Hospital Doctors Research Articles

Prevalence and correlates of burn-out among Nigerian medical doctors during the COVID-19 pandemic: a cross-sectional study

IntroductionPhysician burn-out was an issue before the pandemic. Medical personnel have faced several clinical and non-clinical challenges because of the novel coronavirus (SARS-CoV-2) pandemic, which predisposes them to burn-out. There...

Long-term respiratory consequences of COVID-19 related pneumonia: a cohort study

BackgroundOur aims were to describe respiratory sequelae up to 12 months after discharge in COVID-19 patients with severe pneumonia requiring non-invasive respiratory support therapies.MethodsThis study was undertaken at University Hospital Doctor Josep Trueta (Girona, Spain) between March 2020 and June 2020. Three months after discharge, we evaluated their dyspnoea and performed Saint George’s respiratory questionnaire, pulmonary function tests, blood test, 6-min walking test, and a high-resolution CT (HRCT). At the six and 12-month follow-up, we repeated all tests except for pulmonary function, 6-min walking test, and HRCT, which were performed only if abnormal findings had been previously detected.ResultsOut of the 94 patients recruited, 73% were male, the median age was 62.9 years old, and most were non-smokers (58%). When comparing data three and 12 months after discharge, the percentage of patients presenting dyspnoea ≥ 2 decreased (19% vs 7%), the quality-of-life total score improved (22.8% vs 18.9%; p = 0.019), there were less abnormal results in the pulmonary function tests (47% vs 23%), the 6-min walking test distance was enhanced (368.3 m vs 390.7 m, p = 0.020), ground glass opacities findings waned (51.6% vs 11.5%), and traction bronchiectasis increased (5.6% vs 15.9%). Only age showed significant differences between patients with and without pulmonary fibrotic-like changes.ConclusionMost patients improved their clinical condition, pulmonary function, exercise capacity and quality of life one year after discharge. Nonetheless, pulmonary fibrotic-like changes were observed during the follow-ups.

Hospital doctors’ and general practitioners’ perspectives of outpatient discharge processes in Australia: an interpretive approach

BackgroundUnnecessary delays in patient discharge from hospital outpatient clinics have direct consequences for timely access of new patients and the length of outpatient waiting times. The aim of this study was to gain better understanding of hospital doctors’ and general practitioners’ perspectives of the barriers and facilitators when discharging from hospital outpatients to general practice.MethodsAn interpretative approach incorporating semi-structured interviews with 15 participants enabled both hospital doctors and general practitioners to give their perspectives on hospital outpatient discharge processes.ResultsParticipants mentioned various system problems hampering discharge from hospital outpatient clinics to general practice, such as limitations of electronic communication tools, workforce and workload challenges, the absence of agreed discharge principles, and lack of benchmark data. Hospital clinicians may keep patients under their care out of a concern about lack of follow-up and an inability to escalate timely hospital care following discharge. Some hospital clinicians may have a personal preference to provide ongoing care in the outpatient setting. Other factors mentioned were insufficient supervision of junior doctors, a patient preference to remain under hospital care, and the ease of scheduling follow-up appointments.An effective handover process requires protected time, a systematic approach, and a supportive clinical environment including user-friendly electronic communication and clinical handover tools. Several system improvements and models of care were suggested, such as agreed discharge processes, co-designed between hospitals and general practice. Recording and sharing outpatient discharge data may assist to inform and motivate hospital clinicians and support the training of junior doctors.General practitioners participating in the study were prepared to provide continuation of care but require timely clinical management plans that can be applied in the community setting. A hospital re-entry pathway providing rapid access to outpatient hospital resources after discharge could act as a safety net and may be an alternative to the standard 12-month review in hospital outpatient clinics.ConclusionOur study supports the barriers to discharge as mentioned in the literature and adds the perspectives of both hospital clinicians and general practitioners. Potential solutions were suggested including co-designed discharge policies, improved electronic communication tools and a rapid hospital review pathway following discharge.

