Critical Care Specialists Research Articles

Awareness, opinion, attitude of intensive care unit specialists about the ethical guidelines for dealing with clinical decisions regarding the allocation of scarce resources during the COVID-19 pandemic

Background: With the escalation of the coronavirus disease (COVID-19) pandemic, critical care specialists have been challenged by ethical issues related to the distribution of scarce resources. Many relevant guidelines have been published worldwide. The Saudi Critical Care Society included a local framework for ethics in its first clinical guidelines for clinical decisions regarding the allocation of scarce resources during the COVID-19 pandemic for COVID-19 patients in intensive care units (ICUs). This study aimed to assess the awareness, opinions, and attitudes of ICU specialists concerning these ethical guidelines and the proposed definitions. Methods: A descriptive cross-sectional study using a self-administered questionnaire was conducted. The study population included 300 ICU physicians in Saudi Arabia who were members of the Saudi Critical Care Society. Results: A total of 70 participants (23.3%) responded to the questionnaire. Most were male, non-Saudi, and Muslim. Professionally, they were mostly intensivists with 10 or more years of experience. The most agreed-upon suggested definitions were “health crisis,” “salvageable patients” category, and the “necessity scale” (32; 45.7%, 37; 52.9%, 52; 74.3%, and 34; 48.6%, respectively). Less agreement was observed for the definitions of “de-escalation without omission” and “primary triage scale” (20; 28.6%, and 21; 3%, respectively). The most agreed-upon statements were those requiring healthcare providers to receive training on contagious diseases and calling for providing them with housing if a situation requires them to leave their homes (56; 80%), while the least agreed-upon statements concerned withholding mechanical ventilation from patients (29; 41.4%). Conclusion: During epidemics, health-care workers provide services in unusual, challenging situations. Doing so necessitates support in social, psychological, and professional areas. A decision-making framework is needed that endorses the cultural and religious contexts, as well as the lived experiences of frontline clinicians, including a clear de-escalation plan and a primary triage system during the pandemic.

Perspectives on Excited Delirium and Ketamine

Perspectives on Excited Delirium and Ketamine

Effect of COVID-19 Specific Critical Care Nursing Program on Knowledge and Skills of Nursing Officers in an Apex Level Hospital of Uttarakhand - A Pre-Post Design

Introduction: COVID-19 was global pandemic during its outbreak and it brought challenges for healthcare workers at every level. The patients were admitted in ICU for critical care and COVID-19 specific nursing care was urge in need. Hence, to keep this background in mind there was specific need of training regarding COVID-19 critical care and the study was conducted on same. Methods: A quantitative research analysis was done on 100 nursing personal who worked in COVID-19 areas. The knowledge was assessed and then training was given followed by reassessment of knowledge and skills. The training included different 12 critical care procedures which were specific to COVID-19 care. Results: The study result showed the significant increase in knowledge from pre-test to post-test 1 and 2. The skill assessment was done for 12 procedures with the OSCE checklist. Nursing officers who performed better in posttest also performed better in OSCE skills assessment. COVID-19 specific critical care training program had a significant impact on knowledge and skills of nursing officers. Conclusion: Evidence based nursing practice on COVID-19 specific critical care training was significantly effective on knowledge and skills of nursing officers. The simulator based training on different critical care procedure helped our nurses for enhancing their knowledge, practice, and skills during patient care

COVID 19 and obstetrics: anaesthetic challenges, co-morbid conditions and critical care

The WHO has declared severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) as a pandemic; it affected approximately 44.5million people since its first breakout in December 2019. COVID-19 can present with wide spectrum of clinical manifestations which range from mild illness with myalgia only to acute respiratory distress syndrome with or without multi-organ dysfunction syndrome necessitating the advance critical care and life support. Pregnant women presenting to emergency department needs to be triaged based on imminent risk factors for maternal and fetal compromise, present haemodynamic status of mother with consideration of gestational age. Pregnant women with comorbid conditions require multidisciplinary team approach for better pregnancy outcomes, resource management and minimizing the risk infection to health care providers. This review emphasizes on management of labour, pregnancy outcomes, co-morbidities and complex critical situations associated with COVID-19 infected pregnant women. Development of safe medical practices and infection prevention protocols with involvement of multidisciplinary team including anaesthesiologist, obstetrician, neonatologist, critical care specialist, infectious disease experts and nursing staff for the perioperative management; is required to optimize the patient outcome and mitigate the infection risk to health personnel and their families.

