Patient Journey Research Articles

Improving Decision-Making and Documentation on the Acute Medical Post-Take Ward Round

Abstract Background Frail Older people have a substantial presence on the Acute Medical Take. They also have a large conversion rate to hospital admission after the Post-Take Ward Round (PTWR). They decondition and deteriorate with long delays in the Emergency Department. The PTWR is a particularly important part of the patient journey particularly for capturing senior decision-maker input around key clinical and patient flow parameters. PTWR documentation in Irish hospitals is currently largely captured in an open freehand manner. Decisions made on the PTWR have implications across several domains including quality of care, patient safety, medico-legal outcomes as well as informing patient flow metrics. A structured & standardised approach to PTWR decision-making is anticipated to improve outcomes across these respective domains. Methods A standardised PTWR tool (1) was used to replace freehand PTWR case-note entries. All medical consultants were invited to use the tool on their PTWRs. All auditors were trained in gathering data consistently. Spot audits were undertaken on all wards before and two weeks after the introduction of a Standardised PTWR clerking tool. Capture of Key PTWR documentation and evidence of decisions made were identified. The Chi2 test was used to compare outcomes before and after introducing the intervention tool. Results 138 PTWR patients (number >65y: 124) documentation were assessed before the introduction of the PTWR tool and 74 patients afterwards. Significant improvement was found across 12/16 domains including decisions made relating to Investigations reviewed, Diagnoses made, Thrombo-prophylaxis considered, Ceilings of care reviewed, Discussions with patients and/or advocates and Predicted Date of Discharge (p<0.001). Conclusion A standardised PTWR tool significantly improves the capture of key documentation and decisions made on the Acute Medical Take above conventional freehand case-note entries. This may have significant implications for the care of older people clinically both from an individual and overall patient flow perspective.

Assess, Diagnose and Intervene: Are Hospital Based Out-patient Frailty Intervention Teams Perfectly Positioned to Prevent the Frailty Crisis?

Abstract Background This Frailty Intervention Team (FIT) is relatively novel in the sense that it is a hospital based multidisciplinary team (MDT) that provides an outpatient service to community based frail adults. Its main source of referral is from General Practitioners (GP)1, with the average Clinical Frailty Score of those assessed being 4.98 (4.91 men, 5.05 women) 1. Indicating that the mean service user is ‘Living with Mild Frailty’2. Our objective was to establish if this model of service provision is identifying any new diagnoses and what interventions it provides. Our overarching aim is to establish ‘what we are adding to the patient journey’. Methods 3 independent researchers came together to develop a database for the service that would record new diagnoses made, medical & non-medical interventions provided and frequency of on-wards referral. Standard definitions and codes were agreed upon, and the information inputted by patients facing staff on a daily basis. A descriptive data analysis of this database was carried out after the first quarter. Results 51 new patients were assessed in 4 months. Of these patients, 37.25% of cases received new diagnoses; Parkinson’s disease (15.68%), Orthostatic Hypotension (11.76%), Cognitive Impairment / Dementia (11.76%) and Idiopathic Normal Pressure Hydrocephalus (iNPH) (5.88%). Subsequently 62.74% had changes made to their medications. 96.08% of new service users received at least 1 non-medical intervention. Onward referral was made for 58.82% of service users, to a total of 22 organizations. The total amount of onward referrals made was 54. 51 new patients were assessed in 4 months. Conclusion A hospital-based frailty intervention team adds value to a patient’s journey as it is perfectly placed to make rapid diagnosis due to their MDT nature and access to diagnostics. Furthermore, it provides immediate intervention and appropriate onwards referral. Is this a model of service provision that should be made more readily available nationally?

Patient journey, disease burden, and functional disability in patients with axial spondyloarthritis in South Africa: results of International Map of Axial Spondyloarthritis (IMAS)

