North Bristol NHS Trust Research Articles

FP8.3 - Reducing Waste with Remanufactured Harmonic Devices

Abstract The NHS produces an estimated 590,000 tonnes of waste per annum and disposable harmonic scalpels are costly both financially and environmentally. The average cost of a new harmonic device nationally is £460. Remanufactured harmonic devices are not only recommended by the Intercollegiate Green Theatre Checklist and NHS England but also the Department of Health Med Tech Strategy. North Bristol NHS Trust has engaged with the initiative from Vanguard to reduce clinical waste as well as utilise remanufactured harmonic devices. Initially the project began in January 2023 with collecting used devices only, but this was followed by the rollout and use of remanufactured devices within colorectal surgery in May 2023. The initiative has resulted in a reduction of clinical waste produced as well as a significant cost saving. 56 devices used so far in colorectal surgery have saved £12,880 and the estimated CO2 saving is 97 kilograms. There have been no incidents regarding the use of remanufactured devices or concerns raised. The project’s success has resulted in recent expansion into gynaecological surgery where the first remanufactured devices are in use. Based on previous harmonic device usage within NBT of 618 per annum, projected savings of using remanufactured devices are likely to reach £71,070 and half a tonne of CO2 in the next year. This represents a significant financial and environmental initiative to continue the drive to reduce disposable waste within surgical theatres.

6288628 Analysis of mode of delivery by anaesthesia and ethnicity at North Bristol NHS Trust central delivery suite

6288628 Analysis of mode of delivery by anaesthesia and ethnicity at North Bristol NHS Trust central delivery suite

P063 Beyond the clinical trials: real-world retention rate and use of digital interventions in patients with inflammatory arthritis

Abstract Background/Aims The use of digital tools to deliver healthcare interventions has increased rapidly. Inadequate engagement and retention are two major barriers to widespread and long-term adoption of electronic patient-reported outcomes (ePROs) for monitoring in clinical practice. Whilst retention rates are high in research studies, these are often short-term (<12months) and not representative of routine clinical practice. The reasons for variable engagement remain unclear. We present an analysis of engagement and retention of digital intervention in a routine rheumatology setting. The research aims to explore determinants of long-term sustainability of app-based intervention to collect ePROs in patients with inflammatory arthritis (IA). Methods This is a secondary analysis of real-world data obtained in clinical settings from IA patients who attended routine appointments in the rheumatology clinic at North Bristol NHS Trust between 2018 and 2022. Patients were invited to use a smartphone-based symptom diary (Living With) between appointments to track disease course by reporting RAPID3, HAQ-DI, or self-assessing joint pain/swelling. Statistical tests were performed using Stata16.1. Maximum elapsed days of the app use, number, and time between reports were explored as explanatory variables. Associations between demographic and disease parameters in different user subpopulations were explored by Poisson and tobit regression models. Results were stratified post-hoc by gender, age, diagnosis, and baseline disease activity. The research has ethical approval. Results 673 patients provided ≥1 report of any ePROs. 68% were female, mean age 53.7±13.9 years. 60% had rheumatoid arthritis; 24% - psoriatic arthritis and 17% - other IA. 613(91%) patients provided a RAPID3 measure of disease activity. Among them, 82(12%) participants reported only baseline RAPID3 and were classified as “lost to follow-up”. 531(79%) were identified as “follow-up” users. No difference between these subpopulations considering gender, age, IA type, and baseline arthritis activity was identified in the adjusted Poisson regression model. Retention rates reduced most in the first six months from a baseline of 91% to 38% at month 6 and subsequently to 24% at month 12, whereafter plateaued, highlighting a group of long-term users. Older patients (aged 60-69) were more likely to be long-term users compared to younger age (≤50) participants, demonstrating longer app engagement 379 [169; 645] vs 256 [90; 515] days, p < 0.006. Patients aged 60-69 and ≥70 provided more reports (18 [7; 46] and 25 [8; 62]) compared to younger users (8 [4;18], p < 0.0001). There was no association between the length or frequency of digital tool use and gender, baseline arthritis activity, and disability. Conclusion This analysis offers insights into what might be expected regarding engagement and the long-term sustainability of app-based interventions in routine clinical settings. Understanding the real-world performance and factors that could potentially improve user retention or dropout rates is critical to realizing the promise of digital interventions. Disclosure I. Biliavska: None. E. Lenguerrand: None. J. Tobias: None. P. Hamann: Consultancies; provided consultancy for Living With Ltd Software Company. Royalties; has limited royalty agreement with Living With Ltd Software Company for the development of the smartphone app LivingWith. Honoraria; have received honoraria from Gilead and AbbVie Pharmaceuticals for the production of training materials on remote monitoring for patients with arthritis..

