Aneurin Bevan University Health Board Research Articles

Expanding arts therapies provision: a pilot project in Older Adult Mental Health Services, Aneurin Bevan University Health Board

ObjectivesThe aim of the report is to summarise the progress made during a six-month pilot project expanding arts therapies provision from an inpatient service to community services, in a National Health Service health board's Older Adult Mental Health Services, in response to the need for direct therapy with older adults who have severe cognitive impairment and communication difficulties arising from dementia and/or complex mental health difficulties. Study designThis is a case report on a pilot project. MethodsThe level of need for the service was explored, and indicators of effectiveness were gathered using evaluation forms—observer feedback forms and ARM-5 (Agnew Relationship Measure - 5) - to indicate the therapeutic alliance, team review and feedback from colleagues. ResultsTo gather indications about the level of need, we recorded the following: number of referrals (n = 125) and waiting list numbers at the end of the project (n = 34). ConclusionsThis pilot project indicates that there is need for psychological interventions in older adult community mental health services that arts therapies provision can help address. The number of referrals is one indicator of the level of need, and positive feedback from clients, families and colleagues, is an indicator that the team delivered effectively. The areas of client need addressed in sessions as documented in observer feedback forms indicate that for these clients, arts therapies was a valuable resource in addressing challenges arising from mental health difficulties and/or dementia.

More than 30 community pharmacies in Wales now offer a COVID-19 vaccination service

Four health boards across Wales have commissioned more than 30 community pharmacies to provide COVID-19 vaccinations, nearly double the number reported by The Pharmaceutical Journal in April 2021. As of 29 November 2021, Aneurin Bevan University Health Board, Betsi Cadwaladr University Health Board, Cardiff and Vale University Health Board and Swansea Bay University Health Board said […]

Trauma surgery at a designated COVID-19-free site during the pandemic: a safe model and a possible way to restart routine elective surgery.

AimsElective operating was halted during the COVID-19 pandemic to increase the capacity to provide care to an unprecedented volume of critically unwell patients. During the pandemic, the orthopaedic department at the Aneurin Bevan University Health Board restructured the trauma service, relocating semi-urgent ambulatory trauma operating to the isolated clean elective centre (St. Woolos’ Hospital) from the main hospital receiving COVID-19 patients (Royal Gwent Hospital). This study presents our experience of providing semi-urgent trauma care in a COVID-19-free surgical unit as a safe way to treat trauma patients during the pandemic and a potential model for restarting an elective orthopaedic service.MethodsAll patients undergoing surgery during the COVID-19 pandemic at the orthopaedic surgical unit (OSU) in St. Woolos’ Hospital from 23 March 2020 to 24 April 2020 were included. All patients that were operated on had a telephone follow-up two weeks after surgery to assess if they had experienced COVID-19 symptoms or had been tested for COVID-19. The nature of admission, operative details, and patient demographics were obtained from the health board’s electronic record. Staff were assessed for sickness, self-isolation, and COVID-19 status.ResultsA total of 58 surgical procedures were undertaken at the OSU during the study period; 93% (n = 54) of patients completed the telephone follow-up. Open reduction and internal fixation of ankle and wrist fractures were the most common procedures. None of the patients nor members of their households had developed symptoms suggestive of COVID-19 or required testing. No staff members reported sick days or were advised by occupational health to undergo viral testing.ConclusionThis study provides optimism that orthopaedic patients planned for surgery can be protected from COVID-19 nosocomial transmission at separate COVID-19-free sites.Cite this article: Bone Joint Open 2020;1-6:302–308.

Dialectical behaviour therapy and perinatal mental health: An evaluation of an adapted DBT programme for mothers with emotional dysregulation

An adapted 12-week dialectical behavioural therapy (DBT) skills group was offered to 13 women under the care of the Aneurin Bevan University Health Board (ABUHB) Perinatal Mental Health Team experiencing emotional dysregulation. The intervention was associated with reduced postnatal depression and anxiety and improved emotional awareness.

