Multidisciplinary Members Research Articles

Exploring specialist nurse clinic appointments: supporting a person with multiple sclerosis to manage spasticity and spasms

Background: Managing clinic appointments effectively and efficiently are a fundamental part of being a multiple sclerosis (MS) specialist nurse (MSSN). Opportunities to practice these skills can be limited, which can be daunting for nurses new into the speciality. Aim: This article explores the management of spasticity and spasms and how a MSSN can effectively use time in a clinic appointment to complete a holistic assessment and support people with MS (PwMS) to manage their spasticity and spasms. Method: Narrative methodology was used to synthesise insights from appointments in a specialist nurse clinic, where individuals with MS needed support to manage spasticity and spasms. The insights were constructed into a reflexive narrative and are presented in this article as one clinic appointment. Findings: Strategies for MSSNs to consider during their clinics and spasticity management practices are suggested. These include clinic preparation, verbal and physical assessments, measuring, timely referral to other multidisciplinary members and educating PwMS, such as educating them on the possible triggers that can exacerbate spasticity and spasms, the importance of exercise and stretching, and monitoring the effectiveness of symptomatic treatments, including drug interventions. Conclusion: MSSNs have a vital role in supporting PwMS to manage their spasticity and spasms throughout the disease trajectory. Developing expertise in effectively using time in clinic appointments will benefit the outcomes for PwMS, the individual nurse and the healthcare organisation.

Assisted Living: New Initiatives, Brighter Future

Assisted Living: New Initiatives, Brighter Future

Development of a palliative care lecture series for hematology-oncology fellows.

e24112 Background: Many major organizations endorse provision of palliative care (PC) services for patients with advanced cancers from both oncologists and PC specialists. While ACGME has outlined core PC competencies, PC education during hematology-oncology (HO) fellowship is highly variable, and many fellows feel inadequately trained. We assessed whether incorporation of a PC lecture series could improve fellows’ self-perceived preparedness in basic PC skills. Methods: In this educational quality improvement initiative, current HO fellows at an NCI-designated cancer center received lectures on PC topics. Members of both the HO and hospice and palliative medicine fellowship programs met to discuss key components of a PC curriculum and identify available experts. Seven multidisciplinary faculty members delivered eight one-hour video-recorded virtual lectures to HO fellows over a three-month period. Lecture videos remained available online for later viewing in the event of fellow absences. Within a few weeks both pre- and post-lecture series, HO fellows completed surveys addressing their level of preparedness on a 5-point scale (from 1-not at all prepared to 5-extremely prepared) in performing several key skills. Two-tailed paired t-tests were performed to analyze pre/post changes in fellows’ level of preparedness. Results: Eleven fellows participated in the PC lecture series. Fellows’ level of preparedness increased across several PC topics (Table). The greatest increases were in creating a survivorship plan, converting from one opioid to another, and managing pain in a patient at risk for a substance use disorder. Fellows ranked individual lectures as very helpful to their learning, especially lectures on management of GI symptoms (4.9 +/- 0.3), pain management with opioids (4.8 +/- 0.4), and communication (4.5 +/- 0.5). Conclusions: Incorporation of a structured PC didactics series into HO fellowship is feasible, perceived as very useful, and associated with increased self-perceived preparedness. While more longitudinal and hands-on PC experience would likely promote HO fellows’ PC skills more deeply and durably, dedicated PC lectures are an important adjunctive component that can be easily incorporated into HO fellowship education. [Table: see text]

Effective health communication for age-related macular degeneration: An exploratory qualitative study.

Age-related macular degeneration (AMD) is a major cause of vision loss globally. Patients with AMD may not always understand or retain the information about AMD communicated by their eyecare practitioner. This study aims to explore the characteristics of effective health communication for AMD, from both patients' and eyecare practitioners' perspectives. The purpose is to provide a foundation for understanding how health communication for AMD could potentially be improved in the future. A total of 10 focus groups involving 17 patients with AMD and 17 optometrists were conducted via web conferencing. Each session was audio-recorded, transcribed and analysed using the Grounded Theory Methodology. The five themes identified are as follows: (1) materials' quality, (2) materials' relevance, (3) contextualising for the individual, (4) contextualising for the disease and (5) support network. Participants expressed concern about the unrealistic yet common depiction of vision loss in AMD as a black patch overlying common visual scenes. They also preferred education materials tailored to a specific disease stage and the regular opportunity to ask or answer questions. Longer appointment durations and peer support (from family, friends or others with AMD) were also valued. Optometrists are encouraged to focus on three over-arching dimensions when counselling patients with AMD in routine clinical practice: (1) curating and using disease and stage-specific, impactful education materials, (2) their chairside verbal communication techniques and (3) AMD-specific opportunities for care coordination among patient family and friends, peers and other multidisciplinary members of the care support team.

