Hampshire Hospital Research Articles

Qualitative exploration of patients’ experiences with Intrabeam TARGeted Intraoperative radioTherapy (TARGIT-IORT) and External-Beam RadioTherapy Treatment (EBRT) for breast cancer

ObjectiveTo gather a deep qualitative understanding of the perceived benefits and impacts of External-Beam RadioTherapy (EBRT) and TARGeted Intraoperative radioTherapy (TARGIT-IORT) using Intrabeam to assess how the treatments affected patient/care...

Validation of oxygen saturations measured in the community by emergency medical services as a marker of clinical deterioration in patients with confirmed COVID-19: a retrospective cohort study

ObjectivesTo evaluate oxygen saturation and vital signs measured in the community by emergency medical services (EMS) as clinical markers of COVID-19-positive patient deterioration.DesignA retrospective data analysis.SettingPatients were conveyed by EMS...

Prevalence, Characteristics, and Reasons for Kratom Use among Psychiatrically Ill Inpatients Who Use Substances

Objective Despite kratom impacting neurobiological systems involved in psychiatric disorders, little is known about the prevalence of use among patients with severe psychopathologies. Here, we investigated the prevalence of kratom use, motives for use, and the clinical associations among inpatients with severe psychiatric disorders. Methods A total of 578 patients, aged 18 to 65, were evaluated by New Hampshire Hospital’s Addiction Services from January 1, 2020, to February 28, 2022. The study collected demographic information and used chi-square tests, multivariable logistic regression, and subgroup analyses with 95% confidence intervals to examine trends among kratom users. A receiver operating characteristic curve analysis was also conducted. All statistical tests were performed using IBM SPSS Version 28.0.1. Results Of the patients assessed, 2.2% (n = 13) reported using kratom. The reasons for kratom use were managing withdrawal symptoms (15.4%), maintaining sobriety and reducing cravings for opioids (53.8%), improving focus and concentration (30.8%), alleviating low moods (38.5%), and managing pain (15.4%). Compared to non-kratom users, the only factor with a fair to good association with kratom use is postsecondary education (Area Under Curve, AUC = 0.77). Conclusions Prevalence of kratom use among patients with serious mental illness at our site aligns with that reported in the general population. Users often cite self-management of cravings and sobriety from opioids, as well as treatment of low mood states, as motivations for consumption. While observations suggest a possible association between kratom use and individuals with post-secondary education, multiple substance use, and experience of substance-induced psychosis or mood disorders, it is essential to interpret these links cautiously until further rigorous studies are carried out to substantiate these findings.

P10 Impact of miniaturization and early readout on antimicrobial susceptibility tests

Abstract Background New technologies offer the promise of faster, more accessible antibiotic susceptibility testing. UK policy includes the development and introduction of innovative diagnostics to tackle antimicrobial resistance, and whilst many new technologies are emerging, we still have limited evidence of their performance. Many of these emerging technologies are changing two core aspects of antimicrobial susceptibility tests (AST). Firstly, using microfluidic platforms to miniaturize standard antibiotic susceptibility testing and secondly measuring susceptibility at earlier timepoints, here, we report a comprehensive assessment of 1-mL volume broth microdilution with an early endpoint readout, proving that miniaturization and earlier timepoints of conventional antibiotic susceptibility testing is feasible and accurate. Methods The test measures bacterial growth in 1-mL capillaries in the presence of the metabolic dye resazurin. All other aspects of the test remain standard. Images of the capillaries are taken every 5 minutes over 18 h to determine accuracy at different timepoints during incubation at 37°C. Over a total of 3 sites in the UK, Spain and Thailand, we have tested 367 isolates from clinical samples for 8–17 antibiotics. Results Preliminary data shows that for 99 Gram-negative isolates tested in Thailand, after 6-h incubation, accuracy for antibiotics is as follows: cefotaxime 96%, ceftazidime 92%, meropenem 93%, amikacin 94%, amoxicillin–clavulanic acid 79%, cefuroxime 97%, cefoxitin 80%, ciprofloxacin 84%, gentamicin 93% and trimethoprim 97%. Further testing is ongoing, and isolates from urine samples are currently being collected from Basingstoke and North Hampshire hospital to expand the type of organism tested. Conclusions Unlike many microfluidic systems, the dip and test microcapillary–based broth microdilution test is manufactured in bulk, allowing rapid and testing of large sample sets with minimal investment. An understanding of the effect of miniaturization is vital to developers of microfluidic phenotypic antibiotic susceptibility tests and can provide confidence in emerging systems.