ObjectiveTo assess the unmet needs of South Africans with axial spondyloarthritis (axSpA) focusing on the patient journey, functional disability, and health-related quality of life.MethodsOne hundred forty-six South African axSpA patients completed the International Map of Axial Spondyloarthritis (IMAS) online survey. Patient journey, functional disability, activities of daily living, and psychological stress were analyzed in relation to socio-demographic characteristics, disease activity, diagnostic delay, extra-musculoskeletal manifestations, and drug therapy.ResultsMajority were female (82.2%) and Caucasian (89.7%) and the mean age of participants, age at onset of initial symptoms, and diagnostic delay were 44.7, 26.7, and 10.8 years, respectively. Participants reported a mean of 3.4 visits to healthcare professionals prior to a definitive diagnosis of axSpA, mostly made by rheumatologists (77.9%). Active disease (BASDAI ≥ 4) was reported by 87%, 69.9% suffered from psychological distress (general health questionnaire-12 score ≥ 3), and more than two-thirds suffered functional limitations in daily, personal, and social activities. Multivariable logistic analysis showed that active disease was more common in females [OR (95% CI) = 4.3 (1.2–15.2)] and was associated with greater functional limitation [OR (95% CI) = 1.1 (1.0–1.2)].ConclusionOf all the regions assessed in the IMAS (n = 5557 participants, 27 countries), South Africans reported the longest delay in diagnosis. The South African patient journey depicts a process burdened with diagnostic challenges and delays, coupled with patients experiencing significant personal and social limitations. These results emphasize the urgent need to establish local diagnostic and treatment guidelines for axSpA in South Africa, to reduce diagnostic delay, and to control disease activity associated with functional limitation in axSpA.Key Points• Axial spondyloarthritis (axSpA) in South Africans is associated with significant limitations in physical, mental, and social functioning.• First study to describe the unmet needs of South African patients with axSpA.

Waiting for surgery after hip fracture-Health and/or economic risk?

Waiting for surgery is a disconcerting experience. It can have a negative impact on patients' outcomes and length of stay (LOS) as driver for treatment costs. Process-optimisation may be a strategy to improve quality and cost-efficacy. The study investigates the correlation between waiting for hip fracture surgery and patient characteristics, organisational variables, outcomes, LOS, and the distribution of waiting times and LOS over time, including cost estimates. Thereby the study aims to identify the potential for organisational improvements with respect to managing the waiting time. Ten-year routine health data (patient characteristics and follow-up information) and process-indicators that is, waiting time and LOS from a Swiss trauma-centre were analysed retrospectively. Cost-estimates were calculated based on Swiss diagnosis related groups and daily costs to evaluate hospital revenues. In total, 2572 patients aged ≥60years with low-energy hip fractures were included. Waiting times >48h were associated with sub-optimal outcomes. Over the years long waiting times decreased. This reduction was not reflected by a reduction in LOS which remained stable around 10days, primarily driven by late discharge to in-patient rehabilitation. Reimbursement persisted at an average revenue in the low 4-5-digit range, depending on implant costs. While there has been a reduction of waiting times, this has not translated into a reduction of LOS or potential savings in health care costs, due to the various dependencies along the patient journey. Managing waiting times may be an area for improvement, increasing cost-efficacy, especially since long waiting times are still associated with inferior outcomes and LOS.

The burden of pre-operative anaemia and postoperative outcomes in 15 166 surgical patients from a public hospital in Brazil: A retrospective cohort study.

Preoperative anaemia is associated with poor postoperative outcomes; however, few studies have reported its prevalence in developing countries and its association with significant postoperative outcomes. We aimed to identify the prevalence of anaemia and its association with postoperative outcomes in a major public hospital in Brazil. Retrospective cohort study. Single-centre, 860-bed, quaternary university-affiliated teaching hospital in Southern Brazil. We included adult patients who had undergone surgery between 2015 and 2019. Main outcome measures: The main outcome was the in-hospital 30-day postoperative mortality. According to the World Health Organisation, we defined anaemia and its sub-classification (mild, moderate, and severe). We developed Poisson regression models to examine the association between preoperative anaemia and outcomes. We included 15 166 patients, of whom 6387 (42.1%) were anaemic. After adjustment for confounding factors, patients with anaemia had an increased risk of in-hospital 30-day postoperative mortality (relative risk (RR) 1.69, 95% confidence interval (CI) 1.44 to 1.99, P < 0.001). Mild [relative risk (RR) 1.38, 95% CI 1.12 to 1.71, P = 0.003], moderate (RR 1.73, 95% CI 1.43 to 2.10, P < 0.001), and severe anaemia (RR 2.43, 95% CI 1.92 to 3.07, P < 0.001) were associated with the primary outcome. Anaemia increased the transfusion risk (RR 4.44, 95% CI 3.90 to 5.06, P < 0.001) and postoperative intensive care unit (ICU) admission (RR 1.09, 95% CI 1.04 to 1.16, P = 0.001). Four out of 10 patients had anaemia. These patients had an increased risk of adverse postoperative outcomes. Comprehension of the magnitude and impact of anaemia is essential to establish interventions in low-resource scenarios to optimise the patient's journey. Institutional Review Board Registration number 40522820000005327 (Brazilian CEP/CONEP System, available in https://plataformabrasil.saude.gov.br/).

