Northumbria Healthcare NHS Foundation Trust Research Articles

Improving weekdays to weekends handover at base-site hospitals at Northumbria Healthcare NHS Foundation Trust: a quality improvement project

Improving weekdays to weekends handover at base-site hospitals at Northumbria Healthcare NHS Foundation Trust: a quality improvement project

370 Biochemical Monitoring and Micronutrient Replacement Following Bariatric Surgery

Abstract Aim This project investigates whether patients received appropriate post-operative biochemical monitoring and micronutrient replacement after bariatric surgery, as per British Obesity & Metabolic Surgery Society (BOMSS) guidelines. Method A total of 27 Patients underwent either gastric bypass or sleeve gastrectomy between 1st August 2020 to 31st July 2021 at Northumbria Healthcare NHS Foundation Trust. Data was collected retrospectively. Results Most patients received appropriate micronutrient replacement, with 82% for A-Z multivitamin, 84% for calcium supplement, 72% for vitamin D supplement, 96% for vitamin B12 supplement, and 91% for ferrous sulphate for menstruating women. Similar results found with post-operative blood tests at 6 months, 81% for FBC/LFT/U&E, 74% for ferritin and folate, 74% for calcium and vitamin D, and 70% for vitamin B12. Similar findings at 12 months, 74% for FBC/LFT/U&E, 74% for ferritin and folate, 78% for calcium and vitamin D, 70% for vitamin B12, 67% for zinc, 70% for copper, and 67% for selenium. However, compliance with blood tests at 3 months was inferior, 48% for FBC/LFT/U&E, 37% for ferritin and folate, 37% for calcium and vitamin D, and 44% for vitamin B12. Conclusions Most patients received appropriate biochemical monitoring and micronutrient supplements. Unfortunately, less than half of the patients received monitoring blood tests at 3 months, which is a time where post-operative complications such as malnutrition can be identified and corrected. Several factors may have contributed to this, such as delay in communication between secondary and primary care or lack of facilitation to phlebotomy services.

Pneumothorax Trends from 2010-2020 from a Large-Volume Pleural Unit.

Previous studies in 2018 and 2022 have suggested increasing inpatient burden of pneumothorax and widespread variation in management. Local trends have never been elucidated. Northumbria Healthcare NHS Foundation Trust (NHCT) has a well-established pleural service, serving just over 600,000. Thus, we set up a local retrospective study to look at trends in pneumothorax presentation, management strategies, length of stay, and recurrence. A coding search for 'pneumothorax' was performed for all patients attending NHCT between 2010 and 2020 was performed with local Caldicott approval. A total of 1840 notes were analysed to exclude iatrogenic, traumatic, and paediatric events. After excluding those cases, 580 remained for further analysis, consisting of 183 primary pneumothoraces (PSP) and 397 secondary pneumothoraces (SSP). Median age for PSP was 26.5years (IQR 17) with 69% male, and for SSP 68years (IQR 11.5), 62% male; 23.5% of PSP and 8.6% of SSP were never smokers. The proportion of smokers and ex-smokers has not really changed over time: > 65% every year have been smokers or ex-smokers. Yearly pneumothorax incidence shows a downward trend for PSP but upwards for SSP. Median length of stay (LoS) for PSP was 2days (IQR 2), and SSP 5days (IQR 8), with a clear downward trend. From 2010 to 2015 > 50% PSP were managed with drain, but in 2019-2020 at least 50% managed conservatively, with a significant reduction in aspiration. Trends of recurrence for PSP are increasing, whereas for SSP is decreasing. Seventy-six (20 PSP, 56 SSP) went for surgery at the index time with 5.3% recurrence (20% recurrence in those without surgery). This is the first known analysis of pneumothorax trends in a large trust in the northeast of England. The data in this study have certain limitations, including the lack of information on the size of pneumothorax and frailty indicators that may influence the decision for conservative management. Additionally, there is a reliance on clinical coding, which can introduce potential inaccuracies, and not all patient notes were accessible for analysis. Updated larger datasets should help elucidate trends better.