Experiences of surgical nurses in providing end-of-life care in an acute care setting: a qualitative study.

The number of deaths occurring in hospitals is rising, and many occur in settings other than specialist palliative care, oncology or critical care. Nurses working outside these specialist environments report end-of-life (EoL) care as a source of stress. This research aimed to explore these experiences. This qualitative study, using semi-structured interviews as a research technique, aimed to investigate the experiences of surgical nurses caring for dying patients. Five themes emerged: understanding of and preference for EoL care; perceived barriers while providing EoL care; robust support from the team as a facilitator while providing EoL care; symptom management; future training and support. Participants considered providing EoL care as part of their professional role and reported that they were able to provide appropriate physical care. Participants identified challenges in providing emotional and psychological support to dying patients and their families in an acute surgical setting.

Who is going to turn on the ventilators?

ABSTRACTObjective To analyze the COVID-19 pandemic in Brazil, a continental-sized country, considered as an emerging economy but with several regional nuances, focusing on the availability of human resources, especially for intensive care units.Methods The database of the National Registry of Health Facilities was accessed. Healthcare professionals in the care of COVID-19 were georeferenced. We correlated the number of professionals with the parameters used by the World Health Organization. According to the Brazilian Intensive Care Medicine Association, we correlated the data for adult intensive care unit beds in each state with the number of professionals for each ten intensive care unit beds. The number of professionals, beds, and cases were then organized by state.Results The number of physicians per 100 thousand inhabitants followed the World Health Organization recommendations; however, the number of nurses did not. The number of intensivists, registered nurses, nurse technicians specialized in intensive care, and respiratory therapists, necessary for every ten intensive care beds, was not enough for any of these professional categories. A complete team of critical care specialists was available for 10% of intensive care unit beds in Brazil.Conclusion There is a shortage of professionals for intensive care unit, as we demonstrated for Brazil. Intensive care physical resources to be efficiently used require extremely specialized human resources; therefore, planning human resources is just as crucial as planning physical and structural resources.

Development of a veterinary emergency open standard competency framework using a competency-based model of medical education.

To address the shortage of emergency veterinarians, the profession is exploring accelerated training pathways. We sought to contribute to the solution by developing the foundation for an open standard, competency-based veterinary emergency training curriculum for use by any program. We also developed a curricular delivery, tracking, and assessment system to demonstrate how the framework can be integrated into training programs. DESIGN: Hybrid Delphi method. SETTING: Academia and referral practice. ANIMALS: None. None. An emergency veterinary competency framework was developed by adapting the human Model of the Clinical Practice of Emergency Medicine, which aligns with the Competency-Based Veterinary Education framework, to produce 4 areas of core competency: Patient Care, Interpersonal/Communication, Professionalism, and Practice-based Learning/Improvement. A comprehensive list of veterinary emergency skills was generated and organized within the framework utilizing the hybrid Delphi method. An initial survey completed by 133 emergency and critical care specialists and emergency room clinicians produced data regarding the value of specific skills. An 11-member focus group consisting of survey participants iterated upon the survey results to produce a master library of skills and cases, including 56 Patient Care, 43 Interpersonal/Communication, 11 Practice-based Learning/Improvement, and 20 Professionalism skills, as well as 155 case types. The curricular delivery system tracks and assesses case management proficiency and development of knowledge and professional skills using a patient care eLearning program and simulation training environment. CONCLUSIONS: The increasing need for emergency veterinarians is a shared industry-wide challenge. To contribute toward a collective solution, we have undergone an evidence-based process to create the foundation for an open standard competency framework composed of a library of skills and cases. We offer this open standard framework to the veterinary profession and hope it continues to grow and evolve as we drive toward developing competency-based training programs that address the shortage of emergency veterinarians.

Administration and Therapeutic Drug Monitoring of β-lactams and Vancomycin in Critical Care Units in Colombia: The ANTIBIOCOL Study.