A revision of JPOS/JASCC clinical guidelines for delirium in adult cancer patients: a summary of recommendation statements.

The Japanese Psycho-Oncology Society and the Japanese Association of Supportive Care in Cancer have recently revised the clinical practice guidelines for delirium in adult cancer patients. This article reports the process of developing the revised guidelines and summarizes the recommendations made. The guidelines were developed in accordance with the Medical Information Network Distribution Service creation procedures. The guideline development group, consisting of multi-disciplinary members, created three new clinical questions: non-pharmacological intervention and antipsychotics for the prevention of delirium and trazodone for the management of delirium. In addition, systematic reviews of nine existing clinical questions have been updated. Two independent reviewers reviewed the proposed articles. The certainty of evidence and the strength of the recommendations were graded using the grading system developed by the Medical Information Network Distribution Service, following the concept of The Grading of Recommendations Assessment, Development, and Evaluation system. The modified Delphi method was used to validate the recommended statements. This article provides a compendium of the recommendations along with their rationales, as well as a short summary. These revised guidelines will be useful for the prevention, assessment and management of delirium in adult cancer patients in Japan.

Development of an Implementation Blueprint to Scale-Up Contraception Care for Adolescents with Psychiatric Conditions in a Pediatric Hospital

Implementation blueprints are comprehensive plans that describe implementation strategies, goals, timelines, and key personnel necessary for launching new interventions. Although blueprints are a foundational step in driving intervention rollout, little is known about how blueprints are developed, refined, and used in practice. The objective of this study was to describe a systematic, collaborative approach to developing, refining, and utilizing a formal implementation blueprint for scaling up the Contraception Care at Behavioral Health Pavilion (CC@BHP) intervention for adolescents hospitalized in psychiatric units within a pediatric hospital in the United States. In Stage 1 (Planning/Preparation), we assembled a Research Advisory Board (RAB) of 41 multidisciplinary members and conducted a formative evaluation to identify potential barriers to CC@BHP implementation. Barriers were mapped to implementation strategies using the Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC) tool and used to create an initial blueprint. In Stage 2 (Development/Implementation), RAB members used activity logs to track implementation activities over the 18-month study period, which were then mapped to formal implementation strategies used to further develop the blueprint. About 30% of strategies were situated in the ‘Train and Educate Stakeholders’ ERIC category, 20% in ‘Use Evaluative and Iterative Strategies,’ and 16% in ‘Develop Stakeholder Interrelationships’ category. In Stage 3 (Synthesis/Refinement), the final blueprint was refined, consisting of 16 goals linked to 10 strategies for pre-implementation and 6 strategies for implementation. Feedback on the blueprint emphasized the role of the project champion in translating the blueprint into smaller, actionable steps for implementers.

Palliative oral care in terminal cancer patients: Integrated review.

Palliative care (PC) aims to improve quality of life in patients and its families against life threatening diseases, through suffering's prevention and relief. It is the duty of the dental surgeon to possess the knowledge needed to treat a patient with little life span, in order to establish an adequate treatment plan for each situation. To synthesize the published evidence on oral conditions, impact, management and challenges in managing oral conditions among palliative patients. Articles were selected from PubMed and Scopus electronic platforms, using a research strategy with diverse descriptors related to "palliative care", "cancer" and "oral health". The article's selection was done in two phases. The first one was performed by the main researcher through the reading of the abstracts. In the second phase two researchers selected eligible articles after reading in full those previous selected. Data was tabulated and analyzed, obtaining information about what is found in literature related to this subject and what is necessary to be approached in future researches about PC. As results, the total of 15 articles were eligible, being one a qualitative analysis, 13 (92.8%) clinical trials and one observational study. Of the 15 articles, 8 (53.4%) involved questionnaires, while the rest involved: one systematic review about oral care in a hospital environment, 2 oral exams and oral sample collection, one investigation of terminal patient's (TP) oral assessment records, 2 collection of oral samples and their respective analysis and one treatment of the observed oral complications. It can be concluded that the oral manifestations in oncologic patients in terminal stage are, oral candidiasis, dry mouth, dysphagia, dysgeusia, oral mucositis and orofacial pain. Determining a protocol for the care of these and other complications of cancer - or cancer therapy - based on scientific evidence with the latest cutting-edge research results is of fundamental importance for the multidisciplinary team that works in the care of patients in PC. To prevent complications and its needed to initial the dentist as early as possible as a multidisciplinary member. It has been suggested palliative care protocol based on the up to date literature available for some frequent oral complications in TP with cancer. Other complications in terminal patients and their treatments still need to have further studying.