Knowledge, Attitude, and Practice Towards Usage of Sunscreen and Prevention of Skin CancerAmong Doctors of a Tertiary Care Hospital: ACross-Sectional Study

Objective: Skin cancer is preventable but nowadays it is one of the fastest growing cancers, especially in South Asia. The purpose of this study is to assess knowledge, attitude, and practice towards usage of sunscreen and prevention of Skin Cancer among Doctors of a Tertiary care hospital. Material and Methods: A cross-sectional study was conducted using a validated structured questionnaire covering the areas of knowledge, attitude, and practice of the study participants. Results: Atotal of 150 Doctors participated in thisstudy, 68 men and 82 women.Among the total participants, only 10 (6.66%) were aware thatsunscreen reducessunburns. In contrast, 16 (10.66%) of the candidates denied any sunscreen application asthey found it to be useless. 10% of the participants always used sunscreen whereas the majority (21.33%), only used it sometimes. There was no re-application of Sunscreen by 83 individuals that participated in the survey; however, 20.66% of doctors re-applied it every hour. Protection against skin cancer was the second most common reason of using sunscreen. Majority of the doctors (n=52) avoided sunscreen as they simply forgot to use it. Conclusion: This study has revealed that the knowledge and use of sunscreen among doctors in Lahore, Pakistan is suboptimal. Although 52.7% of participants reported using sunscreen, only 10% consistently used it, with 21.33% applying it occasionally. A substantial number of doctors in our study had poor attitudes and practices regarding sunscreen use, with many only using it during sunny months or citing reasons such as forgetfulness, greasiness, or cost as barriers.

How can NHS trusts in England optimise strategies to improve the mental health and well-being of hospital doctors? The Care Under Pressure 3 (CUP3) realist evaluation study protocol

IntroductionThe growing incidence of mental ill health in doctors was a major issue in the UK and internationally, even prior to the COVID-19 pandemic. It has significant and far-reaching implications,...

Hospital Doctor Interface

This online platform addresses the need for medical professionals, hospitals often encounter challenges in finding qualified doctors for urgent placements, specialized medical procedures, and surgeries. This proposed website connects with highly qualified and skilled doctors who are freelancing or available for immediate surgeries. Keywords — website; hospital; doctors; placements; specialized; freelancing;

Turnover Intention determinants of EU hospital doctors and nurses: results from the METEOR survey

Abstract Background To contrast effectively the shortage of healthcare workers in the EU, it is essential to find the determinants of the intention to leave the hospital (ITL) by analyzing the role of burnout (BO), job satisfaction (JS), and other individual characteristics and working-related variables. This study aims to estimate the prevalence of ITL for physicians and nurses in Europe, to investigate the determinants of ITL, and to suggest possible job retention policies. Methods The METEOR survey is a cross-sectional study on 8 hospitals of Belgium, The Netherlands, Italy, and Poland. Data collection was from May to September 2022. The theoretical model was the Job demands-resources model and validated questionnaires were used. ITL was assessed as agreement with the sentence “I intend to leave my current hospital for another one in the near future” and the response items were scored on a 5-point Likert scale. Two multivariable logistic models for ITL were estimated for both physicians and nurses, including JS, BO, and workers’ individual and hospital characteristics as covariates. Results The study included 381 physicians, and 1351 nurses. Physicians and nurses who agreed with ITL were 17% and 9%, respectively. Logistic models for physicians showed that by increasing JS (OR = 0.31, p < 0.001) as well as age (OR = 0.91, p < 0.001), and living with partner (vs alone) (OR = 0.56, p < 0.039), the odds of ITL decreased. For nurses, the model revealed that by increasing JS (OR = 0.27, p < 0.001), as well as age (OR = 0.97, p < 0.001), and equipment (OR = 0.56, p < 0.039), the odds of ITL decreased. Conclusions Our survey showed high prevalence of ITL for both nurses and physicians. Recruitment and retention policies, at the micro/meso/macro-levels are needed. It is strategic to support healthcare workers’ categories at higher risk of ITL, such as the younger physicians and nurses. Key messages • Our survey found significant individual and work environment characteristics playing a role to explain ITL. • We provide an estimate of ITL prevalence of hospital physicians and nurses in EU.

