Large Acute General Hospital Research Articles

Nosocomial outbreak in a respiratory ward caused by the SARS-CoV-2 Omicron BA 5.2.1 subvariant associated with non-severe illness in vaccinated patients.

In this short report, we describe an outbreak of COVID-19 caused by Omicron subvariant BA.5.2.1 in highly vaccinated patients in a respiratory ward in a large acute general hospital in North West London, United Kingdom. The attack rate was high (14/33 (42%)) but the clinical impact was relatively non-severe including in patients who were at high risk of severe COVID-19. Twelve of fourteen patients had COVID-19 vaccinations. There was only one death due to COVID-19 pneumonitis. The findings of this outbreak investigation suggest that while the transmissibility of Omicron BA.5.2.1 subvariant is high, infections caused by this strain are non-severe in vaccinated patients, even if they are at high risk of severe COVID-19 infection.

174 An Audit on First Time Shoulder Dislocations: Are We Following BESS Guidelines?

Abstract Aim Traumatic shoulder dislocations are the most common joint dislocation in the UK. They are often associated with concurrent injury to the joint and its stabilisers which can occasionally get missed. This can severely affect functional recovery and lead to chronic instability. Our aim was to assess adherence to the BESS guidelines for first time shoulder dislocations in a large acute general hospital. Method We conducted a retrospective review of all patients who attended the emergency department at Birmingham Heartlands Hospital between January and December 2019. A total of 20 patients were selected after verifying data received from the health informatics team. Patient notes, investigations and clinic letters were reviewed. Results The average age of our cohort was 50 with a male to female ratio of 13:7. The cohort was divided into three groups depending on their age i.e.,16–25, 25–40 and >40. Although 85% were seen in a fracture clinic only 25% were seen by a consultant. It was noted that among all three groups only 40% of appropriate imaging was requested. In addition, only 50% were correctly referred to a shoulder surgeon or shoulder clinic to assess shoulder function, however most patients were seen by a physiotherapist. Conclusions We found a large number of concomitant injuries in those investigated for a first-time dislocation. We have therefore designed a pathway to ensure that all patients with a first-time shoulder dislocation are followed up in fracture clinic and appropriate investigations ordered in a timely manner.

Dementia Severity Is Associated With Early Potentially Avoidable Readmissions in an Acute Care Hospital

Understanding the association of dementia severity with early potentially avoidable readmissions (PAR) could encourage the identification of the target patients for the health care providers to provide transitional care (i.e. follow-up and coordination care) to prevent early readmissions. This study examined whether dementia severity before admission was associated with PAR within 90 days (90-day PAR). This retrospective cohort study was conducted using a Diagnosis Procedure Combination database linked with routinely collected dementia assessment data from a large acute general hospital in Tokyo, Japan. Patients aged 65 or older who were discharged to home or facilities (n=8,910; mean age: 79.8 years, standard deviation: 7.4 years) between July 2016 and September 2018. The dementia severity was classified as normal, slight, moderate, severe dementia based on the Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21) from the patient or their family at admission. We conducted a multivariable logistic regression adjusted for covariates (sex, age, insurance copayment rate, diagnosis at admission, Charlson Comorbidity Index, unscheduled admission, ICU utilization, surgical treatment, length of hospital stay, discharge place) to examine the association of severity of dementia with 90-day PAR. Among the patients, 225 (2.5%) experienced 90-day PAR. The adjusted odds of 90-day PAR among patients with moderate dementia were 1.571 times (95% confidence interval [CI]: 1.102-2.240) and patients with severe dementia were 2.386 times (95% CI: 1.294-4.398) higher than the odds among patients without dementia. Patients with moderate and severe dementia before admission would be the target with high priority for providing transitional care.