Anticipation dialogs in Vermont's system of mental healthcare: Sustaining the growth of a dialogic practice culture.

Open dialog is both a therapeutic approach and a way of organizing the system of mental healthcare that has been evolving in Finland since the 1980s. In Vermont, over the last decade, there has been an organic statewide effort to begin to integrate dialogic principles into the public system of mental healthcare. Because of the organic nature of these initiatives, there have not been coordinated systemic changes to support dialogic practices. To learn what visions participants in dialogically informed practice contexts have for the future as well as what structural innovations would support these visions anticipation dialogs were offered at three dialogically informed community mental health centers and one public psychiatric. The anticipation dialog was developed in Finland during the late 1980s to aid stuck professional and social networks in finding ways to move forward looking back from an imagined positive future. Twenty-seven multidisciplinary staff members and one service recipient participated in the dialogs. The authors conducted a multi-step process of thematic discourse analysis of all 4 anticipation dialogs. Findings underscore dilemmas entailed in growing a dialogic practice system, including the toll systemic uncertainty takes on workers in the system and the simultaneous pull to offer some amount of open-endedness to the system change process in the spirit of inclusiveness, mutual trust, democracy, and reducing hierarchy. Other key findings influencing sustainability of dialogic practices in community mental health include integrating dialogic work into roles rather than adding them to existing responsibilities. Our experiences indicate that anticipation dialogs may be a way of conducting systemic research that contributes to the forward momentum of system innovation. Offering a greater length of time for organizational anticipation dialogs would be valuable, as would centering the voices of clients and their networks.

Project BETTER: A Family-Centered, Technology-Delivered Intervention for Pregnant People with Opioid Use Disorder.

Birthing people with opioid use disorder (OUD) face unique stressors during the transition from pregnancy to postpartum that can negatively impact the maternal-infant dyad. This study aimed to describe the development of a family-centered, technology-delivered intervention tailored to help pregnant people receiving medication for OUD (MOUD) prepare for this transition. Formative data from patients and providers identified intervention content: (1) recovery-oriented strategies for the pregnancy-to-postpartum transition; (2) guidance around caring for an infant with opioid withdrawal symptoms; and (3) preparation for child welfare interactions. The content was reviewed in successive rounds by an expert panel and modified. Pregnant and postpartum people receiving MOUD pre-tested the intervention modules and provided feedback in semi-structured interviews. The multidisciplinary expert panel members (n = 15) identified strengths and areas for improvement. Primary areas for improvement included adding content, providing more structure to help participants navigate the intervention more easily, and revising language. Pre-testing participants (n = 9) highlighted four themes: reactions to intervention content, navigability of the intervention, feasibility of the intervention, and recommendation of the intervention. All iterative feedback was incorporated into the final intervention modules for the prospective randomized clinical trial. Family-centered interventions tailored for pregnant people receiving MOUD should be informed by patient-reported needs and multidisciplinary perspectives.

The Impact of Embedding a Palliative Care Advance Practice Provider on a Neuroscience Intensive Care Unit Service

Palliative care is a service that works together with the patient’s primary team in an inpatient setting to provide additional guidance, support, and symptom management to patients dealing with a serious illness. Neuroscience intensive care unit patients are both complex and acute and often require multiple collaborating services to provide efficient and proper care. A palliative care nurse practitioner was embedded on the neuroscience ICU team; in doing so, the number of consults, family meetings, and follow-up visits increased. Multidisciplinary staff members had a better understanding of the role of palliative care. There were many benefits from the addition of a palliative care nurse practitioner.