The Impact of Health Transformation Plan on Bed Occupancy Rate, Average Length of Stay, and Bed Turnover Interval in a Deprived Region of Iran: An Interrupted Time Series

Background: The health transformation plan (HTP) in Iran started in May 2013 with 3 financial support approaches for people, creating justice in access to health services and improving the quality of services in hospitals in 2 health and treatment sectors. In the first phase, this program was divided into 8 separate packages in the treatment section, reducing the amount of payment for hospitalized patients, supporting the longevity of doctors in disadvantaged areas, the presence of resident specialist doctors in hospitals, improving the quality of visiting services in hospitals, improving the quality of hoteling in hospitals, and financial support of incurable, special and low-income patients. It refers to promoting natural childbirth and launching an air emergency service. Objectives: This study aims to investigate the effect of HTP on bed occupancy rate, average length of stay, and bed rotation distance in one of the most deprived areas. Methods: This study was a semi-experimental and retrospective descriptive-analytical study before and after the health system transformation plan based on the information collected from March 2012 to March 2019 in all Sistan and Baluchistan province hospitals. The data of indicators of monthly bed occupancy rate, average length of stay, and bed rotation interval in 83 months in the years before and after the implementation of the transformation plan were collected from the Vice-Chancellor of Treatment of Universities or the statistical units of hospitals and compared. The data were analyzed by Stata software using the interrupted time series (ITS) model, and split regression analysis was used to evaluate the short-term and long-term effects of HTP on the studied indicators. Results: This study showed that the bed occupancy rate increased, and the average length of stay and bed turnover interval decreased immediately after HTP in Sistan and Baluchistan province hospitals. Also, the reform had a long effect on these indicators. Conclusions: Possibly due to underdeveloped hospitalization services in the past, the bed occupancy rate increased, and the average length of stay and bed turnover interval decreased in the hospitals after this province's major health system reform.

How well do we truly understand clitoral anatomy? AnIrish maternity hospital's perspective.

The clitoris has long been ignored in medical literature and teaching, with the first paper describing its anatomy only published in 1993. It is essential that those working in women's health understand the anatomy of this important female sexual organ. The aim of this study was to assess the level of knowledge of the anatomy of the clitoris across five cohorts in a busy teaching maternity hospital in Ireland. A questionnaire was devised, asking ten consultants, ten non-consultant hospital doctors (NCHDs), ten midwives, ten midwifery students and ten medical students to name the anatomical parts of a 3D model of the clitoris. None of the 50 respondents could name all five labelled parts of the clitoris, and 38 of respondents could not correctly name one anatomical part. It is evident that there is a lack of knowledge of the anatomical parts of the clitoris among the medical staff included in this study. This reflects a lack of adequate teaching in this area in both past and recent years. Despite this, we acknowledge that women's health and sexual health awareness is improving all of the time, and we hope that this study can highlight the need for reformed teaching in this area.

Impact of Organizational Culture and Employee Engagement on Intention to Quit Among Medical Professionals During Covid -19 Pandemic

Maintaining proactive health workers having the capabilities to be top performers is acknowledged as a pre-requisite for the long-term success and sustainability of expert doctors in hospitals in lieu of COVID-19 standardised procedures. The present study aims to fill the research gaps that have been identified and find out the impact of prevailing organizational culture on employee engagement and intention to quit. Employee engagement and organisational culture were anticipated to play a pivotal role in the connection among both proactive health workers and their intention to quit as per the undertaken study. The study was conducted on 156 Doctors from several Saudi Arabian hospitals with more than two years of experience and was used as a sample using purposive random sampling techniques. It was found that doctors are involved in experimentation during the Covid which we believe was the need of the hour to experiment with various possible techniques and tools for the sake of survival. Intellectual and affective engagement was also found to be high among doctors and intention to quit the job was found to be at a moderate level. Intention to quit was found to be negatively correlated with all the dimensions of employee engagement.

