Day-case Facilities Research Articles

P184 Geographical variations in delivery of intravenous treatments for ANCA-associated vasculitis

Abstract Background/Aims Timely access to intravenous immunosuppressant therapy is essential to effectively manage systemic vasculitis; however, significant variations in care and outcomes exists across centres. We systematically evaluated access to treatment for ANCA-associated vasculitis across the UK and Ireland. Methods This multi-method study included: a survey of 87 UK and Ireland Vasculitis Society sites and 11 Scottish Health Boards between Nov 2020 and June 2021; interviews with staff and patients with systemic vasculitis. Survey data was analysed descriptively. Interviews were audio or video recorded and analysed thematically. Results 59 responses from 51 Trusts/Health Boards across Scotland (n = 11), England (n = 33), Wales (n = 2), and Ireland (n = 5) included equal numbers of rheumatology and nephrology vasculitis services across diverse healthcare settings. 67 healthcare professionals across six case studies in Scotland (n = 3) and England (n = 3) and 32 patients with systemic vasculitis were interviewed. Services faced significant challenges in prescribing and delivering high-cost drugs to manage systemic vasculitis: balancing accountability versus bureaucracy, and tensions between different specialties looking after vasculitis patients when implementing access to high-cost drugs via multi-disciplinary networks. There was significant variation in how services delivered intravenous treatments: 10%(5/51) used inpatient beds; 35% (18/51) accessed another specialty unit or shared a daycase facility; 65% (33/51) used their own specialty daycase unit. Average wait time for urgent IV treatment was 2.67 days (range 1-10 days). 18% of services had waiting times >7 days, and of those 67% accessed intravenous treatments via another daycase facility. Specific challenges in accessing daycase facilities included availability of slots and staff, particularly in shared units, due to competition with other services and limited awareness of the importance of timely treatment for systemic vasculitis. This could impact on timing and treatment decisions e.g., prolonged steroid prescriptions. Staff training, competencies and governance to deliver cytotoxic drugs was problematic, particularly for smaller services, and 70% of services said national training modules would be helpful. Oncology units could provide workarounds but daycase nurses with vasculitis knowledge were a valuable source of advice and support for patients attending for treatments, identifying medical issues and arranging assessment if required. Conclusion There is significant variation in access to intravenous treatment for systemic vasculitis. Healthcare organisations should ensure timely access to urgent intravenous treatment for systemic vasculitis within 7 days and appropriately trained staff. National training modules for non-cancer chemotherapy could facilitate equitable access to training. Where treatment is delivered via other units, greater awareness of systemic vasculitis would help provision of information and support for patients. Disclosure W. James: None. A. Nicoll: None. L. Locock: None. L. Harper: None. M. Little: None. N. Basu: None. R.J. Hollick: None.

Home initiation of apomorphine infusion: lessons from the COVID-19 pandemic and implications for current clinical practice

Starting Parkinson’s disease (PD) patients on subcutaneous apomorphine (APO) infusion is generally undertaken on a hospital day-case basis. During the COVID-19 pandemic, day-case facilities were unavailable. To avoid delays in treatment, a new procedure was developed for initiation of APO therapy in the patient’s home. A home initiation protocol was developed and followed for each patient in this analysis. The hospital team worked in collaboration with APO nurses provided by the manufacturer of APO therapies to implement initiation and undertake follow-up. In this analysis, 27 PD patients were initiated onto APO infusion and 21 (77.8%) achieved a therapeutic response. Home initiation of APO infusion can be undertaken successfully and has benefits for both patients and healthcare teams. This protocol will now continue as a standard of care at our centre.

UK allergy and immunology in a post‐COVID‐19 era

UK allergy and immunology in a post‐COVID‐19 era

Response of UK interventional radiologists to the COVID-19 pandemic \u2013 survey findings

BackgroundThe COVID-19 pandemic has had an unprecedented effect upon the National Health Service (NHS). Like other specialties, Interventional Radiology (IR) rapidly adapted to the evolving situation. Members of BSIR were surveyed to obtain a snapshot of the experiences of UK IRs in response to COVID-19.An electronic survey was compiled using Google Forms, approved by the BSIR Council Officers and distributed to BSIR members by email on 18 th April 2020. A total of 228 responses were received. The survey was open for a 14-day period and the data analysed in Microsoft Excel 365. The response rate was 29% (228/800).ResultsTwo thirds of respondents work in a Tertiary unit and 33% deliver IR in a District Hospital. 84% have a day-case facility. After the COVID-19 crisis, 81% of respondents were able to maintain 24–7 On-call service. 59% of respondents had been required change their day to day practice to allow the on-call service to continue. 55% of respondents were involved in providing a central line service. Of those questioned, 91% continued to offer endovascular services, 98% genitourinary and 92% hepatobiliary services, although a degree of service reduction was described. 38% have provided IR trainees with additional training material during this pandemic.ConclusionsThis survey has confirmed that the responses of UK IR departments to the COVID-19 crisis have ensured vital on-call and urgent services have continued, including ongoing availability of most IR sub-specialties. Availability of a day case facility has possibly influenced the positive response.

Perioperative blood glucose in a paediatric daycase facility: effects of fasting and maintenance fluid.