Pharmacy technician administration of systematic anticancer therapy: an innovative project by the Northumbria Healthcare NHS Foundation Trust

Pharmacy technician administration of systematic anticancer therapy: an innovative project by the Northumbria Healthcare NHS Foundation Trust

Autologous Blood Patch Pleurodesis for Secondary Spontaneous Pneumothorax: A Narrative Review, a Retrospective Case Series and State of Play in the UK.

Treatment of prolonged air leak due to secondary spontaneous pneumothorax is challenging. Autologous blood patch pleurodesis (ABPP) is a treatment option. Previous evidence is reliant on single-centre series and underpowered trials and is mostly described in air leaks post cardiothoracic intervention. There are no United Kingdom (UK) wide data. Members of the UK Pleural Society were surveyed for their practice and for patients who underwent blood patch. There were 16 respondents from 333 members. Twelve had performed the procedure, and six had kept records and could submit data. Basic demographics, intervention and clinical details of patients were then collected. The study was sponsored by the Audit Department of Northumbria Healthcare NHS Foundation Trust (reference 8124), and Caldicott Clearance for data sharing was provided by the Trust's Information Goverance Board (reference C4221). There was no requirement for informed consent. Data for 12 patients that received ABPP between 2014 and 2022 in six respiratory centres were assessed. The aetiology of the secondary pneumothoraces was mostly due to chronic obstructive pulmonary disease and end-stage interstitial lung disease. The patients had a median age of 75years. The median air leak time before ABPP was 17days. A total of 50-100 ml of blood was used for ABPP. Five patients had two attempts at ABPP. Air leak resolved in six patients (50%). Four patients had pleural apposition prior to ABPP. Four patients were diagnosed with hospital-acquired pneumonia following ABPP. This is the only UK-wide retrospective case series of ABPP of 'medical' patients with secondary pneumothorax. There is widespread variation in care. No formal conclusions can be drawn, and much larger robust datasets are required. An application has been made to the European Respiratory Society to incorporate ABPP within the International Collaborative Effusion database.

Were security guards responsible for patient's death? Leanne Walsh (for Gareth Walsh, deceased) v. Northumbria Healthcare NHS Foundation Trust (Newcastle upon Tyne County Court – Judge Freedman – 19 May 2021)

Were security guards responsible for patient's death? Leanne Walsh (for Gareth Walsh, deceased) v. Northumbria Healthcare NHS Foundation Trust (Newcastle upon Tyne County Court – Judge Freedman – 19 May 2021)

The Cause and Duration of Emergency Admissions to Hospital in People with Idiopathic Parkinson's Disease, Under the Care of a UK Service, During the First Year of the COVID-19 Pandemic.

People with Parkinson's disease (PD) have higher rates of hospitalisation and healthcare utilisation compared to the general population. The COVID-19 pandemic caused significant changes in admissions to hospital and access to healthcare. People with PD are some of the most vulnerable to such changes. There is no pre-existing data on the cause and duration of admission to hospital of people with PD during the COVID-19 pandemic. To determine the cause, duration, and outcome of hospital admissions to Northumbria Healthcare NHS Foundation Trust (NHCFT) for people with idiopathic Parkinson's disease (IPD) in 2020. All people with IPD who had an emergency admission to NHCFT between 01/01/2020 and 31/12/2020 were identified. Demographic and disease characteristics, the number, duration, cause of admission and the location prior to admission were collected from an audit of medical notes. 271 people with IPD had one or more emergency admissions to NHCFT between 01/01/2020 and 31/12/2020. There was a total of 453 emergency admissions, with a median duration of 5 (IQR 2-13) days. The most common causes of admission to hospital were PD-related motor dysfunction (includes falls with no other underlying cause or associated injury) and injury (includes falls with fracture), at 78 (17.2%) and 70 (15.5%) respectively. People with IPD had a short duration but high number of emergency admissions to hospital. Our chronological data on number of admissions shows a peak in admissions during August 2020. As a result of these findings and emerging data we suggest that individuals with PD deconditioned during 2020.

