Outpatient Letters Research Articles

Development of a tool for generating comprehensible, individualized and digitalized outpatient letter

Abstract Background Patients often remember little from a medical consultation or a conversation with a doctor. A comprehensible, individual patient letter summarizing the consultation can support, as a German project which successfully implemented a digital tool to generate such a letter in inpatient care showed. Based on this, our aim is to develop a tool for letters in outpatient care in Switzerland, to support understanding of the consultation and increase patient’s health literacy (HL). Methods The development of the tool was conducted participatively with targeted health professionals (HP) and patients with a chronic disease to 1) identify specific patient groups and situations, 2) confirm eligibility and receive concrete input regarding structure and content, and 3) to ensure the technical practicality and usability by the target groups. Concretely, several expert and patient interviews, a focus group and consultation observations were performed. Further workshops and usability tests are planned. Results We first defined 8 criteria to identify situations suitable for the development of the letter (e.g. high information need) and interviewed 5 experts on selected topics. Based on this, chronic back pain was chosen for a deeper feasibility analysis: A focus group interview (n = 4 HP) and 5 telephone interviews with patients confirmed the eligibility and provided information on the structure and content of the letter. Observations of 5 consultations provided further insights. Then, a first concept for the letter’s content was developed and is currently being finalized. It consists of: 1) summary; 2) background; 3) diagnosis; 4) treatment; and 5) next steps and includes infoboxes and a glossary. Conclusions The tool for patient letters can be adapted to other diseases (e.g. chronic back pain) and settings (outpatient care). In a next phase, the letter will be piloted in an outpatient clinic and evaluated with HP and patients. The effect on HL will also be assessed. Key messages • Comprehensible, individualized, and digitalized patient letters can help patients to deal with health information and take better decisions for their health and well-being. • The developed patient letter and the corresponding tool should be easily adaptable for other diseases and settings.

Medication management and electrocardiogram screening in children with attention deficit hyperactivity disorder.

To quantify the proportion of referrals sent to Crumlin Cardiology Department for cardiac screening prior to commencement or modifying attention deficit hyperactivity disorder medication and assess the number detected with a clinically significant abnormality. A prospective audit was performed over a 6-month period, from November 2021 to April 2022 inclusive. Referrals sent via outpatient department triage letters, electrocardiogram dept. email, and walk-in electrocardiogram service were screened for those pertaining to commencing or modifying medication for children with attention deficit hyperactivity disorder. Each referral was coded against National Institute for Health and Care Excellence guidelines to determine the degree of clinical details given. Reported abnormalities, recommended management, and correspondence were recorded. Ninety-one referrals were received during the 6-month audit period. More than half lacked a clinical indication for referral (53/91, 58.2%), with fewer than one third (26/91, 28.5%) meeting National Institute for Health and Care Excellence criteria for referral for cardiology. Eighty (80/91) referrals had clinical outcomes available for review (missing outpatient department information and age outside of service range accounted for eleven referrals with unavailable clinical outcomes). Of the eighty clinically reviewed referrals, seventy-two (72/80, 90%) were reported as normal with no cardiology follow up required. Eight referrals (8/80, 10%) were reviewed in the Cardiology Outpatient Department prior to commencement or modifying attention deficit hyperactivity disorder medication. Of these, only one (1/80 1%) had a clinically significant abnormality which was a potential contraindication to attention deficit hyperactivity disorder medication use, and this referral was appropriate as per National Institute for Health and Care Excellence guidelines. Routine screening prior to attention deficit hyperactivity disorder medication prescription in the absence of clinical indications (as per National Institute for Health and Care Excellence) contributed to delays in medication initiation among young people with attention deficit hyperactivity disorder. Unnecessary referrals have resource implications for cardiology clinical team. Improved adherence to National Institute for Health and Care Excellence guidelines would provide benefits for patients and clinicians.

