.44 ± 25.1 days during pandemic (p < 0.05). Along with increased admission rates, it suggested a rapid flow of the admission and discharge during the pandemic. Considering diagnostic composition between pre-COVID-19 and COVID-19 periods, psychotic (27.8% v 26.7%) and mood disorders (18.8% v 23.3%) were the predominant; and substance related disorders (20.5% v 16.7%) were the most common comorbidities. Risk to self was associated with 84.3% admissions during the pandemic compared to 78.6% in the pre-pandemic period; however, risk to others was noted in 13.8% v 22.2% (p < 0.01) respectively. There was no difference in proportions getting admitted under Mental Health Act or being discharged with Community Treatment Order. Interestingly, proportions of patients getting discharged under the care of Home Treatment Team decreased from 31.1% pre-pandemic to 16.5% during pandemic period (p < 0.005). Conclusion There is an increase in admission rate and decrease in the number of admission days, suggestive of increased demand of clinical resources during pandemic. This could be reflective of the stressful situation and adverse impact on mental health in the pandemic period. As the impact on mental health is expected to continue, there is a need for greater resources both in community and inpatient psychiatric services.
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Worry and media use behavior during COVID-19 pandemicBackground: Information seeking occurs to reinforce existing information, to solve problems, construct meaning, and as a response to alienation. The continual information uncertainty related to COVID-19 pandemic impacted life, livelihood and triggered worry. Information seeking from multiple sources became necessary to allay anxiety and verify authenticity. This research investigated the various sources of information, and its influence on their level of worry.Methods: An online survey required respondents to indicate their sociodemographic details, different information sources used, awareness of rumors, the ability to check the authenticity of the information, sources, and COVID-19 related experiences. The lowest and highest for worry scale was 1—10. Results: The median worry during the period was seven, and the number of media accessed was five. Overall worry correlated significantly with other worries (personal and family health, income, job, and lack of growth). Worry differed significantly among age groups, education, occupation, and marital status but not across gender and economic status. Individuals, who self-isolated, experienced issues with rumors, feared infection and death reported significantly more worry. Awareness, fear of infection, and rumors influenced significantly more number of media use.Conclusions: The extent of worry and the number of information sources showed complex and non-linear ‘U’ shaped relationship with the lowest at six sources. The article extends the information-seeking behavior literature by indicating that the use of a higher number of media sources is counterproductive. Understanding information exchange and information sources can help address public worry
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COVID-19 and the experience of mothers in perinatal psychiatry services : an explorative study in the UKBackground/Objective: As the health services were reorganized during the COVID-19 restricting access to family caregivers, we explored the experience of women in the perinatal period, attending a specialist perinatal mental health service. Methods: Patients (n = 38) in the outpatient list for review were assessed over phone based on a predesigned, semi-structured questionnaire, comprising both quantitative (demographic, clinical variables) and qualitative open-ended questions regarding their experience of services during COVID-19. Results: The responses provided insight into how the pandemic affected the experience of pregnancy of mentally ill women and the impact of changes in perinatal mental health services. The main concerns centered around reduced support from close family members during the perinatal period due to the lockdown, anxiety regarding COVID transmission, absence of a supporting persons in antenatal clinics, difficulty accessing support from midwives, and health visitors as well as the use of virtual clinics for mental health consultations. Conclusions: The results suggested possible methods of improving perinatal mental health support during challenging times, which included ensuring in-person consultations, access to family even remotely, increasing accessibility through alternative means; providing and close monitoring of additional psychosocial support when needed.