CN28 - Optimising inpatient oncology care

BackgroundAs an ESMO designated centre of integrated oncology and palliative care it is important to have a range of skill mix and experience across the oncology nursing staff caring for these patients. Within a large acute general hospital, with patients on various wards across the hospital, challenges in achieving these aims may present themselves. The core ward consists of 14 single rooms; the non-core wards have a mix of 1, 2, 4 and 6 bedded rooms. This analysis aimed to assess the nature of hospitalisations and the associated outcomes for the whole cohort of patients on the associated ward. MethodsAll inpatients who were admitted or were pre-existing patients during the period of 8 weeks of analysis were assessed. The main features considered were the age, gender, cancer diagnosis, co-morbidities, reason for admission, and whether they returned to home, hospice or died in hospital. Whether patients were on the core chemotherapy ward or on outlying wards was assessed. Data from retrieved from the medical and nursing handover records and clinical information system of the Hospital. ResultsThere were 44 patients (37.8%) cared for over the 50 admissions on the Core Therapeutic Ward staffed by oncology nurses over the 8 week period with the remainder cared for over the 92 admissions on outlying wards staffed by non-oncology nurses. The three most common reasons for admission (core/non-core ward) included symptom management with disease progression (42% vs 50%), anti-cancer therapy associated toxicities (18% vs 13%) & decline in activities of daily living (16% vs 15%). The most common oncology primary cancers included CNS (25% vs 20%), Lower GI (16% vs 15%) and GU (11.4% vs 13.5%). Disease related impaired cognition was the most common baseline co-morbidity present in each cohort (27.3%/12.2%). The patient discharge outcomes on each ward (onc/non-onc) were home (56.8%/85.1%), rehabilitation or long term care (10.1% vs 2.7%), hospice (6.8%/4.1%) and death (27.3%/8.1%) reflecting that less well patients tended to be cared for within the specialist ward. ConclusionsBalancing the optimal location and nursing skill set is a challenge and remains an important focus and priority within a service ranging from high dose chemotherapy administration for curative intent to palliative and terminal care. Legal entity responsible for the studyBeaumont Hospital Cancer Centre. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Support for compassionate care: Quantitative and qualitative evaluation of Schwartz Center Rounds in an acute general hospital

ObjectiveTo evaluate the impact of Schwartz Center Rounds, a multi-disciplinary forum to reflect on the emotional consequences of working in healthcare, on the staff of a large acute general hospital over a three-year period.DesignEvaluation data following each Round were collected routinely from all staff attending over this period and analysed quantitatively and qualitatively.SettingAn integrated university teaching trust with both acute hospital and community services in the North East of England.ParticipantsOver the three-year period of the study, 795 participant evaluation forms were returned by staff attending the Rounds.Main outcome measuresA standard evaluation form completed at the end of each Round by those present, including ratings on a five-point scale against each of eight statements and an opportunity to offer additional free text comments.ResultsThe findings show a very positive response to all aspects of the Rounds by staff who attended. The most highly rated statement was: ‘I have gained insight into how others think/feel in caring for patients’. This was reinforced by the qualitative analysis in which the primary theme was found to be Insight. There were no significant differences between disciplines/staff groups, indicating that all staff whether clinical or non-clinical responded to the Rounds equally positively.ConclusionsSchwartz Rounds are highly valued by staff from all disciplines, and by managers and other non-clinicians as well as clinicians. They appear to have the potential to increase understanding between different staff, and so to reduce isolation and provide support.

Care in specialist medical and mental health unit compared with standard care for older people with cognitive impairment admitted to general hospital: randomised controlled trial (NIHR TEAM trial)

Objective To develop and evaluate a best practice model of general hospital acute medical care for older people with cognitive impairment. Design Randomised controlled trial, adapted to take account of...

Creating a Vision for Nursing Practice in a Tertiary Medical Organization in Israel

Rapid changes in the healthcare system obligate Israeli nursing leaders to reassess current nursing roles and to identify new paradigms that are in line with the demanding needs of acute care settings. The challenge of engaging nurses to achieve the desired changes in nursing role performance and perception can be accomplished by defining a comprehensive organizational vision. The authors present a process creating and implementing a nursing vision intended to empower the nurse's role in a large acute general hospital.