WP4.9 - Audit on writing outpatient clinic letters in the general surgery department at a tertiary care hospital

Abstract Background Clinic letters are crucial medical notes for a patient’s medical history and medico-legal purposes. We assessed the quality of clinic letters with the guidelines from the Academy of Medical Royal College suggested for writing a clinic letter. Method A retrospective collection of data was done from January – May 2023 and a total of 166 clinic letters were collected by independent authors and then analysed to avoid any bias in the collection. Results Multiple parameters were poorly documented and are mentioned in increasing order of missing data – Plan for patient/carer (37.5%), Care planning arrangements (44.6%), Complications (67.5%), Anaesthesia issues (89.4%), Allergies (94%), Diagnosis (94%), Time (99.4%), Preferred name (100%) and Personal identifiers (100%). These findings were presented in the clinical governance meeting and to improve the quality of the clinic letters, we created a generic clinic letter including mandatory parameters suggested by the guidelines. Conclusion There were a few parameters missing from the analysed clinic letters. An adequate intervention after being discussed in the clinical governance meeting, in the form of a generic clinic letter has been introduced. A repeat cycle is planned in 3-5 months to assess the improvement in the quality. There was a lack of documentation, which improved after the intervention advised by QIP. A teaching session for new junior doctors is planned at the induction session, to strengthen the importance of frailty documentation.

The clinical and dermatoscopic features of penile pigmentation in men with genital lichen sclerosus

AbstractBackgroundBenign male genital pigmentation is a confusing field with poorly defined terminology. This entity is frequently encountered in our male genital lichen sclerosus (MGLSc) cohort and suggests an association with prior inflammation, however there is a limited literature on the topic.ObjectivesThis paper describes the attributes of 21 patients with MGLSc and features of benign genital pigmentation, reviews the existing literature on benign male genital pigmentation and makes recommendations for better practice.MethodsWe prospectively identified 21 patients with MGLSc and clinical diagnoses of benign penile pigmentation who attended specialist male genital dermatoses clinics. Relevant findings were abstracted from clinical notes, outpatient letters, medical photographs, dermatoscopic images and histological reports.ResultsThe clinical features of this cohort are discussed and the dermatoscopic images analysed. 15 of 21 patients were followed up for over 2 years and all of these had stable appearance of pigmentation. 87% reported pigmentation to have emerged after the onset of MGLSc symptoms, with latency ranging from one to over 25 years. The terms lentiginosis, melanosis, and post‐inflammatory hyperpigmentation are discussed in context of the existing literature.ConclusionsWe propose that genital lentiginosis and melanosis are clinically indistinguishable macroscopically and are on a clinical and histopathological spectrum. Although there is a compelling narrative that genital melanosis is most often truly benign, there is also emerging evidence to suggest an increased risk of penile melanoma in patients with MGLSc. Furthermore, pigmented lesions in MGLSc can portray concerning morphological features even when benign. A low threshold for biopsy and follow‐up is thus warranted.

Optimising the structure of outpatient clinic letters: insights from a survey of general practitioners and hospital doctors.

Outpatient letters are an essential communication tool in healthcare. Yet doctors receive little training on letter writing and what details recipients consider important. We surveyed 106 hospital doctors and 63 general practitioners (GPs), identifying differences in each group's preferences; GPs preferred more structured, detailed letters. Opportunities for feedback, formal templates and advanced software systems can improve communication in outpatient clinics.

Enhancing Clarity and Patient Safety: Evaluating the Inclusion of Laterality in Orthopaedic Outpatient Correspondence in Galway, Ireland.