Therapeutic drug monitoring (TDM) and continuous infusion strategies are effective interventions in clinical practice, but these practices are still largely unknown in Colombia, especially in the critical care setting. This study aims to describe the practices involved in the administration and TDM of β-lactams and vancomycin reported by specialists in critical care in Colombia and to explore the factors that are related to the use of extended infusion. An online nationwide survey was applied to 153 specialists, who were selected randomly. A descriptive, bivariate analysis and a logistic regression model were undertaken. In total, 88.9% of the specialists reported TDM availability and 21.57% reported access to results within 6 h. TDM was available mainly for vancomycin. We found that 85.62% of the intensivists had some type of institutional protocol; however, only 39.22% had a complete and socialized protocol. The odds of preferring extended infusions among those who did not have institutional protocols were 80% lower than those with complete protocols, OR 0.2 (95% CI: 0.06−0.61). The most important perceived barriers to performing continuous infusions and TDM were the lack of training and technologies. This pioneering study in Colombia could impact the quality of care and outcomes of critically ill patients in relation to the threat of antimicrobial resistance.

Our experience in treating Fournier’s gangrene at Max Hospital, Gurugram

French venereologist Jean-Alfred Fournier described this gangrene as a fulminant gangrene of the penis and scrotum in young men. He reported five cases in his clinical lectures in 1883 though it was first described by Baurienne in 1764. Fournier’s gangrene is a form of necrotizing fasciitis that affects the genital and surrounding perineal and perianal areas. It’s a life-threatening disease leading to 20 to 80 percent mortality. It destroys tissues quickly and infection progresses to septic shock which kills patient if prompt and aggressive treatment is not started. Common symptoms of Fournier’s gangrene are pain in scrotum and or perineum, redness, fever and weakness. Advanced cases have foul smelling discharge from infected tissues. It is due to polymicrobial infection, both aerobic and anaerobic. Fournier’s gangrene is usually diagnosed clinically but imaging investigations such as X-rays, Ultrasound and CT scan help a lot to reach the diagnosis early. Treatment mainly consists of resuscitation, intravenous antibiotics and debridement. We have treated successfully four cases of advanced Fournier’s gangrene with team work of surgeons, anaesthesiologists, physicians and critical care specialists. Full recovery is possible due to a good team work and understanding the disease.

Point of care ultrasound: a clinical decision support tool for COVID-19.

The COVID-19 global pandemic has overwhelmed health services with large numbers of patients presenting to hospital, requiring immediate triage and diagnosis. Complications include acute respiratory distress syndrome, myocarditis, septic shock, and multiple organ failure. Point of care ultrasound is recommended for critical care triage and monitoring in COVID-19 by specialist critical care societies, however current guidance has mainly been published in webinar format, not a comprehensive review. Important limitations of point of care ultrasound include inter-rater variability and subjectivity in interpretation of imaging findings, as well as infection control concerns. A practical approach to clinical integration of point of care ultrasound findings in COVID-19 patients is presented to enhance consistency in critical care decision making, and relevant infection control guidelines and operator precautions are discussed, based on a narrative review of the literature.

When does innovation go too far?

SHOULD innovative veterinary procedures and practice be more regulated? This question was considered during a debate at the recent Animal Welfare Foundation discussion forum. One problem encountered in trying to answer the question is the number of variables that must be considered. First, what can be done under current regulations? Experimental procedures and research are licensed under the Animals (Scientific Procedures) Act 1986 (ASPA), and this can include research carried out on farms and in veterinary practices (for more details on the Act see In Practice, November 2020, vol 42, pp 488–496). However, most vets will be operating under the Veterinary Surgeons Act 1966 (VSA), conducting ‘recognised veterinary practice’. According to the RCVS: ‘The clinical investigation and management of the health or welfare of animals is generally considered to be recognised veterinary practice when it involves an intervention which is of direct benefit to the animal or its immediate peer group.‘ The RCVS gives more advice in the supporting guidance to the code of professional conduct on what actions fall within the ASPA, the VSA or the Veterinary Medicines Regulations 2011, but it is impossible to cover all situations, as the RCVS itself acknowledges. So another variable is what is considered innovative? And if something is considered to be new, should it be regarded as recognised veterinary practice? And who judges this? In many areas, those speaking on both sides of the debate during the discussion forum – Eddie Clutton, a specialist anaesthetist at Edinburgh university and the Roslin Institute, and Karen Humm, a critical care specialist at the Royal Veterinary College – were in agreement. For example, that euthanasia should be part of the discussion for cases being considered for innovative treatment; that humane endpoints should be set so there is no clinical ‘creep’ in outcome that becomes detrimental to welfare; and that certain areas where the evidence base is strong, such as using the medicines' cascade, are suitable for self-regulation. Another area on which there was agreement was that more uncertain ‘heroic’ treatment should be subject to greater ethical overview. Clutton argued that current arrangements were open to potential conflicts of interest and new arrangements should be put in place to create an independent mandatory ‘innovation panel’ to assess the ethics of a proposed treatment and whether it offered enough potential benefit to an animal (or its ‘immediate peer group’). There would need to be the ability to assess treatment after the event if it was conducted in an emergency. Procedures and treatments conducted ‘should not be at the whim of individuals’, said Clutton, and this would go some way to ensuring unproven methods had better scrutiny. Although there will be vets who push the limits for their own promotion or challenge, or because their employer rewards ‘firsts’, the biggest push for unethical treatment came from clients, according to Humm. Often, they had heard or read of a treatment or procedure offered in other countries, and, she said, in such situations, the most essential skill was the ability to explain to these clients why that option was not on offer, rather than the technical skill required to perform it. “Any change to improve regulation would likely be met with enthusiasm Independent ethical overview makes sense. It means new methods can be introduced but acknowledges the need to assess them for an animal's best interests. No one is arguing that veterinary practice should not develop and improve though innovation, but rather, by taking this course of action, evidence will be gathered on how effective new treatments are and ensure that, as a reason, ‘because we can’ is taken out of the equation. BVA grants editorial freedom to the Editor of Vet Record. The views expressed in the journal are those of the authors and may not necessarily comply with BVA policy

