Medical Wards Research Articles

Optimising Delirium Pathways in Geriatric Care: The Impact of Consultant Led Old Age Psychiatry Liaison Service

Abstract Background Delirium is a common and severe condition affecting up to 50% of older adults in hospitals. Delirium is compounded by the noisy and frightening environment of medical wards, often leading to prescription of antipsychotics. There is often no clear plan to monitor effects of these medications. Delirium is also associated with increased rates of institutionalised care on discharge, readmission rates and mortality. Methods This QIP examines the effectiveness of interventions for patients with delirium in COE wards, focusing on involvement of consultant led old-age psychiatry liaison service. This 2-cycle process included 106 patients in the 1st cycle (Feb 2020-Sep 202, nurse-led), and 64 patients in the 2nd cycle (Nov 2022-Aug 2023, consultant-led). Outcome measures the number of patients assessed, new antipsychotic prescription, new nursing home placement, follow-up plans, readmission rate, and 1year mortality. Results The QIP revealed an increase in the number of inpatients reviewed by the POA team (330%) and planned out-patient POA follow-up (320%). There was an increase in the number of antipsychotics prescribed on discharge (61.5%) and discharge to a new appropriate placement (27.6%). The overall readmissions rates had slightly decreased (2.5%), and readmissions with delirium had further reduced (4%) (not significant, p=0.66). The overall mortality rate increased by 4% since the introduction of these measures (not significant, p=0.63), however, this is small and at a level expected with this population group. Conclusion These results suggest that the new consultant led liaison team resulted in an increased use of their expert opinion on challenging patients with delirium. Significantly, more patients received psychiatric follow-up crucial for antipsychotic monitoring. There is a slight reduction in the readmission rates. Although, the increase in the mortality rate is insignificant, this warrants a closer look as antipsychotics are associated with cardiovascular diseases. A larger study over a longer period of time would provide more useful data.

Treatment Escalation Plans: A Snapshot Review on Acute Medical Wards

Abstract Background In medical care, Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR) orders serve as vital tools in determining whether CPR should be administered to patients, particularly those with progressive life-limiting illnesses or approaching the end of life. Failure to make timely and appropriate CPR-related decisions and treatment escalation plans can lead to the risk of administering futile or inappropriate treatments. Methods Admission booklets in our centre prompt clinicians to indicate whether a patient was for CPR or not as part of the admission process, with further instructions to fill out a DNA CPR form if applicable. We conducted a chart review on acute medical wards to assess the frequency and adequacy of DNA CPR decision-making and communication. Data was collected by three investigators on a structured proforma and anonymised. Data analysis was conducted using Excel. Results Data was collected on 67 patients, with a mean age of 76.6. Of those 67, only six had CPR status indicated on admission, with five specified for resuscitation and one not for resuscitation. A total of 14 patients went on to have DNA CPR forms filled out during admission, but in only five cases were these decisions discussed with the patients themselves. The main reasons for lack of patient involvement in the discussions included confusion and cognitive impairment. Documentation regarding discussions with next of kin was present in eight cases. Conclusion Our snapshot review underscores the importance of early discussions regarding treatment escalation plans and DNA CPR decisions. Our findings reveal that these discussions are not occurring as frequently as advised, and when decisions are made, they are not adequately communicated with patients or those close to them. There is an urgent need for further training on the legal aspects and ethical considerations surrounding DNA CPR decisions to ensure better patient-centered care and decision-making.

Ending Pyjama Paralysis; Physical Steps In The Right Direction For An Irish University Hospital