The New Hampshire Hospital Screening and Referral Algorithm (NHHSRA) for Substance Use in People With Serious Mental Illness

Objective: Substance use is a common co-occurrence among psychiatrically hospitalized adults, yet it is especially difficult to identify in those with serious mental illness. Existing screening instruments are not feasible for individuals with serious mental illness, as they rely heavily on subjective self-report. This study aimed to develop and validate an objective substance use screening instrument for use in seriously mentally ill patient populations.Methods: Objective elements were extracted from existing substance use screening instruments and used to develop a new, data-driven referral tool, the New Hampshire Hospital screening and referral algorithm (NHHSRA). Descriptive statistics were employed to compare NHHSRA summed score and individual patient data elements in a convenience sample of patients who were referred to the Addiction Services by expert addiction psychiatrist evaluation to those who were not referred. Pearson correlation coefficients and logistic regression models assessed the association between patient referral and the overall NHHSRA score and individual items. The NHHSRA was then piloted in a smaller convenience sample of patients against the standard clinical-based identification for substance use treatment needs.Results: The instrument consists of 5 objective items. These were tested in a sample of 302 sequentially admitted adults with serious mental illness. Three of the items were significantly associated with likelihood of benefitting from referral for substance use interventions (maximum likelihood estimate and standard deviation [SD] for positive non-tetrahydrocannabinol [non-THC] toxicology screen or > 0% blood alcohol level = 3.61 [0.6]; diagnosis of a substance use disorder = 4.89 [0.73]; and medication-assisted treatment or relapse prevention = 2.78 [0.67]), and these were prioritized in building a decision tree algorithm. The area under the receiver operating characteristic (ROC) curve for the NHHSRA was 0.96, indicating that the NHHSRA has high overall sensitivity and the algorithm was capable of distinguishing between patients needing substance use intervention versus those who do not with 96% accuracy. In the pilot implementation study of another 20 patient admissions, the NHHSRA accurately identified 100% (n = 6) of patients deemed to benefit from substance use interventions by expert addiction psychiatric evaluation. The standard clinical-based referral process identified only 33% (n = 2) and erroneously identified another 4 for referral to substance use intervention that would not have been warranted.Conclusions: The NHHSRA holds promise in its ability to improve objective and timely identification of substance use in a seriously mentally ill inpatient population, helping to facilitate treatment.

P257 Is colorectal screening in IBD fit for purpose?