Many Children are daily exposed to prolonged preoperative fasting time. The choice of intraoperative maintenance fluid continues to be an issue of controversy. This study assesses the duration of preoperative fast among children undergoing ambulatory surgery and the appropriateness of the maintenance solutions used. Seventy-eight children undergoing ambulatory surgery were prospectively randomised to receive lactated Ringer's (LR) solution or 4.3% dextrose in 0.18% saline (DS) as maintenance fluid. The duration of preoperative fast was noted and the blood glucose measured at induction, but before infusion of any intravenous fluid, and subsequently every 30 min. Data were analysed with Statistical Packages for the Social Sciences 16.0 (SPSS incorporated, Chicago Ill, USA). P < 0.05 was considered as significant. The age range was 3 months to 15 years (mean = 4.9 ± 3.6 years); mean weight was 16.3 ± 7.8 kg. The mean duration of fasting was 13.4 ± 3.5 h (range = 4-18.5 h), but no child was hypoglycaemic throughout the study. The mean blood glucose in the LR group rose steadily from 5.18 ± 0.98 mmol/L post-induction to a peak value of 7.40 mmol/L at 120 min. In the DS group, the mean blood glucose level increased from the post-induction value of 5.56 ± 0.86 mmol/L to 12.7 ± 3.98 mmol/L at 120 min. Most children undergoing ambulatory surgery at our facility are still exposed to prolonged fasting time. Glucose containing fluid often administered as maintenance fluid to treat the presumed hypoglycaemia causes worsening hyperglycaemia, which may be harmful.

PMO-046 Audit of a new pathway for enteral feeding head and neck radiotherapy patients

IntroductionIt is well recognised that Head and Neck Cancer (HNC) patients often “have problems with eating and drinking and a substantial proportion have to cope with tube feeding”.1 With no...

Methodological challenges in the study of psychological recovery from modern surgery

Most cases of elective surgery in the UK are now undertaken in day-case facilities, and the trend is set to increase. Surgical and anaesthetic health care is changing rapidly. Traditional pre- and post-operative nursing intervention, once commonly taught and practised, must now be re-evaluated as a result of such transformations. However, undertaking research in order to investigate the fresh challenges facing nursing in the modern surgical environment may present many difficulties. Methodological issues, such as the application of research approaches, time for adequate data collection, and the utilisation of patients as participants undergoing modern surgery, will present numerous barriers. In this article, Mark Mitchell identifies and discusses three problematic methodological issues that currently challenge the effective study of psychological recovery from modern surgery in the UK.

Impact of a dedicated syncope and falls facility for older adults on emergency beds.

syncope and falls are common symptoms in older adults. Dedicated facilities for these symptoms are emerging in the UK. To date, justification for resource allocation for these day case facilities is lacking. A dedicated syncope and falls day case facility for older adults was set up in Newcastle in 1991 (at the Royal Victoria Infirmary). The facility provided rapid access for assessment of appropriate patients from the community, the accident and emergency department, or emergency admissions. Activity and performance in 1999 were compared with peer inner-city teaching hospitals and with previous performance in 1990 at the Royal Victoria Infirmary to determine whether the facility had influenced emergency activity. to describe the impact of the facility on emergency bed activity and performance for the diagnostic categories of syncope, falls, collapses, gait abnormalities and dizziness. descriptive study. syncope and falls day case facility. performance and activity for Healthcare Resource Groups and ICD codes relevant to falls and syncope were compared for adults over 65 years attending the Royal Victoria Infirmary and thirteen peer hospitals. Activity and performance before the facility was set up (1990) at the Royal Victoria Infirmary were also compared with 1999 data. syncope and collapse is the 6th commonest reason for acute hospital attendance of over 65-year olds in the UK. In 1999, the Royal Victoria Infirmary was at variance by-6616 bed days compared with other the other Trusts for these diagnoses. This equates to 18 beds occupied in that year. The degree of emergency activity for the relevant diagnoses (Healthcare Resource Groups data) was much less than at peer trusts-35% versus 97%. The average length of stay for admitted patients was also shorter for Royal Victoria Infirmary than peers-2.4 versus 8.6 days. Acute length of stay at the Royal Victoria Infirmary was reduced from 10.9 days in 1990 to 2.7 days in 1999 (ICD 10 data). In 1991 all activity was emergency. the striking variance in bed days in 1999 is due to lower emergency activity and shorter length of stay at the Royal Victoria Infirmary. This is attributed to the dedicated rapid access day-case facility. This has relevant resource implications for planning of future facilities and implementation of National Service Framework standards for falls and intermediate care.

FIRST YEAR'S EXPERIENCE OF DAY-CASE ARTHROSCOPY IN DIAGNOSIS AND MANAGEMENT OF DISORDERS OF THE KNEE JOINT

Clinical data and questionnaires were obtained for 130 patients with knee disorders admitted to a new day-case unit in a district general hospital in the year from Oct 1, 1981, under the care of one surgeon. A third of the 148 knees investigated had more than one pathological lesion, and in 18% the arthroscopic diagnosis differed from the preoperative diagnosis. Intra-articular arthroscopic surgery was carried out on 59% of knees; only 12% of operations took more than 60 min. The time before return to normal everyday activities, work, and sport was much shorter than after arthrotomy. Postanaesthetic sickness or poor communication with staff were the only causes of discontent, and 93% of the patients were pleased with day-case treatment. With the day-case facilities the number of patients admitted for arthroscopic investigation and treatment of knee disorders has trebled and the waiting-list time has been halved.