Abstract Background The risk of hospital-associated deconditioning for frail older adults (i.e. reduced functional performance after acute hospitalisation, due to low activity levels during an admission) is well recognised, yet continues to occur commonly. This quality improvement project aimed to promote a cultural change within two acute medical wards, in line with the principles of “End PJ Paralysis”, which aims to “get patients out of bed, dressed in their own clothes and when possible, moving rather than lying in bed”. Methods A multidisciplinary committee was formed to oversee this project. An initial audit on observed levels of patient activity was performed, along with a root cause analysis to identify points of action. A multicomponent intervention was designed and implemented over an 8-week period (Oct to Nov 2023), with weekly re-audit of activity levels. Data on the monthly incidence of falls & pressure areas, as well as average length-of-stay, was also collected, with the results for the intervention period (Q4) compared with the monthly averages for the nine months prior (Q1-3). Results A total of 570 Patients were included. Improvements were observed in all outcomes. The proportion of patients dressed in their own clothes increased from 28.5% (18/63) to 51.8% (263/507), those sitting out in a chair increased from 50% (32/63) to 64% (326/507), and those mobilising at the time of audit increased from 60% (38/63) to 71% (360/507). Average falls (Q1-3 vs Q4) fell from 14.8 to 12.6 per month, average pressure sores from 5.5 to 5 per month, and average length of stay from 11.20 to 10 days. Conclusion This project demonstrates that a ward-based multidisciplinary initiative can lead to an increase in the proportion of patients on an acute medical ward being dressed in their own clothes, sitting out, and mobilising, without an increase in the incidence of falls.

Admission characteristics of patients with short term hospitalization

BackgroundSheba Medical Center (SMC) is the largest hospital in Israel and has been coping with a steady increase in total Emergency Department (ED) visits. Over 140,000 patients arrive at the SMC's ED every year. Of those, 19% are admitted to the medical wards. Some are very short hospitalizations (one night or less). This puts a heavy burden on the medical wards. We aimed to identify the characteristics of short hospitalizations.MethodsWe retrospectively retrieved data of consecutive adult patients admitted to our hospital during January 1, 2013, to December 31, 2019. We limited the cohort to patients who were admitted to the medical wards. We divided the study group into those with short, those with non-short hospitalization and those who were discharged from the ED.ResultsOut of 133,126 admissions, 59,994 (45.0%) were hospitalized for short term. Patients in the short hospitalization group were younger and had fewer comorbidities. The highest rate of short hospitalization was recorded during night shifts (58.4%) and the rate of short hospitalization was associated with the ED daily patient load (r = 0.35, p < 0.001). The likelihood of having a short hospitalization was most prominent in patients with suicide attempt (80.0% of those admitted for this complaint had a short hospitalization), followed by hypertension (68.6%). However, these complaints accounted for only 0.7% of the total number of short hospitalizations. Cardiac and neurological complaints however, made up 27.4% of the short hospitalizations. The 30-days mortality rate was 7.0% in the non-short hospitalization group, 4.3% in the short hospitalization group and 0.9% in those who were discharged from the ED.ConclusionsShort hospitalizations in medical wards have special characteristics that may render them predictable. Increasing the rate of treating personnel per patient during peak hours and referring subsets of patients with cardiac and neurological complaints to ED-associated short term observation units may decrease short admissions to medical departments.

Impact of an Early Goals of Care Discussion on Patient Satisfaction and Quality of Life among Seriously Ill Patients Admitted to the Medical Wards – A Quality Improvement Project

Impact of an Early Goals of Care Discussion on Patient Satisfaction and Quality of Life among Seriously Ill Patients Admitted to the Medical Wards – A Quality Improvement Project

Comparison of Traumatic Brain Injury in Adult Patients with and without Facial Fractures.

Facial fractures and associated traumatic brain injuries represent a worldwide public health concern. Therefore, we aimed to determine the pattern of brain injury accompanying facial fractures by comparing adult patients with and without facial fractures in terms of demographic, clinical, and imaging features. This single-center, retrospective study included 492 polytrauma patients presenting at our emergency department from January 2019 to July 2023, which were divided in two groups: with facial fractures (FF) and without facial fractures (non-FF). The following data were collected: age, sex, mechanism of trauma (road traffic accident, fall, and other causes), Glasgow Coma Scale (GCS), the evolution of the patient (admitted to a medical ward or intensive care unit, neurosurgery performed, death), and imaging features of the injury. Data were analyzed using descriptive tests, Chi-square tests, and regression analyses. A p-value less than 0.05 was considered statistically significant. In the FF group, there were 79% (n = 102) men and 21% (n = 27) women, with a mean age of 45 ± 17 years, while in the non-FF group, there were 70% (n = 253) men and 30% (n = 110) women, with a mean age 46 ± 17 years. There was a significant association between brain injuries and facial fractures (p < 0.001, AOR 1.7). The most frequent facial fracture affected the zygoma bone in 28.1% (n = 67) cases. The most frequent brain injury associated with FF was subdural hematoma 23.4% (n = 44), and in the non-FF group, the most common head injury was intraparenchymal hematoma 29% (n = 73); Conclusions: Both groups shared similarities regarding gender, age, cause of traumatic event, and outcome but had significant differences in association with brain injuries, ICU admission, and clinical status.