Prevalence of dermatological self‐treatment among medical doctors of a Spanish hospital

AbstractBackgroundSelf‐medication is a fairly common practice among medical doctors. Although frequently seen in clinical practice, there are few published studies that describe the process of self‐treatment in dermatology, being even lower in number those that evaluate this circumstance among health professionals.ObjectivesTo know the prevalence of self‐medication among medical professionals in our centre, to assess the need for preventive and training actions that help to avoid the misuse of dermatological treatments.MethodsDescriptive cross‐sectional study based on the responses of non‐dermatologist medical professionals at the University Hospital of Pontevedra (Spain). Data were collected through a self‐administered, anonymous and voluntary online questionnaire.ResultsThe questionnaire was completed by 283 physicians (50.63% participation rate, 62.90% females). Up to 77.39% of the physicians carried out self‐treatment for any pathology, and 55.12% for dermatological problems. The mean age of the doctors who practiced self‐treatment was significantly higher. The most used drugs were corticosteroids as topical treatment and antihistamines as systemic therapy. Irritant or allergic contact dermatitis was the most frequent pathology considered suitable for self‐medication (18.02%), followed by fungal infections (16.86%). After self‐treatment, the 7.5% needed to be seen by a dermatologist. A large group of 69.23% stated that they would recommend the treatment carried out to someone suffering from a similar process.ConclusionsThe prevalence of self‐treatment for skin diseases among doctors was strikingly high (55.12%). More than two‐thirds of the surveyed physicians would recommend self‐treatment in the dermatology field. As the literature on this topic is yet scarce, further studies are required to corroborate data collected in this study.

The Mapping Mechanism From the Source Domain “Electronic Devices” Onto the Target Domain “Human Being”: An Online Vietnamese Article Context

The article is a study on the appearance of the metaphor “humans are electronic devices” in online Vietnamese articles to clarify the relationship in Vietnamese people's mind map between "electronic devices" and "humans". Based on the correlation between experiences and knowledge from source domain mapping onto the target domain, this study aimed to decode the conceptual diagram, explain the mapping mechanism and the logically-organized mapping scheme of the conceptual metaphor, identify a unique cognitive style in the conceptual structure which is universally characterized by the Fourth Industrial Revolution. The research findings may be beneficial to journalism students who wish to employ conceptual metaphors in writing about physical and mental health. Additionally, hospital website builders, medical staff, doctors, researchers, biomedical therapists, and others in the medical field can use the findings as a reference to improve their skills in using conceptual metaphors in articles about health care and protection, health risk alerts, and understanding the operation mechanism of the human body as a machine. Furthermore, the research results may offer advertisers suggestions on how to use conceptual metaphors for describing health care products in a way that strongly affects consumer awareness about product values and changes their shopping behavior.

Knowledge, Attitude and Practices of Resident Doctors Towards use of Proton Pump Inhibitors in A Tertiary Care Hospital in Pune, India: A Cross-Sectional Survey

Background and Objectives: The most commonly prescribed drugs in healthcare systems are proton pump inhibitors (PPIs). Several studies have found that globally PPIs are frequently used without proper justification. Appropriate and updated knowledge about PPI among medical professionals is essential to enhance the rationale of PPI application. The present study with this goal was initiated to evaluate the understanding and behavioral practices toward PPI use among resident doctors in a tertiary care teaching hospital in Pune, western India. Method: A cross sectional survey using structured questionnaire. Results: The questionnaire was completed by 137 resident doctors. 82.5% of them prescribed acid-suppressing drugs for acute gastritis and other drugs in combination with them as the most common indications for the majority of their patients. These prescriptions were based on the consultant's or unit's policy, and resident doctors were not given the liberty to breach this policy. 71.5% of the respondents chose PPIs as their first choice, and 75.1% preferred the oral route. 10.2% of them claimed to have encountered a PPI-related adverse event. Despite the fact that 75.9% of the respondents preferred to prescribe PPIs for short durations, a lack of awareness about the possible risks associated with chronic PPI use was noted. 58.4% of resident doctors preferred using the step-down strategy, but 19.7% of participants were unaware of step up or step down when prescribing PPIs. The concept of drug interactions with the co-administration of PPI was also less understood by study participants. Conclusion: In the present survey study participants had less knowledge on correct indications for PPI usage as they fared PPI over any other acid-reducing medications to majority of their patients. There was also a lack of understanding of PPI adverse drug reactions, drug-drug interactions, and specific PPI administration approaches.