A critical case commentary on Avon and Wiltshire Mental Health Partnership and North Bristol NHS Trust v WA and DT: Did the judge reach a fair and just decision regarding the capacity and best interest of the person?

Avon and Wiltshire Mental Health Partnership and North Bristol NHS Trust v WA and DT [2020] EWCOP, [2020] 7 WLUK 271: This case critically evaluates the findings on WA’s capacity assessment and best interest decision made by the courts to determine the treatment plan. From the finding’s on WA’s capacity, it is apparent that the way capacity testing was dealt with was not in accordance with the MCA guiding principles, but rather based on a subjective view of the assessors. Consequently, WA was held to be incapacitated requiring the courts to look at the best interest provisions under section 4 of the MCA in discussing the proposed treatment options. The positive aspect to this case was that Hayden J gave greater weight to WA’s wishes and feelings, and affirmed his autonomy.

A61A comprehensive training programme for Medical Support Workers at a large teaching hospital

The Medical Support Worker (MSW) programme enables International Medical Graduates (IMG) and refugee doctors to support clinical teams, whilst General Medical Council registration is gained [1]. North Bristol NHS Trust, a large teaching hospital in South-West England, has designed and implemented a novel training programme for a second cohort of 30 MSWs. A comprehensive learning needs assessment informed the content of the programme. Learning needs were identified from two probing questionnaires and reflective pieces, completed by 22, 27 and 29 MSWs respectively; alongside Health Education England and General Medical Council guidance [2, 3]. Four principal areas were identified- (1) Communication, (2) Portfolio Development, (3) Career Development, (4) Preparation for work in the NHS. A subsequent teaching programme consisted of simulation, human factors, communication and ethics training, alongside community theatre delivered communication skills, interview preparation practice, portfolio training sessions and a specifically tailored lecture series. The programme was evaluated using two delayed surveys, formed largely of Likert scale questions, completed by 25 and 17 MSWs. Communication, social skills or cultural change were highlighted as the biggest challenges by 64% MSWs. Only 48% of MSWs felt confident working in the NHS. Confidence in managing emergencies, sensitive discussions, presenting cases, and updating relatives was low (0-35%). 75% requested teaching in assessing acutely unwell patients and decision-making. 60% wanted to improve teamworking skills. : Confidence working within the NHS rose from 48% to 92%. 100% of MSWs reported that the teaching programme helped them prepare for work as doctors in the NHS. There was a greater understanding of the structure and function of the NHS, the role of allied healthcare professionals, plus the portfolio and professional development requirements of doctors (92%). 100% of MSWs felt their communication skills had improved. 87.5% reported increased confidence with informal conversation and 100% reported increased confidence in voicing opinions and raising concerns. Additionally, 100% of MSWs reported increased confidence recognizing and assessing acutely unwell patients. Confidence in managing emergencies, sensitive discussions, presenting cases, and updating relatives improved (60-88%). This well-received, novel programme addresses some of the unique learning needs of MSWs and helps them prepare for work as doctors in the NHS. Collaborations with other trusts are taking place to establish whether the programme could be adapted for IMGs more broadly. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