Abstract Background Patients with IBD are at increased risk of CRC with it recommended that patients with longstanding colitis undergo regular surveillance endoscopy. However, there is conflicting evidence for the quality and effectiveness of IBD surveillance programmes. We undertook an audit of the effectiveness of our surveillance programme against national standards alongside a case-note review of cases of CRC arising in patients with IBD diagnosed over the same period. Methods Sequential colonoscopies for IBD surveillance at Hampshire Hospitals Foundation Trust from 01/01/2019 to 31/12/2020 were reviewed retrospectively. The quality of the surveillance endoscopy programme was assessed against the BSG and SCENIC guidelines. Patients with CRC and IBD were identified using the International Classification of Diseases coding system over the same period with subsequent case-note review of identified cases. Results 250 colonoscopies were reviewed with 6 excluded (3 inadequate bowel preparation, 3 severe active disease) leaving 244 for analysis. 203 (83.2%) were adherent to the guidelines. Non-compliance was either due to lack of dye-spray or inadequate number of biopsies (35 had 3-10 biopsies, 6 no biopsies). Overall, 2421 random biopsies were taken along with 90 targeted biopsies and/or polypectomies. 1 adenocarcinoma (0.45%), 1 HGD (sporadic polyp), 1 LGD, and 1 indefinite lesion were detected along with 19 sporadic polyps. During the same period 9 patients were diagnosed with CRC that were not in the surveillance programme. 3 had a diagnosis of probable pre-existing IBD made at the time of diagnosis of cancer (2 UC, 1 CD), 2 had a historical diagnosis of UC but were not known to secondary care, 1 was not under surveillance due to age (85), 2 had ileocaecal CD with CRC in unaffected segment of large bowel, and 1 had colitis <8 yrs. Conclusion Our audit showed that the quality of the surveillance endoscopy had improved since our previous audit (2016) with the majority of cases now undertaken with dye-spray, and less cases undertaken by non-specialist endoscopists. Though there remains room for improvement with 16.8% non-complaint primarily due to inadequate biopsies, it was reassuring that 83.2% of procedures were performed in adherence with current guidance. Despite this only 1/10 (10%) of cases of CRC in patients with IBD were picked up through surveillance with 9/10 (90%) diagnosed in patients with IBD outside the programme. These results suggest that targeting resources at improving the surveillance programme further is likely to have a limited impact on reducing CRC in patients with IBD and that research is needed to identify and address why the majority of IBD patients that develop CRC are not reached by current surveillance strategies.

Discrete choice experiment exploring women’s preferences in a novel device designed to monitor the womb environment and improve our understanding of reproductive disorders

ObjectivesThe study aims to determine the relative importance of key attributes of a novel intrauterine device. The device monitors uterine oxygen, pH and temperature in real time with the aim...

Precision medicine for liver tumours with quantitative MRI and whole genome sequencing (Precision1 trial): study protocol for observational cohort study

IntroductionRadiogenomic analysis of patients being considered for liver resection is seldom performed in the clinic despite recent evidence indicating that quantitative MRI could improve posthepatectomy outcomes. Meanwhile, the increasingly accessible...

COVID-19 Oximetry @home: evaluation of patient outcomes.

BackgroundCOVID-19 has placed unprecedented demands on hospitals. A clinical service, COVID-19 Oximetry @home (CO@h) was launched in November 2020 to support remote monitoring of COVID-19 patients in the community. Remote monitoring through CO@h aims to identify early patient deterioration and provide timely escalation for cases of silent hypoxia, while reducing the burden on secondary care.MethodsWe conducted a retrospective service evaluation of COVID-19 patients onboarded to CO@h from November 2020 to March 2021 in the North Hampshire (UK) community led service (a collaboration of 15 General Practitioner (GP) practices covering 230 000 people). We have compared outcomes for patients admitted to Basingstoke and North Hampshire Hospital who were CO@h patients (COVID-19 patients with home monitoring of oxygen saturation (SpO2; n=115), with non-CO@h patients (those directly admitted without being monitored by CO@h (n=633)). Crude and adjusted OR analysis was performed to evaluate the effects of CO@h on patient outcomes of 30-day mortality, Intensive care unit (ICU) admission and hospital length of stay greater than 3, 7, 14 and 28 days.ResultsAdjusted ORs for CO@h show an association with a reduction for several adverse patient outcome: 30-day hospital mortality (p<0.001, OR 0.21, 95% CI 0.08 to 0.47), hospital length of stay larger than 3 days (p<0.05, OR 0.62, 95% CI 0.39 to 1.00), 7 days (p<0.001, OR 0.35, 95% CI 0.22 to 0.54), 14 days (p<0.001, OR 0.22 95% CI, 0.11 to 0.41), and 28 days (p<0.05, OR 0.21, 95% CI 0.05 to 0.59). No significant reduction ICU admission was observed (p>0.05, OR 0.43, 95% CI 0.15 to 1.04). Within 30 days of hospital admission, there were no hospital readmissions for those on the CO@h service as opposed to 8.7% readmissions for those not on the service.ConclusionsWe have demonstrated a significant association between CO@h and better patient outcomes; most notably a reduction in the odds of hospital lengths of stays longer than 7, 14 and 28 days and 30-day hospital mortality.