The effect of clinical supervision model on nurses’ self-efficacy and communication skills in the handover process of medical and surgical wards: an experimental study

BackgroundThe handover process is a vital part of patient safety continuity, particularly conducted between nurses at the end of shifts. Nurses often face challenges in handover due to a lack of self-efficacy and inadequate communication skills. The clinical supervision model, by providing emotional, educational, and organizational support, aids in skill acquisition and instills confidence.ObjectiveThis study was conducted to investigate the effect of the clinical supervision model on nurses’ self-efficacy and communication skills in the handover process within medical and surgical wards.MethodThis experimental two-group (pre-and post-test) study was conducted in 2024 at selected hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. Convenience sampling was used, and participants were randomly assigned to either the intervention or control group. Data were collected using the ISBAR communication checklist, communication clarity, the Sherer General Self-Efficacy Scale (GSES), the Visual Analog Scale (VAS) for handover self-efficacy, and the Manchester Clinical Supervision Scale (MCSS). The clinical supervision model and routine supervision were implemented in six sessions for the intervention and control groups, respectively. Data were analyzed using SPSS version 16, employing independent t-tests, covariance analysis, paired t-tests, chi-square tests, and repeated measures ANOVA with a significance level of p < 0.05.ResultsNo significant differences were observed between the intervention and control groups in terms of baseline characteristics. Inter-group analysis indicated that there were no significant differences in the scores of self-efficacy, ISBAR, and communication clarity between the control and intervention groups before the intervention (P > 0.05). According to the intra-group analysis, the ISBAR and communication clarity scores in the intervention group significantly increased over time (p < 0.001), whereas no such increase was observed in the control group. The intervention group showed a significant increase in general self-efficacy (p < 0.001) compared to the control group. Although both groups showed a significant improvement in handover self-efficacy, the mean scores of the intervention group were higher than those of the control group (p < 0.001). The mean score of the Manchester Clinical Supervision Scale in the intervention group was 128.98, indicating the high effectiveness of implementing the clinical supervision model.ConclusionThe findings indicated that the use of the clinical supervision model improves self-efficacy and communication skills in the handover process of nurses in medical and surgical wards. Therefore, it is recommended to use this model in handover training to enhance the quality of care and improve patient safety.

Prevalence and associated risk factors of staphylococcus aureus and methicillin-resistant staphylococcus aureus isolates obtained from patients seeking treatment in Nakuru county referral and teaching hospital, Kenya

Staphylococcus aureus is a pathogenic bacterium that can evolve rapidly to methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a global health concern that is associated with significant morbidity and mortality. This study was to determine the prevalence and Associated Risk Factors of staphylococcus aureus and MRSA isolates obtained from patients seeking treatment in Nakuru County Referral and Teaching Hospital. A descriptive cross-section study design was used with a laboratory experimental component and it was carried out in Nakuru County Referral and Teaching Hospital, Kenya. A total of 354 laboratory samples were randomly collected from different laboratory samples/sites: blood, urine, wound, nasal swabs, pus, tissue, abscess, sputum, ear swabs, as well as cerebrospinal fluid (CSF) culture, skin swabs and synovial fluid culture over a period of six months. These samples were tested for presence of staphylococcus aureus and MRSA isolates using Culture methods and Antibiotic Sensitivity Tests. The study analyzed 354 participants, with a median age of 35 years. Most participants (56.7%) were from medical wards, 20.4% from outpatient clinics, and 11% from Diabetic Care Centre. Staphylococcus aureus was found in 7.1% of samples, with MRSA present in 2.3%. Other isolated organisms included Coagulase Negative Staphylococci (7.1%), E. coli (6.8%), Proteus spp. (5.1%), and Pseudomonas spp. (5.9%). The prevalence of MRSA among the participants is low.

