Patient Feedback Questionnaires Research Articles

Medical Students' General Beliefs and Specific Perceptions about Patient Feedback Before and after Training in a Clinical Context.

Despite its high potential, patient feedback does not always result in learning. For feedback to be effective students must engage with it, which partly depends on their perceptions of feedback. To better understand student engagement with patient feedback in a clinical context, this study explored the following research questions: 1) What are medical students' general beliefs about patient feedback and what are their specific perceptions of feedback messages? 2) What is the difference between these general beliefs and feedback message perceptions before and after patient feedback training? The study context was a 12-week clerkship combining Pediatrics and Gynecology, which included feedback training for students and asking for patient feedback. Ninety 4th-year medical students completed pre- and post-clerkship questionnaires. The questionnaires (Beliefs about Patient Feedback Questionnaire, Feedback Perception Questionnaire) were adapted from validated peer-feedback questionnaires. Questionnaires were quantitatively analyzed. Both pre- and post-clerkship, students had positive general beliefs about patient feedback and positive perceptions of the feedback messages they received. However, paired t-tests showed that students' general beliefs and feedback message perceptions became less positive after feedback training and experience. Patient feedback is not an easy means to learn and students do not become feedback literate in terms of patient feedback overnight. We suggest that future researchers further explore reasons for the decline in positive perceptions of patient feedback. We suggest implementing longitudinal feedback training in medical curricula, where students are guided and supported in the complex task of learning from patients through feedback.

Evaluating step-down, intermediate care programme in Buckinghamshire, UK: a mixed methods study

BackgroundIntermediate care (IC) services are models of care that aim to bridge the gap between hospital and home, enabling continuity of care and the transition to the community. The purpose of this study was to explore patient experience with a step-down, intermediate care unit in Buckinghamshire, UK.MethodsA mixed-methods study design was used. Twenty-eight responses to a patient feedback questionnaire were analysed and seven qualitative semi-structured interviews were conducted. The eligible participants were patients who had been admitted to the step-down IC unit. Interview transcripts were analysed using thematic analysis.FindingsOur interview data generated five core themes: (1) “Being uninformed”, (2) “Caring relationships with health practitioners”, (3) “Experiencing good intermediate care”, (4) “Rehabilitation” and (5) “Discussing the care plan”. When comparing the quantitative to the qualitative data, these themes are consistent.ConclusionsOverall, the patients reported that the admission to the step-down care facility was positive. Patients highlighted the supportive relationship they formed with healthcare professionals in the IC and that the rehabilitation that was offered in the IC service was important in increasing mobility and regaining their independence. In addition, patients reported that they were largely unaware about their transfer to the IC unit before this occurred and they were also unaware of their discharge package of care. These findings will inform the evolving patient-centred journey for service development within intermediate care.

Developing a post-myocardial infarction medicines optimisation clinic: core competencies for upskilling pharmacists and initial patient feedback

BackgroundMedicines optimisation and adherence support are essential to secondary prevention after myocardial infarction (MI). Following successful implementation of a consultant pharmacist-led post-MI medicines optimisation clinic, the service was expanded by...

139 A PHARMACIST-LED INTERVENTION TO IMPROVE QUALITY OF CARE AND REDUCE RISK OF RECURRENCE IN HOSPITALISED STROKE PATIENTS

Abstract Background Stroke is the leading cause of acquired disability, and the 3rd leading cause of death, in Ireland. This Quality Improvement Project focused on improving the pathway of care provided to stroke inpatients in an acute general hospital admitting up to 60 stroke patients per annum. The care pathway of stroke patients should include specialist input from the wider Multi-Disciplinary Team (MDT), including pharmacists. Methods An audit collected data in 2 phases: (A) a retrospective data review looking for broader themes, and (B) a prospective data collection focused on primary drivers of quality care, including patient feedback questionnaires and follow-up phone calls to patients post-discharge. A Pharmacist Screening Tool was applied to individual patient data, and medication changes documented. Key drivers of improvement were identified Results Phase A of the audit included 20 patients with confirmed stroke, average age 66 years, all with ischaemic stroke. Phase B included 20 patients, average age 69 years, all with ischaemic stroke. Four primary drivers of quality were identified: (1) Lack of, or delayed, referral to the stroke specialist team; (2) Transcription/prescription errors; (3) Low rate of patient counselling on medications pre-discharge; (4) High rates of interventions and medication changes, with other complexities in medication regimens. Future audit cycles will implement (a) increased education of healthcare professionals about best-practice in stroke and (b) dedicated specialist pharmacist input for stroke inpatients. Conclusion Patient feedback highlighted that written information given on discharge was unclear; and errors in medication prescriptions or lack of specialist input were common. A focused, patient-centric approach can improve patient satisfaction, and overall outcomes post-stroke. Pharmacist-led interventions are a key part of the stroke bundle of care.