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What can we learn from the COVID pandemic about care of older adults?The elderly population has been worst hit during the COVID pandemic. Society should take this challenge to learn from the experience to improve the support services for the elderly and preparedness for pandemic. Proper planning and strategies in health, social care, and public services are required
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Clinical profile and comorbidity of elderly patients presenting to a psychiatric outpatient unit of a tertiary care hospital in Odisha, India : a cross sectional studyBackground: With gradually increasing older population, the profile of elderly attending psychiatric services needs exploration to inform changing service needs. Aims: Clinical characteristics of elderly attending a psychiatric outpatient department and the challenges faced by their caregivers were studied. Methods: An explorative, interview-based study. Results: The sample included 78 consecutive (49 male and 29 female) patients; between 60-80 years of age (63.7+4.7); amongst them 12.8% were widowed, and 19.2% were still working. The common diagnoses were schizophrenia and bipolar disorder at 29.5% each, and major depression and dementia 10.3% each. Comorbid physical illnesses were reported in 56%, which were mostly neurological side effects and illnesses (26.9%), hypertension (19.2%), and diabetes (15.4%). Majority (85.9%) of elderly had antipsychotic drugs and 16.4% of them had two antipsychotics. Challenges in caregiving were financial (59.0%), hampered leisure (62.8%) or family (60.3%) activities, psychological stress and mental health problems (55.1% each), and physical health problems (33.3%) and other problems (37.2%). The patients had to travel on an average of 81.9±77.9 km with an average travel time of 2.3±2.0 hours. Conclusion: Most elderly attending psychiatric outpatients had severe mental illnesses and there were major caregiving concerns which need to be addressed
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War and older adults : consequences and challengesThe catastrophic nature of war has deleterious impact on almost all individuals of the affected populations; amongst them older adults are known to be one of the most vulnerable groups. Along with the life changing economic and social adversities, the physical and mental health of the older adults are seriously impaired secondary to war. The consequences are immediate; but most continue long-term; in fact, experiences of the war have lifelong impact. In addition, people who are exposed to war in younger age continue to have health related morbidities in the old age. There are enormous needs for protection, support and care of older adults during and in post-war situations. While efforts should be taken to mitigate the devastating effect of the war on all, including the elderly people; it is important to prevent war at all costs
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Coping strategies used by adult survivors in the process of recovery from disaster trauma : a narrative reviewCONTEXT The catastrophic stress of disasters and the associated secondary traumas lead to negative mental health outcomes in a great proportion of survivors. A range of coping strategies are used, which may have possible preventive and therapeutic effects related to posttraumatic stress-related manifestation. AIMS It is essential to learn about the coping strategies employed by the survivors following disasters to reflect about their usability as possible intervention methods. This review intended to explore the literature about coping mechanisms used by adult survivors of the disasters. METHODS Comprehensive literature search and review. RESULTS It was observed that various coping strategies have been reported, along with posttraumatic mental health conditions. Many of the coping strategies differ in different cultures and other demographic groups. Some articles have made reference to the effectiveness of the coping strategies. It has been observed that the ways coping can be facilitated at different levels. These observations may help in designing culture-specific, pre- and post-disaster management programs for effective and holistic recovery of the survivors. CONCLUSION There is a need to understand the coping mechanisms in different cultures and the factors associated with the resilience in the face of the massive trauma of disasters. It is probable that these could be instrumental in recovery process and expected to help in supporting disaster survivors
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A qualitative study of the experience of mothers with mental illness during the COVID-19 pandemic : learnings from a perinatal psychiatry serviceBACKGROUND/OBJECTIVES: Pregnancy and childbirth are one of the vulnerable periods in women’s lives, and women with mental illness require additional support during this period. The COVID‑19 pandemic along with its impact on clinical services brought challenging situations. We intended to study the experiences of women with mental illness in their perinatal period reecting about the perinatal psychiatric services.METHODS: It was a qualitative, interview‑based study. Information was collected through a discussion with the patients through telephone. Both open‑ and closed‑ended questions were used to explore their experiences and facilitate the content. The content was analyzed into various themes.RESULTS: There were a few major themes in the following areas: the effect of COVID on life during pregnancy and postnatal period, the effect of COVID on prenatal and postnatal care, a preference for in‑person, face‑to‑face assessment and care, areas where the perinatal psychiatry services performed well, and suggestions from patients for improvement of the services.CONCLUSIONS: The study ndings can help to improve existing perinatal psychiatric services to make these more accessible and responsive to the needs of the patients, especially during challenging times
