Musgrove Park Hospital Research Articles

Patient experience and satisfaction with telephone consultations in maternity POAC—a service evaluation at Musgrove Park Hospital Taunton

Patient experience and satisfaction with telephone consultations in maternity POAC—a service evaluation at Musgrove Park Hospital Taunton

1111 Shifting the Paradigm of Abscess Treatment – From Theatre to Clinic

Abstract Aim Treatment of skin and soft tissue abscesses forms a substantial part of the emergency general surgery workload. Abscesses account for approximately 2% of presentations to Accident and Emergency, with 0.9% of patients requiring surgical intervention. Incision and drainage is often performed in theatre and may necessitate admission to hospital, impacting bed space and theatre availability. This study aims to identify if the introduction of a clinic-based abscess service could reduce the number of abscess drainages in theatre without compromise to clinical outcomes. Method Retrospective data was collected for patients undergoing abscess treatment at Musgrove Park Hospital (Taunton) in September 2019. Subsequently, a Nurse-led abscess drainage pathway was initiated in Emergency Surgery Ambulatory Clinic (ESAC) encompassing initial assessment and drainage at the bedside. Prospective data was then collected for abscesses drained in theatre and ESAC during September 2020 and compared with data from 2019. Result 22 abscess drainages were performed in September 2019 vs 25 in September 2020. 8 cases were carried out in theatre during September 2020, with the rest being treated in ESAC. Of those who were treated in clinic (n = 17), admission was prevented in 16 patients. Readmission rates were similar between ESAC (16%) and theatre (18.1%). Conclusions A clinic-based abscess service is achievable and prevents unnecessary use of theatres and hospital admissions, with comparable re-presentation rates. A nurse led approach also relieves pressure on Doctors during busy surgical on calls. Nonetheless, a larger data set would be needed to consolidate the findings from this study.

Telephone-based consultation in an acute eye clinic service: A patient satisfaction survey.

The coronavirus pandemic has forced healthcare staff across all medical specialties to adapt new and different ways of working. A new approach has been set up in the Acute Referral Clinic (ARC) at Musgrove Park Hospital and a survey has been conducted to measure the impact of the new method on patient and healthcare professionals' satisfaction with the new service. A telephone-based consultation was introduced in ARC at Musgrove Park Hospital in March 2020 and patients were instructed to fill out a questionnaire containing eight items using a Likert Scale 1 ('very poor/disagree') to 4 ('very good/strongly agree') plus two boxes for open positive and negative comments respectively. Likewise a questionnaire was designed in order to assess the healthcare professionals' satisfaction using the new approach. Data collection took place over a two month period between the end of March 2020 and end of May 2020. The data underwent quality control and was analysed using descriptive statistics. Patient responses illustrated high satisfaction scores with an overall rating of very good (89.4%). The healthcare professionals' rating of the service was good (28.6% - 'very good/strongly agree', 57.1% - 'good/agree'). The safety rating of the new approach was overall rated 'very good' with 90.4% and 71.4% of patients and healthcare professionals respectively. The telephone consultations introduced in the wake of COVID-19 are well accepted by both patients and doctors. There are some limitations of the approach, foremost being consultation time and clinic space but these do not outweigh the general benefit of this format amidst a pandemic setting.

Humeral shaft fractures: how effective really is functional bracing?

The aim of this study was to assess the effectiveness of functional bracing in the treatment of humeral shaft fractures and identify factors that increased the risk of delayed or non-union. All patients with humeral shaft fractures treated at Musgrove Park Hospital between 2010 and 2017 were identified. Patient electronic records were reviewed to identify demographic data, as well as outcomes and complications following treatment. Radiographs were reviewed to identify fracture pattern and location as well as fracture displacement and angulation. In total, 65 patients were treated with functional bracing of which 22 patients (34%) had a delayed or non-union. Fracture displacement and angulation were significantly associated with delayed or non-union. In particular, patients with fractures displaced more than 30 mm or angulated more than 30° had a significantly higher risk of delayed or non-union. Fracture location or pattern was not significantly associated with delayed or non-union. Functional bracing is an effective treatment modality for the majority of patients with humeral shaft fractures, but patients with markedly displaced or angulated fractures are at a higher risk of failure of conservative treatment and therefore early operative intervention should be considered.