306 GERIATRICIAN-LED COMPREHENSIVE GERIATRIC ASSESSMENT IN THE EMERGENCY DEPARTMENT: A COST-EFFECTIVE SERVICE APPROVED BY PATIENTS

Abstract Background Many older people are brought to the Emergency Department (ED) who do not require acute hospital admission but there are risks to these patients if this occurs. The Frailty Intervention Team (FIT) are an interdisciplinary team based in the ED including physiotherapy, occupational therapy, speech and language therapy, dietetics, pharmacy, advanced nurse practitioners, and a geriatric registrar and consultant. They assess frail older patients and suggest alternative care pathways to admission. We aimed to investigate the impact of FIT on admission avoidance, bed days saved and to obtain patient feedback on their experience. Methods Routinely collected data from May 2021 to April 2022 was reviewed retrospectively. An anonymous patient feedback questionnaire was posted to 40 patients randomised from the FIT worklist between January to May 2022. Results 2,025 Comprehensive Geriatric Assessments (CGA) were completed between May 2021 and April 2022. 38% percent of patients were discharged home, 45% of this number had follow-up arranged. 104 patients were transferred directly to an offsite bed, mostly rehabilitation. We estimate we avoided 51 admissions to the acute hospital per month, almost half of these were patients admitted to the hospital and, who we discharged to alternative care pathways or home. The average length of stay in April 2022 was 22 days – by avoiding 615 admissions between May 2021 and April 2022 we have saved 13,530 bed days at an estimated cost saving of almost €11 million. 15 completed questionnaires were returned. 73% were very satisfied with their experience. 87% felt the FIT team helped facilitate their discharge from ED. The main themes identified from open ended questions included thorough assessment, patient centred care and satisfaction with early intervention and discharge. Conclusion A Frailty Intervention Team is a cost effective and patient centred way of avoiding unnecessary admissions for older people presenting to the ED.

Patient-reported outcomes in a pilot clinical trial of twice-weekly hemodialysis start with adjuvant pharmacotherapy and transition to thrice-weekly hemodialysis vs conventional hemodialysis

BackgroundPhysical and emotional symptoms are prevalent in patients with kidney-dysfunction requiring dialysis (KDRD) and the rigors of thrice-weekly hemodialysis (HD) may contribute to deteriorated health-related quality of life. Less intensive HD schedules might be associated with lower symptom and/or emotional burden.MethodsThe TWOPLUS Pilot study was an individually-randomized trial conducted at 14 dialysis units, with the primary goal to assess feasibility and safety. Patients with incident KDRD and residual kidney function were assigned to incremental HD start (twice-weekly HD for 6 weeks followed by thrice-weekly HD) vs conventional HD (thrice-weekly HD). In exploratory analyses, we compared the two treatment groups with respect to three patient-reported outcomes measures. We analyzed the change from baseline in the score on Dialysis Symptom Index (DSI, range 0–150), Generalized Anxiety Disorder-7 (GAD-7, range 0–21), and Patient Health Questionnaire-9 (PHQ-9, range 0–27) at 6 (n = 20 in each treatment group) and 12 weeks (n = 21); with lower scores denoting lower symptom burden. Analyses were adjusted for age, race, gender, baseline urine volume, diabetes mellitus, and malignancy. Participants’ views on the intervention were sought using a Patient Feedback Questionnaire (n = 14 in incremental and n = 15 in conventional group).ResultsThe change from baseline to week 6 in estimated mean score (standard error; P value) in the incremental and conventional group was − 9.7 (4.8; P = 0.05) and − 13.8 (5.0; P = 0.009) for DSI; − 1.9 (1.0; P = 0.07) and − 1.5 (1.4; P = 0.31) for GAD-7; and − 2.5 (1.1; P = 0.03) and − 3.5 (1.5; P = 0.02) for PHQ-9, respectively. Corresponding changes from week 6 to week 12 were − 3.1 (3.2; P = 0.34) and − 2.4 (5.5; P = 0.67) in DSI score; 0.5 (0.6; P = 0.46) and 0.1 (0.6; P = 0.87) in GAD-7 score; and − 0.3 (0.6; P = 0.70) and − 0.5 (0.6; P = 0.47) in PHQ-9 score, respectively. Majority of respondents felt their healthcare was not jeopardized and expressed their motivation for study participation was to help advance the care of patients with KDRD.ConclusionsThis study suggests a possible mitigating effect of twice-weekly HD start on symptoms of anxiety and depression at transition from pre-dialysis to KDRD. Larger clinical trials are required to rigorously test clinically-matched incrementally-prescribed HD across diverse organizations and patient populations.Trial registrationRegistered at ClinicalTrials.gov with study identifier NCT03740048, registration date 14/11/2018.