An investigation of mobile health (mHealth) applications available to support knee arthroplasty rehabilitation and recommendations for implementation: A scoping review

Keywords: mHealth; Applications; Arthroplasty Purpose: Length of hospital-stay following total knee arthroplasty (TKA) is approximately 1-3 days, with associated costs of revisions around £75,000 per patient. Patient control of recovery, self-management and compliance to home-based rehabilitation is therefore of utmost importance. The use of mHealth applications (apps), to promote independence and self-management, provides potential for a cost-effective, patient-centred strategy to achieve this. The objective of this study was to scope and review the quality of publicly available, patient-focused apps for TKA, with the aim of identifying and recommending one for trial and clinical implementation within a Hampshire hospital. Methods: A scoping review was chosen to systematically map, synthesise and review the latitude of apps available via the Apple Store and Google Play. Apps were identified if they were free of charge to the user, suitable for use within the UK and in English; due to the ubiquitous nature of app usage, apps were selected if they targeted both total knee or hip arthroplasty. Quality analysis of each app was conducted using the Mobile App Rating Scale (MARS); a simple 4-dimension, objective, and reliable tool for classifying and assessing quality of mhealth apps. Results: Nine apps, from 692 screened, met the inclusion criteria and were reviewed using MARS. The mean overall MARS score (where 1 = inadequate and 5 = excellent) was 3.57 (SD = ±0.87). Four apps had a score above 4, three of which were identified as utilising an app platform already in use by NHS Trusts. Five apps had a score of less than 3. The highest rated app was the Northumbria Orthopaedic NHS Trust App (4.57) which utilised the app platform ‘My Patient Journey’. This app was noted to consider features that ensured the app was engaging and also likely to promote positive rehabilitative behaviours. Conclusion(s): This study provides an overview of mHealth apps available to health-care professionals and patients post-TKA. Further investigation into the use of this platform is required, to personalise and adjust it for specific Trust use. Randomised trials are now required in order to characterise the use and efficacy of this app on health knowledge, behaviours and use. Moreover, to understand their effectiveness in rehabilitation and improve quality of life following TKA, hereby reducing its burden on public health and clinical systems. Impact: The NHS finds itself in the midst of an mHealth revolution and mobile technology offers the opportunity to access clinical apps, evidence-based resources and advanced mobile communication in one device. The mobility of such apps enables patients to use them in their home setting, reducing the need for face-to-face contact and, in light of the COVID-19 pandemic, has shown itself to be a technology that presents a future healthcare option. This study provides an overview of the mHealth apps available to a range of health-care professionals across all disciplines and patients post-TKA surgery; summarising their strengths and limitations to make recommendations for future implementation. The introduction of such management will take time, funding, a shift in clinician approach and patient expectation-management, in addition to further research to optimise delivery. Funding acknowledgements: This study is a final year physiotherapy dissertation, courtesy of University of Winchester. No funding was received from internal/external sources.

Mid-regional proadrenomedullin (MR-proADM), C-reactive protein (CRP) and other biomarkers in the early identification of disease progression in patients with COVID-19 in the acute NHS setting

AimsThere is a lack of biomarkers validated for assessing clinical deterioration in patients with COVID-19 on presentation to secondary or tertiary care. This evaluation looked at the potential clinical application...