4 Effects on Hospital Admissions from the Completion of Good Quality Treatment Escalation Plans in Care Homes

Abstract Topic Some care home residents are admitted to hospital when they either do not wish for admission or will not benefit from admission. Meeting residents and their next of kin to explore the person’s goals and priorities can facilitate the completion of a good quality Treatment Escalation Plan (TEP). Intervention A pilot service was commenced in November 2018 to complete and review TEPs in the top ten admitting care homes to Musgrove Park Hospital. A small team of clinicians (1.5 full time equivalent) worked in the selected care homes completing and reviewing TEPs, with an aim to see 80% of residents. Clinicians met residents and their next of kin to discuss the person’s wishes. Completed TEPs were left in the care home, shared with GPs and uploaded to the IT system in the acute hospital. The number of Emergency Department (ED) attendances and inpatient admissions from care homes were recorded and compared to data from 2017/18. Improvement Over 5 months, 492 residents had TEPs reviewed or completed by the team; this was 76% of the total bed base of the selected care homes. Data were compared to the same period a year earlier. During the final two months of the pilot, attendances to ED from care homes with the intervention were reduced by 24%, whilst the control group saw an 8% decrease. In the same period, inpatient admissions from the intervention group were reduced by 35%, compared to an 11% decrease in the control care homes. Discussion Whilst there are too few data to provide conclusive evidence, early indications suggest that facilitating the discussion of good quality TEPs in care homes reduces attendances to ED and inpatient admissions. Further evaluation is required as the service continues. There were challenges to the implementation of the pilot; these included communication and engagement with GPs, in addition to access to GP IT systems.

Sensitivity to change of the UK Diabetes and Diet Questionnaire in a specialist weight management service

AbstractThe UK Diabetes and Diet Questionnaire (UKDDQ) is a brief dietary questionnaire developed for people with, or at high risk of, type 2 diabetes(1). It consists of 20 items scored from 0–5 (0 healthiest, 5 least healthy). It has been demonstrated to be reliable and compares well with food diaries. A study evaluating sensitivity to change of the UKDDQ was undertaken at the specialist weight management service (WMS) at Musgrove Park Hospital, Taunton. WMS patients receive an initial appointment with an endocrinologist and dietitian, followed by referral to group sessions or dietary advice. Follow up appointments with a WMS specialist occur over the next 26 weeks. Adults attending the service were recruited for the study between September 2016-March 2017. Participants completed the UKDDQ in the waiting room at the initial appointment and the first follow-up. Diabetes status, binge eating assessment and weight at both timepoints were obtained from WMS records. UKDDQ scores from 0–5 were calculated for each participant by summing the score for each item and dividing by 20. Change in UKDDQ scores and absolute and percentage change in weight between appointments were calculated. Paired sample t-tests were used to test differences in means for UKDDQ scores and weight from baseline to follow up. Multivariable regression analysis was used to examine associations between changes in the UKDDQ scores and percentage change in weight. The model was adjusted for age, gender, follow up time, diabetes status and binge eating. Forty-eight White British participants completed the study (67% women, 37% type 2 diabetes, 29% binge eating). Baseline mean weight was 132.4 (29.4)kg, mean BMI 46.5(7.7)kg/m2 and mean UKDDQ score was 1.39 (0.49). Participants lost weight (-2.4 (6.9)kg, p = 0.006) and the UKDDQ score improved between baseline and follow up (-0.27(0.53), p = 0.001). The mean percentage weight change was -1.6 (5.0)%. There was some evidence that a one point deterioration in healthy eating was associated with a 2.4 (-0.2 to 5.1)% increase in weight (p = 0.072). The UKDDQ can measure dietary change in people attending a specialist WMS and there is some evidence that a change in score is associated with a change in weight. The UKDDQ could be used as an outcome measure in these services.

Quality of life after in-hospital cardiopulmonary resuscitation for patients over the age of 80 years

ObjectivesSuccess of in-hospital resuscitation decreases with age; however, national data show that 11.3% of patients over 80 years survive to discharge. There are few published qualitative data about the quality...

A new era for junior doctor roster management for the medical directorate in Musgrove Park Hospital, Taunton: Ensuring equity, contractual compliance and pro-active safe staffing across all clinical areas. A work in progress.