Role of Hospital Connectedness in Brain Metastasis Outcomes

Although patients with brain metastases receive interdisciplinary and multi-institutional care, the association between neuro-oncologic care networks and patient outcomes remains unknown. As patients often interact with multiple facilities, quantifying this association across a network of hospitals is critical to capture the complexity of the health care journey for patients with brain metastases. To evaluate how statewide health care network metrics are associated with inpatient mortality and hospital length of stay (LOS) for patients with brain metastases. This multicenter, statewide cohort study used data from the 2018 to 2019 Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases. Primary analyses were completed by August 2023. Participants included adults with a brain metastases receiving care in Massachusetts. All inpatient and emergency department visits mapped for patients following the first diagnosis of brain metastasis. Inpatient mortality and hospital LOS were the main outcomes assessed. Hospital interdependence in brain metastases care was calculated using a connectedness score (weighted degree: weighted sum of ties to other care facilities). The association between hospital connectedness and clinical outcomes was analyzed using mixed-effects logistic and linear regression models, adjusting for hospital-level features. In this cohort study, 4679 patients with brain metastases were identified with inpatient or ED encounters in Massachusetts (from 2018 to 2019). The median (IQR) age was 64 (57-73) years, and 2559 (55%) were female. There was interdependence in brain metastases care, with 993 patients (21%) visiting 2 or more unique hospitals. Highly connected hospitals were heterogeneous, with many being small and one-half lacking subspecialty neuro-oncologic care or teaching status. Increased hospital connectedness was significantly associated with improved inpatient mortality for patients with brain metastases, with the lowest connectedness quartile associated with more than double the risk of mortality compared with the highest quartile (odds ratio, 2.34; 95% CI, 1.33-4.11; P = .003). A stepwise increase in inpatient mortality risk was observed as hospital connectedness decreased, independently of hospital volume. Furthermore, intermediate hospital connectedness was associated with increased hospital LOS (coefficient, 1.08; 95% CI, 0.17-1.95; P = .006). This study found that hospital-to-hospital interconnectedness was significantly associated with improved clinical outcomes for patients with brain metastases. The salience of network metrics highlights their potential role alongside other patient-level and hospital-level variables to evaluate and improve oncology care delivery.

Understanding the influences on hospital discharge decision-making from patient, carer and staff perspectives

BackgroundGaps in discharge planning are experienced by 41% of hospital patients in Australia. There is an established body of knowledge regarding the features of the discharge process that need to be improved to avoid subsequent hospital readmission and enhance the discharge experience. However, many of these studies have focused solely on factors related to unplanned hospital readmissions and there has been limited success in operationalising improvements to the discharge process. The aim of this study was to explore and describe the factors that influence the decision to discharge adult medical patients from hospital, from patient, carer and staff perspectives.MethodsA qualitative descriptive study was conducted in one acute medical ward in Melbourne, Australia. The study data were collected by observations of clinical practice and semi-structured interviews with patients, carers and staff. Participants were: i) English-speaking adults identified for discharge home, ii) patient carers, and iii) staff involved in the discharge process. Observation data were analysed using content analysis and interviews data were analysed using thematic analysis.ResultsTwenty-one discharges were observed, and 65 participants were interviewed: 21 patients, two carers, and 42 staff. Most patients (76%) were identified as being ready for discharge during morning medical rounds, and 90% of discharge decisions were made collaboratively by the medical team and the patient. Carers were observed to be notified in 15 discharges by the patient (n = 8), doctors (n = 4), or nursing staff (n = 3). Five themes were constructed from thematic analysis of interviews: Readiness for Home, Fragmented Collaboration, Health Literacy, Unrealistic Expectations, and Care beyond Discharge. A collaborative team and supportive carers were considered to enhance risk assessment and discharge planning, however fragmented communication between clinicians, and between clinicians and patients/carers was a barrier to discharge decision-making.ConclusionsOur study highlights the need for a more coordinated approach to discharge decision-making that optimises communication with patients and carers and multidisciplinary workflows and reduces fragmentation. The importance of patient-centred care and a personalised approach to care are well established. However, there is a need to design systems to customise the entirety of the patient journey, including the approach to discharge decision making.

Predictors of the length of stay in psychiatric inpatient units: a retrospective study for the Paris Psychiatry Hospital Group.