Background In medical documentation, accurate mention of laterality, whether a condition or treatment pertains to the left or the right side of the body, is critical for avoiding errors like wrong-site surgeries, which can have severe repercussions. This study aims to assess compliance regarding the mention of laterality in outpatient clinic letters at Galway University Hospital. Methods An analytical cross-sectional study was conducted at Galway University Hospital from February to August. We reviewed outpatient letters in the Orthopaedic Department. The Fisher exact and Chi-square tests were employed to observe the association between the levels of practitioners and laterality. Results A total of 278 outpatient letters from 37 practitioners in one week were analyzed. The overall laterality rate was 65.1%.It was observed that there was a male predominance in the workforce (31; 83.8%). Conclusion In conclusion, our study revealed satisfactory improvement in the prevalence of mentioning laterality among healthcare providers. It is recommended that educational sessions and re-auditing be carried out to enhance the quality of care.

Adherence to best practice guidelines: Are we addressing outpatient letters to patients and are they readable? A closed loop audit at Mid and South Essex NHS breast unit

Adherence to best practice guidelines: Are we addressing outpatient letters to patients and are they readable? A closed loop audit at Mid and South Essex NHS breast unit

A multi-lesional analysis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a single-centre analysis

To conduct a multi-lesional computed tomography (CT) analysis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) patients to determine volumetric changes in lesions over 5 years. A retrospective case-note review was undertaken to identify 16 patients with histological and radiological features of DIPNECH between 2012-2021. Area and volume were calculated for 17 sets of lesions identified on high-resolution CT. Clinical data were extracted from electronic patient records, which included demographic data, outpatient clinic letters, histology reports, and imaging reports. One hundred and twenty-eight lesions were identified in 16 patients (one male, 15 female) and followed-up annually over a median 1,985 days (range 1,450-2,290). At year 1 follow-up, lesion area ranged from 1-48 mm2, and lesion volume ranged from 8-18,380 mm3; lesion area ranged from 1-45mm2 and lesion volume ranged from 11-17,800 mm3 and year 5. Half (8/16) of the patients had concomitant typical carcinoid tumours and one patient had an atypical carcinoid tumour. No statistically significant correlation (p<0.05) was found between lesion cross-sectional area or volume and duration of follow-up (years and days). No metastatic spread was observed at the time of analysis. No significant increase was observed in the size of over 100 lesions in patients with DIPNECH over a 5-year period and no metastasis occurred during the study period affirming the relatively indolent course of the disease.

Improving the Format, Content, and Writing Process of Outpatient Clinic Letters Within a Musculoskeletal Therapy Department.

Outpatient clinic letters are recognized as an important component of patient care. This project aimed to coproduce clinic letters that have meaning and relevance for key stakeholders. This health care improvement project was conducted in one musculoskeletal therapy (physiotherapy and osteopathy) department in southern England using a Lean Six Sigma Define, Measure, Analyze, Improve, and Control-inspired framework. The views and experiences of key stakeholders, including therapists, general practitioners, and patients, were explored using surveys and group meeting methods. New letter designs were coproduced with stakeholders, including patient partners and personalized care lead staff, and were refined through a pilot phase. Qualitative data were analyzed thematically, and quantitative data were analyzed descriptively. Overall, patients and therapists found the clinic letters an important and meaningful part of care. However, therapists reported that they often did not write the letters, and time was identified as the main barrier. The main theme identified from patient feedback was that patients wanted to write the letters in collaboration with the clinician. The pilot phase demonstrated that, on average, the new letters took less time to write. This project has coproduced new clinic letters and operational processes centered on the needs of key stakeholders. This article will help other outpatient departments reflect on their own clinic letters and consider their meaning and relevance for their stakeholders.

Design of Information System for Outpatient Emergency Room Eligibility Letter to Support BPJS Claim Reporting

The advancement of technology in this era has had a significant impact on various fields, including healthcare. Hospitals strive to provide the best service to their patients so that they can get the best solution to their illnesses. A good hospital can be seen from the services provided to its patients. This research aims to produce an information system for creating patient eligibility letters in the emergency department. The method used in this research is a qualitative method with a descriptive approach by conducting data collection stages through interviews, observations, and literature studies, and the method used for developing the device is the System Development Life Cycle (SDLC) method. From this research, several problems were found in processing the creation of patient eligibility letters, namely the creation of eligibility letters still uses claim that has not been bridged with sims, causing the process of creating patient eligibility letters to take a long time, thus affecting the quality of healthcare services in the hospital's emergency unit. The suggestion given is the need for a redesign in the sims system to be bridged with vclaim.