Intravenous cannula induced phlebitis in a tertiary care referral hospital: A prospective observational study with implication from patient's feedback system

BackgroundMedicines delivered directly to systemic circulation have saved many lives from life-threatening conditions, but also can impart undesirable effects. Materials and methodsA prospective observational study was performed for 10 months in the tertiary care hospital to identify and evaluate cannula induced phlebitis in our study population. The data collection form retrieved demographic details, diseases and cannulation particulars of each patient. Moreover, a patient feedback questionnaire (Cronbach's alpha=0.70) retrieved their concerns toward cannulation. ResultsPhlebitis was identified in 96 patients out of 146 subjects enrolled in the study; 52% had the first sign of phlebitis. Female patients were more prone, and the complication occurred irrespective of age (p>0.05). On the other hand, those on IV cefoperazone-sulbactam (n=13, 13.5%) followed by amoxicillin clavulanic acid (n=6, 6%) had significant cannulation complication (p<0.01). The cannula indwells time (p=0.001) and vein assessment (p=0.001) were statistically associated with incidence of phlebitis. Half of our samples had pain lasting about five minutes (χ2=9.2, p<0.05). Nevertheless, limited patients (n = 35, 36.5%) were prescribed topical Heparin Benzyl Nitrate, and none preferred to self-medicate nor opted for other home remedies. ConclusionsThe study depicted high prevalence of phlebitis factored in by poor vein assessment and increase in indwelling time. We recommend proper awareness with on-site skill improvement program for health professionals on administration techniques and monitoring principles in order to lower cannulation related complications.

Using Smartwatches to Observe Changes in Activity During Recovery From Critical Illness Following COVID-19 Critical Care Admission: 1-Year, Multicenter Observational Study.

BackgroundAs a sequela of the COVID-19 pandemic, a large cohort of critical illness survivors have had to recover in the context of ongoing societal restrictions.ObjectiveWe aimed to use smartwatches (Fitbit Charge 3; Fitbit LLC) to assess changes in the step counts and heart rates of critical care survivors following hospital admission with COVID-19, use these devices within a remote multidisciplinary team (MDT) setting to support patient recovery, and report on our experiences with this.MethodsWe conducted a prospective, multicenter observational trial in 8 UK critical care units. A total of 50 participants with moderate or severe lung injury resulting from confirmed COVID-19 were recruited at discharge from critical care and given a smartwatch (Fitbit Charge 3) between April and June 2020. The data collected included step counts and daily resting heart rates. A subgroup of the overall cohort at one site—the MDT site (n=19)—had their smartwatch data used to inform a regular MDT meeting. A patient feedback questionnaire and direct feedback from the MDT were used to report our experience. Participants who did not upload smartwatch data were excluded from analysis.ResultsOf the 50 participants recruited, 35 (70%) used and uploaded data from their smartwatch during the 1-year period. At the MDT site, 74% (14/19) of smartwatch users uploaded smartwatch data, whereas 68% (21/31) of smartwatch users at the control sites uploaded smartwatch data. For the overall cohort, we recorded an increase in mean step count from 4359 (SD 3488) steps per day in the first month following discharge to 7914 (SD 4146) steps per day at 1 year (P=.003). The mean resting heart rate decreased from 79 (SD 7) beats per minute in the first month to 69 (SD 4) beats per minute at 1 year following discharge (P<.001). The MDT subgroup’s mean step count increased more than that of the control group (176% increase vs 42% increase, respectively; +5474 steps vs +2181 steps, respectively; P=.04) over 1 year. Further, 71% (10/14) of smartwatch users at the MDT site and 48% (10/21) of those at the control sites strongly agreed that their Fitbit motivated them to recover, and 86% (12/14) and 48% (10/21), respectively, strongly agreed that they aimed to increase their activity levels over time.ConclusionsThis is the first study to use smartwatch data to report on the 1-year recovery of patients who survived a COVID-19 critical illness. This is also the first study to report on smartwatch use within a post–critical care MDT. Future work could explore the role of smartwatches as part of a randomized controlled trial to assess clinical and economic effectiveness.International Registered Report Identifier (IRRID)RR2-10.12968/ijtr.2020.0102