Trauma surgery at a designated COVID-19-free site during the pandemic

Aims Elective operating was halted during the COVID-19 pandemic to increase the capacity to provide care to an unprecedented volume of critically unwell patients. During the pandemic, the orthopaedic department at the Aneurin Bevan University Health Board restructured the trauma service, relocating semi-urgent ambulatory trauma operating to the isolated clean elective centre (St. Woolos’ Hospital) from the main hospital receiving COVID-19 patients (Royal Gwent Hospital). This study presents our experience of providing semi-urgent trauma care in a COVID-19-free surgical unit as a safe way to treat trauma patients during the pandemic and a potential model for restarting an elective orthopaedic service. Methods All patients undergoing surgery during the COVID-19 pandemic at the orthopaedic surgical unit (OSU) in St. Woolos’ Hospital from 23 March 2020 to 24 April 2020 were included. All patients that were operated on had a telephone follow-up two weeks after surgery to assess if they had experienced COVID-19 symptoms or had been tested for COVID-19. The nature of admission, operative details, and patient demographics were obtained from the health board’s electronic record. Staff were assessed for sickness, self-isolation, and COVID-19 status. Results A total of 58 surgical procedures were undertaken at the OSU during the study period; 93% (n = 54) of patients completed the telephone follow-up. Open reduction and internal fixation of ankle and wrist fractures were the most common procedures. None of the patients nor members of their households had developed symptoms suggestive of COVID-19 or required testing. No staff members reported sick days or were advised by occupational health to undergo viral testing. Conclusion This study provides optimism that orthopaedic patients planned for surgery can be protected from COVID-19 nosocomial transmission at separate COVID-19-free sites. Cite this article: Bone Joint Open 2020;1-6:302–308.

O37 Utility of RA classification criteria in early inflammatory arthritis referral prioritisation

Abstract Background Early arthritis clinics are increasingly utilised as a method of ensuring patients suspected of disease are assessed promptly to enable suitable treatment. Early recognition with treat to target has been demonstrated in systematic reviews to significantly improve mortality and morbidity outcomes. The United Kingdom’s National Institute for Health and Care Excellence (NICE) recommend potentially affected patients are referred from primary care within 3 days and seen in secondary care within 3 weeks. We hypothesised that utilising the ACR/EULAR 2010 rheumatoid arthritis classification criteria we could identify variables within the primary care referral which make an early arthritis more or less likely. Methods A retrospective study of all the patients seen in early inflammatory arthritis (EIA) Clinic from September 2017 to August 2018 in Aneurin Bevan University Health Board. EULAR scores of 145 patients were calculated based on the data provided in the primary care referral. These scores and their components were then compared to the eventual diagnosis. Results EULAR score of ≥ 5 had specificity of > 78% and sensitivity of < 30% in predicting EIA. EULAR score of 8 or more was 100% specific for EIA with positive likelihood ratio of infinity. Whereas EULAR score < 3 had a specificity of > 70% and sensitivity of < 45% for Non EIA with a positive likelihood ratio of 1.59. Considering individual EULAR components a high positive Rheumatoid Factor (RF) or Anti-citrullinated peptide antibody (ACPA) and involvement of greater than 10 joints had a positive likelihood ratio of ≥ 3.00 for EIA. A low positive RF or ACPA had a specificity of 66.67% and sensitivity of 27.59% for EIA with a positive likelihood ratio of 0.83. Surprisingly involvement of 4-10 small joints or 2-10 large joints or just 1 large joint had a specificity of ≥ 75% for EIA and a positive likelihood ratio of greater than 1.00. A positive ESR or CRP had a specificity of 36.84% and sensitivity of 67.92% with a positive likelihood ratio for EIA of 1.08. A negative ESR and CRP had a specificity of 67.92% and a sensitivity of 35.00% for Non EIA with a positive likelihood ratio of 1.09. The duration of symptoms of < 6 weeks had a specificity of 77.55% and sensitivity of 24.39% with positive likelihood ratio for Non EIA of 1.08, however duration of > 6 weeks had a positive likelihood ratio of 0.97 for EIA with a lower specificity of 22.45% . Conclusion The total EULAR score and individual components can be used to prioritize primary care referrals. A EULAR score of less than 3, duration of symptoms of < 6 weeks, a negative ESR and CRP, a low positive RF or ACPA makes EIA less likely. Disclosures S.M. Imaduddin None. P. O'Biern None.

Inpatient hip fractures: understanding and addressing the risk of this common injury.