110 Identification of Urinary Incontinence through Comprehensive Geriatric Assessment among an integrated care programme of older persons population

Abstract Background Urinary incontinence (UI) is an under-reported and treatable condition, associated with reduced quality of life. The Integrated Care programme of Older Persons (ICPOP) supports people with complex care needs in their home. There is no available research on the rate of UI among the ICPOP population. This study aimed to assess UI in this group. Methods A convenience sample of 100 patient records selected randomly from an ICPOP serving approximately 30,000 people from 2017 to present were retrospectively reviewed; including patients charts, Comprehensive Geriatric Assessments (CGAs) and outpatient letters. As part of the CGA each person was assessed for UI on domiciliary visit. Irish geriatric medicine trainees were surveyed to assess their self-reported confidence assessing and treating UI. Results Of the 100 patients CGAs reviewed, 62% were female. 11% had UI reported on their referral to ICPOP. 56% reported UI during their CGA. Only 18% of those with UI had UI generated on to their problem list. Of those patients with UI, polypharmacy (≥5 medications) was noted in 89%. 77% of those with UI were on a medication associated with worsening UI, while only 18% of those with UI were on a treating medication for UI. 25% had their UI assessed at clinic, including 7% who were referred onwards to urology for management of their UI. 80% of geriatric medicine trainees said that they did not feel confident managing UI and 100% said they would like to receive further teaching on UI. Conclusion CGA is an excellent method for identifying UI. This data suggests that UI is more prevalent among the ICPOP as compared with an inpatient population and the general population in the same age group. Further specialist teaching is needed to improve trainee confidence in this area.

1053 An Insight into Cardiac Tumours Using Over 20 Years of Up-to-Date Historical Data.

Abstract Aim Cardiac tumours are uncommon and frequently incidental findings. The study aims at analysing the demographics, presentation, histological prevalence and outcomes for cardiac tumours over the past 21 years. Method An observational retrospective data analysis on an SCTS database of all patients undergoing cardiac surgery at 3 different centres in the UK was performed. Further data was collected through operative summaries, pathology reports and outpatient letters. Results 207 patients underwent an operation for a cardiac tumour between 2001 and 2022, 66.2% were female and 33.8% male. Mean age was 62 years (17- 86 years). 62.3% were urgent procedures, 21.3% elective and 16.4% emergencies. 44 patients presented with chest pain, 29 stroke, 18 palpitations/arrhythmias, 15 shortness of breath and 7 syncope. In 51 patients the finding was incidental. Average cardiopulmonary bypass time was 80 minutes, and the average cross clamp time was 52 minutes. In 80.2% of cases the left chamber was involved, 10.6% right atrium, 1% left ventricle and 0.5% right ventricle. The final pathological specimen was reported as myxoma in 80.2% of cases, fibroelastoma in 3.9%, thrombus in 7%, sarcoma in 2.9 % and 1% calcified mass. Other histologies included osteosarcoma, lymphoma, granulation tissue, infected mass, cardiac fibroma, and lipoma. In-hospital mortality was 1.5%. Conclusions Despite the rarity of cardiac tumours and the lack of presenting symptoms, the study demonstrated that surgical mortality is low and although the overwhelmingly the commonest histology was confirmed to be myxoma, sarcoma is also an important differential as are the other histologies, which may be surprising.