P140 Patient experience of osteoporosis telephone consultations

Background/AimsThe COVID-19 pandemic resulted in a rapid change to the use of virtual consultations in both primary and secondary care. Since April 2020, our osteoporosis clinic appointments have predominantly been undertaken by telephone. We wanted to assess our patients’ experience of telephone consultations.MethodsA patient feedback questionnaire was developed by the osteoporosis team which was validated by the Patient Advice and Liaison Service team (PALS) at the Royal United Hospital Bath. A questionnaire consisting of 15 questions was sent to patients following their telephone consultation. Patient consent to receive the questionnaire was requested by the consulting clinician for each participant. The patients were provided with a stamped addressed envelope to return the completed anonymous questionnaire. Thematic analysis was used to identify themes in the qualitative data.ResultsA total of 39 questionnaires were completed. More than 86% of patients reported that their telephone consultation definitely met their needs. Over 89% answered ‘yes definitely’ to questions regarding understanding of the reason for their appointment, opportunities for questions, clear understandable answers, feeling listened to, and treatment plans. 59% of patients responded ‘yes definitely’ that they were given information prior to the appointment about what would happen in the consultation, 10% reported they hadn’t, with 31% responding they had but to some extent only. 72% of respondents reported that it was clear who they should contact if they had any further questions following the consultation. Regarding preference for future appointments, 47% of patients indicated that they would prefer a mixture of telephone, face to face and video consultations; 24% preferred telephone, 16% preferred hospital face to face, and 3% preferred video. 11% reported that they had no preference. Thematic analysis of individual comments identified positive themes such as flexibility, good communication with clinicians and convenience. Areas for development are around communication with regard to physical barriers such as hearing and telephone signal problems. There are also limitations around both physical examination and the transmission of implicit information (non-verbal communication).ConclusionVirtual consultations provide an opportunity to safely assess patients whilst meeting social distancing requirements and minimising patient flow through the hospital. Questionnaire analysis indicates an overall positive experience of telephone consultations. However, most patients would prefer a mixture of face to face, video and telephone consultations in future. There are a number of areas for improvement including: a review of the information provided to patients prior to the consultation, review of contact information for patients following the consultation, and mechanisms for identifying patients with physical/sensory limitations. The information gained through this small review will help us improve the overall telephone consultation experience for our patients.Disclosure J.L. Webb: None. S.A. Hardcastle: None. S.M. Warren: None. D.J. Hart: None. J.A. Shipley: None. T. Ahmed: None.

Quality Assessment Methods Regarding the Processing of the Patient Feedback Questionnaire Form an Emergency County Hospital - Case Study

Abstract The patient feedback mechanism is the set of measures and procedures aimed at assessing patients satisfaction with medical services received in public hospitals, by analyzing the responses provided by patients on the quality of services, respect for patients’ rights and moral conduct of medical staff. Following the interpretation of the result of the data obtained from the verification of the patient feedback questionnaire, when asked how satisfied you are with the medical services offered by the hospital, there is an increase of 8% in 2021 compared to 2020. At the same time, there is an increase of 6%, of patients very satisfied with the cleanliness of the hospital and the appearance of the underwear and the effects in the hospital, in 2021 compared to 2020. Regarding the clear explanations regarding the diagnosis and treatment, we have a percentage decrease of 1%, compared to 2020.