The impact and outcome of hip fractures are well described for people living in the community, but inpatient hip fracture (IHF) have not been extensively studied. In this study, we examine the patient characteristics, common falls risk factors and clinical outcomes of this condition. Between January 2016 and December 2017, we analysed all inpatient falls that resulted in hip fracture within Aneurin Bevan University Health Board (ABUHB) in Wales. The overall falls rate was 8.7/1000 occupied bed days (OBD). Over the 2years, 118 patients sustained an IHF, giving a rate of 0.12/1000 OBD. The mean age was 81.8 ± 9.5 (range 49-97) years and 60% were women. Most patients (n= 112) were admitted from their own home. Mean Charlson Comorbidity Index and the number of medications on admission were 5.5 ± 1.9 and 8.5 ± 3.7, respectively.Fifty-three patients (45%) sustained the IHF following their first inpatient fall. Twenty-four IHF (20%) occurred within 72h. Mean length of stay was 84.9 ± 55.8days. Only 43% were discharged back to their original place of residence following an IHF; 27% were discharged to a care home (26 new care home discharges), and 30% died as an inpatient. One-year mortality was 54% (n= 64/118). The most common comorbidity was dementia (63%). Mortality and need for care home placement are both much higher after IHF than following community hip fracture. Most people who suffer a hip fracture in hospital have already demonstrated their need for falls risk management by having fallen previously during the same admission.

72 Prevalence of Reported and Unreported Vertebral Fractures in Ctpas in Older Adults Above 75 Years

Abstract Introduction Identifying vertebral fractures is prudent in the diagnosis of osteoporosis as they occur early in this hidden condition. Unfortunately, due to their unspecific presentation, only 25% are clinically recognised. Computerised Tomography Pulmonary Angiogram (CTPA) are frequently requested to confirm pulmonary thromboembolisms, but could also aid in detecting clinically silent vertebral fractures. Current literature suggests that less than one-third of incidental vertebral fractures are reported. The aim of this study is to measure the prevalence of vertebral fractures in CTPA and its relevance to clinical outcomes. Methods This is retrospective observational study based on the analysis of existing CTPA for acutely unwell patients admitted to medical assessment unit or A & E across three acute sites within Aneurin Bevan University Health board, Wales, UK between January and December 2015. All CTPA reports were reviewed for fragility factures and CTPA images were reassessed for any unreported vertebral fractures. Age and gender were recorded for all patients. Analysis was done for all patients in respect to subsequent fragility fractures and mortality. Difference of proportion test was used to compare two groups with and without vertebral fractures. Results 179 CTPA were reviewed, 161 patients were included for further analysis. 14.3% (n=23/161) were reported to have a vertebral fracture, however only 8.7% (n=14/161) of reports used the correct terminology of ‘fracture’. On subsequent review, an additional 24.2% (n=39/161) vertebral fractures were noted. Therefore, overall prevalence of vertebral fractures was 38.5% (n=62/161). Only 9.1% (n=9/99) of patients without a vertebral fracture developed a subsequent fragility fracture. In comparison, 22.5% (n=14/62) of patients with a previous vertebral fracture sustained a new fragility fracture over next 4 years and this was significantly higher (p = 0.017). Overall mortality over 4 years follow-up was significantly higher for patients with vertebral fractures (64.5%, n=40/62) as compared to those without fractures (43.4%, n=43/99, p = 0.009). Only 48.4% (n=30/62) received osteoporosis treatment. Conclusions Vertebral fractures could be underreported by radiologists, likely due to human factors as they might be concentrating on the clinical scenario to exclude a pulmonary embolism. However, considering a significant higher mortality in patients with underlying vertebral fracture, it justifies that radiologists could be asked to examine sagittal view in the bone window for possible underlying vertebral fractures, to ensure osteoporosis is treated to guidance.

The Aneurin Bevan University Health Board (ABUHB) level 3 multidisciplinary (MDT) service: description of age, demographic and anthropometric characteristics and 1-year and 2-year weight changes

The Aneurin Bevan University Health Board (ABUHB) level 3 multidisciplinary (MDT) service: description of age, demographic and anthropometric characteristics and 1-year and 2-year weight changes

Driving Improvements in Child Protection and Safeguarding Practice

Driving Improvements in Child Protection and Safeguarding Practice

153 - Small cell lung cancer survival: a 5-year cohort at Aneurin Bevan University Health Board

153 - Small cell lung cancer survival: a 5-year cohort at Aneurin Bevan University Health Board

Audit of patient retention in pre-exposure prophylaxis (PrEP) services in an integrated sexual reproductive health service setting.