Colorectal cancer care in the COVID-19 era: outcomes from a 'mixed site' model.

The COVID-19 pandemic has presented many challenges to colorectal cancer (CRC) care. Many organisations opted to perform CRC resections in 'cold' sites. Infrastructure in Northumbria Healthcare NHS Foundation Trust (NHCT) necessitated co-locating CRC care with 'hot' COVID streams but with additional precautions. This study aimed to evaluate that approach for a consecutive series of CRC cases, diagnosed before and during the COVID-19 pandemic. A prospectively populated data set of CRC patients diagnosed between 1 April 2019 and 30 September 2020 was used. Patients presenting before 1 April 2020 were considered 'pre-COVID' and those presenting subsequently as 'COVID era'. Some 344 cases were diagnosed in the 12 months 'pre-COVID' and 166 in the 6 months of the 'COVID era'. The median numbers of days from referral to diagnosis (21 vs 20, p=0.373) and operation (63 vs 61, p=0.208) were unchanged. The 'COVID era' saw an increase in the proportion of radiological diagnoses (39.5% vs 53.0%, p=0.004) with an associated decrease in endoscopic diagnoses (56.7% vs 45.8%, p=0.021). Rates of inoperable (1.5% vs 1.2%, p=0.821), obstructing (11.0% vs 16.2%, p=0.272) and perforated tumours (0.6% vs 1.5%, p=0.492) remained the same. One patient developed COVID-19 perioperatively. Rates of laparoscopic operation (59.5% vs 61.8%, p=0.751), anastomotic leak (6.4% vs 5.9%, p=0.891), re-operative surgery (10.4% vs 4.4%, p=0.138), primary stoma (40.5% vs 32.4%, p=0.244) and 90-day mortality (0.6% vs 1.5%, p=0.492) did not change. With appropriate infection control measures, it may be safe to continue providing standard elective and urgent CRC care without access to a 'COVID clean' site.

COVID-19 Mortality in Patients with a Ward-Based Ceiling of Care

Objectives: COVID-19 patients thought unlikely to benefit from organ support, thereby having a ward-based ceiling of care (WBCoC), represent a distinct subgroup. There are no associated studies in mortality. We sought to identify clinical risk factors for inpatient COVID-19 mortality. Design and setting: this was a retrospective observational study of patients admitted to Northumbria Healthcare NHS Foundation Trust. Clinical variables were associated with inpatient mortality via logistic regression. Participants: all patients admitted with COVID-19 infection and who had a WBCoC at point of admission were included (n = 114). Main outcome measures: the outcome measure was inpatient death.

P33.02 Day Case Thoracocoscopy With IPC Insertion

Northumbria Healthcare NHS Foundation Trust runs a large pleural service. Local anaesthetic medical thoracoscopy (LAT) is a well-established procedure in undiagnosed pleural effusions. Patients were traditionally admitted for a mean of 3.4 days and had a large bore drain inserted post LAT with pleurodesis. The Covid-19 pandemic has forced day case LAT provision with IPC placement without pleurodesis to minimise transmission risk. We describe our experience. LAT is performed in theatre under conscious sedation. All notes of patients requiring day case LAT between July 2020-Feb 2021 were analysed. Basic demographics and outcomes were collected. A descriptive analysis of the data was performed. 17 patients underwent day case LAT. All had negative pre-operative Covid-19 swabs: mean age 70.8 years (range 34-82), 12 male,5 female. Diagnoses included 5 lung cancers, 6 mesotheliomas and 4 fibrinous pleuritis. The lung did not deflate, not enabling biopsies in 2. Non-malignant diagnoses are currently presumed. 14 IPCs and 2 large bore drain were inserted due to 2 immediate complication (surgical emphysema). 1 patient developed an empyema within 30days. 9 out of the 11 IPCs have already been removed due to pleurodesis occurring (mean number days 60. All were discharged on the same day except the two requiring further drain insertion. We have thus transformed our service after more than a decade of providing LAT as an inpatient service. This is a small cohort of patients but proves the feasibility and safety of day case LAT with massive reduction in inpatient stay. The Covid-19 pandemic has transformed our service but for the better. Further qualitative work should elucidate the acceptability of such a pathway for patients.