P59 Results of sentinel lymph node biopsies in thin melanomas (Breslow thickness 0.8–1.0 mm) and correlation with histopathological features

Abstract In July 2022, the National Institute for Health and Care Excellence (NICE) melanoma guidelines were updated to include recommendation for a sentinel lymph node (SLN) biopsy for those with a Breslow thickness of 0.8–1 mm and at least one of the following: ulceration, lymphovascular invasion and/or a mitotic index of ≥ 2 mm². SLN biopsy is a staging procedure and therefore has an impact on prognosis. However, SLN biopsy is an invasive procedure with associated morbidity. A 5-year retrospective review of melanoma data in the south east of Ireland was undertaken to establish the correlation between positive sentinel lymph node biopsies in 0.8–1.0-mm-thick melanomas and the risk factors outlined above. Melanoma outcomes, histopathology reports and outpatient clinic letters were assessed and data were extracted from 1 January 2018 to 31 December 2022 inclusive. A total of 52 patients were identified with a melanoma of Breslow thickness of 0.8–1 mm from the predetermined timeframe. Eight per cent (n = 4) of lesions were ulcerated. Thirteen per cent (n = 7) had a mitotic index of ≥ 2 mm². One lesion was both ulcerated and had a mitotic index of ≥ 2 mm². No lesions demonstrated lymphovascular invasion. Nineteen (36%) patients underwent SLN biopsy. All patients who underwent SLN biopsy were negative. One patient with an ulcerated melanoma did not undergo SLN biopsy and five with a mitotic index of ≥ 2 did not undergo SLN biopsy. There was no evidence of disease recurrence within the follow-up period (2 months–5 years). This population showed a 0% positivity rate on SLN biopsy. No correlation with mitotic index or ulceration and SLN biopsy was identified. No patients have developed local recurrence or metastatic disease within the follow-up period. This study supports the updated NICE guidance recommending SLN biopsies for thicker melanomas (i.e. Breslow thickness &amp;gt; 1.0 mm) and SLN biopsy in thinner melanomas (Breslow thickness 0.8–1 mm) only if concerning features are present on histology (i.e. ulceration, lymphovascular invasion and/or a mitotic index of ≥ 2).

P051 Development and evaluation of a text-analytics algorithm for automated application of the BSR COVID-19 shielding criteria in rheumatology patients

Abstract Background/Aims In April 2020 the British Society for Rheumatology (BSR) issued a risk stratification guide to identify patients at the highest risk of COVID-19 requiring shielding. This guidance was based on patients’ age, comorbidities, and immunosuppressive therapies - including biologics that are not captured in primary care records. This meant rheumatologists needed to manually review outpatient letters to score patients’ risk. The process required considerable clinician time, with shielding decisions not always transparently communicated. Our aim was to develop an automated shielding algorithm by text-mining outpatient letter diagnoses and medications, reducing the need for future manual review. Methods Rheumatology outpatient letters from Salford Royal Hospital, a large UK tertiary hospital, were retrieved between 2013-2020. The two most recent letters for each patient were extracted, created before 01.04.2020 when BSR guidance was published. Free-text diagnoses were processed using Intelligent Medical Objects® software1 (Concept Tagger), which utilised interface terminology for each condition mapped to a SNOMED-CT code. We developed the Medication Concept Recognition tool (MedCore Named Entity Recognition) to retrieve medications type, dose, duration and status (active/past) at the time of the letter. The medication status was established based on the heading where they appeared (e.g. past medications, current medications), but incorporated additional information such as medication stop dates. The age, diagnosis and medication variables were then combined to output the BSR shielding score. The algorithm’s performance was calculated using clinical review as the gold standard. Results To allow for the comparison with manual decisions, we focused on all 895 patients who were reviewed clinically. 64 patients (7.1%) had not consented for their data to be used for research as part of the national opt-out scheme. After removing duplicates, 803 patients were used to run the algorithm. 11,558 free-text diagnoses were extracted and mapped to SNOMED CT, with 15,003 free-text medications (that included past, present and any planned treatment). The automated shielding algorithm demonstrated a sensitivity of 80.3% (95% CI: 74.7, 85.2%) and specificity of 92.2% (95% CI: 89.7, 94.2%). Positive likelihood ratio was 10.3 (95% CI: 7.7, 13.7), negative likelihood ratio was 0.21 (95% CI: 0.16, 0.28), F1 score was 0.81. False positive rate was 7.9%, whilst false negative rate was 19.7%. Further evaluation of false positives/negatives revealed clinician interpretation of BSR guidance and misclassification of medications status were important contributing factors. Conclusion An automated algorithm for risk stratification has several advantages including reducing clinician time for manual review to allow more time for direct care, improving efficiency and transparently communicating decisions based on individual risk. With further development, it has the potential to be adapted for future public health initiatives that requires prompt automated review of hospital outpatient letters. Disclosure M. Jani: None. G. Alfattni: None. M. Belousov: None. Y. Zhang: None. M. Cheng: None. K. Webb: None. A. Kanter: None. W. Dixon: Consultancies; Google (unrelated to this work). G. Nenadic: None.

