Shared Care Model Research Articles

Midwife-led continuity of care increases women’s satisfaction with antenatal, intrapartum, and postpartum care: North Shoa, Amhara regional state, Ethiopia: A quasi-experimental study

BackgroundThe provision of midwife-led continuity of care (MLCC) is effective in high-resource settings in improving maternal satisfaction. This study aimed to evaluate the effect of MLCC on women’s satisfaction with care in a low-income/resource setting. MethodA study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals in the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low-risk women were allocated to one of two groups; the MLCC (intervention group) that received all antenatal, intrapartum, and immediate postnatal care from a primary midwife or backup midwife) (n = 589) and the shared model of care (SMC) group that received care following established practice in Ethiopia, care from different staff members at different times) (n = 589). Data for this paper were collected using face-to-face interviews at the women’s home at the end of the postpartum period. The study’s outcome was the mean sum-score of satisfaction with care through the antenatal, intrapartum, and postnatal period continuum, where mean sum-scores range from 1 (lowest) to 5 (highest). FindingsCompared with SMC, MLCC was associated with statistically significantly higher satisfaction with all continuity of care (4.07 vs. 2.79 adjusted mean difference 1.27, 95% CI 1.18–1.35; p < 0.001), during antenatal care (4.14 vs. 2.81 adjusted mean difference 1.33 (95% CI 1.22–1.52), intrapartum care (3.83 vs. 2.71 adjusted mean difference 1.06 (95% CI 0.88–1.23) and postnatal care (5.46 vs. 3.71 adjusted mean difference 1.75 (95% CI 1.54–1.94)). ConclusionMLCC increased women's satisfaction with maternity care for women at low risk of medical complications. These findings confirm that the MLCC model will be applicable in the Ethiopian health care system with similar settings.

Models of Follow-Up Care and Secondary Prevention Measures for Survivors of Colorectal Cancer: Evidence-Based Guidelines and Systematic Review.

Objective: To provide recommendations for preferred models of follow-up care for stage I-IV colorectal (CRC) cancer survivors in Ontario; to identify signs and symptoms of potential recurrence and when to investigate; and to evaluate patient information and support needs during the post-treatment survivorship period. Methods: Consistent with the Program in Evidence-Based Medicine’s standardized approach, MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO databases were systematically searched. The authors drafted recommendations and revised them based on the comments from internal and external reviewers. Results: Four guidelines, three systematic reviews, three randomized controlled trials, and three cohort studies provided evidence to develop recommendations. Conclusions: Colorectal cancer follow-up care is complex and requires multidisciplinary, coordinated care delivered by the cancer specialist, primary care provider, and allied health professionals. While there is limited evidence to support a shared care model for follow-up, this approach is deemed to be best suited to meet patient needs; however, the roles and responsibilities of care providers need to be clearly defined, and patients need to know when and how to contact them. Although there is insufficient evidence to recommend any individual or combination of signs or symptoms as strong predictor(s) of recurrence, patients should be educated about these and know which care provider to contact if they develop any new or concerning symptoms. Psychosocial support and empathetic, effective, and coordinated communication are most valued by patients for their post-treatment follow-up care. Continuing professional education should emphasize the importance of communication skills and coordination of communication between the patient, family, and healthcare providers.

Community based Primary Care for Adolescents and Young Adults Transitioning From Pediatric Specialty Care: Results from a Scoping Review.