Total Plasma Exchange for the Management of Thrombotic Thrombocytopenic Purpura in a 13-Year-Old Female – A Case Presentation

Abstract Acquired thrombotic thrombocytopenic purpura (TTP) is a rare thrombotic microangiopathy, affecting preferentially young women in their fourth decade. Intensive care admission is often required due to organ dysfunction development risk and for specific critical care measures (Plasma Exchange-PEX). In this article, we will discuss our experience with PEX in the treatment of TTP. Case report: A previously healthy 13-year-old female presented with neurological impairment, and suspicion of stroke. The head computed tomography (CT) scan revealed absence of acute intracranian pathology, and biological evaluation displayed severe thrombocytopenia and haemolytic anemia. After 24 hours, the neurological symptoms were remitted and suspicion of thrombotic thrombocytopenic purpura was raised. The presence of ADAMTS-13 antibodies and Moschcowitz’s pentad confirmed the diagnosis. Discussions: The distinctiveness of this case lies in the development of the disease in a 13-year-old person, though TTP usually occurs after the age of 40. The exact cause of ADAMTS-13 low activity could not be established. The use of a high dose of steroids and of plasma exchange is considered to be the first line therapy, with the use of monoclonal antibodies in refractory cases, as it was in our case. Conclusions: The primary end points of our management was to prevent organ damage and to achieve a platelet count greater than 150 000 /µL, as well as a normal or an almost normal lactate dehydrogenase. We achieved this by using high dose corticosteroid therapy, filtration of approximately 50 liters of plasma in 14 PEX session and by administration of monoclonal antibodies.

Converting an Under-Construction Healthcare Facility into a COVID-19 Screening and Emergency Response Centre During Complete Lockdown in India.

In view of the COVID-19 surge, the construction of the Burns and Plastic Surgery Block at AIIMS, New Delhi was expedited at war footing level and converted into a COVID-19 Emergency response Centre (ERC). Engineering works were completed in a speedy manner and various patient care areas were equipped as deemed necessary for providing tertiary care to COVID-19 patients. A highly spirited team comprising of Emergency Medicine Specialists, Anesthesia and Critical Care specialist, Hospital Administrators and Nursing Officers was formed. Effective segregation of patient care areas into clean, contaminated, and intermediate zones was done using physical barriers and air conditioning modifications. The screening area for patients suspected of having COVID-19 was created in addition to a 2-step process i.e., Triage 1 and Triage 2, thereafter, patients requiring admission would be referred to the emergency area. An in-house designed and fabricated sampling booth was created to bring down the use of PPEs and for better infection control. The ERC has a general ward and state of the art intensive care units. Mobilizing resources (machinery, manpower, consumables etc.) during the lockdown required commitment from top leadership, motivated teams, expeditious procurement, coordination with multiple agencies working on site, expediting statutory clearances, coordination with police services, transportation of labor etc.

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper on the Diagnosis and Management of Pediatric Acute Liver Failure.