Shortening the length of hospital stay (LOS) has become a major challenge for psychiatric hospitals in reducing unnecessary costs and improving the patient healthcare experience. We investigated the key factors associated with a long psychiatric hospitalization. This was a retrospective study of 8,870 full-time psychiatric hospital stays (6,216 patients) in the Paris Psychiatry Hospital Group, with a discharge in 2022. We used machine learning tools and univariate and multivariate methods to explore the impact of demographic, pathway-related, and clinical variables on the LOS. LOS >30 days was associated with age >55 years {odds ratio [OR] =2 [95% confidence interval 1.7-2.3]}, admission from outside the sectorization zone [OR=1.2 (1.1-1.3)], admission via a psychiatric emergency unit [OR, 1.2 (1.1-1.4)], and some clinical severity markers, such as psychotic disorder diagnosis [OR, 1.5 (1.3-1.7)], mandatory care [request of a third party, OR, 2.5 (2.1-2.9); case of imminent danger, OR, 2.3 (1.9-2.7)], the presence of seclusion and mechanical restraint measures (highlighting the positive effect of restraint duration), the somatic comorbidity for female sex [OR, 1.4 (1.2-1.7)], and treatment resistance [OR, 1.4 (1.2-1.6)]. Conversely, LOS ≤30 days was associated with being in a relationship [OR, 0.6 (0.5-0.8)], admission during a travel-related psychiatric episode [OR, 0.5 (0.3-0.6)], and personality and behavior disorders [OR, 0.7 (0.6-0.9)]. We found no significant association for features such as sex and a lack of treatment compliance. To our knowledge, this is the first recent study to investigate and highlight the impact of factors related to various illness severity markers, medication adherence, and patient journeys on the length of psychiatric hospital stay. A better understanding of long-stay risk factors might be helpful for optimizing the allocation of medical resources and anticipating tailored therapeutic programs.

A Comprehensive Analysis of Wait Times in Ambulatory Obstetrics and Gynecology Clinic at a Tertiary Care Hospital in Pakistan.

Objective Wait times are an important determinant of patient satisfaction measured objectively and associated significantly with it. It is a measure of time taken from the arrival of patients to the registration desk of a facility to the time they access service. This study focuses on current patient pathways at the Obstetrics and Gynecology Outpatient (OBGYN) Ambulatory Clinic at Shalamar Hospital and assesses wait times by stratifying it at each step of the pathway. Methodology Data on consultation times was obtained from 105 patient processes over three months. We had in-depth discussions with the doctors, nurses, and paramedical staff to better comprehend the medical conditions, the terminologies, the structural hierarchy, and the functions of the department. Based on this the patient journey through the clinic was further dissected into operational steps including the check-in process, patient vitals screening, patient history, physical examination, medical hierarchy, referral for further testing or procedures, and lastly prescription generation. Results The average wait time for obstetrics and gynecology patients is 45.18±39.37 minutes. The average time the patients waited for the check-in process was 1.73±1.80 minutes, for the vitals screening was 3.08±10.07 minutes, for patient history and examination was 19.90±22.71 minutes, and for consultation within the medical hierarchy (SR and Consultants) patients waited 1.31±5.71 minutes. For those patients who had no other tests or procedures recommended, the prescription generation required a further 4.10±3.14 minutes. While those who had tests or procedures recommended waited 5.75±28.27 minutes for voucher generation for the specific test or procedure and 9.31±11.35 minutes for the test or procedure itself. Conclusion The obstetrics and gynecology clinic at Shalamar Hospital has average wait times comparable to others in the region of approximately 45 minutes. The longest wait during the visit is before patient history and examination approximately 20 minutes. To improve wait times, the clinic should implement staggered appointments, use a token system, manage queues better, follow clinic hours, and improve coordination between doctors. This will allow for improved patient experiences, faster patient turnovers, and increased patient inflow.

Patient lived experiences of functioning and disability following lumbar discectomy: a secondary analysis of qualitative data