SUPPORT AND TREATMENT AFTER JOINT REPLACEMENT (STAR): TRANSLATING TRIAL FINDINGS INTO NHS PRACTICE

AbstractIntroductionTotal knee replacement (TKR) aims to reduce pain and functional limitations. Despite a good outcome for many, 15–20% patients report chronic pain three months after TKR.The STAR Care Pathway is a clinically important and cost effective treatment to improve pain outcomes over 1 year for people with chronic pain at 3 months after total knee replacement surgery. The care pathway is delivered by specially trained Extended Scope Practitioners (ESPs).There is a gap between research findings and translation into practice. This work shows how the STAR trial findings were implemented into NHS practice at a single centre and the further work required to enable national implementation.MethodologyTrial findings were presented to NHS managers with a business case for an implementation pilot. Trial documentation was adapted for use in usual care using the COM-B model for behaviour change and evidence-based approaches to increase the return of postal questionnaires. Trial sites were contacted to understand their capacity to implement the intervention locally.ResultsThe STAR care pathway was successfully implemented into NHS practice with a screening response rate of 83%. It is now permanently part of usual care at North Bristol NHS Trust. Trial centres indicated that lack of availability of STAR trained ESPs as a barrier to implementation. The trial manual and training session were adapted for online delivery in partnership with Health Education England.ConclusionThe STAR care pathway has been successfully embedded into NHS care. A toolkit and online clinician training package enables national implementation.

The randomised thoracoscopic talc poudrage+indwelling pleural catheters versus thoracoscopic talc poudrage only in malignant pleural effusion trial (TACTIC): study protocol for a randomised controlled trial

IntroductionMalignant pleural effusion (MPE) is common, with 50 000 new cases per year in the UK. MPE causes disabling breathlessness and indicates advanced disease with a poor prognosis. Treatment approaches...

P009 Navigating giant cell arteritis (GCA) service during and post COVID-19 pandemic: an audit of GCA care at North Bristol NHS Trust against the BSR quality standards

Abstract Background/Aims GCA is a systemic vasculitis predominantly affecting the large vessels that requires prompt diagnosis and management. This clinical audit aims to study the impacts of COVID-19 pandemic on our GCA service and to identify areas for improvement to ensure good and safe practice amid healthcare crisis. Methods We audited referrals for suspected GCA from February 2021 until September 2022 and measured our patient care against the BSR quality standards. We performed retrospective data collection from digital care record systems and analysed our data using the IBM SPSS Statistics version 29. Results 106 patients with suspected GCA were included, 73% were female and the mean age was 70 years. 75% of the referrals were from primary care. Main presenting symptoms were headaches (95.7%), scalp tenderness (69.6%), tongue/jaw claudication (52.2%), visual symptoms (47.8%), constitutional symptoms (43.5%) and polymyalgic symptoms (21.7%). 33% of patients were diagnosed and treated as GCA. Mean CRP was 23.9mg/L and mean plasma viscosity was 1.89mPA. The mean referral-to-specialist review time has reduced to 1.6 days, compared with 2.7 days pre-pandemic. All patients had vascular ultrasound but only 7.5% had a temporal artery biopsy (TAB), compared with 41% pre-pandemic. Table 1 compares expected and achieved BSR quality standards. Conclusion Changes in work pattern during the pandemic meant that the time from referral to specialist review was significantly reduced, by implementing twice weekly registrar-led ‘Hot’ clinics and reserving ad hoc slot(s) in on-call consultant’s clinics for GCA referrals. We have ramped up our vascular imaging capacity for vascular ultrasound during the pandemic in response to reduced surgical operating capacity for TAB. Strategies to address areas for improvement identified in this audit include: (1) clear and timely communication with referrer about steroid initiation and dosage, at the time of referral; (2) improving communication with primary care, emphasising need for urgent Ophthalmology input in patients with suspected GCA-related visual symptoms, through updating our regional GCA guideline for primary care; (3) standardising and implementing a GCA review proforma or checklist in our department to ensure that the BSR GCA care bundle is being implemented and addressed at the earliest opportunity. Disclosure K. Lim: None. I. Shahriar: None. S.J. Villar: None. F. Sin: None.

P053 Patient engagement in long-term PROMs collection: 48-month observation in real-world clinical practice