Characteristics and Effectiveness of Mobile- and Web-Based Tele-Emergency Consultation System between Rural and Urban Hospitals in South Korea: A National-Wide Observation Study.

(1) Background: The government of South Korea has established a nationwide web- and mobile-based emergency teleconsultation network by designating urban and rural hospitals. The purpose of this study is to analyze the characteristics and effectiveness of the tele-emergency system in South Korea. (2) Methods: Tele-emergency consultation cases from May 2015 to December 2018 were analyzed in the present study. The definition of a tele-emergency in the present study is an emergency consultation between doctors in rural and urban hospitals via a web- and mobile-based remote emergency consultation system (RECS). Consultations through an RECS are grouped into three categories: medical procedure or treatment guidance, image interpretation, and transportation requests. The present study analyzed the characteristics of the tele-emergency system and the reduction in unnecessary transportation (RUT). (3) Results: A total of 2604 cases were analyzed in the present study from 2985 tele-emergency consultation cases. A total of 381 cases were excluded for missing data. Consultations for image interpretation were the most common in trauma cases (71.3%), while transfer requests were the most common in non-trauma cases (50.3%). Trauma patients were more frequently admitted to rural hospitals or discharged and followed up with at rural hospitals (20.3% vs. 40.5%) after consultations. In terms of disease severity, non-severe cases were statistically higher in trauma cases (80.6% vs. 59.4%; p < 0.001). The RUT was statistically highly associated with trauma cases (60.8% vs. 42.8%; p < 0.001). In an analysis that categorized cases by region, a statistically higher proportion of transportation was used in island regions (69.9% vs. 49.5%; p < 0.003). More RUT was associated with non-island regions (30.1% vs. 50.5%; p = 0.001). (4) Conclusions: The tele-emergency system had a great role in reducing unnecessary patient transportation in non-severe trauma cases and non-island rural area emergency cases. Further research is needed for a cost/benefit analysis and clinical outcomes.

Factors influencing engagement in online dual practice by public hospital doctors in three large cities: A mixed-methods study in China.

In the digital age, a rising number of public sector doctors are providing private telemedicine and telehealth services on online health care platforms. This novel practice pattern - termed online dual practice - may profoundly impact health system performance in both developed and developing countries. This study aims to understand the factors influencing doctors' engagement in online dual practice. Using a mixed-methods design, this study concurrently collects quantitative demographic and practice data (n = 71 944) and semi-structured interview data (n = 32) on secondary and tertiary public hospital doctors in three large Chinese cities: Beijing, Shanghai and Guangzhou. We use the quantitative data to examine the prevalence of the online dual practice and its associated factors via the binary logit regression model. The qualitative data are used to further explore associated factors of online dual practice via thematic analysis. The findings about associated factors from the two parts were merged using the categories of personal, professional, and organisational characteristics. Our quantitative analysis shows that at least 47.1% of public hospital doctors are involved in online dual practice. The shares in Beijing, Shanghai, and Guangzhou are 43.7%, 53.1%, and 44.8%, respectively. This practice is more prevalent among doctors who are male, senior, and non-managerial. Different specialties, hospital ownership, hospital levels, and locations are also significantly associated with this practice. The qualitative analysis further suggests that financial returns, perceived effectiveness of telemedicine, and hospital directors' attitude towards telemedicine may affect doctors' engagement with online dual practice. Online dual practice is prevalent among doctors at tertiary and secondary public hospitals in Beijing, Shanghai, and Guangzhou. Personal, professional, and organisational characteristics are all associated with doctors' choice to engage in online dual practice. The findings in this study provide implications for promoting telemedicine adoption and developing relevant regulatory policies in China and other countries.

An intelligent telemonitoring application for coronavirus patients: reCOVeryaID.