Hospital discharge processes: Insights from patients, caregivers, and staff in an Australian healthcare setting

Hospital discharge is a pivotal point in healthcare delivery, impacting patient outcomes and resource utilisation. Ineffective discharge processes contribute to unplanned hospital readmissions. This study explored hospital discharge process from the perspectives of patients, caregivers, and healthcare staff. Qualitative data were collected through semi-structured interviews with adult patients being discharged home from a medical ward, their caregivers, and healthcare staff at an Australian hospital. Thematic analysis followed established guidelines for qualitative research. A total of 65 interviews and 21 structured observations were completed. There were three themes: i) Communication, ii) System Pressure, and iii) Continuing Care. The theme ‘Communication’ highlighted challenges and inconsistencies in notifying patients, caregivers, and staff about discharge plans, leading to patient stress and frustration. Information overload during discharge hindered patient comprehension and satisfaction. Staff identified communication gaps between teams, resulting in uncertainty regarding discharge logistics. The theme ‘System Pressure’ referred to pressure to discharge patients quickly to free hospital capacity occasionally, even in the face of inadequate service provision on weekends and out-of-hours. The ‘Continuing Care’ theme drew attention to gaps in patient understanding of follow-up appointments, underscoring the need for clearer post-discharge instructions. The lack of structured systems for tracking referrals and post-discharge care coordination was also highlighted, potentially leading to fragmented care. The findings resonate with international literature and the current emphasis in Australia on improving communication during care transitions. Furthermore, the study highlights the tension between patient-centred care and health service pressure for bed availability, resulting in perceptions of premature discharges and unplanned readmissions. It underscores the need for strengthening community-based support and systems for tracking referrals to improve care continuity. These findings have implications for patient experience and safety and suggest the need for targeted interventions to optimise the discharge process.

Understanding the influences on hospital discharge decision-making from patient, carer and staff perspectives

BackgroundGaps in discharge planning are experienced by 41% of hospital patients in Australia. There is an established body of knowledge regarding the features of the discharge process that need to be improved to avoid subsequent hospital readmission and enhance the discharge experience. However, many of these studies have focused solely on factors related to unplanned hospital readmissions and there has been limited success in operationalising improvements to the discharge process. The aim of this study was to explore and describe the factors that influence the decision to discharge adult medical patients from hospital, from patient, carer and staff perspectives.MethodsA qualitative descriptive study was conducted in one acute medical ward in Melbourne, Australia. The study data were collected by observations of clinical practice and semi-structured interviews with patients, carers and staff. Participants were: i) English-speaking adults identified for discharge home, ii) patient carers, and iii) staff involved in the discharge process. Observation data were analysed using content analysis and interviews data were analysed using thematic analysis.ResultsTwenty-one discharges were observed, and 65 participants were interviewed: 21 patients, two carers, and 42 staff. Most patients (76%) were identified as being ready for discharge during morning medical rounds, and 90% of discharge decisions were made collaboratively by the medical team and the patient. Carers were observed to be notified in 15 discharges by the patient (n = 8), doctors (n = 4), or nursing staff (n = 3). Five themes were constructed from thematic analysis of interviews: Readiness for Home, Fragmented Collaboration, Health Literacy, Unrealistic Expectations, and Care beyond Discharge. A collaborative team and supportive carers were considered to enhance risk assessment and discharge planning, however fragmented communication between clinicians, and between clinicians and patients/carers was a barrier to discharge decision-making.ConclusionsOur study highlights the need for a more coordinated approach to discharge decision-making that optimises communication with patients and carers and multidisciplinary workflows and reduces fragmentation. The importance of patient-centred care and a personalised approach to care are well established. However, there is a need to design systems to customise the entirety of the patient journey, including the approach to discharge decision making.