NS-65: Introducing frailty assessment into a myeloma service – a Quality Improvement Project (QIP)

Developments in management and treatment of myeloma have extended survival rates in the myeloma population (Kumar et al, 2008) resulting in older patients living with the effects of myeloma and treatments and also the concurrent problems of ageing. The myeloma multidisciplinary team (MDT) in Leicester UK introduced frailty assessment for newly diagnosed patients over 65 years using QIP methodology as a Clinical Nurse Specialist (CNS) led initiative. The aim being to improve MDT decision making and documentation about treatment attenuation and furthermore to proactively identify frailty to enable enhanced support for frailer patients. This was aimed to be the initial development of an older person's pathway of care. The International Myeloma Working Group (IMWG) frailty score (Palumbo et al 2015) and Clinical Frailty Score (Rockwood et al, 2005) were used as assessment tools, the latter being widely used throughout UK healthcare settings. Following initial audit and project planning, stakeholder engagement was undertaken using questionnaires, experience surveys and presentations. Interventions were planned using the Plan-Do-Study-Act (PDSA) method. Data was collected via audit of a number of team documentation sources and via patient feedback questionnaires. The aim of the project was surpassed and in both PDSA 2 and 3, 100% of newly diagnosed patients were frailty assessed, results being discussed in MDT, documented and communicated to primary care. The quality of information about patient frailty and function assisted MDT decision-making processes and improved over the QIP. This enabled clear rationales for MDT decisions to be documented in relation to individualised patient treatment options. There were no extra demands on CNS time, in fact consultation time decreased. Patient experience was maintained. The MDT recognised during the project that frailty scores need to be used with caution taking into consideration myeloma burden and presenting complications to avoid the risk of under-treatment (American Society of Haematology, 2019). Frailty scoring is now embedded into practice and assessment.

Patient experience of virtual consultations in Oral Medicine during the COVID-19 pandemic.

ObjectiveThe COVID‐19 pandemic resulted in a rapid shift to the use of virtual consultations in both primary and secondary care. The aim of this study was to assess patient experience of virtual consultations (telephone and video) in the Oral Medicine department during the first wave of the COVID‐19 pandemic.MethodsA validated survey was developed with the Patient Experience Team in Guy's and St Thomas' NHS Foundation Trust. A combination of previously validated questions and newly validated psychometric questions were used to design the patient feedback questionnaire. The survey was administered to all patients following their virtual (telephone or video) consultation. Data were synthesised and electronically analysed. Qualitative data were thematically analysed.ResultsA total of 115 surveys were completed. Over 82% rated their experience as good or very good and 69% preferred a virtual consultation for their next consultation. Thematic analysis of individual comments identified positive themes including convenience and positive/helpful clinical experience. Areas for development identified from thematic analysis included accessibility and clinical limitations in not undertaking a physical examination.ConclusionOverall, the patient experience of virtual consultations in Oral Medicine was positive.

Providing dignity therapy to patients with advanced cancer: a feasibility study within the setting of a hospital palliative care unit

BackgroundDignity is a basic principle of palliative care and is intrinsic in the daily practice of professionals assisting individuals with incurable diseases. Dignity Therapy (DT) is a short-term intervention aimed at improving the sense of purpose, meaning and self-worth and at reducing the existential distress of patients facing advanced illness. Few studies have examined how DT works in countries of non-Anglo Saxon culture and in different real-life settings. Moreover, most studies do not provide detailed information on how DT is conducted, limiting a reliable assessment of DT protocol application and of its evaluation procedure.The aim of this study was to assess the feasibility and acceptability of a nurse-led DT intervention in advanced cancer patients receiving palliative care.MethodThis is a mixed-method study using before and after evaluation and semistructured interviews. Cancer patients referred to a hospital palliative care unit were recruited and provided with DT. The duration of sessions, and timeframes concerning each step of the study, were recorded, and descriptive statistical analyses were performed.The patients' dignity-related distress and feedback toward the intervention were assessed through the Patient Dignity Inventory and the Dignity Therapy Patient Feedback Questionnaire, respectively. Three nurses were interviewed on their experience in delivering the intervention, and the data were analyzed qualitatively.ResultsA total of 37/50 patients were enrolled (74.0%), of whom 28 (75.7%) completed the assessment. In 76.7% of cases, patients completed the intervention in the time limit scheduled in the study. No statistically significant reduction in the Patient Dignity Inventory scores was observed at the end of the intervention; most patients found DT to be helpful and satisfactory. Building opportunities for personal growth and providing holistic care emerged among the facilitators to DT implementation. Nurses also highlighted too great of a time commitment and a difficult collaboration with ward colleagues among the barriers.ConclusionsOur findings strongly support the acceptability, but only partially support the feasibility, of nurse-led DT in advanced cancer patients in a hospital setting. Further research is needed on how to transfer the potential benefits of DT into clinical practice.Trial registrationRetrospectively registered on ClinicalTrial.gov NCT04738305.