1169 QUALITY IMPROVEMENT PROGRAMME ON NON-MEDICINAL MANAGEMENT OF POSTURAL HYPOTENSION AMONG MDT MEMBERS IN THE MEDICAL WARDS (COE)

Abstract Introduction Postural Hypotension is a very common presentation in the elderly population. Appropriate knowledge to record postural hypotension and non-medicinal management for this is very important among MDT members working in the care of the elderly wards. Method We set out a questionnaire to assess the knowledge among MDT (multidisciplinary) members. An educational programme was initiated to improve the knowledge among MDT members. A complete audit cycle was done and the knowledge was reassessed with the same questionnaire based on the principles of the PDSA (Plan, Do, Studt and Act) cycle. Results It showed that the correct way of checking for postural blood pressure improved from 52.4% to 92% in recording the blood pressure. Correct identification of postural blood pressure improved from 33.3% to 88%. Self-rating of confidence to identify correctly postural blood pressure improved from 47.6% to 64% among the MDT Members. It was difficult to compare the answers about non-medicinal methods and exercises to help postural hypotension as there was heterogeneity in answers. It was also not possible to compare the impact of individual interventions on the alleviation of postural blood pressure. Conclusion Good improvement in the recording and non-medicinal management of Postural hypotension was observed in both the wards among the MDT Members. It is very important to have good knowledge and understanding in the management of this common condition as it helps in the identification and better management.

121: POST-ICU CLINICS MAY REDUCE ICU STAFF BURNOUT: CRITICAL & ACUTE ILLNESS RECOVERY ORGANIZATION REPORT

Introduction: Clinician burnout is far-reaching and impact individuals, healthcare systems, and patient care, and has been declared an area of major priority by leading critical care societies. The unprecedented demands of the COVID-19 pandemic have exacerbated mental health issues, including anxiety and post-traumatic stress disorder for intensive care unit (ICU) staff who were already at increased risk, leading to subsequent increased burnout. Therefore, we explored the secondary role that post-ICU clinics may play in reducing the symptoms of ICU staff burnout. Methods: We performed a qualitative secondary analysis of semi-structured interviews with multidisciplinary post-ICU clinician members of the Critical and Acute Illness Recovery Organization (CAIRO) between February and March 2021. The original study examined how clinicians perceived the COVID-19 pandemic changed post-ICU care delivery. Data were analyzed post-hoc through a constant comparative method. Results: Twenty-nine multidisciplinary clinicians from 15 international sites (Canada, the United States, the United Kingdom) participated in the study. The sample was largely female (72.4%) working in academic clinical settings (69.0%). Median length of time in clinician role was 16 years (IQR 7, 21), and median length of time working with a post-ICU program was 3 years (IQR 1, 4). We identified two overlapping mechanisms by which participants perceived reduced symptoms of ICU staff burnout: 1) staff exposure to and expression of humanizing behaviors and 2) visualizing and communicating treatment successes. Practical examples included sharing videos, photographs, and written stories of survivors with the ICU team; directly staffing post-ICU clinics; and in-person contact between ICU staff and survivors and families after ICU discharge. Conclusions: Multidisciplinary clinicians in post-ICU clinics commonly perceived that a bidirectional compassionate relationship and authentic interaction and communication with ICU survivors reduced the symptoms of burnout. Interprofessional teams in the ICU and healthcare administration should consider how programs that facilitate interaction with critical illness survivors may reduce the symptoms of burnout in ICU staff.

Call the SIM team – a tale of building a simulation faculty in a small district general hospital