Abstract Background/Aims Patient-reported outcome measures (PROMs) allow effective communication of disease experiences and encourage shared decision-making for people with inflammatory arthritis (IA). This analysis examines the long-term utilization of PROMs collection in a real-world clinical environment. Methods Clinical practice review at North Bristol NHS Trust rheumatology clinic (July 2018 - July 2022), focussing on PROMs collection (joint assessment (self-JA), HAQ, RAPID3) from patients with IA, using a smartphone-based diary (Living With) to assess and record disease activity. The app is GDPR and NHS Data Security and Protection Toolkit (ODS Code 8JP33) compliant. Ethical approval wasn’t required for this service review. Data were fully anonymized prior to analysis. Statistical analysis was completed in RStudio (V.1.4.1717). Kaplan-Maier analysis estimated app engagement. “Long-term” users were defined as those completing ≥1 PROM over 12 weeks before data cutoff. Participants recruited ≤16 weeks before data cutoff were excluded. Results Over 48 months, 1257 patients were invited and 967 (76.9%) downloaded the app.711 (56.6%) completed a PROM at least once. 79 (11.1%) were excluded due to diagnosis change out of IA group. Among 632 IA patients: 69.1% were female, mean age was 53.7±13.9 years. 63.7% had rheumatoid arthritis, 25.2% psoriatic arthritis; 7.4% undifferentiated IA, 2.1% enteropathic, 1.6% reactive arthritis, respectively. Recruitment increased over time with a noticeable rise in April 2020. The median number of completed RAPID3 was 9 [4; 30], self-JA - 9 [3; 26] and HAQ - 4 [1; 10]. 71.8% of recruited patients completed all PROMs; 15.8% - two PROMs and 12.3% - at least once. Median time in days from registration to first completed RAPID3 was 1 [0; 15], self-JA - 2 [0; 23] and for HAQ - 3 [0; 30]. Table 1 shows the proportion of “long-term” app users. The median duration of engagement was: RAPID3- 64.1 95%CI [36.9; 55.0], self-JA -57.9[52.7; 65.1], HAQ - 44.3 [36.9; 55.0] weeks. Conclusion Engagement in PROMs collection has markedly increased since 2020 but does decrease over time. Ongoing encouragement from health professionals to use and integrate PROMs into care pathways is essential and provides valuable information on the effectiveness and tolerability of health interventions. Disclosure I. Biliavska: None. E. Lenguerrand: None. E. Sparey: None. J.H. Tobias: None. P.D.H. Hamann: Consultancies; provided consultancy for Living With Ltd Software Company for the development of the smartphone application -Living With Rheumatoid Arthritis. Royalties; limited royalty agreement with Living With Ltd Software Company. Honoraria; from Gilead Pharmaceuticals for the production of training materials on remote monitoring for patients with arthritis.

The Bristol Self Harm Register (BSHR) dataset: Linked self-harm register records of the children in the Avon Longitudinal Study of Parents and Children (ALSPAC)

This data note describes the linking of records of the Bristol Self Harm Register with the cohort of the index children of the Avon Longitudinal Study of Parents and Children (ALSPAC – also known as ‘Children of the 90s’). These records were obtained from the computerised data base maintained by the Bristol Self Harm Register (BSHR). The BSHR is operated out of the two largest NHS trusts in the ALSPAC study catchment area, North Bristol NHS Trust (NBT) based at Southmead Hospital (SMH) in Bristol and the University Hospitals Bristol and Weston NHS Foundation Trust (UHBWT) based at Bristol Royal Infirmary (BRI), also in Bristol. The BSHR database was designed to be populated by staff after an encounter with a patient attending with an indication of self-harm. Some of the information in the BSHR database was self-reported by the patient and was unable to be independently verified. Software syntax was written using STATA (StataCorp LLC, version 17) to convert the original files into a single consistent format in a data base which was reviewed for its potential use in future research. The cleaned BSHR records provide a contemporaneous record of a subset of the ALSPAC cohort over a period of the ALSPAC study in an easily accessible format, which is valuable when other sources of data may be missing.

Evaluation of the feasibility and acceptability of an integrative group psychological intervention for people with Multiple Sclerosis: A study protocol.