Pre-exposure prophylaxis (PrEP) for HIV in Wales was launched in July 2017. We set up a PrEP service delivered via our integrated sexual reproductive health service in Aneurin Bevan University Health Board (ABUHB), south east Wales. Public Health Wales (PHW) data show a 22% ‘lost to follow-up’ rate amongst Welsh PrEP patients. Over 18 months, 278 patients booked into ABUHB PrEP clinics. Of these, 275 were men who have sex with men (MSM). One hundred and ninety-three patients commenced PrEP, 5 were diagnosed with HIV at baseline, 42 did not attend their first appointment. The remainder declined PrEP. Of those commenced on PrEP, 51.7% had reduced clinic attendances; all were MSM. Patients with reduced attendances were more likely to be younger (mean age 33 vs. 37 years), reside outside ABUHB catchment area (56.4% vs. 49.6%) and have mental health issues (28.6% vs. 18.8%), but were less likely to disclose substance misuse (24.2% vs. 27.1%) than those attending in line with operational guidance. Of the 63 patients who stopped attending the PrEP clinic, 32.3% (21) had documented reasons, the most common being reduced self-perceived risk. This is the first evaluation of reasons why patients stop attending as well as risk factors associated with those lost to follow-up in PrEP services in Wales.

Establishing a regular systems-based teaching programme for core medical trainees within a district general hospital.

Although Health Education and Improvement Wales (HEIW) provide regional teaching days for core medical trainees (CMTs) in line with the curriculum, the local teaching for CMTs within hospitals in Aneurin Bevan University Health Board has been variable. Focusing on the Royal Gwent Hospital where no formal teaching was being run locally, I aimed to establish regular teaching sessions for CMTs incorporating clinical skills, simulation training and useful systems-based discussions that are relevant to day to day working practices. The aim is to drive cultural change in a hospital that has never run local teaching sessions for CMTs to establish a regular programme that can be continued beyond August 2019 with the new introduction of internal medicine trainees in Wales. Having initially asked the current cohort of CMTs what type of teaching they would like to receive, it was apparent that most CMTs wished to have clinical skills and simulation teaching to help them gain confidence in core procedures and emergency scenarios as they progress …

Missing: Outlying medical patients. If found please bleep the medics.

The Society for Acute Medicine has recently updated its third Clinical Quality Improvement (CQI) standard, which states that, ‘All patients should be reviewed by the admitting consultant physician or an appropriate specialty consultant physician within 12 hours of arrival to hospital’.1 This is in line with NHS Improvement which recommends that all patients should receive a ‘consultant approved care plan’ within 12 hours of admission.2 This CQI is subsequently used as a benchmarking tool during the annual Society of Acute Medicine Benchmarking Audit (SAMBA). In the 2018 benchmarking audit, overall 62.8% of all patients received a consultant review within this time period.1 Within Aneurin Bevan University Health Board the statistics for time between patient admission and consultant post-take ward round (PTWR) are in line with national average. However, medical patients are still missed off PTWR due to a number of identified factors including:

Establishing a regular systems-based teaching programme for core medical trainees within a district general hospital

Although Health Education and Improvement Wales (HEIW) provide regional teaching days for core medical trainees (CMTs) in line with the curriculum, the local teaching for CMTs within hospitals in Aneurin Bevan University Health Board has been variable. Focusing on the Royal Gwent Hospital where no formal teaching was being run locally, I aimed to establish regular teaching sessions for CMTs incorporating clinical skills, simulation training and useful systems-based discussions that are relevant to day to day working practices. The aim is to drive cultural change in a hospital that has never run local teaching sessions for CMTs to establish a regular programme that can be continued beyond August 2019 with the new introduction of internal medicine trainees in Wales. Having initially asked the current cohort of CMTs what type of teaching they would like to receive, it was apparent that most CMTs wished to have clinical skills and simulation teaching to help them gain confidence in core procedures and emergency scenarios as they progress …

Missing: Outlying medical patients. If found please bleep the medics

The Society for Acute Medicine has recently updated its third Clinical Quality Improvement (CQI) standard, which states that, ‘All patients should be reviewed by the admitting consultant physician or an appropriate specialty consultant physician within 12 hours of arrival to hospital’.1 This is in line with NHS Improvement which recommends that all patients should receive a ‘consultant approved care plan’ within 12 hours of admission.2 This CQI is subsequently used as a benchmarking tool during the annual Society of Acute Medicine Benchmarking Audit (SAMBA). In the 2018 benchmarking audit, overall 62.8% of all patients received a consultant review within this time period.1 Within Aneurin Bevan University Health Board the statistics for time between patient admission and consultant post-take ward round (PTWR) are in line with national average. However, medical patients are still missed off PTWR due to a number of identified factors including:

Dementia in an Acute Hospital Setting: Health Service Research to Profile Patient Characteristics and Predictors of Adverse Clinical Outcomes.