BackgroundKnowledge of patient lived experiences of functioning and disability is limited. This study aims to address the gap in the literature by exploring patient lived experiences of functioning and disability following lumbar discectomy.MethodA secondary analysis, reported in line with the Standards for Reporting Qualitative Research, was conducted of qualitative data exploring patient journeys following lumbar discectomy surgery (DiscJourn). Adult patients (≥ 16 years) undergoing elective or emergency primary lumbar discectomy were recruited from one National Health Service secondary care centre in the UK. Semi-structured interviews were conducted at 1–3 weeks and 1-year post surgery. Participants who completed both semi-structured interviews were eligible for the secondary analysis. Transcripts from the semi-structured interviews were analysed using interpretative phenomenological analysis (IPA). IPA involved two independent reviewers identifying themes for individual data sets followed by an iterative process involving the wider research team to identify overarching themes that represented the whole date set. Subthemes generated from the IPA were mapped against the International Classification of Functioning, Disability and Health (ICF) framework at the level of chapters, in order to ascertain the ICF’s utility in capturing experiences of functioning and disability. Strategies to enhance trustworthiness of data analysis included blind coding, peer examination and debrief, declaration of pre-conceived beliefs and active reflexivity throughout the study.ResultsNine participants met the eligibility criteria and their interview transcripts were analysed. Patient lived experiences of functioning and disability were captured by three overarching themes: Immediate impact following surgery, Multiple roads to recovery over 1 year, and Functioning influenced by personal loci of control. Each theme consisted of three subthemes which were subsequently mapped onto the ICF. Three subthemes mapped to the ICF’s body component, 1 to activity and participation and 3 to environment. Two subthemes themes did not map onto the ICF.ConclusionFindings provide valuable insights into patient experiences of functioning and disability following lumbar discectomy. Convergence in experiences of functioning and disability were identified immediately following surgery. Divergence in such experiences were identified with regards to the roads to recovery over 1 year and the individuals’ locus of control. Findings build on the body of literature exploring patients functioning and disability following discectomy and make recommendations for future research and clinical practice.

SATURN: assessing the feasibility of utilising existing registries for real-world evidence data collection to meet patients, regulatory, health technology assessment and payer requirements

BackgroundSATURN (Systematic Accumulation of Treatment practices and Utilisation, Real world evidence, and Natural history data) for the rare condition osteogenesis imperfecta (OI) has the objective to create a common core dataset by utilising existing, well-established data sources to meet the needs of the various stakeholders (physicians, registry/dataset owners, patients and patient associations, OI community leaders, European [EU] policymakers, regulators, health technology assessments [HTA]s, and healthcare systems including payers). This paper describes the steps taken to assess the feasibility of one existing OI registry (i.e., the Registry of OI [ROI]) as a candidate for SATURN. The same methodology will be applied to other existing OI registries in the future and this same concept could be utilised for other rare disease registries.MethodsThe approach to assessing the feasibility of the ROI registry consisted of three steps: (1) an assessment of the registry characteristics using the Registry Evaluation and Quality Standards Tool (REQueST); (2) a gap analysis comparing SATURN required Core Variables to those being captured in the registry’s Case Report Form (CRF); and (3) a compliance check on the data exchange process following the Title 21 of Code of Federal Regulations (CFR) Part 11/EudraLex Annex 11 Compliance Checklist. The first registry that SATURN has assessed is the ROI database at the Istituto Ortopedico Rizzoli (IOR) in Italy.ResultsThe results from the ROI REQueST have demonstrated satisfactory complete responses in terms of methodology, essential standards, interpretability, and interoperability—readiness for data linkage, data sources, and ethics to meet the needs of data customers. However, the ROI data is from a tertiary referral centre which may limit the ability to understand the full patient journey. The gap analysis has revealed that an exact or logical match between SATURN requested variables and the ROI current variables exists for the following items: patient characteristics, treatment of OI (medical and surgical) and treatment of pain (with the exception of frequency of treatment and reasons for discontinuation), fracture history and bone density. However, data on safety was missing. The compliance check has implied that the ROI implemented appropriate controls for the web-based platform (i.e., Genotype–phenotype Data Integration Platform [GeDI]) that is involved in processing the electronic patient data, and GeDI is a validated/compliant application that follows relevant 21 CFR Part 11/EudraLex Annex 11 regulations.ConclusionsThis robust feasibility process highlights potential limitations and opportunities to develop and to refine the collaboration with the ROI as the SATURN programme moves forward. It also ensures that the existing datasets in the rare condition OI are being maximised to respond to the needs of patients, data customers and decision-makers. This feasibility process has allowed SATURN to build a compliant methodology that aligns with the requirements from the European Medicines Agency (EMA) and HTAs. More data variables will continue to be developed and refined along the way with more registries participating in SATURN. As a result, SATURN will become a meaningful and truly collaborative core dataset, which will also contribute to advancing understanding of OI diagnosis, treatment, and care.

Impact of next-generation sequencing vs polymerase chain reaction testing on payer costs and clinical outcomes throughout the treatment journeys of patients with metastatic non-small cell lung cancer.