Multiple Sclerosis (MS) is characterised by significant symptom diversity and complexity. The unpredictability of the symptoms and the emotional and cognitive facets of the disease have a significant impact on the patients' quality of life, relationships and other significant areas of living. Psychological interventions have been found to have moderate effects on quality of life, depression, stress reduction, improvement of wellbeing, anxiety, fatigue, sleep disturbances and emotion regulation. Most interventions so far are based on generic models of therapy which cannot always cover the complexity and unpredictability of MS. The present research project follows from an exploratory mixed method study on the experience of psychological interventions and the impact on the management of MS. The results of that study generated themes that led to the development of an integrative group psychological intervention named MyMS-Ally. The current study aims to explore the feasibility and acceptability of MyMS-Ally intervention and obtain preliminary data on the effects on quality of life, emotion regulation, depression and anxiety through the application of a convergent mixed methods design. People with MS will be recruited at the Bristol and Avon Multiple Sclerosis centre, North Bristol NHS Trust. They will participate in MyMS-Ally group intervention for 8 weeks. Individual semi-structured interviews drawing on Interpretative Phenomenological methodology will be conducted before and after the intervention and at three months follow up. Participants will complete quantitative measures on quality of life, emotion regulation, depression and anxiety before and after the intervention and at one and three months follow up. The aim is to explore the relevance, sustainability and adherence to the intervention and study processes (feasibility) as well as the appropriateness of the intervention based on the emotional and cognitive responses, satisfaction and perceived effectiveness (acceptability). It is aspired that this patient-centred psychological intervention will address needs and preferences of people with MS. The results of the present study will provide data for further development of the intervention and will lead to a big scale evaluation study.

Avon Community-Acquired Pneumonia (AvonCAP) Surveillance Study: A Pan-pandemic Acute Lower Respiratory Tract Disease Surveillance Study, and the linked records of the participants in the Avon Longitudinal Study of Parents and Children (ALSPAC)

This data note describes the linking of records of the Avon Community-Acquired Pneumonia (AvonCAP) Surveillance Study – A Pan-pandemic Acute Lower Respiratory Tract Disease Surveillance Study (ISRCTN: 17354061), with the participants of the Avon Longitudinal Study of Parents and Children (ALSPAC – also known as ‘Children of the 90s’). These records were obtained from a database created specifically by AvonCAP operating within the two acute care NHS Trusts in Bristol, which is the centre of the ALSPAC study catchment area. These two trusts are the (a) North Bristol NHS Trust (NBT) based at Southmead Hospital (SMH) and (b) the University Hospitals Bristol and Weston NHS Foundation Trust (UHBWT) based at Bristol Royal Infirmary (BRI). The AvonCAP database was updated by staff using a combination of clinical records and self-reporting by the participant, which was unable to be independently verified. Data was collected using the REDCap (Research Electronic Data Capture) software program. Software code was created to transform the original files into a single data base which was reviewed for data-completeness and for its potential value as a research resource. The AvonCAP records provide a contemporaneous record of a subset of the ALSPAC cohort who experienced Lower Respiratory Tract Disease. It is available for research and may be used in conjunction with other ALSPAC data.

Immersive, cross-departmental simulation – mapping emergency obstetric care from admission to delivery

‘Translational’ simulation activities are effective at improving patient safety when directed towards a specific patient journey [1]. North Bristol NHS Trust cares for around 6,000 obstetric patients per annum, with around 1,000 infants delivered by unplanned caesarean section each year. The in-situ simulation presented here facilitated an in-depth exploration of our cross-departmental response to a hypertensive pregnant patient presenting to the Emergency Department (ED). Severe pre-eclampsia in a preterm patient is a complex clinical scenario which, akin to previous successes seen with trauma care, may benefit from simulation focused on teamwork behaviours. The potential for benefit was optimised by application of the ASPiH Standards for Simulation-Based Education [2]. The aim of the simulation was to prospectively identify latent safety threats to emergency obstetric care in patients presenting to the Emergency Department at Southmead Hospital. An in-situ simulation was conducted to simulate a pre-term woman presenting with pre-eclampsia and reduced conscious level. The high-fidelity scenario involved collaboration from 28 staff in emergency medicine, radiology, obstetrics, neonatal medicine, anaesthetics, and theatres as the patient journey evolved, ending in emergency caesarean section in the non-obstetric emergency theatre complex. Members of the expert panel acted as passive observers to record an accurate log of events during the scenario. A formal debriefing was conducted at the conclusion of the simulation where participants were invited to discuss potential hazards arising from the scenario. Failure modes and effects analysis was employed to assess the identified latent risks [3]. Ten latent safety threats were identified from the simulation. These were stratified according to severity and action plans were agreed to address them. Cross-departmental changes are being instigated and tested. These include amendments to emergency grab-bags, implementation of site-wide tools for location mapping in clinical emergencies, wider availability of the obstetric WHO checklist in emergency theatres, and clarification on the availability of blood for neonatal transfusion in non-obstetric theatres. This immersive scenario engaged clinical teams from a number of specialities and clinical areas across the hospital. Reflecting a real-life patient journey allowed for a rich and nuanced understanding of the response to an evolving emergency scenario. Cross-departmental collaboration in simulation-based training can be effective in assessing latent safety threats, particularly where staff operate in unfamiliar environments. Through carefully conducted debriefing, task allocation and follow-up, it is possible to diagnose and treat a broad range of latent threats to workflow, systems and processes. 1. Brazil V. Translational simulation: not ‘where?’ but ‘why?’ A functional view of in-situ simulation. Advances in Simulation. 2017; 2(1):1–5. 2. Association for Simulated Practice in Healthcare. Simulation-based education in healthcare: standards framework and guidance (2016). 3. Davis S, Riley W, Gurses AP, Miller K, Hansen H. Failure Modes and Effects Analysis Based on In-Situ Simulations: A Methodology to Improve Understanding of Risks and Failures. In: Henriksen K, Battles JB, Keyes MA, Grady ML (Eds). Advances in Patient safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Rockville(MD): Agency for Healthcare Research and Quality (US); 2008.