The COVID-19 emergency underscored the importance of resolving crucial issues of territorial health monitoring, such as overloaded phone lines, doctors exposed to infection, chronically ill patients unable to access hospitals, etc. In fact, it often happened that people would call doctors/hospitals just out of anxiety, not realizing that they were clogging up communications, thus causing problems for those who needed them most; such people, often elderly, have often felt lonely and abandoned by the health care system because of poor telemedicine. In addition, doctors were unable to follow up on the most serious cases or make sure that others did not worsen. Thus, uring the first pandemic wave we had the idea to design a system that could help people alleviate their fears and be constantly monitored by doctors both in hospitals and at home; consequently, we developed reCOVeryaID, a telemonitoring application for coronavirus patients. It is an autonomous application supported by a knowledge base that can react promptly and inform medical doctors if dangerous trends in the patient's short- and long-term vital signs are detected. In this paper, we also validate the knowledge-base rules in real-world settings by testing them on data from real patients infected with COVID-19.

267 Survey of knowledge and medications Management of Patients with Parkinson’s Disease among non- consultant hospital doctors

Abstract Background Parkinson’s Disease is a progressive neurodegenerative movement disorder. is the second most common neurodegenerative condition after Alzheimer Disease. The incidence is 1–2:1000 of the general population and 1:100 of the over 80’s, therefore estimating that there are approximately 12,000 people living with Parkinson’s in Ireland. Providing care services and best management for Parkinson’s disease patients needs to be ensured through training staff and continuously auditing the service to meet international standards and patient satisfaction. Methods This study was conducted using an anonymous online survey completed by hospital doctors from all levels and specialties of Non-Consultant Hospital Doctors (NCHD) in a tertiary hospital. The survey contained two sections, the first asked questions on confidence and how commonly NCHD manage patients with Parkinson’s Disease. The second section contained questions to assess general knowledge on medications. Results Of the 40 respondents of non-consultant hospital doctors (NCHD) 50% were SHOs, 30% Interns 20% Registrars. 38% reported to lack confidence in managing patients with Parkinson’s and 50% somewhat confident and only 12% were confident. 77% weren’t familiar with medication side effect and 90% weren’t aware about rescue medications. 82% weren’t familiar with conversion methods. 95% felt that they needed more training. Conclusion Parkinson’s disease patients are commonly admitted to hospitals under medical and surgical teams, and ensuring every patient gets the best management should be our goal. More training is required among hospital doctors, in addition to other continuous easily accessible supportive materials, such as information leaflets, links to be included into hospital’s mobile phone application, Parkinson’s nurse specialist as a point of contact, and regular education.

261 Perceptions of and attitudes towards problematic polypharmacy and prescribing cascades in older adults: a stakeholder analysis

Abstract Background Research to date on appropriate prescribing in older adults has focused on characterising inappropriate prescribing using explicit prescribing indicator tools. Less is known about other causes of problematic polypharmacy such as prescribing cascades. Prescribing cascades occur when a medication is prescribed to treat or to prevent the symptoms of an adverse drug reaction and may be characterised as intentional or unintentional, as well as appropriate or inappropriate. Prescribing cascades, therefore, represent an important and under-researched area of problematic polypharmacy. The aim of this study was to conduct a stakeholder analysis (patients with polypharmacy; carers; General Practitioners [GPs]; hospital doctors; community pharmacists; professional organisation representatives and policymakers) to elicit perceptions of and attitudes towards problematic polypharmacy, with a focus on prescribing cascades. Methods Qualitative one-to-one semi-structured interviews were conducted. Participants were recruited via a gatekeeper approach. Interview duration ranged from 58 to 80 minutes. Interviews were analysed thematically. Results Thirty-one participants (six patients, two carers, seven GPs, eight community pharmacists, four hospital doctors, two professional organisation representatives, and two policy makers) were interviewed. The challenges of communication at the interface of primary and secondary care were outlined, including the lack of clear ownership of drug monitoring. The community pharmacist and, at times, the patient were relied upon to fill in these gaps in communication. Patients discussed the burden of taking multiple medications. GPs described the importance of ‘mindful prescribing’ to avoid, where possible, unintentional prescribing cascades. The need for further education for health care professionals and patients on prescribing cascades was highlighted, as was the importance of improved collaboration between health care professionals. Conclusion Understanding the perceptions of different stakeholders towards problematic polypharmacy and prescribing cascades is key to the development of effective tools or resources to improve patient care.