215P The feasibility of day case thoracoscopy

Background: Northumbria Healthcare NHS Foundation Trust runs a very successful pleural service catering for patients with malignant pleural fluid, pleural infection and pneumothorax. Local anaesthetic medical thoracoscopy (LAT) is a well-established diagnostic, therapeutic and preventative procedure in undiagnosed pleural effusions. Patients were traditionally admitted for a mean of 3.4 days and had a large bore drain inserted post LAT and pleurodesis was performed. The Covid-19 pandemic has forced us to provide day case LAT with IPC placement without pleurodesis to minise transmission risk. We thus describe our local experience. LAT is performed in theatre under conscious sedation. Methods: All the notes of patients requiring day case LAT between July 2020-Dec 2020 were analysed. Basic demographics were collected as well as diagnoses and what interventions were performed. A descriptive analysis of the data was performed. Results: 13 patients underwent day case LAT. All had negative preoperative Covid-19 swabs. Mean age was 69.7 years (range 24–82). 10 were male and 3 female. Definite diagnoses included 5 lung cancers, 4 mesotheliomas and 2 fibrinous pleuritis. The lung did not deflate, not allowing for biopsies in 2 patients. Non-malignant diagnoses are currently presumed. 10 IPCs and 1 large bore drain were inserted due to 1 immedidate complication (surgical emphysema). 1 patient developed an empyema within 30days. 8 out of the 10 IPCs have already been removed due to pleurodesis occuring (mean number of days 27.5, range 16–72). All patients were discharged on the same day except 1 patient who required a large bore drain and stayed overnight. Conclusions: We have thus transformed our service after more than a decade of providing LAT as an inpatient service. This is a small cohort of patients but proves the feasibility and safety of day case LAT with massive reduction in inpatient stay. The Covid-19 pandemic has transformed our service but for the better. Further qualitative work should elucidate the acceptability of such a pathway for patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

163 Frailty, Doesn’t That Mean Birdlike? Research Into Attitudes and Understanding of Frailty in Undergraduate and Postgraduate Trainees

Abstract Introduction Frailty is an increasingly recognised concept, with 25–50% of over 85’s estimated to be frail1,. Previous research considered medical students’ attitudes towards older people2, yet despite the correlation between frailty and increased age3, little is known about attitudes of healthcare professionals towards frailty. We researched attitudes towards, and understanding of, frailty in undergraduate and postgraduate trainees, with a view to guiding future educational interventions. Method Approval was granted by Northumbria Healthcare NHS Foundation Trust (NHCT) Research and Development department, Newcastle University’s Research Management Group and the HRA. 3 cohorts were recruited; 3rd year Newcastle University MBBS Students, 5th year Newcastle University MBBS Students and Foundation Year 2 and Core Medical Trainees working for NHCT (junior doctors). Data was collected during scheduled teaching at NHCT and individuals were invited to participate via email prior to this. Those not participating were still required to attend the teaching. Participants provided written consent. Within each cohort, small group discussions around frailty and Comprehensive Geriatric Assessment (CGA) were prompted using open questions (e.g. “what does frailty mean to you?”), during which participants anonymously submitted phrases to an online word-cloud generator. Discussions were audio recorded and transcribed. Transcriptions and word-clouds were analysed using Simple Content Analysis. The over-arching themes within each cohort were identified and compared with other cohorts. Interpretations were reviewed by an independent researcher to enhance rigour. Results Each cohort associated frailty with older age and weakness, and often used it as a byword for complexity. Frailty was described as an abstract construct composed of personal experiences rather than an objectively defined descriptor. All associated it with negative emotions. Cohorts differed in their approach, with 3rd year students primarily focussed on defining frailty, whereas junior doctors prioritised the clinical challenges it presented. Junior doctors demonstrated limited understanding of CGA whilst undergraduate students were almost universally ignorant of it. Conclusions The lack of understanding around frailty and CGA is concerning given its high prevalence. The identification of negative emotions increases this concern. To challenge this, focussed educational interventions addressing understanding and attitudes ought to be developed for tomorrow’s doctors.