The Bristol Self Harm Register (BSHR) dataset: Linked self-harm register records of the children in the Avon Longitudinal Study of Parents and Children (ALSPAC)

This data note describes the linking of records of the Bristol Self Harm Register with the cohort of the index children of the Avon Longitudinal Study of Parents and Children (ALSPAC – also known as ‘Children of the 90s’). These records were obtained from the computerised data base maintained by the Bristol Self Harm Register (BSHR). The BSHR is operated out of the two largest NHS trusts in the ALSPAC study catchment area, North Bristol NHS Trust (NBT) based at Southmead Hospital (SMH) in Bristol and the University Hospitals Bristol and Weston NHS Foundation Trust (UHBWT) based at Bristol Royal Infirmary (BRI), also in Bristol. The BSHR database was designed to be populated by staff after an encounter with a patient attending with an indication of self-harm. Some of the information in the BSHR database was self-reported by the patient and was unable to be independently verified. Software syntax was written using STATA (StataCorp LLC, version 17) to convert the original files into a single consistent format in a data base which was reviewed for its potential use in future research. The cleaned BSHR records provide a contemporaneous record of a subset of the ALSPAC cohort over a period of the ALSPAC study in an easily accessible format, which is valuable when other sources of data may be missing.

The stair climb challenge: a holistic approach to maintaining medical professionalism at North Bristol NHS Trust

The stair climb challenge: a holistic approach to maintaining medical professionalism at North Bristol NHS Trust

978 ADVANCED CARE PLANNING IN PATIENTS WITH PARKINSONIAN DISORDERS

Abstract Introduction Advanced care planning (ACP) supports individuals to make decisions regarding their future care. Guidelines (NICE, 2017) recommend offering ACP discussions to people with Parkinson’s Disease (PD), but uptake lags behind other countries (Sokol, NPJ Parkinson’s Dis, 2019, 22:5–24). As part of a project to improve ACP in the community we audited ACP practice at North Bristol NHS Trust. Method Records for 100 patients with idiopathic PD or atypical Parkinsonian syndromes seen in Movement Disorders clinics from March to October 2021 were scrutinised. ACP was defined as including: Do not attempt cardio-pulmonary resuscitation (DNACPR), Advanced Statement of Wishes, Advanced Decision to Refuse Treatment (ADRT) and Lasting Power of Attorney (LPOA). Disease severity was assessed using Hoehn and Yahr (H&Y) score. Results 87 records were audited, 13 were excluded due to non-Parkinsonian disorders (11) or unavailable records (2). ACP was completed for 22 (25%) cases, (18 DNACPR and 11 Advanced Statements, 1 LPA, 0 ADRT). Informal ACP, such as documentation of wishes in clinic letters, were present in 5 cases. Of the 22 instances of ACP, 20 were recorded on Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms. Preferences included ventilation (10), hospital admission (6), life prolonging treatments (6), preferred place of care (4), nutrition (0). Completed ACP was associated with higher H&Y scores or atypical syndromes. Conclusion It is recognised that there is a need to further investigate how ACP is delivered for patients with Parkinsonian Disorders. Three US studies estimated ACP rates ranging from 14.6%–53%. (Nimmons, European Journal of Neurology 2020, 27:1971–1987). We are not aware of any comparable UK data. This is a preliminary audit for a project to improve ACP within our MD Service. We are collecting further data on the views of our community movement disorders team with a view to upskilling in ACP.

