Research Audit and Clinical Practice

Improving and Sustaining the Quality of Discharge Summaries

Research Audit and Clinical Practice, Volume 21, Issue 3, Pages 121-164 (2022)

High quality discharge information communication has been linked to a reduction in the incidence of adverse events, decreasing the risk of prescription errors and lost follow up. In this paper we describe how our trust-wide quality improvement project, led by acute physicians, successfully improved discharge documentation. We demonstrate how we identified obstacles to continued success, and the interventions we implemented. We recommend how discharge summary quality can be optimised through training of junior doctors, recruitment of local champions, and use of novel methods to preserve engagement, such as gamification.

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Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21): assessing national performance of acute medicine services

Research Audit and Clinical Practice, Volume 21, Issue 1, Pages 1-64 (2022)

The Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21) took place on 17th June 2021, providing the first assessment of performance against the Society for Acute Medicine’s Clinical Quality Indicators (CQIs) within acute medical units since the start of the COVID-19 pandemic.

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Length of stay in Acute Medical Admissions: Analysis from the Society for Acute Medicine Benchmarking Audit

Research Audit and Clinical Practice, Volume 21, Issue 1, Pages 1-64 (2022)

Medical admissions to hospital represent a diverse range of patients, from those managed on ambulatory pathways through Same Day Emergency Care (SDEC) services, to those requiring prolonged inpatient admission. An understanding of current patterns of admission through acute medicine services and patient factors associated with longer hospital admission is needed to guide service planning and improvement.

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Point of care ultrasound 3-point compression vs departmental scanning for lower limb DVT in ambulatory and internal medicine patients

Research Audit and Clinical Practice, Volume 20, Issue 4, Pages 249 – 308 (2021)

Point of care ultrasound scanning (POCUS) is safe and effective in positively identifying lower limb DVT in emergency departments globally. In the UK, the requisite knowledge and skills are integrated into the FAMUS and FUSIC curricula.
Five FAMUS practitioners of varying experience performed 3-point compression POCUS on medical ambulatory and inpatients. Accuracy and timing of POCUS was compared between practitioners and with subsequent departmental scans.
89% sensitivity and 97% specificity were observed, with little difference between supervisors and candidates. Additionally, a significantly higher proportion of POCUS vs departmental scans (69% vs 7%, p = 0.0001) occurred within 24 hours of request.
Minimal experience was required to produce accurate results within ambulatory and internal medicine settings, and significant time savings can be made.

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A change in perspective to see the bigger picture. A thematic analysis of Audit and Quality Improvement submissions to the last seven UK based SAM Conferences

Research Audit and Clinical Practice, Volume 19, Issue 2, Pages 61 – 112 (2020)

Aims: To create a profile of Society for Acute Medicine (SAM) Audit and Quality Improvement (A&QI) accepted abstracts from the last seven UK based conferences.

Methodology: The profile elements for 380 SAM A&QI abstracts accepted for poster presentation were compiled from their respective conference programme booklets. Abstracts were classified into 30 categories based on key themes. Further sub-categorisation of abstracts was based on secondary detail of the submissions. Data was analysed with Pareto charts.

Findings: The majority of submissions were covered by a small representation of themes, with 30% of category themes covering 80% of A&QI abstracts.

There is a repetitive trend of theme categories across all the conferences.

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Medical High Dependency Unit series, Article 4: Tracheostomy management

Research Audit and Clinical Practice, Volume 16, Issue 4, Pages 153 – 212 (2017)

Abstract

The number of patients with tracheostomies managed within high dependency units is increasing. National audits have suggested that the care of these patients could have been improved upon with a significant minority of cases resulting in death or serious adverse events. Because of this, it is crucial that staff working within medical high dependency units have a good understanding of the indications for and techniques of insertion of tracheostomies. In addition, knowledge of the various tube types and ancillary equipment is mandatory. Ideally, care should be standardised across hospital sites and all staff trained to deal with routine and basic emergency care using national guidelines. It is fundamental that medical staff without expertise in the advanced management of emergencies are aware of the equipment required and who to contact within their hospital should such procedures be necessary. Temporary tracheostomies should be removed at the earliest opportunity under the guidance of the teams responsible for their insertion.

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Using a Delphi study approach to develop competencies for Allied Health Professionals working in Acute Medicine

Research Audit and Clinical Practice, Volume 16, Issue 4, Pages 153 – 212 (2017)

Abstract

A Delphi study approach was used to develop a national standard of competencies for Occupational Therapists and Physiotherapists working in acute medicine. Nineteen expert therapists participated in the Delphi study, which consisted of four rounds. A total of two hundred and seventy one competencies were developed and agreed for inclusion in a single document. This paper describes the methodology and challenges presented in developing such a diverse range of competencies.

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Acute Medical Ward for better care coordination of patients admitted with infection – evidence from a tertiary hospital in Singapore

Research Audit and Clinical Practice, Volume 16, Issue 4, Pages 153 – 212 (2017)

Abstract

Coordination and consolidation of care provided in acute care hospitals need reconfiguration and reorganization to meet the demand of large number of acute admissions. We report on the effectiveness of an Acute Medical Ward AMW (AMW) receiving cases that were suspected to have infection related diagnosis on admission by Emergency Department (ED), addressing this in a large tertiary hospital in South East Asia. Mean Length of Stay (LOS) was compared using Gamma Generalized Linear Models with Log-link while odds of readmissions and mortality were compared using logistic regression models. The LOS (mean: 5.8 days, SD: 9.1 days) of all patients admitted to AMW was similar to discharge diagnosis-matched general ward (GW) patients admitted before AMW implementation, readmission rates were lower (15-day: 5.3%, 30-day: 8.1%). Bivariate and multivariate models revealed that mean LOS after AMW implementation was not significantly different from before AMW implementation (Ratio: 0.99, p=0.473). Our AMW had reduced readmission rates for patients with infection but has not made an overall impact on the LOS and readmission rates for the epartment as a whole.

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Long-term health related quality of life in patients with sepsis after intensive care stay: A systematic review

Research Audit and Clinical Practice, Volume 16, Issue 4, Pages 153 – 212 (2017)

Abstract

Sepsis is a major health care issue and sepsis survivors are often confronted with long-term complications after admission to the intensive care unit (ICU) which may negatively influence their health related quality of life (HRQOL). This study aimed to systematically evaluate the outcome in terms of HRQOL in patients with sepsis after ICU discharge.

A literature search was conducted in the bibliographic databases PubMed, EMBASE, and CINAHL, including reference lists of published guidelines, reviews and associated articles.

Sixteen studies were included, thirteen (81.3%) reported that sepsis survivors suffer from impaired HRQOL in physical and mental domains which persist from months to years after a sepsis episode.

More focus on improving long-term outcomes for patients surviving sepsis and the ICU is needed.

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Characteristics and outcome of acute medical admissions with hyponatremia: even mild hyponatremia is associated with higher mortality

Research Audit and Clinical Practice, Volume 16, Issue 4, Pages 153 – 212 (2017)

Abstract

Hyponatremia is a common finding in hospitalized patients. In this retrospective cohort study we assessed the characteristics and outcome of acute medical admissions with hyponatremia. Compared to the normal sodium group, those with hyponatremia were significantly older and the Charlson Comorbidity Index (CCI) was higher. The number of admissions to MCU/ICU between both groups was similar, but hyponatremic patients had a longer length of stay and both 28-day and one-year mortality were higher, even in patients with mild hyponatremia. Hyponatremia was independently associated with mortality after adjustment for age, CCI and polypharmacy, as was found in the subgroup with mild hyponatremia.

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