248. Outcomes of Patients with Prosthetic Septic Arthritis with Debridement and Implant Retention

BackgroundIDSA has published guidelines for the diagnosis and management of prosthetic joint infection (PJI). However, we have observed significant variability in the interpretation and application of these guidelines with respect to the management of those with PJI following debridement and implant retention (DAIR). It is not clear if variations in antimicrobial management are affecting clinical outcomes.MethodsWe performed a retrospective review at an academic hospital in rural New Hampshire. We included all adult patients from 1/1/2017 to 12/31/2018 with PJI of hip or knee who underwent DAIR. The demographic data, microbiology data, antibiotics treatment and duration were collected. The primary endpoint was overall re-infection rate within 2 years of surgery. Secondary endpoint was re-infection rate stratified by organism and antimicrobial type and duration.ResultsA total of 26 patients were included in our study. 65% involved knee joint. 50% had late-onset infection ( >12 months). The top organisms were Streptococcus spp. (34%), CoNS (26 %) and MSSA (18 %). 15% were associated with bacteremia. Ceftriaxone was the most common antibiotic used (54 %). 38 % of patients received Rifampin PO along with IV antibiotics. All patients received PO antibiotic(s) after completing the course of IV therapy, and 7 patients were also on concomitant rifampin PO. The duration of PO antibiotic therapy was varied. 30% of patients received PO antibiotics for 6 months post IV treatment. Life-long suppression therapy were noted in 9 patients. Treatment failure within 2 years occurred in 8 patients (31%). Among those, 75% had Staphylococcal infection. All patients required hardware removal except one patient who required amputation. 2 patients developed recurrent PJI after completing 6 months and one year of PO suppression therapy, one patient had a recurrent infection while on life-long suppression. Staphylococcal infection was significantly associated with treatment failure.ConclusionTreatment of PJI with DAIR is challenging. Despite long-term IV therapy followed by oral antibiotics, there was a high rate of treatment failure (31% in our study) particularly with Staphylococcal infection. There was no association of variation of treatments and outcomes in our small cohort. Disclosures All Authors: No reported disclosures

Evaluation of an Artificial Intelligence–Augmented Digital System for Histologic Classification of Colorectal Polyps

Colorectal polyps are common, and their histopathologic classification is used in the planning of follow-up surveillance. Substantial variation has been observed in pathologists' classification of colorectal polyps, and improved assessment by pathologists may be associated with reduced subsequent underuse and overuse of colonoscopy. To compare standard microscopic assessment with an artificial intelligence (AI)-augmented digital system that annotates regions of interest within digitized polyp tissue and predicts polyp type using a deep learning model to assist pathologists in colorectal polyp classification. In this diagnostic study conducted at a tertiary academic medical center and a community hospital in New Hampshire, 100 slides with colorectal polyp samples were read by 15 pathologists using a microscope and an AI-augmented digital system, with a washout period of at least 12 weeks between use of each modality. The study was conducted from February 10 to July 10, 2020. Accuracy and time of evaluation were used to compare pathologists' performance when a microscope was used with their performance when the AI-augmented digital system was used. Outcomes were compared using paired t tests and mixed-effects models. In assessments of 100 slides with colorectal polyp specimens, use of the AI-augmented digital system significantly improved pathologists' classification accuracy compared with microscopic assessment from 73.9% (95% CI, 71.7%-76.2%) to 80.8% (95% CI, 78.8%-82.8%) (P < .001). The overall difference in the evaluation time per slide between the digital system (mean, 21.7 seconds; 95% CI, 20.8-22.7 seconds) and microscopic examination (mean, 13.0 seconds; 95% CI, 12.4-13.5 seconds) was -8.8 seconds (95% CI, -9.8 to -7.7 seconds), but this difference decreased as pathologists became more familiar and experienced with the digital system; the difference between the time of evaluation on the last set of 20 slides for all pathologists when using the microscope and the digital system was 4.8 seconds (95% CI, 3.0-6.5 seconds). In this diagnostic study, an AI-augmented digital system significantly improved the accuracy of pathologic interpretation of colorectal polyps compared with microscopic assessment. If applied broadly to clinical practice, this tool may be associated with decreases in subsequent overuse and underuse of colonoscopy and thus with improved patient outcomes and reduced health care costs.

Creation of State Antibiogram and Subsequent Launch of Public Health-Coordinated Antibiotic Stewardship in New Hampshire: Small State, Big Collaboration.