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Non-attendance at psychiatric outpatient clinics : comparison of clinical, risk and demographic factors between attenders and non-attendersAims With an overarching aim of decreasing the incidence of non-attendance in psychiatric outpatient clinics, this service evaluation was intended to explore the profile of non-attenders. Specifically, the clinical, risk and demographic features of patients who did not attend their psychiatric outpatient appointments were compared with those of attenders. The outcome of patients who did not attend was also studied. Method All the consecutive non-attenders (n = 32) in November 2020 in a psychiatric outpatient clinic were compared with 32 consecutive attenders. The groups were compared based on clinical features (diagnosis, medical treatment, psychological treatment, care programme approach, first contact), risk profile (self or others) and demographic features (age, gender, ethnicity, accommodation, occupation, benefits). The non-attender sample was also analysed to consider the outcome after their missed appointment, following local Trust protocols. Result The overall rate of patients who did not attend their appointment was 22%. There was a statistically significant difference between the age and gender of non-attenders. Males were less likely to attend their appointment than females (p = 0.024). The mean age of patients who did not attend their appointment was 36.4 compared with 44.8 years in the attenders (p = 0.005). There were a few clinically relevant findings. Around one third (34%) of patients who did not attend their appointments had a history of risk of self-harm noted in previous appointments. The results also showed that 75% of individuals who did not attend their outpatient appointments were unemployed. There were no significant differences based on the type of treatments (depot injections, lithium, clozapine, antipsychotics or antidepressants) patients received. Patients who did not attend were more likely to have a mood disorder (59% compared with 40%), and less likely to have a psychotic disorder (25% compared with 44%). Of the patients who did not attend, all were appropriately contacted as per the local Trust guidelines via a letter, and were provided with appointments where appropriate; 34% of non-attenders were discharged from services. Conclusion Non-attendance at psychiatric outpatient appointments is a concern, particularly for younger and male patients. Considering the clinical risks associated with this patient population, efforts need to be taken to improve their engagement with mental health services. Future studies may explore patients’ perspectives of non-attendance and how to ameliorate any hindrances to attending.
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Social trust and COVID-appropriate behavior : learning from the pandemicIntroduction: General trust and trust in various social institutions/agents are argued to positively influence the outcome, more so, in a crisis. Mitigating a crisis requires actions from individuals, family, friends, co-workers, various policymaking, and implementing agencies, media, and other agencies with whom people interact. In the COVID-19 situation, people individuals did not have a choice but to access essential services even with the risk of infection. Personal experiences also guide individuals' trust in various social groups and are responsible for taking individual action of protecting themselves in the pandemic. To what extent people trusted various social groups and observed appropriate behavior is investigated in this research. Methods: Responses were collected through a structured, web-based questionnaire where respondents self-reported their trust in various social agents and the extent to which they observed COVID-appropriate behavior. Respondents primarily belonged to the eastern part of India. Results: This study finds significant demographic differences in observing appropriate behavior leading to an identification of a vulnerable group. Second, trust in the inner group (family, friends, neighbors, and co-workers among others) is least important whereas trust in professionals and administrative institutions is the most important. Trust in the central government, media, and politicians among others is counterproductive to observing the appropriate behavior. Conclusion: People repose higher trust in professionals and administrative institutions in a crisis situation. Professional and administrative leadership helps in more effective crisis management leading to better behavioral compliance of the public. Any other leadership may be ineffective or counter-productive.