For patients with metastatic non-small cell lung cancer (mNSCLC), next-generation sequencing (NGS) biomarker testing has been associated with a faster time to appropriate targeted therapy and more comprehensive testing relative to polymerase chain reaction (PCR) testing. However, the impact on payer costs and clinical outcomes during patients' treatment journeys has not been fully characterized. To assess the costs and clinical outcomes of NGS vs PCR biomarker testing among patients with newly diagnosed de novo mNSCLC from a US payers' perspective. A Markov model assessed costs and clinical outcomes of NGS vs PCR testing from the start of testing up to 3 years after. Patients entered the model after receiving biomarker test results and then initiated first-line (1L) targeted or nontargeted therapy (immunotherapy and/or chemotherapy) depending on actionable mutation detection. A few patients with an actionable mutation were not detected by PCR and inappropriately initiated 1L nontargeted therapy. At each 1-month cycle, patients could remain on treatment with 1L, progress to second line or later (2L+), or die. Literature-based inputs included the rates of progression-free survival (PFS) and overall survival (OS), targeted and nontargeted therapy costs, total costs of testing, and medical costs of 1L, 2L+, and death. Per patient average PFS and OS as well as cumulative costs were reported for NGS and PCR testing. In a modeled population of 100 patients (75% commercial and 25% Medicare), 45.9% of NGS and 40.0% of PCR patients tested positive for an actionable mutation. Relative to PCR, NGS was associated with $7,386 in savings per patient (NGS = $326,154; PCR = $333,540) at 1 year, driven by lower costs of testing, including estimated costs of delayed care and nontargeted therapy initiation before receiving test results (NGS = $8,866; PCR = $16,373). Treatment costs were similar (NGS = $305,644; PCR = $305,283). In the PCR cohort, the per patient costs of inappropriate 1L nontargeted therapy owing to undetected mutations were $6,455, $6,566, and $6,569 over the first 1, 2, and 3 years, respectively. Relative to PCR testing, NGS was associated with $4,060 in savings at 2 years and $1,092 at 3 years. Patients who initiated 1L targeted therapy had an additional 5.4, 8.8, and 10.4 months of PFS and an additional 1.4, 3.6, and 5.3 months of OS over the first 1, 2, and 3 years, respectively, relative to those who inappropriately initiated 1L nontargeted therapy. In this Markov model, as early as year 1, and over 3 years following biomarker testing, patients with newly diagnosed de novo mNSCLC undergoing NGS testing are projected to have cost savings and longer PFS and OS relative to those tested with PCR.

Allies not enemies-creating amore empathetic and uplifting patient experience through technology and art.

To understand whether art and technology (mainly conversational agents) may help oncology patients to experience amore humanized journey. This narrative review encompasses acomprehensive examination of the existing literature in this field by amulticenter, multidisciplinary, and multiprofessional team aiming to analyze the current developments and potential future directions of using art and technology for patient engagement. We identified three major themes of patient engagement with art and three major themes of patient engagement with technologies. Two real-case scenarios are reported from our experience to practically envision how findings from the literature can be implemented in different contexts. Art therapy and technologies can be ancillary supports for healthcare professionals but are not substitutive of their expertise and responsibilities. Such tools may help to convey amore empathetic and uplifting patient journey if properly integrated within clinical practice, whereby the humanistic touch of medicine remains pivotal.

Establishing Australia’s national linked COVID Register

Objective and ApproachThe Australian Institute of Health and Welfare (AIHW) is an independent statutory Australian Government agency tasked with collating health data across federal and state/territory governments, and is accredited to provide complex integration, de-identification and secure access to linked data. To support research into the COVID pandemic, the AIHW has created a national-level COVID Register, which integrates COVID case data from infectious disease registers, and data from hospitals and intensive care, immunisation, deaths, health system usage data, aged care and disability support. ResultsData were probabilistically linked using the AIHW’s linkage spine, matching names, addresses, date of birth and sex. The AIHW data linkage protocols are based on the Five Safes framework which reinforce management of the privacy and confidentiality of data. Linkage rates for COVID cases across participating jurisdictions generally exceeded 95%. Ongoing work aims to increase the coverage of COVID cases, both in time and to include case data from one remaining jurisdiction. ConclusionsLinking disparate datasets from multiple sources has created a critical resource for exploring COVID and patient journeys in Australia. Currently, the Register supports projects to estimate expenditure associated with COVID, describe the impact of COVID for subgroups such as people living rural and remote areas, or those with dementia. ImplicationsUltimately, the Register will be integrated into the National Health Data Hub to enable ongoing health research and analysis through enduring national linked health data. The value of the Register extends beyond COVID and into other infectious diseases and chronic conditions.