Knowledge and Attitudes Regarding Antimicrobial Drug Use and Antimicrobial Resistance Among Patients Admitted to Medical Wards of a Selected Teaching Hospital in Colombo, Sri Lanka

Introduction: Antimicrobial resistance (AMR) is a significant global public health threat. The rising levels of resistance negatively impact healthcare costs, hospital stays, and mortality rates. This study aimed to evaluate knowledge and attitudes regarding antimicrobial drug usage and AMR among patients admitted to the medical wards of Colombo South Teaching Hospital.Methods: A descriptive cross-sectional design was employed. An interviewer-administered questionnaire, developed based on similar studies, was used. The sample consisted of 231 patients selected via convenience sampling. Patients with a Glasgow Coma Scale score below 15 or altered levels of consciousness or abnormal behavior were excluded. Data were analyzed using SPSS version 26.0, with a significance level set at p&lt;0.05.Results: Approximately 52.4% of participants had poor knowledge about antimicrobial usage. Among 195 respondents who had taken antibiotics, 82.7% received them through a prescription, while 27.3% of them are regularly using antibiotics without a prescription. A significant 42.9% were unaware of the term "antimicrobial resistance," although 50.2% recognized it as a global health issue. Only 28.71% of participants had a positive attitude towards antimicrobial usage, but 87.5% demonstrated a good attitude towards AMR. About 54.5% perceived they used antimicrobial drugs rationally.Conclusions: While half of the participants exhibited poor knowledge and attitudes toward antimicrobial drug usage, the majority had a positive attitude toward AMR. Educational programs targeting all societal levels, including school children, are essential to improve public health knowledge.

Unveiling Patient Perspectives: A Quality Assessment of User Satisfaction in a Leading Private Hospital in Gujranwala, Pakistan

Background: Inpatient departments are crucial for long-term patient care, requiring high-quality environmental conditions to ensure patient satisfaction. This study aimed to evaluate user satisfaction with the environmental quality of the male medical ward in Jinnah Memorial Hospital, Gujranwala, Pakistan.Objective: To assess the environmental quality and patient satisfaction within the male medical ward.Methods: A cross-sectional observational study was conducted from March to May 2019. Data were collected using a structured questionnaire administered to 100 respondents, including patients, staff, and attendants. Observations and environmental assessments were performed, focusing on thermal comfort, lighting, air quality, and ward design. Data analysis was conducted using SPSS version 25.Results: Only 28% of respondents were satisfied with thermal comfort, 40% with indoor air quality, 48% with acoustic control, and 30% with visual comfort. Issues highlighted included poor lighting, inadequate ventilation, and overcrowding, with 67% citing the hospital as expensive despite quality services.Conclusion: The study identified significant deficiencies in the environmental conditions of the male medical ward, necessitating targeted design interventions to improve patient satisfaction and overall healthcare quality.

Impact of the COVID-19 Pandemic on Blood Transfusion among Hospitalized Patients with Chronic Kidney Disease.

Background and Objectives: Hematological disorders, especially chronic anemia and coagulation disorders, are common in patients with chronic kidney disease (CKD). Severe anemia is associated with increased cardiovascular morbidity and mortality in this special group of patients and is also responsible for decreased hope and quality of life. Despite the use of appropriate iron therapy and erythropoietin-stimulating agents, red blood cell transfusion is occasionally required, usually in the setting of acute bleeding or for correction of perioperative anemia. The COVID-19 pandemic has accelerated the progression of chronic diseases and worsened the outcomes for patients with nephrological conditions. As a precautionary measure against infections, patients' access to hospitalization for their procedures has been reduced and their chronic complications, including hematological abnormalities, have gotten out of control. Materials and Methods: Our retrospective observational study was designed to evaluate the impact of the COVID-19 pandemic on blood transfusion for the patients with chronic kidney disease hospitalized in our emergency county medical unit, over a period of four years (2019-2022) who were admitted or at least referred for evaluation to the Nephrology department. We also followed the measures adopted to ensure the necessary blood products during this time. Results: Between 2190-2022, a total of 24,096 hospitalized patients were transfused at the Emergency County Clinical Hospital in Constanta, Romania. Meanwhile, in the nephrology and other medical or surgical wards of our medical unit, 1590 CKD patients were transfused with different blood derivatives. During the pandemic years, as expected, the number of transfused patients and transfused blood units decreased by 4% and 7%, respectively, in comparison with the pre-pandemic year, 2019. Unlike the general trend of transfusion activity, more patients with CKD transfused in 2022 (580) than before the pandemic (414 in 2019), and the number of blood units was higher in 2022 than in 2019 for red blood products and plasma. Between 2020-2022, from the total number of transfused patients in our study, 254 with CKD patients (16%) and 798 non-CKD (4%) died in-hospital. Conclusions: The adaptive strategies implemented to ensure the necessary blood products in the hospital during the COVID-19 pandemic mainly included restrictive transfusion and limitation of elective surgical procedures. The subject matter of the article is important as blood shortages are a problem that healthcare workers may encounter in future pandemics.