Background:Ongoing primary care during adolescence is recommended by best practice guidelines for adolescents and young adults (AYAs; ages 12-25) with chronic conditions. A synthesis of the evidence on the roles of Primary Care Physicians (PCPs) and benefits of primary care is needed to support existing guidelines.Methods:We used Arksey and O’Malley’s scoping review framework, and searched databases (MEDLINE, EMBASE, PsychINFO, CINAHL) for studies that (i) were published in English between 2004 and 2019, (ii) focused on AYAs with a chronic condition(s) who had received specialist pediatric services, and (iii) included relevant findings about PCPs. An extraction tool was developed to organize data items across studies (eg, study design, participant demographics, outcomes).Results:Findings from 58 studies were synthesized; 29 (50%) studies focused exclusively on AYAs with chronic health conditions (eg, diabetes, cancer), while 19 (33%) focused exclusively on AYAs with mental health conditions. Roles of PCPs included managing medications, “non-complex” mental health conditions, referrals, and care coordination, etc. Frequency of PCP involvement varied by AYAs; however, female, non-Black, and older AYAs, and those with severe/complex conditions appeared more likely to visit a PCP. Positive outcomes were reported for shared-care models targeting various conditions (eg, cancer, concussion, mental health).Conclusion:Our findings drew attention to the importance of effective collaboration among multi-disciplinary specialists, PCPs, and AYAs for overcoming multiple barriers to optimal transitional care. Highlighting the need for further study of the implementation of shared care models to design strategies for care delivery during transitions to adult care.

Erratum: Collaboration in the Time of COVID-19: Lessons for Community Shared Care Models

Erratum: Collaboration in the Time of COVID-19: Lessons for Community Shared Care Models

Detecting young people with mental disorders: a cluster-randomised trial of multidisciplinary health teams at the GP office

BackgroundYoung people with mental health challenges present a major global challenge. More than half of adults with mental disorders experience their onset before age 14, but early detection and intervention...

Effectiveness and implementation of models of cancer survivorship care: an overview of systematic reviews.

PurposeTo critically assess the effectiveness and implementation of different models of post-treatment cancer survivorship care compared to specialist-led models of survivorship care assessed in published systematic reviews.MethodsMEDLINE, CINAHL, Embase, and Cochrane CENTRAL databases were searched from January 2005 to May 2021. Systematic reviews that compared at least two models of cancer survivorship care were included. Article selection, data extraction, and critical appraisal were conducted independently by two authors. The models were evaluated according to cancer survivorship care domains, patient and caregiver experience, communication and decision-making, care coordination, quality of life, healthcare utilization, costs, and mortality. Barriers and facilitators to implementation were also synthesized.ResultsTwelve systematic reviews were included, capturing 53 primary studies. Effectiveness for managing survivors’ physical and psychosocial outcomes was found to be no different across models. Nurse-led and primary care provider-led models may produce cost savings to cancer survivors and healthcare systems. Barriers to the implementation of different models of care included limited resources, communication, and care coordination, while facilitators included survivor engagement, planning, and flexible services.ConclusionsDespite evidence regarding the equivalent effectiveness of nurse-led, primary care-led, or shared care models, these models are not widely adopted, and evidence-based recommendations to guide implementation are required. Further research is needed to address effectiveness in understudied domains of care and outcomes and across different population groups.Implications for Cancer SurvivorsRather than aiming for an optimal “one-size fits all” model of survivorship care, applying the most appropriate model in distinct contexts can improve outcomes and healthcare efficiency.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11764-021-01128-1.

Clinical update on public and private psychiatric practice shared-care partnerships - Can the twain work together?

We explore the previous research and current context regarding opportunities for shared-care partnerships between public and private psychiatric practice. Since the early 2000s, when there was impetus for the development of public-private psychiatric shared-care models as part of a previous National Mental Health Strategy, there has been surprisingly little research and policy development. Given an apparent exodus of psychiatrists to private practice due to current challenges facing the public health sector, it is timely to reconsider models of private and public sector shared-care that may improve the quality of public mental healthcare.