Analysis of COVID-19 patients from Northumbria Healthcare NHS Trust not requiring level 2/3 care

In Northumbria Healthcare NHS Foundation Trust, the surge of the COVID-19 pandemic occurred in March 2020 and April 2020. It is vital to understand local epidemiological data in the context of national and global data and to delineate any notable differences. A retrospective review of all patients receiving level 1 (ward-based) care with positive SARS-CoV-2 ribonucleic acid PCR on swab between 01 March 2019 and 27 of April …

Frailty in level 1 patients in Northumbria Healthcare NHS Foundation Trust

There is a research gap with regards to supporting the use of the clinical frailty score (CFS) in the acute management of COVID-19 patients. The COPE study assessed the effect of frailty on outcomes in people of all ages with COVID-19 and showed that frailty …

The value of bronchoscopy in patients with non-massive haemoptysis and a clear or benign computer tomogram scan.

The preferred diagnostic pathway for patients presenting with non-massive haemoptysis and normal or benign computer tomography (CT) radiological findings is unclear. The common approach is to investigate with both CT and bronchoscopy, irrespective of patient-specific factors. The value of performing fibreoptic bronchoscopy (FOB) in patients with non-massive haemoptysis and clear or benign CT findings remains undetermined. We aimed to investigate its value using a large retrospective case series. A retrospective review of 4376 FOBs performed in Northumbria Healthcare NHS Foundation Trust from January 2012 to December 2019 for patients presenting with haemoptysis and clear or benign CT findings. Statistical analysis was performed to describe patient-specific variables, clinical characteristics, pathological findings and subsequent management decisions. A total of 4376 FOBs were performed during the study period, 275 were indicated to investigate non-massive haemoptysis. Two hundred and fifty-nine patients underwent a CT scan (158 before and 101 after FOB); 16 never had a CT because the treating physician did not feel it was necessary. About 258 CT scans showed normal anatomy. All patients underwent FOB; 192 showed normal findings. Bronchoscopic findings did not alter clinical management in 274 patients. One patient was referred to the ear, nose and throat department following the identification of polypoid vocal cord lesion which, following thorough investigation, was confirmed as benign. FOB provides minimal value for identifying lung malignancies in patients with non-massive haemoptysis and a clear or benign CT scan irrespective of patient-specific risk factors. Cost savings would be associated if physicians altered practice accordingly.

Building on the RCP FallSafe care bundles: Is observation and review the key to reducing inpatient falls? The Northumbria experience 2013–2020

The Royal College of Physicians (RCP) FallSafe care bundles are the recommended foundation for inpatient falls prevention in the UK. Yet there is a paucity of data to support its widespread use and the reductions in falls demonstrated in the original pilot and in subsequent small studies have not yet been reproduced in larger patient groups. Northumbria Healthcare NHS Foundation Trust (NHCFT) has seen a significant reduction in falls, falls per 1,000 bed days and harm from falls between 2013-2020 when combining the RCP FallSafe care bundles with a supportive observation policy (SOP) related to falls prevention. Highlighting the potential cost savings (∼£5.3 million over a 3-year period) has supported the growth and development of the NHCFT inpatient falls prevention service and the implementation of the SOP.

Resuscitation discussions: learning from Covid-19.

The Clinical TeacherVolume 18, Issue 3 p. 206-207 INSIGHTS Resuscitation discussions: learning from Covid-19 Kristen Davies, Corresponding Author Kristen Davies [email protected] [email protected] orcid.org/0000-0003-2246-9048 Northumbria Healthcare NHS Foundation Trust, Northumberland, UK Correspondence Kristen Davies, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK. Emails: [email protected]; [email protected]Search for more papers by this author Kristen Davies, Corresponding Author Kristen Davies [email protected] [email protected] orcid.org/0000-0003-2246-9048 Northumbria Healthcare NHS Foundation Trust, Northumberland, UK Correspondence Kristen Davies, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK. Emails: [email protected]; [email protected]Search for more papers by this author First published: 09 October 2020 https://doi.org/10.1111/tct.13278Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume18, Issue3June 2021Pages 206-207 RelatedInformation

Clarification on Pleural Effusions in COVID-19.