Consistent FFP2-masking as part of reducing viral respiratory infections on medical wards for allogeneic hematopoietic stem cell transplantation

Patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) are highly susceptible to infections. The consequent use of masks on wards for allo-HSCT has been controversial in the past decades and was not common before the COVID-19 pandemic. We retrospectively compared incidence and outcomes of viral respiratory infections during allo-HSCT on our specialized ward between 01/2018 and 09/2020 to the era of FFP2 masking between 10/2020 and 10/2022 covering similar seasons of the year. Each group consisted of 150 matched patients. The usage of FFP2 masks reduced the incidence of viral respiratory infections from 22.1 to 2.1% (p < 0.005). This reduced the time on ward from a median of 26 days to 23.5 days (p = 0.002). It also resulted in less use of CT-scans (p = 0.003) and bronchoalveolar lavage procedures (p = 0.057). Median time to proof of infection was 21 days after admission in both groups. No difference was detected in progression free survival, hospital survival or non-relapse mortality (p = 0.78). Our retrospective results indicate that FFP2 masks worn by patients and hospital staff may help to significantly reduce the incidence of viral respiratory infections, including COVID-19, shorten the in-hospital time, and reduce costs without affecting survival.

Rate and predictors of thromboprophylaxis in internal medicine wards: Results from the AURELIO study

BackgroundRandomized controlled trials suggest that prophylactic doses of anticoagulants effectively prevent venous thromboembolism (VTE) in hospitalized medical patients with high thromboembolic risk. However, no prospective studies exist regarding the real-world prevalence of prophylactic anticoagulant use. This prospective study aimed to determine the rate and predictors of thromboprophylaxis in an unselected population of patients hospitalized in medical departments. MethodsWe conducted a multicenter prospective observational study (AURELIO – rAte of venous thrombosis in acutely iLl patIents hOspitalized) to assess the rate of deep vein thrombosis (DVT) in unselected acutely ill patients hospitalized in medical wards using compression ultrasound (CUS) at admission and discharge. Additionally, we evaluated the rate of pharmacological thromboprophylaxis administration in this population and analyzed the thrombotic risk by assessing RAMs (Risk Assessment Models) such as the IMPROVE-VTE and PADUA scores following the clinician's decision to administer thromboprophylaxis. Patients with IMPROVE-VTE scores ≥3 and/or PADUA scores ≥4 were classified as high thrombotic risk; those with IMPROVE-VTE scores <3 and/or PADUA scores <4 were classified as low risk. ResultsWe recruited 2371 patients (1233 males [52 %] and 1138 females [48 %]; mean age 72 ± 16 years). The median length of hospitalization was 13 ± 12 days. Overall, 442/2371 (18.6 %) patients received prophylactic parenteral anticoagulants (subcutaneous low weight molecular heparin or fondaparinux once daily) at admission. Assessing the thrombotic risk of the population recruited 1016 (42.9 %) patients were classified as high risk and 1354 (57.1 %) were low risk. Among high-risk patients, 339/1016 (33.4 %) received anticoagulant prophylaxis compared to 103/1354 (7.6 %) low-risk patients. During hospitalization, 9 patients developed DVT, comprising 7 asymptomatic and 2 symptomatic cases of proximal DVT. Of these, 3 patients were on anticoagulant prophylaxis, while 6 were not. Among the high-risk population, 7 out of 1016 patients (0.7 %) experienced proximal DVT during hospitalization, with 2 out of these 7 (28 %) receiving anticoagulant thromboprophylaxis. In the low-risk population, 2 out of 1354 patients (0.2 %) developed DVT, with 1 out of these 2 (50 %) receiving anticoagulant thromboprophylaxis. Age, heart or respiratory failure, pneumonia, active neoplasia, previous VTE, reduced mobility, and absence of kidney failure were more frequent in patients receiving prophylaxis. Multivariable logistic regression identified age (RR 1.010; CI 95 % 1002–1019; p = 0.015), heart/respiratory failure (RR 1.609; CI 95 % 1248–2075; p < 0.0001), active neoplasia (RR 2.041; CI 95 % 1222–2141; p < 0.0001), pneumonia (RR 1.618; CI 95 % 1557–2676; p < 0.0001), previous VTE (RR 1.954; CI 95 % 1222–3125; p < 0.0001), and reduced mobility (RR 4.674; CI 95 % 3700–5905; p < 0.0001) as independent predictors of thromboprophylaxis. ConclusionsThis study, conducted without pre-established thromboembolic risk scores, offers a comprehensive view of venous thromboembolism prophylaxis in medical patients with acute conditions hospitalized in internal medicine departments. It reveals that advanced age, heart or respiratory failure, active cancer, pneumonia, previous VTE, and reduced mobility are predictors that may influence the decision to administer thromboprophylaxis in these patients.