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Ethnic differences in dose and levels of Clozapine : exploring need for any specific monitoring needsAims: Clinical research shows that compared to Caucasian patients, Asian patients appear to have a lower clozapine dose requirement for clinical efficacy. Hence, appropriate dose adjustment should be considered in Asian patients receiving maintenance clozapine therapy. Secondly, studies in the UK report that Asian patients with treatment-resistant schizophrenia were less likely to receive clozapine than Caucasian patients. The objectives of this study were to find out the ethnic difference in dose and levels of clozapine in ethnic minority patient (BME (Black and minority ethnic) populations and to explore if there is a need for any specific monitoring. Methods: Demographic (age, gender, and ethnicity) and clinical variables (diagnosis, clozapine dose, plasma level of clozapine and nor-clozapine, smoking status, side effect profile, and physical comorbidities) were collected from the electronic patient records and analysed. Results: The sample consisted of 66 (56.4%) Caucasians, 22 (18.8%) Asians, 21 (17.9%) African-Caribbean, and 8 (6.8%) mixed ethnicity patients. Their age range was 19-80, with an average of 46.9 ±11.9 years. Among the ethnic groups, age, clozapine, nor-clozapine level and QTc were comparable, except for the dose of clozapine; Caucasian had the highest dose (414.8±140.0 mg), followed by African-Caribbean (373.8±163.7 mg), Asian (333.8±121.2 mg) and mixed (260.7±110.7 mg) (F3.68, p<0.05). The difference remained significant when all the BME groups were combined as well. Side effects such as hypersalivation, drowsiness, blurred vision, polyuria, sore throat, headache, vomiting (none), dizziness, difficulty passing urine, urine incontinence, flu-like symptoms, nausea, were comparable among ethnic groups. There was no difference in smoking among the groups. Considering comorbidities compared to BME, Caucasians had significantly lower rate of hypertension (27.1% vs 9.1%, p<0.01); diabetes (18.6% vs 4.5%, p<0.05), however dyslipidemia (5.1% vs 3.0%) was comparable. In addition to the above, the dose of clozapine was positively correlated with clozapine and norclozapine levels (p<0.05). Clozapine and norclozapine levels correlated significantly (p<0.001). Age was negatively correlated with norclozapine assay (p<0.05) and positively with the number of cigarettes. It appears as the age increases, the number of cigarettes goes up, and norclozapine levels come down. Conclusion: There are a few variations of clozapine prescribing in different ethnic groups. Although the Caucasians had higher doses, they had comparable blood levels. A higher proportion of BME patients on clozapine had hypertension and diabetes, emphasizing metabolic risk. Our study findings suggest clozapine monitoring should look into ethnicity related risk factors.
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Risk factors related to driving : a review of clinical practice evaluating and addressing fitness to drive among psychiatric inpatientsAims: Mental illness is linked with a higher risk of dangerous driving; e.g. patients with neurotic disorders have 50% more accidents than controls and 10% of drivers involved in accidents have reported feeling suicidal. The Driver and Vehicle Licensing Agency (DVLA) have provided guidance related to fitness to drive for those with mental illness. In this context we intended to study the risk factors associated with psychiatric inpatients related to driving and whether concerns have been documented in clinical reviews. Methods: Case notes of 100 randomly selected psychiatric inpatients in one calendar month were evaluated including: their driving status; concerns regarding driving based on their clinical status (Diagnosis, Medications, Side effects); any clinical advice given and communication with DVLA in the previous one year, were ascertained from electronic records. Missing values were not included in calculation. Results: The sample consisted of 51 female and 49 male patients (mean age 39.7±13.5 and 39.1±12.7 respectively), with the majority 69% from Caucasian ethnicity; 64% were informal. There was no difference noted in driving status based on ethnicity or legal status on admission. On admission 33% of patients reported that they were not driving, 12% were driving, 2% refused to answer and in more than half (53%) driving status was not documented. Considering some of the risk factors for driving, persistent alcohol use was noted in 39.8%, drug use in 34.4%, personality disorder 37%, attention deficit hyperactivity disorder or autistic spectrum disorder in 4%, being on medications with side effects that may impair driving 80.8%, having side effects that impair driving 10%, and suicidality 54.5%. Only in a minority of cases were fitness to drive related issues discussed in their last review (3%), in progress notes (1%), or in discharge notes (2%). There was no documentation related to communication with the DVLA for any patients. Conclusion: The results suggest there is a need to record the driving status of psychiatric inpatients and to discuss driving related concerns when considering mental state, medications and side effects. Information related to driving should be given to patients, and DVLA should be notified as appropriate. This might help in improving safety related to driving by psychiatric patients.