Introduction: Patients with dementia often have other associated medical co-morbidities resulting in adverse outcomes. The National Audit of Dementia (NAD) in the UK showed a wide variation in the quality and clinical care for acute dementia patients. This study aims to record the clinical profile and benchmark clinical outcomes of acute dementia patients admitted within Aneurin Bevan University Health Board, Wales (UK). Methods: This was a retrospective observational study based on analysis of the existing data for all acute dementia patients. Ethical approval was not required for this service evaluation. Results: In 2016, a total of 1770 dementia patients had 2474 acute admissions. We studied 1167 acute admissions (953 dementia patients) from 1st January 2016–30th June 2016. The mean age was 84.5 ± 7.8 years (females = 63.5%). Mean Charlson comorbidity index and the number of drugs were 6.0 ± 1.5 and 5.1 ± 2.1. 15.4% (147/953) patients were on antipsychotics. Overall mean hospital stay was 19.4 ± 27.2 days. 30-days readmission rate was 17.2% (138/800) with a mean hospital stay of 14.6 ± 17.9 days. 3.4% (32/953) patients were excluded due to a coding error. 70.3% (n = 670/953) were previously living in their own homes and only 26.3% (n = 251/953) were admitted from care homes. 59.5% patients (n = 399/670) were discharged back to their homes and 21.6% (145/670) were discharged to a new care home, which represents an approximately 1.68 times higher rate of new care home occupancy than the patients being originally admitted from a care home. Overall inpatient was 16.0% (153/953). 30-days and one-year mortality were 22.3% (213/953) and 49.2% (469/953) respectively. The observed mortality rates between patients admitted from home or from a care home were highly significant for one-year mortality (p < 0.001). The inpatient falls rate was significantly higher (1.8 times) as compared to overall general medical inpatient falls rate. Conclusion: Acute patients with dementia have a higher risk of adverse outcomes and the impact of hospitalisation. Prompt comprehensive geriatric assessment and quality improvement initiatives are needed to improve clinical outcomes and to enhance the quality of care.

The Risk Reference Panel: a thematic analysis of a multidisciplinary forum for complex cases.

Aims and methodTo describe the functions of the Aneurin Bevan University Health Board Risk Reference Panel and characterise the typical referrals presented and outcomes from the panel. A structured thematic analysis was performed on verbatim transcripts of 48 panel sessions. RESULTS: The 79 codes identified were grouped into 16 subthemes. Four principal themes were identified: two characterising cases brought to the panel (childhood risk factors and current presenting difficulties) and two describing advice given (risk management and wider organisational issues). Quotations are given to illustrate cases presented and advice given by the panel.Clinical implicationsThe panel provides a valuable source of special expertise in the management of complex and exceptional cases where risk of harm is significant and clinical teams have ongoing concerns. This paper describes a model of peer-working to support staff and may further reduce the risk of harm associated with mental illness.Declaration of interestNone.

284 Acute neurology in aneurin bevan university health board

Aneurin Bevan University Health Board (ABUHB) provides for a population of 6 40 000 in South East Wales, in addition to South Powys. The large geographical area contains 3 sites with acute unselected medical intake as well as 3 other hospitals. The neurology department, comprising 6 consultants (1 stroke/neurology), 1 associate specialist and 1 trainee, is based in Newport. Service evaluation (2013) revealed that 1 in 6 neurology clinic appointments were used to see patients discharged from acute medicine, with a median waiting time of 14 weeks. In 2015 the ‘Neurologist of the Week’ service was launched; 5 consultants participate on a weekly rota. Routine work is cancelled and replaced with a 10 DCC (~40 hours) acute neurology week. This includes 3 acute clinics (each 3 patients), daily MAU round for the largest site, and a triage and advice service for primary and secondary care. Visits to other hospital sites are made when needed. The service has led to significant improvements in quality of care, neurology training and undergraduate teaching and is highly valued by colleagues. Repeated evaluations show ~55% of acute clinic patients are discharged, with ~40% of appointments preventing or shortening an admission. Diagnosis is significantly changed in ~40% of consultations.

A novel solution to the nursing workforce crisis: recruitment of overseas nurses living locally.

Aneurin Bevan University Health Board has recruited nurses from overseas from within and outside the European economic area. This article describes an innovative recruitment initiative that has focused on nurses who trained overseas and are living and working in the local community, but cannot work in a registered nurse role without financial and practical support. It provides an overview of the robust selection processes used, which are in line with the Nursing and Midwifery Council registration requirements, and the stepwise employment offer made to successful applicants.