Implementation of routine HIV testing policy in medical admissions in the sultanate of Oman: An experience from the Middle East.

To tackle the issue of late HIV diagnosis in the country, the Ministry of Health (MOH) in Oman introduced a national policy of routine opt-out HIV in medical admission units in September 2022. We hereby report the implementation and outcomes of this policy. All patients aged 16-65years admitted to a medical ward in secondary and local hospitals were offered an HIV test regardless of their symptoms by medical doctors, with training and support from HIV teams. A retrospective review for the period from September 2022 to September 2023 was conducted to determine the HIV testing rate and outcomes of those testing HIV seropositive. Over 12months, there were 23,399 admissions; 6889 had HIV tests. Thirty-two patients (0.46 %) were diagnosed with HIV; all of them were new diagnoses. Two cases were diagnosed during seroconversion. 12 cases had AIDS-defining illnesses. Four contacts were tested HIV positive. Twenty-five out of 28 alive patients are on ART. This is the first national policy of a routine opt-out HIV in medical admission units in the MENA region. Our experience showed that, even in low HIV prevalence and high HIV stigma settings, this policy is feasible, acceptable, and effective.

Written Mobility Communication in Acute Care Medical Wards: An Observational Study of Physical Therapists' and Nurses' Documentation Practice.

Low inpatient mobility is associated with poor hospital outcomes. Poor communication between clinicians has been identified as a barrier to improving mobility. Understanding how mobility is communicated within the multi-disciplinary team may help inform strategies to improve inpatient mobility. The aim of this study was to describe written mobility communication by physical therapists and nurses in acute care medical wards. This cross-sectional observational study was conducted across 4 hospitals in an Australian health service. A survey of physical therapists and nurses identified preferred sources and content of written mobility communication. An audit described and compared written mobility communication in the most strongly preferred documentation sources. Findings were described and compared graphically between discipline and site. Questionnaires were completed by 85 physical therapists and 150 nurses. Twenty-two sources of documentation about mobility were identified. Preferences for sources and content varied between disciplines. Physical therapists nominated several preferred information sources and sought and documented broader mobility content. Nurses often sought nursing documents which focused on current mobility assistance and aids, with limited communication of mobility level or mobility goals. Audits of 104 patient records found that content varied between sources and sites, and content was variably missing or inconsistent between sources. Written mobility communication focused on mobility assistance and aids, rather than mobility levels or mobility goals, with poor completion and inconsistency within documentation. More complete and consistent documentation might improve progressive mobilization of hospital inpatients. Physical therapists and nurses seek and document different content in a wide range of locations, leading to incomplete and inconsistent written documentation.Understanding and resolving these practice differences offers potential to improve mobility communication and practice.

Correlation between neutrophil to lymphocyte ratio and C-reactive protein in diverse disease states in hospitalized patients.