328 From delirium detection to correction: enhancing peri-operative care for older patients

Abstract Background Delirium is a common peri-operative complications in older adults. It is associated with poorer outcomes including functional decline, increased length of hospital stays, increased admissions to long term care and higher mortality. Therefore, this project aimed to assess the peri-operative care of older patients admitted under the surgical service in accordance with the standards set by the Collaborative for Peri-operative Optimisation of People (CPOP) and British Geriatrics Society (BGS) Peri-operative Care for People Living with Frailty undergoing Elective and Emergency Surgery Guidelines. Methods The study examined four key aspects of the guidelines: (1) surgical staff training on delirium; (2) proactive screening in for delirium in surgical patients; (3) proactively documenting delirium and implementing delirium guidelines; and (4) documentation of delirium diagnosis in discharge summaries. Results Data were collected from 72 surgical admissions over a fourteen-day period, of which 26 patients were aged &amp;gt;65. Results indicated suboptimal adherence to the guidelines, with only 4/26 older patients (15.4%) being screened for delirium. Three of 4 of these patients screened positive for delirium using the 4AT. No patients had delirium mentioned in their discharge summaries. Additionally, a survey of surgical non-consultant hospital doctors revealed that only 4/16 (25%) had received formal training on delirium. Conclusion In response to these findings, interventions were implemented, including teaching at surgical grand rounds, hospital-wide education for World Delirium Awareness Day, introduction of delirium care bundles, and an updated discharge summary template for surgical patients to include a delirium diagnosis. A reaudit is underway to evaluate the impact of these interventions on guideline adherence and the peri-operative care quality for older patients. These initial findings underscore the need for improved staff education and adherence to CPOP and BGS guidelines. The reaudit will provide valuable insights into the effectiveness of the implemented interventions in enhancing the perioperative care experience for the older patient cohort.

297 Assessing continence care in a rehabilitation unit: insights from an audit

Abstract Background Urinary incontinence, a prevalent condition and one of the original geriatric giants, remains a taboo topic and is frequently underreported. Urinary incontinence significantly impacts patients and often times their discharge destination. However, urinary incontinence is neither inevitable nor always irreversible. This audit aimed to assess continence and incontinence wear in a rehabilitation facility. Methods The continence care quality in a medical gerontology ward was assessed using the Royal College of Physicians (RCP) National Audit of Continence Care (NACC) standard. A prospective audit was conducted over a five-day period, documenting incontinence wear and urinary continence on a medical gerontology ward. Two interventions were implemented prior to re-auditing. Firstly, continence was incorporated as a teaching topic on the Non-Consultant Hospital Doctor (NCHD) teaching schedule. Secondly, the Multi-Disciplinary Team (MDT) proforma was adjusted to include a patient-specific continence record. A snapshot re-audit was conducted to evaluate any changes resulting from these interventions. Results In the initial audit, 31 patients were included. Among them, 26 (83.9%) wore incontinence wear, with 21 (80.8%) voluntarily opting for it. Urinary incontinence was documented in 13 patients (41.9%). In the re-audit, 40 patients were included. Among them, 27 (67.5%) wore incontinence wear, with 19 (70%) choosing it. Urinary incontinence was documented in 18 patients (45.7%). Conclusion The re-audit revealed a slight decrease in incontinence wear usage (67.5% compared to 83.9% initially). Many patients wearing incontinence wear expressed a preference for it in both audit cycles. The prevalence of urinary incontinence remained similar between audits (41.9% and 45.7% respectively). The persisting prevalence of urinary incontinence calls for effective strategies to address this issue. Additionally, the patients’ preference for incontinence wear emphasises the importance of engaging not only the MDT but also the patients themselves in future interventions. Future projects should focus on gaining a deeper understanding of patients’ perspectives on continence care and evaluating the impact of incontinence on patient outcomes.