HomeRadiology: Cardiothoracic ImagingVol. 2, No. 3 Previous Letters to the EditorFree AccessClarification on Pleural Effusions in COVID-19Avinash Aujayeb Avinash Aujayeb Author AffiliationsDepartment of Respiratory and Acute Medicine, Northumbria Healthcare NHS Foundation Trust, Northumbria Way, Cramlington NE23 6NZ, Englande-mail: [email protected]Avinash Aujayeb Published Online:Jun 11 2020https://doi.org/10.1148/ryct.2020200330MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack Citations ShareShare onFacebookTwitterLinked In Editor:We thank Dr Tabatabaei and colleagues for their recent article in the April 2020 issue of Radiology: Cardiothoracic Imaging on CT characteristics of 120 patients with coronavirus disease 2019 (COVID-19) with a wide range of clinical outcomes (1). A total of 12.5% (19 of 96) of ward patients, 45% (nine of 11) of those in intensive care, and 23% (three of 13) of those deceased had pleural effusions. The authors rightly mention that the incidence of pleural effusions is out of keeping with other published studies and that pleural effusions are uncommon in COVID-19 (2). Therefore, we must dispute this finding in the absence of further explanations. It would be important to know if the effusions were unilateral or bilateral, whether those patients had any coexisting comorbidities such as concurrent heart, renal, or liver failure, or any disseminated malignancies which are by far the most common cause of pleural effusions, and more importantly whether any of those effusions were sampled and what were the resultant biochemical and microbiologic characteristics. So far, in the literature, there is only one report of pleural effusions in deceased COVID-19 patients being positive for the virus (3). However, patient characteristics in that study are also not described. We run a large pleural service in the North East of England, and this would greatly inform local and national practice (4). Current British Thoracic Society guidance suggests that all pleural procedures are potentially aerosol generating and could spread the virus, but the statement mentions that the evidence is poor (5). We believe the case series will be greatly enhanced if the details above are provided. If they cannot be provided, perhaps a note of caution should be added to the article by way of reply to this letter? We would also welcome any chance of international collaboration on the matter.Disclosures of Conflicts of Interest: A.A. disclosed no relevant relationships.

A review of pleural infection in Northumbria Healthcare NHS Foundation Trust

Understanding epidemiology of and deficiencies in care is crucial to inform practice. We serve 600,000 patients in a well-established pleural service.[1][1] A retrospective analysis of all patients with pleural infection between December 2016 and December 2017 was conducted. 36 patients were

Assessing the prevalence of alcohol consumption in early pregnancy using blood biomarker analysis: a consistent pattern across north-east England?

We previously investigated the prevalence of alcohol consumption in early pregnancy in Northumbria Healthcare NHS Foundation Trust, a locality of north-east England. The prevalence was 1.4% based on blood sample biomarker analysis using carbohydrate deficient transferrin (CDT) and 3.5% for gamma-glutamyltransferase (GGT). To supplement this research by investigating the prevalence of alcohol use using identical methods in a different locality of the same region. Six-hundred random blood samples taken at the antenatal booking appointment were anonymously analysed for the presence of CDT, a validated marker of chronic alcohol exposure (normalizing 2-3 weeks from abstinence) and GGT, a liver enzyme elevated for up to 8 weeks after alcohol exposure. The North Tees and Hartlepool NHS Foundation Trust data revealed a CDT prevalence rate of 1.7% (95% CI: 0.7-2.9) and GGT prevalence rate of 4.2% (95% CI: 2.6-5.9). However, these measures are not sensitive to low levels of alcohol; and no overlapping cases were identified or a significant correlation demonstrated between CDT or GGT. These data support our earlier work. Prevalence rates according to CDT and GGT analysis were similar in both areas, suggesting similar patterns of sustained alcohol use in pregnancy across the region.