Tele-Otolaryngology at a Tertiary Care Center in North India During COVID-19 Pandemic Lockdown: A Validated Patient Feedback Questionnaire Based Study

Providing medical care using the telecommunication networks holds the promise of increased access and efficiency of healthcare particularly during global emergencies like the Coronavirus disease 2019 (COVID-19) pandemic. Most of the hospital setups worldwide have put telemedicine into practice ever since the onset of the COVID-19 pandemic. This study aimed at assessing the effectiveness of Tele-otolaryngology (TO) at a tertiary care centre during the pandemic lockdown. A validated patient feedback questionnaire was developed and distributed to 2577 patients who utilised the TO mobile health service at our institute. Patient feedback-based assessment of TO effectiveness during COVID-19 lockdown was carried out. The validated questionnaire in English and Hindi was statistically robust with Cronbach’s alpha value of 0.808 and 0.886 respectively. 1751 patients completed their feedback to the questionnaire. 97.5% utilised WhatsApp for TO consultation. 15.2% patients were detected of Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection with TO guidance. Up to 75% patients had a positive response to the questionnaire and 91.1% opined of savings achieved either with travel time, cost incurred or the treatment time. With respect to patient health status, 71.5% recovered, 20.1% had no change and 8.4% deteriorated with a mortality rate of 1.65%. Telehealth in otolaryngology during the COVID-19 pandemic lockdown was indispensable in managing exigencies. Redesigning of clinical protocol and technical constraints, clinician training and a validated patient feedback questionnaire would effectively bestow upon the global emergencies.

Coping with and management of COVID-19 restrictions within the secure and forensic inpatient setting - a patients' and carers’ perspective

AimsTo seek patients' feedback on their wellbeing and the service adaptations during the COVID-19 pandemicTo obtain carers’ views on service adaptations during the COVID-19 pandemic.To establish impact on patients' wellbeing and progress in the context of COVID-19BackgroundThe COVID-19 pandemic resulted in unprecedented challenges faced by healthcare systems worldwide. Public Health England (PHE) provided guidance to manage the spread of the virus. In response to the national lockdown, the Forensic Healthcare Service part of Sussex Partnership NHS Foundation Trust (SPFT) took measures that were considered necessary to prevent the risk of spread to patients and staff.Restrictions necessary to contain the virus included immediate suspension of all patients leave except emergency leave, suspension of visits by family members and professionals including legal visits and restrictions on multidisciplinary (MDT) members physically present on the wards. It was necessary to adapt our existing model of care to reflect and represent the challenges faced by such restrictions.A service evaluation project was undertaken to ascertain the patients' and carers’ perspectives of the management of restrictions.MethodStandardsIt is noteworthy that no service standards in the context of this unique global pandemic were available internationally, nationally or regionally at the time of undertaking the project.Methodology / Data collectionAn anonymous patient feedback questionnaire was developed to collect data on voluntary basis from all the inpatients within the secure and forensic CDS. Patients' feedback was broadly divided in to three sections 1) personal factors, 2) satisfaction with access to information and 3) satisfaction with services to include mental and physical well-being.Patients' feedback was collected during a 6-week period. For observation purposes, risk comparison anonymous data were also collected. Informal Carers' feedback was collected with regard to virtual visits.ResultDuring the data collection period 99 out of 105 beds were occupied. The response rate was 49% (49 responders).Overall 73% of responders expressed that their mental health was affected. Approximately 51% of responders expressed that progress towards their discharge was very much affected. 91% of responders were not coping well with the new circumstancesOverall, carers' feedback was positive in regard to provision of virtual visits.ConclusionOur survey has shown that the necessary COVID-19 pandemic restrictions have in some domains resulted in a negative impact on patients’ mental wellbeing and progression. However, it also identifies positive areas of new practice, which have been maintained by the service.