For many years, simulation-based education (SBE) at Walsall Manor Hospital (WMH) was carried by a one-man simulation technician, with intermittent input from department facilitators. Inadvertently creating SBE dis-equality across departments. Studies have demonstrated that formalized SBE plans improve training [1] and clinical outcomes [2]. We aimed to create standardisation and equity in SBE across departments by formulating a SBE training and delivery plan and governance structure at WMH. In the Autumn 2021, WMH started standardising SBE across the Trust in order to improve both the undergraduate and postgraduate standard of education [3]. The team grew to incorporate five multidisciplinary members; SIM technician, SIM lead (consultant), SIM nurse, SIM project support, and SIM technician support. With further expansion to now include speciality simulation leads in emergency medicine (EM) and paediatrics. Currently there is active recruitment for speciality leads in other departments. The SIM staff were appointed already holding simulation education related qualifications and/or experience. In addition, staff attended the University of Stafford foundations in simulation and debriefing courses. The governance process has been developed and implemented around the appointment of simulation speciality staff, formation of simulation courses, and simulation delivery. Furthermore, collection of attendance, feedback forms, certificates of participation and attendance have been made mandatory element of simulation delivery. In addition, there has been internal and external investment in increasing simulation equipment, including paediatric manikins and immersive technology. In seven months, achievements have included: a range of simulation-based training events, the implementation of in-situ simulation in acute medicine, simulated sessions for final year medical students, the development of a simulation Foundation Year 1 and 2 curriculum, successful construction and running of mock royal college of physicians viva examination, multiple medical procedure courses, the re-introduction of Ill Medical Patients’ Acute Care Treatment (IMPACT) course, and simulation sessions for student nurses. SBE activities were delivered by and to a multidisciplinary team. Putting together a simulation team and formalizing the governance process around SBE delivery has increased the number of educational activities for both undergraduate medical/nursing students and postgraduate doctors and allied health care professionals. Feedback scores have been good to excellent and multidisciplinary work in EM has improved. The SIM team will continue to promote, implement, embed, and sustain SBE within the Trust to bigger and bolder activities. We would like to thank and acknowledge the Dinwoodie charitable company for their support. 1. Weaver SJ, Salas E, Lyons R, Lazzara EH, Rosen MA, DiazGranados D, Grim JG, Augenstein JS, Birnbach DJ, King H. Simulation-based team training at the sharp end: A qualitative study of simulation-based team training design, implementation, and evaluation in healthcare. Journal of Emergencies, Trauma and Shock. 2010;3(4):369–377. 2. Houzé-Cerfon CH, Boet S, Marhar F, Saint-Jean M, Geeraerts T. Simulation-based interprofessional education for critical care teams: Concept, implementation and assessment. Presse Medicale (Paris, France: 1983). 2019;48(7–8 Pt 1):780–787. 3. Irwin PM, Brown RA, Butler S. The undergraduate simulation framework: standardising design and delivery’. Higher Education, Skills and Work-Based Learning. 2020;11(2):576–586.

QLTI-12. THE IMPACT OF MENTORING ON EARLY CAREER FACULTY: ASSESSMENT OF A VIRTUAL MENTORING PROGRAM

Abstract BACKGROUND Participation in mentorship programs for early career physicians is crucial to developing key skills and professional networks, but availability and opportunities for mentorship may be hampered by racial, ethnic and gender leadership disparities in medicine. A 6-month virtually facilitated peer mentorship program for women and diverse early career faculty was developed and piloted through the Society for Neuro-Oncology (SNO) Women & Diversity Committee. METHODS We designed and conducted a 6-month pilot open to SNO’s multidisciplinary early career members, leveraging peer-mentoring sessions with mid-to late-career physician mentors. A curriculum with online resources was provided and group assignments were based on time-zones and interests. Pre- and post-participation surveys assessed mentee experience and descriptive statistics assessed participant demographics and survey results. Results/ CONCLUSION Twenty mentee applicants participated in 5 groups. Mentees were 90% women, 60% from diverse racial and ethnic backgrounds. Most were aged 31-40 (75%) and junior faculty (50%) in neuro-oncology (65%). Five mentors (2 female) practiced either neuro-oncology (3), neurosurgery (1) or radiation oncology (1). The proportion of mentees with a signature talk increased from 15% to 71% during the pilot. A large majority (64%) reported a positive impact of the program on their profile, career and networking, and reported participation was worthwhile (86%), and worth recommending to others (93%). Feedback themes included personal growth, peer support, networking, job opportunities, desire for late career female mentors, and scheduling constraints. The virtual environment during a global pandemic allowed participants to connect, creating a venue to discuss topics such as work-life balance, burnout, and self-advocacy. We did not have 100% post pilot follow up despite multiple attempts, limiting complete understanding of the pilot. This virtual mentorship pilot program proved feasible and of value in development of early career women and diverse individuals. A resource toolkit has been designed to scale and diffuse.