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A quality improvement project to increase junior doctors’ satisfaction with handover process using Microsoft teams (MS Teams) as a platformAims: To improve junior doctors’ satisfaction with handover process to >70% over a period of 10 weeks. Methods: Baseline level of overall satisfaction with current handover practice was measured through a survey using Likert scale. Using the same scale, the team also looked at: 1. Degree of confidence in tasks being completed 2. Degree of confidence in handover being confidential 3. Degree of confidence in handover being sufficient for medico-legal purposes Part of the survey also asked junior doctors using free text comments on how handover is currently carried out between shifts. The results from the survey were analysed and suggestions were considered for improvement. A new method of handover using MS Teams was trialled. During subsequent PDSA cycles change ideas were adopted to improve engagement with the new process and allow for safe handovers. On a weekly basis, post-intervention level of overall satisfaction with the new handover process was measured using the same Likert scale. Other measurements measured weekly included: 1. Percentage of handovers completed using the agreed template 2. Percentage of handed over jobs being acknowledged to signify receipt of handover Results: Pre-intervention, verbal handover was the most frequent way of handing over (85.7%) followed by WhatsApp/text messaging (64.3%) and paper (42.9%). Baseline level of overall satisfaction of handover process is 21.4%. At the end of PDSA Cycle 1, this increased significantly to 78% and by week 10 (end of PDSA Cycle 2) it rose to 92%. Pre-intervention, 35.7% of junior doctors reported feeling confident in the handed over tasks being completed. 28.5% were confident that the handover process is confidential and 14.3% that it is sufficient for medico-legal purposes. Post-intervention, 100% of the handovers are completed using a standardised template and 100% of the tasks were being acknowledged by the appropriate team members. Conclusion: Prior to this intervention the process of junior doctor handover was not uniform and led to near-misses. This created confusion hence opportunities for errors to occur which can compromise patients’ care. Following the introduction of MS Teams as the handover platform, overall satisfaction from junior doctors on the handover process has increased significantly. Moreover, it provides a clear record of handovers taking place which ensures accountability, safety and continuity of patients’ care.
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Prevalence and comparison of the profile of patients who did not attend (DNA) their appointments through face-face, pre-pandemic vs. telephonic consultations, pandemic at the complex care service-South, Wolverhampton - a service evaluationAims: Patients who do not attend the appointments (DNA) pose a significant financial burden on the health care system. During the COVID-19 pandemic, there has been a shift from face-face to telephonic consultations. Our hypothesis was that pandemic can affect the prevalence of profile of clients who DNA. With this background, the aim of the current service evaluation was to assess the prevalence and profile of patients who did not attend their appointments through face-face consultation and telephonic consultations at the Complex care service south [CCS-South], Wolverhampton over a period of one year. Methods: Retrospective evaluation of records of DNA appointments at CCS- South, Wolverhampton of Face-face appointments during March 17th 2019- March 16th 2020 [Pre-pandemic group] and telephonic consultations during March 17th 2020 – March 16th 2021 [pandemic group] was done. Prevalence of DNA was calculated as the number of DNA in CCS South/ number of DNA in total CCS × 100. Student t test, Mann U Whitney test, Chi square test were used to analyse the data. Results: The number of DNA in the pandemic group (625) was significantly higher than the pre-pandemic group (376) [χ2 = 86.31, p <0.00001]. Males had significantly higher DNA in pre-pandemic group (59.52%) whereas females had significantly higher DNA in the pandemic group (66.76%) [χ2 = 72.97, p <0.00001]. The mean (SD) age of clients in the pandemic group was 41.17 (12.39) years was significantly