P052 Hydroxychloroquine retinopathy incidence in a UK specialist centre: a machine learning/natural language processing pilot study

Abstract Background/Aims Hydroxychloroquine (HCQ) is an antimalarial drug commonly used in autoimmune conditions such as systemic lupus erythematous (SLE) and rheumatoid arthritis (RA). In SLE, it has been shown to significantly improve survival and morbidity, but is known to be rarely associated with sight-threatening retinopathy. Data from the US suggested HCQ retinopathy was significantly more common than previously thought (up to 7%), causing the Royal College of Ophthalmology to recommend increased screening in 2018. Natural language processing (NLP) is a machine learning technique which purports to be able to identify patients with a specific diagnosis or taking specific mediations from unstructured data such as clinic letters. This study aimed to understand whether NLP could be used to (i) identify patients taking HCQ and (ii) determine rates of HCQ retinopathy from clinic letters in a UK tertiary Rheumatology centre. Methods The study was set across the Kellgren Centre for Rheumatology (regional tertiary lupus centre) and the Manchester Eye Hospital. Analysis was performed using CogStack/MedCat, an open source self-supervised NLP framework which extracts SNOMED coded items from unstructured electronic health data such as clinic letters. All clinical documents 2012-2022 were identified for patients attending clinics coded as HCQ retinopathy screening. These were processed through Cogstack/MedCat in two stages. Firstly, it identified all patients exposed to HCQ according to their clinic letters. Subsequently, MedCat searched all clinical documents for those patients for references to HCQ retinopathy, HCQ retinopathy screening or retinopathy. Diabetic retinopathy was used to sense-check for other forms of retinopathy. Finally, manual validation of the HCQ retinopathy positive cases was performed. Results From an original 202,704 documents, HCQ exposure was identified in 3904 unique patients. These patients had 74,377 associated clinical documents, from which the NLP process indicated 2815 referenced HCQ retinopathy or retinopathy alone (including screening). From clinic codes 1299 individual patients (33.3% of the HCQ exposed population) were confirmed to have undergone screening; 1094 (84.2%) were female, mean age 54.8 years at the time of screening. Of those screened, NLP highlighted 568 references to HCQ retinopathy from 507 patients, within which 10 (0.77%) were confirmed to have HCQ retinopathy by manual validation. Conclusion The study has demonstrated that NLP is a promising technique to quickly identify subsets of patients (e.g. those taking HCQ) from large numbers of outpatient clinic letters. Further training of the algorithm may improve its ability to identify rare but important clinical outcomes. In a tertiary SLE centre, roughly one third of patients on HCQ were screened for HCQ retinopathy and 0.77% confirmed HCQ retinopathy. This is much lower than data from the previous studies in the US, but is in keeping with more recent publications in UK data, reflected in recent amendments to screening guidelines. Disclosure Y. Mushtaq: None. G. Tilston: None. K.L. Hyrich: None. A. Barton: None. N. Peek: None. B. Parker: None. D. Griffiths: None. J.H. Humphreys: None.