MO692: A Four-Year Analysis on Home Dialysis at the North Bristol NHS Trust—What to Do Next?

Abstract BACKGROUND AND AIMS Home dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), has been associated with improved patient autonomy, quality of life and overall cost effectiveness (Weinhandl et al. Propensity matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. J Am Soc Nephrol. 2010; 21: 499–506). The 2021 Get It Right First Time (GIRFT) Renal report revealed that home dialysis patients were at a lower risk of contracting and dying of coronavirus disease 2019 (COVID-19), compared to those who received in-center hemodialysis (ICHD) (2). Despite these advantages, uptake of home dialysis is still lower than that of ICHD. The aim of our study was to analyse the numbers and reasons for home dialysis withdrawal at the North Bristol NHS Trust between 2018 and 2021. METHOD All patients on PD and HHD between 2018 and 2021 were included. Analysis of the episodes that led to home dialysis cessation was carried out. As some patients required withdrawal more than once during the 4-year period, each episode of dropout was considered separately. The prevalence rate of patients on home dialysis was calculated. RESULTS The total number of patients on home dialysis increased from 74 in 2018 to 98 in 2021. The male: female ratio of patients was 3:2 with an average age of 58.3. The number of patients on PD increased from 58 at the end of 2018 to 82 in 2021. The number of patients on HHD remained stable over the years, with an average of 16. The prevalence rate of home dialysis was 17.1% at the end of 2021. Figure 1 shows the total number of patients who started and dropped out of home dialysis every year. The number of patients initiating PD was 58 in 2018, 55 in 2019, 37 in 2020 and 59 in 2021. The number of dropouts was 57 in 2018, 41 in 2019, 29 in 2020 and 43 in 2021. The dip in number of patients initiated on PD in 2020 can be attributed to the start of the COVID-19 pandemic, when elective procedures were temporarily withheld. On the other hand, a lower number dropped out during 2020. This may be explained by the emphasis given to self-isolation rules and persistence with home dialysis during the outbreak. The overall increase in PD uptake in 2021 may be explained by the establishment of a new specialist clinic that promotes the uptake of home dialysis. The initiation of a new peer support service group in 2021 may also have contributed. The number of patients initiating and withdrawing from HHD followed the same pattern, with a significant dip in 2020. Figure 2 demonstrates the reasons for withdrawal from PD over the study period. The most prevalent reasons were PD-related infections and transplantation. The observed figures for transplantation reflect the continuous efforts involved in the maintenance of a successful transplant programme. The figure also shows that termination of PD due to failure was highest in 2021. The authors postulate that this surge might be due to the previous year's low PD dropout rate. The leading reason for stopping HHD was transplantation. Other reasons included recovery of renal function and switching to conservative management. Death led to one dropout/year in 2018–20, but none in 2021. CONCLUSION Around 17% of the NBT’s total dialysis population is currently on home dialysis. The commonest reasons for termination of home dialysis were transplantation and PD-related infections. The GIRFT report recommends that all adult renal units in the UK should reach a minimum prevalence rate of 20% of their dialysis population on home dialysis by the end of 2024 (Lipkin et al. Renal medicine: Get It Right First Time (GIRFT) Programme National Specialty Report. March 2021. NHS England and NHS Improvement). Whereas our statistic falls slightly short of this, we aim to reach this target through various strategies. These include continued audit, home dialysis campaign, continued psychological services and a reduction in waiting time for PD catheter insertion.