Malnutrition, nutrition support and dietary intervention: the role of the dietitian supporting patients with head and neck cancer

Malnutrition is prevalent in patients with head and neck cancer (HNC) at diagnosis but can occur at any stage of the treatment pathway. The impact of disease burden and treatment side effects can lead to altered anatomy, compromised quality and quantity of saliva and impaired swallowing function, which can result in deleterious effects on nutritional status. Optimising nutrition status is critical, as malnutrition is adversely associated with treatment tolerance and outcomes, wound healing, morbidity, mortality, quality of life and survival. Dietitians are integral members of the HNC multidisciplinary team and are uniquely qualified in the assessment, management and optimisation of nutritional status across the care pathway. This includes providing informational counselling to patients and carers on the short- and long-term nutritional impact of planned treatments alongside multidisciplinary members. Dietitians lead on the recommendation, provision and monitoring of nutrition support, which can be via the oral, enteral or parenteral route. Oral nutrition support includes dietary counselling, nourishing dietary, food fortification advice and high energy/protein oral nutritional supplements. Enteral nutrition support, or tube feeding, can be required on a short- and/or long-term basis and dietitians support appropriate decision-making for the type of tube and timing of placement across the care pathway.

Pediatric traumatic hemorrhagic shock consensus conference recommendations.

Hemorrhagic shock in pediatric trauma patients remains a challenging yet preventable cause of death. There is little high-quality evidence available to guide specific aspects of hemorrhage control and specific resuscitation practices in this population. We sought to generate clinical recommendations, expert consensus, and good practice statements to aid providers in care for these difficult patients.The Pediatric Traumatic Hemorrhagic Shock Consensus Conference process included systematic reviews related to six subtopics and one consensus meeting. A panel of 16 consensus multidisciplinary committee members evaluated the literature related to 6 specific topics: (1) blood products and fluid resuscitation for hemostatic resuscitation, (2) utilization of prehospital blood products, (3) use of hemostatic adjuncts, (4) tourniquet use, (5) prehospital airway and blood pressure management, and (6) conventional coagulation tests or thromboelastography-guided resuscitation. A total of 21 recommendations are detailed in this article: 2 clinical recommendations, 14 expert consensus statements, and 5 good practice statements. The statement, the panel's voting outcome, and the rationale for each statement intend to give pediatric trauma providers the latest evidence and guidance to care for pediatric trauma patients experiencing hemorrhagic shock. With a broad multidisciplinary representation, the Pediatric Traumatic Hemorrhagic Shock Consensus Conference systematically evaluated the literature and developed clinical recommendations, expert consensus, and good practice statements concerning topics in traumatically injured pediatric patients with hemorrhagic shock.

Development of a respiratory quality improvement faculty in an acute hospital using QI methodology

National Health Service (NHS) clinical staff are required to demonstrate involvement in quality improvement (QI) and patient safety. Clinicians are often best placed to identify problems and design solutions for...

Impact of Dual Intensive Care Unit and Rapid Response Team Nursing Roles on Service Delivery in the Intensive Care Unit.

Rapid response teams generally consist of multidisciplinary specialist staff members with advanced knowledge and skills to manage deteriorating patients outside of the intensive care unit. These teams consist predominantly of intensive care unit nurses, who often undertake intensive care unit and rapid response team duties concurrently. Little has been published on the impact of these nurses' absence while attending a rapid response call on the nursing workforce, patient care, and resource allocation in the intensive care unit. To explore the impact of nurses' absence due to attending rapid response calls in other areas of the hospital on service delivery and resource allocation in the intensive care unit. A comprehensive search of 3 databases was performed to identify studies on relationships among the rapid response team, the intensive care unit, and nursing staff. The search yielded 6 quantitative studies, 2 qualitative studies, and a mixed-methods study that were included for analysis. Four key themes were identified: (1) workforce, staffing processes, and resource allocation; (2) alterations to workload and resource allocation; (3) adverse events or incidents; and (4) funding variability of rapid response team models. Review of the studies indicated that dual intensive care unit and rapid response team nursing roles have negative effects on nurses' workload, increase the risk of adverse events, and may compromise patient safety. The staffing of both the intensive care unit and the rapid response team should be examined carefully with an eye toward sustainability, cost-effectiveness, and clear outcome measures.