General practitioners’ perspectives on data linkage in Australian general practice

ObjectiveIn the rapidly evolving landscape of digital health, data sharing using primary health care records has gained prominence. Linking primary care data with other administrative health datasets has the potential to provide a whole-of-life perspective on the patient journey and improve health outcomes. This study aimed to gain insight into Australian General Practitioners' (GPs) perspectives on the use of general practice health records for research and data linkage. ApproachThe study employed a mixed-methods approach. We conducted semi-structured interviews with GPs who had little experience of data sharing, focusing on understanding the challenges and opportunities that increased data sharing poses. We also conducted a three-round modified Delphi study with GPs with experience of and interest in research and data sharing to refine recommendations for data sharing using general practice data. ResultsIn this paper we describe the findings from both arms of the study and compare their recommendations to contribute to a nuanced understanding of general practitioners’ views on data linkage and sharing in general practice. Conclusions and ImplicationsBridging the knowledge gap between novices and expert practitioners, the findings will inform policies, practices, and initiatives to address the ethical, legal and social implications of data sharing in general practice settings in Australia.

Osteogenesis Imperfecta: A study of the patient journey in 13 European countries

IntroductionOsteogenesis imperfecta (OI) is a heritable skeletal disorder and comprises various subtypes that differ in clinical presentation, with Type I considered the least severe and Types III/IV the most severe forms. The study aim was to understand the OI patient diagnostic and treatment journey across Europe.MethodsWe conducted a qualitative, descriptive study to understand the OI patient journey. A selection of people with OI/their caregivers and clinicians involved in OI-patient care from across Europe were interviewed using a specially developed questionnaire.ResultsBetween May 2022 and July 2022, 22 people with OI/caregivers and 22 clinicians (endocrinologists, orthopaedic surgeons, geneticists and metabolic specialists) from across Europe were interviewed. Our study showed various areas of concerns for the OI community. Timely diagnosis of OI is essential; misdiagnoses and a delay to treatment initiation are all too common. There are a lack of consensus guidelines regarding optimal treatments (including when bisphosphonate therapy should be initiated and the route of administration) and patient management throughout the duration of the patient’s life. Adult OI patients do not have a medical home and are often managed by endocrinologists and rheumatologists. Adult care is often reactive based on the development of new symptoms. The psychosocial burden of OI impacts on the patient’s quality of life.ConclusionsThere is an urgent need for increased awareness about OI and its wide range of symptoms. In particular, there is a need for consensus guidelines outlining the optimum care throughout the duration of the OI patient’s life.

SP9.1 - Enhancing Personalised Care by Introducing Frailty Management On Lower GI 2ww Pathway

Abstract Introduction/Aim Increasing number of patients with suspected lower GI cancer are being sent Straight-To-Test to achieve the 28Day Faster Diagnosis Standards (FDS) following GP referral. This means that elderly frail patients may not get personalised care unique to their needs and undergo unnecessary investigations. Since 2022, we have piloted a frailty pathway incorporated into the protocol for management of LowerGI 2ww referrals. Aiming to provide a holistic and personalised geriatric assessment to improve outcomes and reduce health inequality. This study analyses the outcomes. Methods A prospectively maintained database of all 2ww lowerGI cancer referrals between January2022-November2023 was analysed. Patients age&amp;gt;75 with a frailty score&amp;gt;=5 or performance status&amp;gt;=3, dementia, poly-pharmacy or from care home were referred straight to the frailty-unit for assessment and discussion of the value of further investigation, based on a locally designed SOP. The patient journey was mapped and outcomes compared to the standard pathway. Results Over 22 months-period, 228 patients with suspected cancer were seen on the frailty pathway. The average number of investigations per referral was0.5 for frail patients compared to 1 for other patients on the standard pathway. 49.5% (113 patients) were found to be unfit for further investigations or declined/self-discharged. 5 patients required optimisation prior to investigation. Only 1patient was diagnosed with cancer. The 2ww standard was met in 80% of frail patients compared to 55% in &amp;gt;75s who were sent straight-to-test on the standard pathway. The 28-day FDS standard was met in 50% of frail patients compared with 18% in &amp;gt;75s. Conclusion The frailty pathway is an effective initiative in reducing unnecessary invasive investigations. Frail patients benefit from holistic geriatric assessment prior to invasive investigations, ensuring suitability and appropriateness.