An antibiogram is a summary of antibiotic susceptibility patterns for selected bacterial pathogens and antibiotics. The New Hampshire Department of Health and Human Services' Division of Public Health Services (DPHS) sought to create an annual state antibiogram to monitor statewide antibiotic resistance trends, guide appropriate empiric antibiotic prescribing, and inform future statewide antibiotic stewardship. Through legislative authority, DPHS required hospital laboratories to report antibiogram data annually. DPHS convened an advisory group of infectious disease and pharmacy stakeholders and experts to develop a standardized reporting form for bacteria and antibiotic susceptibility, which was disseminated to all 26 hospitals in New Hampshire. We combined the reported data into a statewide antibiogram, and we created clinical messaging to highlight findings and promote rational antibiotic prescribing among health care providers. All hospital laboratories in New Hampshire submitted annual antibiogram data for 2016 and 2017, including more than 30 000 and 20 000 bacterial isolates recovered from urine and nonurine cultures, respectively, each year. The advisory group created clinical messages for appropriate treatment of common infectious syndromes, including uncomplicated urinary tract infections, community-acquired pneumonia, skin and soft-tissue infections, intra-abdominal infections, and health care-associated gram-negative aerobic infections. The statewide antibiograms and clinical messaging were widely disseminated. The small size of New Hampshire, a centralized public health structure, and close working relationships with hospitals and clinical partners allowed for efficient creation and dissemination of an annual statewide antibiogram, which has fostered public health-clinical partnerships and built a foundation for future state-coordinated antibiotic stewardship. This process serves as a model for other jurisdictions that are considering antibiogram development.

Use of point-of-care testing for respiratory viruses in hospital

In The Lancet Respiratory Medicine, Tristan Clark and colleagues report the results of a randomised controlled trial of point-of-care testing for influenza in patients in two UK hospitals in Hampshire, UK.1 Before the emergence of COVID-19, influenza was the most important cause of admission to hospital with a respiratory virus. In England, influenza is estimated to have caused an average of 11 300 deaths per year between the 2015–16 and 2019–20 influenza seasons.2 Influenza often goes undiagnosed in hospital, in part because of an absence of routine testing of patients with respiratory illness in this setting.

Clinical impact of a routine, molecular, point-of-care, test-and-treat strategy for influenza in adults admitted to hospital (FluPOC): a multicentre, open-label, randomised controlled trial

Diagnosis of influenza in patients admitted to hospital is delayed due to long turnaround times with laboratory testing, leading to inappropriate and late antiviral treatment and isolation facility use. Molecular point-of-care tests (mPOCTs) are highly accurate, easy to use, and generate results in less than 1 h, but high-quality evidence for their effect on management and clinical outcomes is needed. The aim of this study was to assess the clinical impact of an mPOCT on influenza detection, antiviral use, infection control measures, and clinical outcomes in adults admitted to hospital with acute respiratory illness. In this multicentre, pragmatic, open-label, randomised controlled trial (FluPOC), we recruited adults admitted to hospital with acute respiratory illness during influenza seasons from two hospitals in Hampshire, UK. Eligible patients were aged 18 years and older, with acute respiratory illness of 10 days or fewer duration before admission to hospital, who were recruited within 16 h of admission to hospital. Participants were randomly assigned (1:1), using random permuted blocks of varying sizes (4, 6 and 8), to receive mPOCT for influenza or routine clinical care (control group). The primary outcome was the proportion of patients infected with influenza who were treated appropriately with antivirals (neuraminidase inhibitors) within 5 days of admission. Safety was assessed in all patients. Secondary outcomes included time to antivirals, isolation facility use, and clinical outcomes. This study is registered with the ISRCTN registry, ISRCTN17197293, and is now complete. Between Dec 12, 2017, and May 3, 2019, over two influenza seasons, 613 patients were enrolled, of whom 307 were assigned to the mPOCT group and 306 to the control group, and all were analysed. Median age was 62 years (IQR 45-75) and 332 (54%) of 612 participants with data were female. 100 (33%) of 307 patients in the mPOCT group and 102 (33%) of 306 in the control group had influenza. 100 (100%) of 100 patients with influenza were diagnosed in the mPOCT group and 60 (59%) of 102 were diagnosed though routine clinical care in the control group (relative risk 1·7, 95% CI 1·7-1·7; p<0·0001). 99 (99%) of 100 patients with influenza in the mPOCT group were given antiviral treatment within 5 days of admission versus 63 (62%) 102 in the control group (relative risk 1·6, 95% CI 1·4-1·9; p<0·0001). Median time to antivirals was 1·0 h (IQR 0·0 to 2·0) in the mPOCT group versus 6·0 h (0·0 to 12·0) in the control group (difference of 5·0 h [95% CI 0·0-6·0; p=0·0039]). 70 (70%) of 100 patients with influenza in the mPOCT group were isolated to single-room accommodation versus 39 (38%) of 102 in the control group (relative risk 1·8 [95% CI 1·4-2·4; p<0·0001]). 19 adverse events occurred among patients with influenza in the mPOCT group compared with 34 events in the control group. No patients with influenza died in the mPOCT group and two (2%) died in the control group (p=0·16). Routine mPOCT for influenza was associated with improved influenza detection and improvements in appropriate and timely antiviral and isolation facility use. Routine mPOCT should replace laboratory-based diagnostics for acute admissions to hospital during the influenza season. National Institute for Health Research.