P54 Evaluating capacity issues and safety of uveitis adolescent services at Moorfields Eye Hospital (MEH)

Introduction/BackgroundThe uveitis Young Adults Clinic (YAC) was implemented at MEH in 2019, with the aim of facilitating the transition from children's to adults' services. It receives new patients mainly from paediatric uveitis clinics at MEH and Great Ormond Street Hospital (GOSH), both reference centres, but also from multiple other paediatric services across London and the UK. The patients are seen from the age of 16 to 21 (or more in special circumstances). As this clinic runs only for one session weekly, it has been facing capacity issues with overbooking and backlog of patients waiting to be booked.Description/MethodA service evaluation audit was performed with the objectives of quantifying the Uveitis YAC capacity issues and evaluating its safety during the period from December 2020 to December 2021.1) Clinical capacity issues were quantified by checking clinic numbers per staff (new and follow-up patients) and comparing them to other uveitis clinics and the service’s template of 6 patients/doctor.2) Clinic safety was analysed by:- Checking the percentage of YAC patients that receive their hospital appointments within 25% of their intended follow-up period (25% follow-up delay target), following the Royal College of Ophthalmology key outcome measure (minimum standard of 85%).- Quantifying the backlog of new patients waiting to be booked into clinic for more than 18 weeks (RTT referral to treatment time 18 weeks - minimum standard of 85%).A total of 614 patient visits were identified during that time (with 202 unique patient IDs). The data sources used to extract the data were electronic medical records (PAS, Openeyes) and doctors' rota. Patient data were extracted in an automated way from EMR by a senior information analyst from the Service Improvement department. Data processing and analysis were done by two members of the clinical team independently with Excel and R.Discussion/ResultsA total of 421/614 visits had available intended follow-up times at PAS. Of these, 246 patients (58%) were seen within 25% of their requested follow-up.A total of 303 new patient appointment requests were retrieved from the YAC waiting list during that period (screenshot of first day/month). Of these, 94 were unique patients (patients stayed in the waiting list for more than one month). We excluded the patients added in the last month of December 2021 (total 18), as there was no way of checking when they left the waiting list. Out of the remaining 76 patients, 56.6% were not seen within 18 weeks of referral (43.4% were seen).There were 56 clinic dates during the period December 2020 to December 2021. From the first clinic in December 2020 to the last in June 2021, 191 patients were seen in YAC (178 follow-ups and 13 new). The mean number of patients per doctor was 6.8. From July to December 2021, 213 patients were seen (198 F/U and 15 news). The mean number of patients per doctor was 8.5. When comparing to the adult uveitis clinic which happens at the same dates and times, in the first 6 months, the number of patients per doctor was 4.3, compared to 5.8 in the second semester.The results show that the follow-up times are not reaching safety standards following RCO recommendations. New patient referrals are not being seen according to RTT standards. The number of patients per doctor exceeds service guidelines of 6 patients/doctor for complex uveitis patients.Key learning points/ConclusionThe YAC is a unique service that receives patients from major London uveitis services and works closely with UCLH Rheumatology Adolescent services to deal with complex and vulnerable cases. This audit shows that the clinic is working above this capacity and needs further support to be able to provide safe and high-quality care for adolescent patients. Possible improvements would involve increasing the clinical team, ideally with multidisciplinary members, and optimising scrutiny and booking of patients.

“You Killed the Hospital, They Have No Place Left”: The Experience of Nursing Home Multidisciplinary Staff in Israel during the COVID-19 Pandemic

ABSTRACT The purpose of the present study is to examine how multidisciplinary staffs experienced and coped with the COVID-19 pandemic crisis in nursing homes. The research included six in-depth online focus groups consisting of 21 multidisciplinary staff members from 14 Israeli nursing homes. The qualitative analysis was encoded in stages with repeated comparisons between individual participants and within groups and led to four main themes: (a) Multidisciplinary staff perceptions of nursing home management’s performance in relation to them, which was experienced as insufficient appreciation and feelings of abandonment among the non-medical staff; (b) Multidisciplinary staff perceptions of the Ministry of Health’s performance, which was experienced as chaotic and disconnected albeit supportive on the personal level; (c)The nursing home multidisciplinary staff experience during the COVID-19 pandemic, in terms of perceived stress and burnout, as well as development of a routine; (d) The multidisciplinary staff’s coping strategies, which included commitment to work despite risk, redefinition of their role, and staff insights about the need to take responsibility for their role and not rely on outside help. The findings indicate the importance of relationships that promote support and mutual communication between multidisciplinary staff, and both nursing home management and Ministry of Health. KEY POINTS Nursing home multidisciplinary staff experienced disconnection from and abandonment by nursing home management and Ministry of Health during the Covid-19 pandemic. Nursing home multidisciplinary staff experienced stress and burnout but also developed a routine. Despite intensified negative emotional feelings, multidisciplinary staff also underwent processes of redefining their role and gaining greater independence. Findings indicate the importance of creating a climate that facilitates mutual sharing, listening and learning.