SP9.3 - Introducing Frailty Assessment into The Suspected Lower GI Cancer Pathway – Results of a 2 Year Pilot

Abstract Introduction &amp; Aim An Increasing number of patients with suspected lowerGI cancer are being sent Straight-To-Test to achieve the 28 Day Faster Diagnosis Standards (FDS) following GP referral. This means that elderly frail patients may not get personalised care unique to their needs and undergo unnecessary investigations. Since 2022, we have been piloting a frailty pathway incorporated into the protocol for secondary care management of LowerGI 2ww referrals. Aiming to provide a holistic and personalised geriatric assessment to improve outcomes and reduce health inequality. This study analyses the outcomes. Methods A prospectively maintained database of all 2ww lowerGI cancer referrals between January2022-January2024 was analysed. Patients aged&amp;gt;75 with a frailty score of &amp;gt;=5 or performance status&amp;gt;=3, dementia, poly-pharmacy or from care home were referred straight to the frailty unit for assessment and discussion of the value of further investigation, based on a locally designed SOP. The patient journey was mapped and outcomes compared to the standard-pathway. Results Over a 24-month period, 228patients with suspected cancer were seen on the frailty pathway. 49.5%(113patients) were found to be unfit for further investigations or declined/self-discharged. The 2ww standard was met in80%of frail patients compared to55% in&amp;gt;75s who were sent straight-to-test on the standard pathway. The 28day-FDS standard was met in50%of frail patients compared with18%in the other&amp;gt;75s.The average number of investigations per referral was0.5for frail patients compared to 1 for patients on the standard-pathway. 5patients required optimisation prior to investigation. Only 1patient was diagnosed with cancer. Conclusion The frailty pathway is an effective initiative in reducing unnecessary invasive investigations, whilst providing timely investigations on the suspected cancer pathway.

EP120 - A Retrospective Review of Pregnant Patients Referred to an Emergency General Surgery Service

Abstract Aims To gain insight into the journey and outcomes of pregnant patients referred to an emergency general surgery service. Methods Surgical handover lists from Jan 2021-Dec 2023 were reviewed to identify pregnant patients referred to the service. Data was collected from the electronic patient record on demographics, timeline, imaging, diagnosis, management and subsequent delivery method if pregnancy reached term. Results There were 91 referrals of pregnant women to the emergency general surgery service over the 3 year period. 80% were for abdominal pain. 64% of patients received a documented review by a general surgery consultant, and 35% received a documented review by an obstetric consultant. For those presenting with abdominal pain, 79% had imaging other than plain film, the most common being ultrasound abdomen (75%). 5% of patients had an MRI abdomen and pelvis, and 4% of patients had a CT abdomen and pelvis. Of the 21 patients treated for a confirmed abdominal surgical diagnosis who had a documented delivery, 29% required emergency c-sections. In comparison, out of 17 patients who had either non-surgical pathologies or extra-abdominal surgical pathologies, excluding pregnancy-related complications, 0 went on to have emergency c-sections. This is statistically significant (p=0.0241). Conclusion The investigation and management of an acute abdomen in pregnancy poses a number of unique challenges. Our dataset, though small, has hinted at unacceptable rates of consultant review and under-utilisation of cross-sectional imaging. Furthermore, there is the suggestion that patients with confirmed abdominal surgical pathology may be at increased risk of delivering via emergency c-section. There is a need for further research into this patient population.

Enhanced Pharmacy Service Delivery Through a Pharmacy Information System at a Medical Center: A Case Study.

A pharmacy information system (PIS) is a crucial tool for preventing errors and enhancing patient safety. This study aims to assess the influence of a PIS on workflow and medication errors (MEs) within the pharmacy department of a medical city in Saudi Arabia. The analysis encompasses an evaluation of the current workflow within pharmacy modules (in-patient, out-patient, and clinical pharmacy modules) and an exploration of associated challenges and inefficiencies. The study employed both qualitative and quantitative methodologies, incorporating structured interview techniques and the review of system records, such as logs, incident reports, and ME databases. Respondents recognized the benefits of the PIS, including the management of high-quality real-time data (26%), reduction of MEs (25%), acceleration of healthcare practices (23%), and absence of space-time constraints (14%). The study highlighted the role of PIS in addressing medication stock control and shortage issues, thereby improving overall medication availability. Furthermore, PIS significantly enhanced safety (93.3%), efficiency (80%), reliability, accuracy, ease of use (56.7%, 56.7%), and cost-effectiveness (53.7%). Following the implementation of the PIS, there was an increase in ME reporting, indicating improved error detection and management. The research revealed an increase in ME reporting rates in hospitals after PIS installation, attributed to improved medication management processes resulting in higher detection rates. As healthcare facilities increasingly embrace electronic medical records, the understanding of patient care quality will be significantly impacted. Consequently, further research is warranted to explore the role of PIS in reporting, detecting, analyzing, and mitigating MEs, as well as their influence on the work environment to promote a secure and efficient patient journey.