Incorporating Simulation-Based Education Into Stroke Training.

Incorporating Simulation-Based Education Into Stroke Training.

Rezum water vapour therapy: promising early outcomes from the first UK series.

The management of symptomatic BPH is evolving and there is now an expanding portfolio of minimally invasive surgical therapies (MIST). These provide an attractive option for men looking for meaningful improvement in urinary symptoms whilst avoiding the risks of adverse effects, particularly with regards to maintaining sexual function.

Delirium pathway: a North Hampshire experience

Delirium is an acute disturbance of mind that results from a physical insult. In most cases it resolves rapidly after management of the underlying medical problem but in some cases, particularly in the elderly, it may extend for longer. Here, Dr Al‐Rawi describes how Basingstoke and North Hampshire Hospital collaborated with North Hampshire Clinical Commissioning Group and Hampshire County Council Adult Social Services to develop a pathway that allows these patients to leave hospital early and leads to improved care of this group of patients.

Effect of Inpatient Medication-Assisted Therapy on Against-Medical-Advice Discharge and Readmission Rates

BackgroundPatients who present to the hospital for infectious complications of intravenous opioid use are at high risk for against-medical-advice discharge and readmissions. The role of medication-assisted treatment for inpatients is not clear. We aimed to assess outcomes prior to and after rollout of an inpatient buprenorphine-based opioid use disorder protocol, as well as to assess outcomes in general for medication-assisted therapy. MethodsThis was a retrospective observational cohort study at our community hospital in New Hampshire. The medical record was searched for inpatients with a complication of intravenous opioid use. We searched for admissions 11 months prior to and after the November 2018 buprenorphine protocol rollout. ResultsRates of medication-assisted therapy usage and buprenorphine linkage increased significantly after protocol rollout. Rates of against-medical-advice discharge did not decrease after protocol rollout, nor did readmissions. However, when evaluating the entire group of patients regardless of date of presentation or protocol use, against-medical-advice discharge rates were substantially lower for patients receiving medication-assisted therapy compared with those receiving supportive care only (30.0% vs 59.6%). Readmissions rates were lower for patients who were discharged with any form of ongoing medication-assisted therapy compared with those who were not (30-day all-cause readmissions 18.8% vs 35.1%; 30-day opioid-related readmissions 10.1% vs 29.9%; 90-day all-cause readmissions 27.3% vs 42.7%; 90-day opioid-related readmissions 15.1% vs 33.3%). ConclusionsThere is a strong association between medication-assisted therapy and reduced against-medical-advice discharge rates. Additionally, maintenance medication-assisted therapy at time of discharge is strongly associated with reduced readmissions rates.