This study aims to find if any significant correlation exists between C-reactive protein and Neutrophil to Lymphocyte Ratio as an indirect measure of inflammation. We selected 983 patients with any inflammatory condition who presented to a tertiary care hospital and were admitted in medical wards or Intensive Care Units (ICUs) of KRL Hospital Islamabad from December 2021 to December 2022. The study was a cross sectional study and convenience sampling was done. The patients were categorized into five groups depending upon their pathophysiology. Kolmogorov Smirnov test was used to assess the normality of the data, and Spearman's coefficient was used to calculate the correlation between NLR and CRP. A total of 983 patients were included. Mean CRP and NLR levels were 89.9±3.2 and 7.06±0.24, respectively. There was a significant positive correlation between CRP-NLR in the infectious, non-infectious non-inflammatory, and malignancy groups (0.420, 0.381, 0.642, p <0.01), and inflammatory group (0.322, p <0.05), and no correlation with chronic diseases. A significant correlation was shown to exist between CRP and NLR in patients with malignancies, non-infective non-inflammatory, inflammatory, and infective conditions and can therefore be used interchangeably to detect the presence of inflammation. Further exploration of these associations may contribute to a more nuanced understanding of the intricate relationships between different markers of inflammation and response to treatment.

FP6.6 - Diagnosing the improvements required for enhancing the medical student ward round bedside teaching experience utilising a cohort of surgical teaching fellows

Abstract Aim After previously having mixed student feedback as a learning experience, our UK medical school have embedded a cohort of dedicated surgical teaching fellows into acute surgical ward rounds. Since this has happened, we aimed to further improve traditional Surgical Ward Round Bedside Teaching methods. Method Post event, retrospective, optional questionnaire formed of 5 Questions evaluated by a Likert scale and 2 open ended Questions. Presented to year 3, UK undergraduate medical students. Results 20 complete responses received. The majority of students strongly agreed that Surgical Ward Round Bedside Teaching sessions with dedicated fellows present were effective in enhancing clinical knowledge and skills. 90% strongly agreed that teaching fellows were engaging and approachable during Surgical Ward Round Bedside Teaching. Also 90% strongly agreed that they felt comfortable asking questions and seeking clarification during Surgical Ward Round Bedside Teaching sessions. However, only 60% strongly agreed that Surgical Ward Round Bedside Teaching sessions were well-organized and focused on relevant surgical/clinical cases. When asked ‘How could the bedside/Ward Round teaching sessions be improved?’ – Responses revolved around suggesting teaching in smaller groups, reminding wards/departments to expect students/clinical fellows, providing online resources or hand-outs before teaching, identifying teaching session objectives, and spend more time on history taking and examination sessions Conclusions The introduction of surgical teaching fellows has had a positive impact on the student Surgical Ward Round Bedside Teaching experience. There is still room for future refinement however and further enhancement strategies are in progress.

SP4.14 - Mild acute biliary pancreatitis: still a surgical disease. A post-hoc analysis of the MANCTRA-1 international study

Abstract Aims The current standard of care for mild acute biliary pancreatitis (MABP) involves early laparoscopic cholecystectomy (ELC) reducing the risk of early recurrence. The MANCTRA-1 project disclosed a discrepancy in translating this evidence into clinical practice, estimating a 35 to 70% probability of narrowing this gap within 2025. This study assesses the safety of suboptimal ELC implementation in MABP, looking for risk factors for recurrent acute biliary pancreatitis (ABP) in patients awaiting interval cholecystectomy after an uneventful episode of MABP. Methods We conducted a post hoc analysis of the MANCTRA-1 registry. Clinicaltrials.gov ID NCT04747990. We included MABP patients who did not undergo ELC during the index hospitalization, excluding those who experienced disease-related complications. The primary outcome was the 30-day hospital readmission rate due to ABP recurrence. We performed univariable and multivariable logistic regression to identify risk factors for 30-day ABP recurrence. Results Between January 2019 and December 2020, a total of 2,253 MABP patients from 150 centres were included. The 30-day readmission rate due to ABP recurrence was 6%. The multivariable logistic regression showed that admission to a medical ward (internal medicine or gastroenterology) odds ratio (OR) 1.62 (95%[CI] 1.1;2.37), p=0.01 was an independent risk factor for 30-day ABP recurrence. Conclusion Our real-world analysis provides valuable insights to manage MABP, particularly in centres where ELC strategies cannot be fully implemented due to organizational and clinical constraints. Despite the admitting ward, it underscores the importance of timely access to surgical care in reducing the risk of early recurrence, disclosing the need to implement surgical consultation pathways in ABP care bundles.