Intracranial venous stenting for idiopathic intracranial hypertension.

There is increasing evidence in the literature to support venous sinus stenting in patients with idiopathic intracranial hypertension who fail first-line therapy. Venous sinus stenting is a safe and successful technique compared with cerebrospinal fluid diversion procedures. This study examines the clinical outcomes of patients post intracranial venous stenting for intracranial hypertension across three tertiary hospitals in Western Australia. A retrospective analysis was performed on 83 consecutive patients treated with intracranial venous stenting for IIH at three tertiary hospitals from October 2013 to March 2020. Data were collected from outpatient clinic letters, electronic discharge letters, electronic radiological imaging and procedural reports. 89.2% patients were able to cease Acetazolomide post stenting. 78.3% patients reported resolution of headaches. 84.3% patients demonstrated resolution of their papilloedema. 91.6% patients demonstrated improvement of their visual acuity. Compared with a recent meta-analysis by Satti and Chaudry in 2015, our results demonstrated a higher technical success rate and lower complication rates. Our study findings support the paradigm shift from CSF diversion procedures to venous sinus stenting in patients with IIH who fail first-line therapy. Venous sinus stenting has a high technical success rate and significantly lower complication rates than other invasive treatments.

Outpatient Letters in Real Time for Better Patient Outcomes

The Sunshine Coast Hospital and Health Service commenced a six-month proof-of-concept to trial speech recognition and self-type software in 2020. This action was taken in response to an ageing medical transcription workforce; an increase in outpatient letters due to population growth and the novel coronavirus pandemic; and more timely transfer of care communication to GPs. The proof-of-concept presented the health service with a unique opportunity as no other public hospital in Queensland had leveraged speech recognition or self-type software for the production and distribution of outpatient letters. The proof-of-concept trial provided 18 clinicians with the choice to type or dictate outpatient letters, electronically sign, and distribute to referring general practitioners (GPs) in one transaction. The results of the proof-of-concept demonstrated a 39% uptake of speech recognition and self-type software, demonstrating an opportunity to supplement the medical transcription workforce to address the rising outpatient activity. The proof-of-concept also demonstrated an average reduction in transaction time of 25% from the baseline measure over the six-month trial period. This finding supports the timely transfer of communication to GPs. However, it will need to be carefully analysed against the participant frustrations of voice to text accuracy to minimise the risk of poor adoption.

Giant cell arteritis: A population-based retrospective cohort study exploring incidence and clinical presentation in Canterbury, Aotearoa New Zealand.

To determine the epidemiology and clinical features of giant cell arteritis (GCA) in Canterbury, Aotearoa New Zealand, with a particular focus on extra-cranial large vessel disease. Patients with GCA were identified from radiology and pathology reports, outpatient letters and inpatient hospital admissions in the Canterbury New Zealand from 1 June 2011 to 31 May 2016. Data was collected retrospectively based on review of electronic medical records. There were 142 cases of GCA identified. 65.5% of cases were female with a mean age of 74.2 years. The estimated population incidence for biopsy-proven GCA was 10.5 per 100,000 people over the age of 50 and incidence peaked between 80 and 84 years of age. 10/142 (7%) people were diagnosed with large vessel GCA, often presenting with non-specific symptoms and evidence of vascular insufficiency including limb claudication, vascular bruits, blood pressure and pulse discrepancy, or cerebrovascular accident. Those with limited cranial GCA were more likely to present with the cardinal clinical features of headache and jaw claudication. Patients across the two groups were treated similarly, but those with large vessel disease had greater long-term steroid burden. Rates of aortic complication were low across both groups, although available follow-up data was limited. This study is the first of its kind to describe the clinical characteristics of large vessel GCA in a New Zealand cohort. Despite small case numbers, two distinct subsets of disease were recognized, differentiating patients with cranial and large vessel disease. Our results suggest that utilization of an alternative diagnostic and therapeutic approach may be needed to manage patients with large vessel disease.