Pediatric acute liver failure (PALF) is a rare, rapidly progressive clinical syndrome with significant morbidity and mortality. The phenotype of PALF manifests as abrupt onset liver dysfunction, which can be brought via disparate etiology. Management is reliant upon intensive clinical care and support, often provided by the collaborative efforts of hepatologists, critical care specialists, and liver transplant surgeons. The construction of an age-based diagnostic approach, the identification of a potential underlying cause, and the prompt implementation of appropriate therapy can be lifesaving; however, the dynamic and rapidly progressive nature of PALF also demands that diagnostic inquiries be paired with monitoring strategies for the recognition and treatment of common complications of PALF. Although liver transplantation can provide a potential life-saving therapeutic option, the ability to confidently determine the certainness that liver transplant is needed for an individual child has been hampered by a lack of adequately tested clinical decision support tools and accurate predictive models. Given the accelerated progress in understanding PALF, we will provide clinical guidance to pediatric gastroenterologists and other pediatric providers caring for children with PALF by presenting the most recent advances in diagnosis, management, pathophysiology, and associated outcomes.

Acute on Chronic Neuromuscular Respiratory Failure in the Intensive Care Unit: Optimization of Triage, Ventilation Modes, and Extubation

Critical care management of acute respiratory failure in patients with neuromuscular disease (NMD) such as amyotrophic lateral sclerosis (ALS) is not standardized and is challenging for many critical care specialists. Progressive hypercapnic respiratory failure and ineffective airway clearance are key issues in this patient population. Often at the time of hospital presentation, patients are already supported by home mechanical ventilatory support with noninvasive ventilation (NIV) and an airway clearance regimen. Prognosis is poor once a patient develops acute respiratory failure requiring intubation and invasive mechanical ventilatory support, commonly leading to tracheostomy or palliative-focused care. We focus on this understudied group of patients with ALS without tracheostomy and incorporate existing data to propose a technical approach to the triage and management of acute respiratory failure, primarily for those who require intubation and mechanical ventilatory support for reversible causes, and also for progression of end-stage disease. Optimizing management in this setting improves both quality and quantity of life.Neuromuscular patients with acute respiratory failure require protocolized and personalized triage and treatment. Here, we describe the technical methods used at our single institution. The triage phase incorporates comprehensive evaluation for new etiologies of hypoxia and hypercapnia, which are not initially presumed to be secondary to progression or end-stage neuromuscular respiratory failure. In select patients, this may involve intubation or advanced adjustments of NIV machines. Next, once the acute etiology(s) is identified and treated, the focus shifts: training and use of mechanical airway clearance to optimize pulmonary function, facilitation of NIV wean or successful extubation to NIV, and transition to a stable regimen for home ventilation. The comprehensive protocol described here incorporates multi-institutional approaches and effectively optimizes acute respiratory failure in patients with neuromuscular pulmonary disease.

Elisa Estenssoro: a career devoted to critical care

Unusually for a critical care specialist, Elisa Estenssoro always wanted to work in this field. “It was the early 1980s, and critical care was just beginning”, Estenssoro tells The Lancet Respiratory Medicine. “I heard about it, I read about it—and I knew it was for me.”

Evaluation of the Effect of Intubation Box use on Tracheal Intubation Difficulty with King Vision® and Truview Videolaryngoscope in Manikin in a Tertiary Care Hospital.

The procedures of introducing an airway by intubation are associated with increased risk of aerosolisation of SARS-CoV-2 virus, posing a high risk to the personnel involved. Newer and novel methods such as the intubation box have been developed to increase the safety of healthcare workers during intubation. In this study, 33 anaesthesiologist and critical care specialists intubated the trachea of the airway manikin (US Laerdal Medical AS™) 4 times using a King Vision® videolaryngoscope and TRUVIEW PCD™ videolaryngoscope (with and without an intubation box as described by Lai). Intubation time was primary outcome. Secondary outcomes were first-pass intubation success rate, percentage of glottic opening (POGO) score and peak force to maxillary incisors. Intubation time and the number of times a click was heard during tracheal intubation were considerably higher in both groups when an intubation box was used (Table 1). When comparing the two laryngoscopes, the King Vision® videolaryngoscope enabled much less time to intubate than did the TRUVIEW laryngoscope, both with and without the intubation box. (P<0.001) In both laryngoscope groups, first-pass successful intubation was higher without the intubation box, although the difference was statistically insignificant. POGO score was not affected by intubation box but a higher score was observed with King Vision® laryngoscope (Tables 1,2). This study indicates that use of an intubation box makes intubation difficult and increases the time needed to perform it. King Vision® videolaryngoscope results in lesser intubation time and better glottic view as compared to TRUVIEW laryngoscope.