30 - Impact of the COVID-19 pandemic on suspected lung cancer referrals and subsequent lung cancer diagnoses at North Bristol NHS Trust (NBT)

30 - Impact of the COVID-19 pandemic on suspected lung cancer referrals and subsequent lung cancer diagnoses at North Bristol NHS Trust (NBT)

578 Insights into Patient Satisfaction with Telephone Fracture Clinic Consultations During COVID-19

Abstract Aim The COVID-19 pandemic led to an unusually fast pace of change in clinical practice in the UK. An early requirement to reduce outpatient attendances to a pminimum meant that this Trust adopted remote consultations for fracture clinics whenever possible. This study aimed to evaluate patient satisfaction with the new system of telephone consultations to assess its acceptability and guide future decisions. Method 299 patients who received remote telephone consultations for fracture clinic appointments at North Bristol NHS Trust during the COVID-19 pandemic in early 2020 were retrospectively identified and sent a postal survey. Satisfaction levels were assessed through degree of agreement with statements (9 items), yes/no answers (4 questions) and space for comments. Data was analysed with Excel pivot tables and Chi-squared tests. Results 131 survey responses were included (43.8% response rate). The majority of patients were satisfied overall with the care they received (82%) and preferred a telephone consultation to a face-to-face appointment during the pandemic (78%). However, only 22% maintained this preference in ‘normal’ (pre-COVID-19) times. Conclusions The positive responses to the survey reassure us that telephone consultations for fracture clinic consultations are acceptable to the majority of patients during a pandemic. The results as well as free text comments will help us ameliorate the fracture clinic service to minimise infection risk without compromising on quality of care.

#3108 Initial assessment structure in a specialist outpatient clinic for acquired brain injury in adults

Consistent with the NHS quality agenda, Dept. of Health, 20111 there has been a drive to routinely incorporate outcome and performance measurement data in clinical practice. An absolute requirement within NHS services2 are Patient-Rated Outcome Measures (PROMS) which are used by some Royal College of Psychiatry faculties to quantify outcomes, improve accountability, performance management and service. They can also be used to screen for common health problems and ensure the comprehensive assessment of complex Acquired Brain Injury (ABI) Patients who typically present with various neurological and psychiatric comorbidities.The North Bristol NHS Trust Outpatient Clinic at The Frenchay Brain Injury Rehabilitation Centre and The Rosa Burden, Southmead Hospital, conducts new assessments and regular patient reviews for referrals from South West England. As part of a quality improvement initiative a semi-structured process of assessment was trialled, to improve patient experience by providing a comprehensive initial assessment, improving treatment productivity and reducing over-running clinics.MethodReferrals were audited and common reasons for referrals identified. Questionnaires and tools used in the clinic were reviewed and those most frequently used were compiled. The evidence for questionnaires utilized for different psychiatric comorbidities and applicability in ABI was examined in the literature. The finalized patient questionnaires booklet section and their sequence was decided based on expert peer recommendations and patient feedback. The collateral section was similarly developed with some questionnaires modified for operational reasons.SECTION ONE: SELF RATED PRE-ASSESSMENT QUESTIONNAIRERivermead Post Concussion Symptoms Questionnaire, Patient Health Questionnaire (15): Somatic Screen, Patient Health Questionnaire-9: Depression screen, General Anxiety Disorder 7: Anxiety screen, Mood Disorder Questionnaire: Bipolar Affective Disorder screen and the Civilian Version PTSD Checklist.SECTION TWO: CARER/FAMILY PRE-ASSESSMENT QUESTIONNAIREModified Overt Aggression Scalescreen for aggression, Neuropsychiatry Inventory Questionnaire: assesses psychiatric symptoms in patients with neurological disordersOutcomeThe final booklet was divided into three sections:Patient-Rated, ObserverRated and Clinician Section. Consultation efficiency was improved with the Patient and Observer rated sections completed prior to the initial assessment. The checklist is used for all initial assessments with good uptake and allowed for standardization of clinical information gathering. PROMs for mood are collected at each clinic appointment with other domains repeated if abnormal at initial clinic assessment or clinically relevant.References Fossey M, Parsonage M. Outcomes and performance in liaison psychiatry: developing a measurement framework. Centre for Mental Health and Royal College of Psychiatrists Report June 2014. Trigwell P, Kustow J, Santhouse A, et al. Framework for routine outcome measurement in liaison psychiatry (FROM-LP): faculty of liaison psychiatry royal college of psychiatrists faculty report. The Royal College of Psychiatrists 2015. vretveit J, Zubkoff L, Nelson EC, et al. Using patient-reported outcome measurement to improve patient care. Int J Qual Health Care 2017 Oct 1;29(6):874879.