There are two types of rosters for junior doctors working in the medical directorate: one for their in-hours commitments; one for their out-of-hours commitments. The out-of-hours roster is set from a rota template coordinated by central admin staff. In-hours rosters are needed for each separate clinical area to ensure safe staffing levels. They need to account for: out-of-hours commitments; annual leave; study leave; rest days. Musgrove Park Hospital (MPH) in-hours rosters are created and self-policed by junior doctors. Audit demonstrated:

A new era for junior doctor roster management for the medical directorate in Musgrove Park Hospital, Taunton: Ensuring equity, contractual compliance and pro-active safe staffing across all clinical areas. A work in progress.

There are two types of rosters for junior doctors working in the medical directorate: one for their in-hours commitments; one for their out-of-hours commitments. The out-of-hours roster is set from a rota template coordinated by central admin staff. In-hours rosters are needed for each separate clinical area to ensure safe staffing levels. They need to account for: out-of-hours commitments; annual leave; study leave; rest days. Musgrove Park Hospital (MPH) in-hours rosters are created and self-policed by junior doctors. Audit demonstrated:

A 12 month review of the maxillofacial SHO on call data involving 913 patients managed at Musgrove Park Hospital

A 12 month review of the maxillofacial SHO on call data involving 913 patients managed at Musgrove Park Hospital

Axillary staging in breast cancer: Improvements in pre-operative ultrasound evaluation at Musgrove Park Hospital

Axillary staging in breast cancer: Improvements in pre-operative ultrasound evaluation at Musgrove Park Hospital

Quality improvement project the effect of an enhanced recovery programme on length of stay and patient experience following elective spinal surgery at Musgrove Park Hospital

Enhanced recovery in arthroplasty surgery has demonstrated that with careful pre-operative planning, engagement and education; recovery, rehabilitation and the patient experience is improved. Historically, spinal surgery patients have an ill-defined care pathway with variable inpatient management, experience and satisfaction.

Sign up to Safety: developing a safety improvement plan.

The Sign up to Safety (SutS) programme was launched in June 2014 by health secretary Jeremy Hunt. It focuses on listening to patients, carers and staff, learning from what they say when things go wrong, and then taking action to improve patient safety. The programme aims to make the NHS the safest healthcare system in the world by creating a culture devoted to continuous learning and improvement (NHS England 2014). Musgrove Park Hospital, part of Taunton and Somerset NHS Foundation Trust, was one of 12 NHS organisations that signed up to the SutS programme, making public its commitment to the national pledges to be 'open and transparent' and to develop a safety improvement plan. This paper describes the development of the strategy.

MARIE CURIE COMPANIONS AT MUSGROVE PARK HOSPITAL

IntroductionThe Marie Curie Companions are a group of volunteers who have been specially trained by Marie Curie and Musgrove Park hospital to provide emotional support to dying patients and their...

Quality improvement project the effect of an enhanced recovery programme on length of stay and patient experience following elective spinal surgery at Musgrove Park Hospital

Quality improvement project the effect of an enhanced recovery programme on length of stay and patient experience following elective spinal surgery at Musgrove Park Hospital

Assessment of a condition‐specific quality‐of‐life measure for patients with developmentally absent teeth: validity and reliability testing

This article describes the process of validity and reliability testing of a condition-specific quality-of-life measure for patients with hypodontia presenting for orthodontic treatment. The development of the instrument is described in a previous article. Royal Devon and Exeter NHS Foundation Trust & Musgrove Park Hospital, Taunton. The child perception questionnaire was used as a standard against which to test criterion validity. The Bland and Altman method was used to check agreement between the two questionnaires. Construct validity was tested using principal component analysis on the four sections of the questionnaire. Test-retest reliability was tested using intraclass correlation coefficient and Bland and Altman method. Cronbach's alpha was used to test internal consistency reliability. Overall the questionnaire showed good reliability, criterion and construct validity. This together with previous evidence of good face and content validity suggests that the instrument may prove useful in clinical practice and further research. This study has demonstrated that the newly developed condition-specific quality-of-life questionnaire is both valid and reliable for use in young patients with hypodontia.

18 Testing for EGFR mutations in patients with non-small-cell lung cancer at Musgrove Park Hospital, Taunton

18 Testing for EGFR mutations in patients with non-small-cell lung cancer at Musgrove Park Hospital, Taunton

Implementation of a combined Cardiopulmonary Resuscitation and Treatment Escalation Plan document in a District General Hospital.