Enhanced recovery after surgery (ERAS) in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC): a cross-sectional survey.

ObjectivesEnhanced recovery after surgery (ERAS) protocols have been questioned in patients undergoing cytoreductive surgery (CRS) with/without hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies. This survey was performed to study clinicians’ practice about ERAS in patients undergoing CRS-HIPEC.MethodsAn online survey, comprising 76 questions on elements of prehabilitation (n=11), preoperative (n=8), intraoperative (n=16) and postoperative (n=32) management, was conducted. The respondents included surgeons, anesthesiologists, and critical care specialists.ResultsThe response rate was 66% (136/206 clinicians contacted). Ninety-one percent of respondents reported implementing ERAS practices. There was encouraging adherence to implement the prehabilitation (76–95%), preoperative (50–94%), and intraoperative (55–90%) ERAS practices. Mechanical bowel preparation was being used by 84.5%. Intra-abdominal drains usage was 94.7%, intercostal drains by 77.9% respondents. Nasogastric drainage was used by 84% of practitioners. The average hospital stay was 10 days as reported by 50% of respondents. A working protocol and ERAS checklist have been designed, based on the results of our study, following recent ERAS-CRS-HIPEC guidelines. This protocol will be prospectively validated.ConclusionsMost respondents were implementing ERAS practices for patients undergoing CRS-HIPEC, though as an extrapolation of colorectal and gynecological guidelines. The adoption of postoperative practices was relatively low compared to other perioperative practices.

Temporary Diverting End-Colostomy in Critically Ill Children with Severe Perianal Wound Infection.

Broad and deep perianal wounds are challenging in both adult and pediatric ICUs. These wounds, if contaminated with gastrointestinal flora, can cause invasive sepsis and death, and recovery can be prolonged. Controlling the source of infection without diverting stool from the perianal region is complicated. The option of protective colostomy is not well-known among pediatric critical care specialists, but it can help patients survive extremely complicated critical care management. These authors present three critically ill children who required temporary protective colostomy for perianal wounds because of various clinical conditions. Two patients were treated for meningococcemia, and the other had a total artificial heart implantation for dilated cardiomyopathy. There was extensive and profound tissue loss in the perianal region in the patients with meningococcemia, and the patient with cardiomyopathy had a large pressure injury. Timely, transient, protective colostomy was beneficial in these cases and facilitated the recovery of the perianal wounds. Temporary diverting colostomy should be considered as early as possible to prevent fecal transmission and accelerate perianal wound healing in children unresponsive to local debridement and critical care.

An audit of liaison service provision in Aneurin Bevan University Health Board

AimsAneurin Bevan University Health Board (ABUHB) isundertaking a review of the Mental Health Liaison Service provision within it's acute general hospitals. The current liaison service is a small nurse led team which is available between 8am and midnight. ABUHB has recently opened a new Specialist Critical Care Hospital with the liaison service moving into a new base. A new model of care has been developed across the healthboard which has stretched the Liaison Service across several sites. Therefore, the liaison service may need to expanded to be able to provide high quality and timely care across a wide geographical area. The audit aims to idenitfy areas in which the liaison service is performing well in while identiying areas that need improvement. This audit may provide a focus for recommendations to enhance the current liaison provision.MethodThe liaison service was audited against RCPsych Psychiatric Liaison Accreditation Network (PLAN) quality standards. PLAN identified eighteen functions of a liaison team and provided details of quality standards within each function. These standards are either considered essential, expected or desirable. An accredited service is expected to meet 100% of essential standards, 80% of expected standards and 60% of desirable standards. Data were taken from a combination of sources including ABUHB policies, service managers and senior clinicians within both mental health and acute services.ResultWhen comparing the current liaison service provision in ABUHB, 30% of essential standards were not met and 21% were only somewhat met. Particular domains that were identifed as needing improvement included policies and procedures and urgent and emergency mental health care. 36% of expected standards were met with 41% not met. Notable domains that the service was performing poorly in included governance; induction, and providing teaching and support to acute colleagues. 89% of desirable standards were not met.ConclusionThe audit idenitifed that the current liaison service fails to meet core standards set out by RCPsych. This audit provides quantitative data to demonstrate that the liaison service is in need of improvement and investment. As a result, enhaving the current liaison service is now a priortity for the health board. A business case is being developed to consider enhancing the liaison service with a view to developing a Consultant led multidisciplinary team. The business case can use PLAN quality standards to make recommendations for improvements to the service.