Implementing a community model of early pregnancy care

BackgroundIn the UK Early Pregnancy Assessment Units (EPAUs) are usually situated alongside hospital maternity and gynaecology services. In June 2018, the Oxford EPAU relocated from the John Radcliffe Hospital to a community clinic. This is to our knowledge, the UK’s first community-based EPAU. This change was inspired by our patient feedback describing the co-location of the EPAU with maternity services as distressing.MethodsFollowing the introduction of the community EPAU we developed a database to capture information on the patients seen in the clinic. This is a retrospective observational study of a single cohort of patients attending the clinic over an 8 month period. Data was collected from 1st July 2018 to 28th February 2019. This data included clinical, safety and patient experience outcomes.ResultsTwo thousand nine hundred and twenty patient episodes were recorded, 1,932 were new patients. Mean waiting time to be seen in clinic was 1.3 days. When miscarriage was confirmed 48.6% chose conservative management, 19.9% chose medical management, and 31.5% chose surgical management. The mean rate of ambulance transfers to hospital was 3.1 per month. Of all patients seen in EPAU 32 had unplanned admissions, which accounted for 2.7% of all patients seen in EPAU. Patient feedback questionnaires have been consistently positive.ConclusionThe development of a community EPAU has improved services to allow care closer to home in an environment separate from maternity care. Our data shows that a community EPAU can deliver timely, good quality patient care, is safe, and a service valued by patients. Further research is indicated to evaluate the cost-effectiveness of community EPAUs and the long term safety and effectiveness of care.

9 The ‘Colchester Older Persons’ Evaluation for Surgery (COPES)’ Clinic: A Multidisciplinary Approach to Preoperative Management of Frail, Older Patients

Abstract Introduction In 2014-15, 2.5 million patients over 75 years old underwent surgery compared to 1.5 million in 2006-7. The population is aging with increasing numbers of comorbidities, and associated frailty.1 The Royal College of Anaesthetists recommends that preoperative assessment for these complex older patients takes a “cross-specialty approach.”2 In Colchester the COPES clinic has been introduced in which selected high-risk patients are seen by a Consultant Anaesthetist and Consultant Geriatrician. This aims to medically optimise patients prior to surgery and to facilitate shared decision making. Methods The new clinic was introduced in October 2018. The following data was collected from COPES clinic letters from October to February 2018-19 (n=46):Patient/ surgery characteristics: age, comorbidities, frailty score and any cognitive impairmentInterventions: changes to medication, specialty referral, intravenous iron, diabetes optimisation, otherOutcomes of surgery following the COPES clinic Patients were asked to complete feedback forms to evaluate the service. Results 52% of patients had 4-6, and 28% had 7-9 comorbidities. The majority had Rockwood frailty scores of 4 or 5. 28% of patients had medications changed, 48% had specialty referrals, 17% received intravenous iron, 8.7% required diabetes optimisation and 28% of patients had investigations including echocardiograms, MRI and CT scans. 12/46 patients had surgery deemed unlikely to go ahead after shared decision making with patients in conjunction with the multidisciplinary team involved in their care. 2 patients died of their comorbidities after deciding not to proceed with surgery. 12/46 patients underwent surgery; 4 developed post-operative complications, none died and the mean length of stay was 3.38 days. The remaining 22/46 patients are awaiting surgery. Patient feedback questionnaires (n=10) were overwhelmingly positive. Everyone felt that they were treated with respect and that their fears were addressed and they were clear in the next steps in management. Conclusions The introduction of the ‘COPES’ clinic has helped address frailty and multiple comorbidities by optimising patients’ medical conditions and allowing alternatives to surgery to be considered. Patients were very satisfied with the COPES clinic and felt it has prepared them for upcoming surgery.

Evaluating Effectiveness of an Acute Rehabilitation Program in Hospital-Associated Deconditioning.