Documentation of appropriate escalation of treatment was identified as a problem for junior doctors and Critical Care Outreach Nurses at Musgrove Park Hospital. An audit of resuscitation and escalation documentation of all wards found that of the patients who were not for Cardiopulmonary resuscitation (and therefore not for full escalation of care), 78.4% had no documentation of the appropriate level of escalation of treatment should they deteriorate. The majority of junior doctors had experienced cases where they felt that inappropriate treatment had been given, where no escalation plan was documented.Using several Plan, Do, Study, Act (PDSA) cycles, drawing tools used in other trusts and departments, and the views of clinicians, we developed a treatment escalation plan (TEP) tool, to be included in the resuscitation form. This included consideration of referral to critical care, ward based non-invasive ventilation, and appropriate use of intravenous or oral antibiotics. This then prompted the responsible clinician to consider and document appropriate escalation of treatment.The CPR-TEP form was trialed using a quasi-experiment design allowing the aim to be tested using two groups - intervention and control. All patients in the intervention group were not for CPR and therefore had their TEP-CPR form filled in fully (n=68). The control group consisted of patients who were not for CPR but who did not have a TEP form filled in (n=36).The appropriateness of OOH (out of hours) treatment in those patients who experienced clinical deterioration was judged by questionnaire-based feedback from the in-hours team the following morning. Levels of inappropriate treatment between the two groups were compared to test the aim.At the end of the study period, questionnaire feedback indicated that 11.1% of patients in the group with the new CPR-TEP document had received inappropriate OOH care compared to 44.4% of patients in the group without the document.Using the TEP alongside resuscitation documentation prompts the responsible clinician to consistently consider and document the appropriate escalation of care for their patient, improving communication with the out of hours team and appropriate escalation of care in the event of patient deterioration.

1613P - Acute Oncology Service and Reduction of Inpatient Length of Stay for Cancer Patients. A report for 846 Patients Admitted with Oncological Emergencies

ABSTRACT Background The Acute Oncology Service (AOS) has been recommended in the UK since 2008, when the National Chemotherapy Advisory Group (NCAG), and the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reported the results of safety and quality in systemic therapy for cancer patients. The National Patient Safety agency (NPSA) recommended that cancer related emergencies be dealt in a systematic approach. This abstract refers to the data from patients with known or undiagnosed cancer, admitted in Musgrove Park Hospital (MPH) and referred to the AOS. Materials and method We collected the data of patients admitted to MPH because of cancer or treatment-induced complications or undiagnosed cancer. Patients were referred via the inpatient referral system and were registered daily in a purpose built database. We recorded patients' demographics, diagnosis, metastatic sites, treatment type, reason of admission and length of in-hospital stay (LOS). Results From June 2010 to April 2012, 846 patients were admitted with oncological complications. 48% had multiple metastatic sites, 18% had primary diagnosis of breast cancer, 19% urological, 16% lung, 24% upper and lower GI cancers and 5% of unknown primary. Only 1% of patients were referred from A&E department, 28% from medical assessment unit and 71% from the medical wards. 29% of patients were admitted during their chemotherapy period, 8% during their radiotherapy treatment, whereas for 38%, the type of treatment was not reported. The reasons of admission were: Dyspnoea 14%, Neutropenic sepsis 8%, CNS related 9%, metastatic spinal cord compression 6%, pain 12%, miscellaneous/unclear 51%. Admission was attributed to cancer and/or treatment in 73% of patients and it was unclear/unknown in 23%. The number of referrals has increased from 50 for the first 2 months to 97, the last 2 months. The LOS ranged from 0-102 days and the median remained stable at 10 days. Conclusion The majority of cancer patients with complications are admitted in medical wards. This real time audit will be used to re-define the appropriate AOS model. Further education, communication, recourses and training are mandatory to reduce the patients' LOS and develop a cost-efficient service. Disclosure All authors have declared no conflicts of interest.

‘Spot’ audit of strong opioid prescribing at Musgrove park hospital, Taunton

This audit examined compliance with best practice within a busy district general hospital (750 beds) on 1 day. Audit Measures: • First line strong opioid, morphine-exceptions, renal impairment, documented sensitivity...