lower than the mean (SD) age of clients in the pre-pandemic group, 42.87 (13.72) years [t = 1.97; p = 0.049]. There was an increase in the Caucasian British (49.73% vs 38.40%) and Asian (29.52% vs 26.41%) in the pandemic group compared to pre-pandemic group. There was a decrease in the African-Caribbean group (10.11% vs 16.11%) and the mixed/other/unstated group (10.64% vs 19.20% vs) in the pandemic group compared to pre-pandemic group. It was the first DNA for twenty-four service users in the pre-pandemic group and none in the pandemic group. Those in the pandemic group (6.39 (6.79)) had significantly higher mean (SD) number of previous DNA than the pre-pandemic group (5.41 (7.50) [U = 98145; W = 293770; Z= -4.40; p = 0.000). There was no significant difference between the time of the appointment in both groups. Conclusion: There was an increased number of DNA during the pandemic period and the profile of those who DNA during the pandemic was of that a female with a mean age of about 41 years with previous DNAs.
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Re-audit of blood monitoring of lithium in outpatients of working age under Dudley mental health servicesAims: Lithium remains the first line mood stabilising therapy recommended by NICE for Bipolar Disorder and an important treatment option for augmentation of the treatment of Depression. Lithium has a strict monitoring requirement due to long term impact on Renal, Thyroid function and risk of toxicity due to a narrow therapeutic range. This Re-Audit aimed to assess improvement in Lithium Blood monitoring in working age adults in Dudley following an initial 2021 audit. Methods: We used the standards set by NICE CG185- Bipolar Disorder Assessment and Management. We agreed a standard of 3 monthly monitoring of lithium levels due to the number of indications for 3 monthly monitoring to ensure safest practice. We also agreed to standards for 6 monthly monitoring of Urea and Electrolytes (U&Es) and Thyroid Function Tests (TFTs). An additional standard was agreed that at every outpatient review Lithium blood results should be reviewed and documented. A sample of 40 patients was gathered from the 8 outpatient sector teams. We used Rio notes system for demographic, diagnosis and clinical information and blood results systems EMIS and ICE for blood results over a period of November 2021- November 2022. Results: There was a noted minor improvement to compliance with 3 monthly monitoring, overall increasing from 10% to 17.5%, but this result is still poor. The number of patients who had 4 or more Lithium blood tests over the 12 month period was more of a positive increase, to 32.5% from 17.5% in the previous audit cycle. There was also an improvement in the mean number of lithium blood tests per patient from 2.67 to 3.3. For U&Es 90% of patients were monitored 6 monthly while for TFTs 85% of patients were monitored 6 monthly. There was a slight reduction in documentation of blood results at clinic review, reducing to 62.5% from 67.5% in the initial audit. Conclusion: While the progress is positive, the results are still far below where the trust would like to be. We considered whether frequency of outpatient review, poor awareness of 3 monthly monitoring standards and a lack of formal system to remind or ensure patients are monitored appropriately. It was agreed that measures to ensure compliance such as a lithium blood monitoring clinic may be useful to improve compliance with monitoring.
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Translation of recovering quality of life (ReQoL) to Gujarati : for use in mental health servicesThe Recovering Quality of Life (ReQoL) scale is a short scale for routine clinical use in mental health services. Its shorter 10-item version in English was translated and validated in Gujarati, an Indian language, spoken in the western state of Gujarat in India. The translation process involved following process: forward and back-translation, pilot-testing involving patients, review and reconciliation steps. The linguistic issues encountered during the translation process were addressed. The Gujarati version of ReQoL was considered linguistically acceptable for use in patients with mental illness. It is expected that ReQoL Gujarati version will add to QOL instruments in Gujarati language which can be used in routine clinical practice.