Acute hospitalization can result in significant decline in functional ability, known as hospital-associated deconditioning. Older adults are most vulnerable, with resultant functional difficulties and increased risk of institutionalization. This study evaluates the effectiveness of a multidisciplinary acute rehabilitation program in hospital-associated deconditioning on routinely collected outcome data to examine its impact to determine whether a controlled trial is warranted. We conducted a retrospective review of the hospital database for the national rehabilitation clinical registry for 2013 and 2014. We analyzed responses from patient feedback questionnaires over a 2-year period to assess patient experience of the rehabilitation program. The analysis included 289 patients referred to our acute rehabilitation program. Most patients were aged 81-90 years, representing 47% (n = 137) of all admissions. The main impairment group was deconditioning (54%). The median entry time to the acute rehabilitation program for this impairment group was 5 days from admission and length of stay in the rehabilitation program was 9 days. Many of these patients (57%) were directly discharged home, with only 21% needing transfer for inpatient rehabilitation. The average Functional Independence Measure score gain was 22 for the patients directly discharged home, with an average discharge Functional Independence Measure score of 94/126. Of the patient feedback responses received (response rate: 24%), 96% rated the program as very good or good. We observed improved functional outcomes among program participants, with the majority directly discharged home, reduced transfer to rehabilitation hospitals, and patient acceptance of this acute rehabilitation program. These promising results suggest that a more rigorous evaluation of this acute rehabilitation program in the management of hospital-associated deconditioning is warranted.

Delivering and evaluating a scalable training model for strengthening family medicine in resource-limited environments: the Gaza experience. A mixed-methods evaluation.

BackgroundSince 2007, Gaza Palestine has been subject to blockade affecting over 1.9 million people. This denies health professionals access to continuing professional development (CPD). In Gaza, family physicians are scarce, and their level of training does not meet the needs of United Nations Relief and Works Agency’s (UNRWA) Family Health Team (FHT) model for better population health.AimThis study sought to develop a postgraduate training programme for Gazan doctors via a Diploma in Family Medicine (FM PG), and evaluate its impact on physicians and patients.Design & settingA mixed-methods evaluation of a postgraduate diploma in Gaza Palestine.MethodThe programme was delivered over 1 year, to 15 primary care doctors. The impact was evaluated through focus group discussions and patient feedback questionnaire survey comparing FM PG graduate doctors and doctors without the FM PG Diploma.ResultsAll participating doctors graduated successfully and found the experience extremely positive. Trainees felt that the Diploma helped them take more individualised approach to patients; have a better understanding of psychosocial elements affecting patient health; feel more inclined towards team-working and collaborative approaches to health care; and more insight into non-verbal communication such as active listening and tactile gestures. Statistical analysis of patients’ feedback showed significantly improved patient-reported outcomes and satisfaction when treated by course diplomates compared to non-diplomates.ConclusionWhere there are limited training opportunities, investment in a structured postgraduate diploma training programme can improve quality of health service delivery. UNRWA’s experience in Gaza demonstrates the value of a scalable model in resource-limited settings.

Comparing psychiatric care experiences shared online with validated questionnaires; do they include the same content?

Patient feedback is considered integral to patient safety and quality of care. However, limited research has compared the content of validated questionnaires with subjective patient experiences shared online. The aim of this study was to therefore identify and compare the content of psychiatric care experiences shared online with validated questionnaires. All research was conducted in co-production with a volunteer mental-health-patient-research-partner. We analysed all reviews published on the United Kingdom’s leading health and social care feedback platform Care Opinion, between 2005-2017 that discussed adult psychiatric care and compared findings with two validated questionnaires (ACP360 and General Medical Council patient feedback questionnaire). Our research findings show that patients describe some different measures of psychiatric care quality online and use different terminology to those used in validated questionnaires. Psychiatric care was also rarely discussed in relation to an individual psychiatrist alone. Multiple interactions affect patient experience and perceived care quality. Further work is needed to incorporate patient perceptions and terminology of care quality into patient feedback questionnaires and surveys. This may best be achieved through co-design although exploration of this approach is required. The current focus of patient feedback in revalidation is of limited value as patients do not typically disaggregate the care provided by an individual clinician from the wider healthcare team, system or environment. Although focused on psychiatry, research findings have clear implications for those looking to facilitate quality improvement and professional development.