196 AN AUDIT OF PROTON-PUMP INHIBITOR PRESCRIBING IN PATIENTS ATTENDING A RAPID ACCESS FRAILTY ASSESSMENT UNIT

Abstract Background Proton-Pump Inhibitor (PPI) usage has revolutionised gastroenterology practice with clinical indications for conditions such as Gastro-Oesophageal Reflux Disease (GORD), gastric and duodenal ulceration and Barrett's Oesophagus. However, these drugs are inappropriately prescribed, particularly among patients with an already heavy polypharmacy burden. PPI usage has been linked with electrolyte disturbances, most commonly hypomagnesaemia, resulting in higher rates of osteoporosis. It has also been shown to have adverse effects on renal function, an increased correlation with clostridium difficile and most recently, a deleterious impact on cognitive function. The purpose of this audit was to assess the appropriateness and clinical indication of PPI prescribing among patients attending Rapid Access Frailty Assessment Unit (RAFAU) in 2022. Methods A database of patients attending RAFAU in an Irish regional hospital was accessed. Records from years 2021-2022 were searched and documents citing patients’ medical history and clinical indication for prescribed medications included hospital discharge letters, outpatient clinic letters and GP referral letters. NICE guidelines from the UK NHS were used as comparison for prescribing guidelines. Results 120 patients’ records were assessed. 63 (52.5%) patients were found to be prescribed a PPI among this cohort. Of those taking PPIs, only 15 (23.8%) patients were prescribed a PPI with a documented clinical indication in accordance with NICE Guidelines. Although several patients were taking gastro-erosive drugs including antiplatelets, anticoagulants and steroids, only one patient record mentioned PPIs being prescribed for iatrogenic gastritis. No records mentioned deprescribing or cessation of PPIs. Conclusion Most patients prescribed PPIs were without documented appropriate clinical indication and without clear duration of use. This is of particular importance among a frailty population where de-prescribing medications associated with significant co-morbidities should be prioritised.

Development of a Semiautomated Database for Patients With Adult Congenital Heart Disease.

Databases for Congenital Heart Disease (CHD) are effective in delivering accessible datasets ready for statistical inference. Data collection hitherto has, however, been labour and time intensive and has required substantial financial support to ensure sustainability. We propose here creation and piloting of a semiautomated technique for data extraction from clinic letters to populate a clinical database. PDF formatted clinic letters stored in a local folder, through a series of algorithms, underwent data extraction, preprocessing, and analysis. Specific patient information (diagnoses, diagnostic complexity, interventions, arrhythmia, medications, and demographic data) was processed into text files and structured data tables, used to populate a database. A specific data validation schema was predefined to verify and accommodate the information populating the database. Unsupervised learning in the form of a dimensionality reduction technique was used to project data into 2 dimensions and visualize their intrinsic structure in relation to the diagnosis, medication, intervention, and European Society of Cardiology classification lists of disease complexity. Ninety-three randomly selected letters were reviewed manually for accuracy. There were 1409 consecutive outpatient clinic letters used to populate the Scottish Adult Congenital Cardiac Database. Mean patient age was 35.4 years; 47.6% female; with 698 (49.5%) having moderately complex, 369 (26.1%) greatly complex, and 284 (20.1%) mildly complex lesions. Individual diagnoses were successfully extracted in 96.95%, and demographic data were extracted in 100% of letters. Data extraction, database upload, data analysis and visualization took 571 seconds (9.51 minutes). Manual data extraction in the categories of diagnoses, intervention, and medications yielded accuracy of the computer algorithm in 94%, 93%, and 93%, respectively. Semiautomated data extraction from clinic letters into a database can be achieved successfully with a high degree of accuracy and efficiency.