Midwife-led continuity of care improved maternal and neonatal health outcomes in north Shoa zone, Amhara regional state, Ethiopia: A quasi-experimental study

BackgroundIn a low-resource setting, information on the effect of midwife-led continuity of care (MLCC) is limited. Therefore, this study aimed to determine the effect of MLCC on maternal and neonatal health outcomes in the Ethiopian context. MethodA study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals of the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low risk women were allocated to one of two groups; the midwife-led continuity of care (MLCC or intervention group) (received all antenatal, labour, birth, and immediate postnatal care from a single midwife or backup midwife) (n = 589) and the Shared model of care (SMC or comparison group) (received care from different staff members at different times) (n = 589). The two outcomes studied were Spontaneous vaginal birth and preterm birth. Outcome variables were compared using multivariate generalized linear models (GLMs) and reported using adjusted risk ratios (aRR) with 95% confidence intervals. FindingsWomen in MLCC were, in comparison with women in the SMC group more likely to have spontaneous vaginal birth (aRR of 1.198 (95% CI 1.101–1.303)). Neonates of women in MLCC were in comparison with those in SMC less likely to be preterm (aRR of 0.394; 95% CI (0.227–0.683)). ConclusionIn this study, use of the MLCC model improved maternal and neonatal health outcomes. To scale up and further investigate the effect and feasibility of this model in a low resource setting could be of considerable importance in Ethiopia and other Sub-Saharan Africa countries.

A genealogy of what nurses know about 'the good death': A socio-materialist perspective.

In this article, we report the outcome of a sociological inquiry into nursing knowledge of death and dying, specifically 'the good death'. A genealogical approach informed by actor-network theory and appreciative inquiry were used to compose a broad socio-material account of how nurses concern themselves with the care of the dying and end-of-life care. Our enquiry revealed similarly to other studies, that there was no shared or overarching model of care. Key themes derived from nurses' translations of 'the good death' were re-presented pictorially as six pillars and two processes to comprise a new diagram of The Personalised Ideal Death.

Shared care for children with cancer in India through social and healthcare partnerships during the COVID-19 pandemic.

BackgroundThe COVID pandemic posed a challenge for the tertiary centers to continue treatment. Some tertiary centers were designated as COVID‐only hospitals, making it difficult for existing childhood cancer patients to continue their treatment at those centres. The need for shared care in childhood cancer was perceived by Cankids and its partnering childhood cancer‐treating centers in North and East India.AimWe aim to show how Cankids upscaled its shared care model to ensure that COVID designated hospitals connected with other hospitals who have to continue to provide care to childhood cancer patients in the pandemic and thus ensured the continuation of treatment for these patients.Methods and resultThe need assessment of the beneficiaries was done in discussion with the hospital of origin and destination hospital. The need for shared care was also discussed with the families and consent was taken before shifting their children. Cankids with the help of advisors identified cases of high risk that need immediate attention, proactive regular monitoring, and help in care planning with the perspective and recommendation of the multiple providers. The shared care unit came forward with reasonable and discounted packages for treatment.There was a total of five hospitals requiring shared care, and 55 children were supported from April to November 2020. The median age was 8 years and their hospital of origin are in Bihar, Uttar Pradesh, West Bengal, and Delhi. The expenditure on the treatment of the 55 patients was INR 61 61 636 ($ 84 843), with a median of INR 41765 (IQR 19491–174 129) on each patient. Total 291 trips for the transport were arranged and all the patients combined stayed 174 days at Cankids accommodation facility.ConclusionThe shared care helped the patients access standard treatment and reduce the financial burden.

Venous Thrombotic Events Are Independently Associated with Inferior Survival Outcome in Pediatric Cancer Patients: A Multicenter Study

Background: Venous thrombotic events (VTE) are well recognized complications in pediatric oncology patients. Although risk factors for VTE have been studied the association of VTE with survival in pediatric cancer patients has not been well studied. We hypothesized that pediatric oncology patients who experienced VTE have significantly inferior survival outcome as compared to patients who did not experience VTE.Aim: To determine the association of VTE with survival outcome in pediatric oncology patients.Methods: The population studied were oncology patients from 2000-2015 in Atlantic Canada: 3 Maritime provinces (population= 1.8 million) and from the province of Newfoundland and Labrador (population= 530,000). All pediatric oncology patients from the Maritimes (Nova Scotia, New Brunswick and Prince Edward Island) are treated at the IWK Health Centre (IWK) in a shared care model with regional provincial hospitals. All pediatric oncology patients in Newfoundland and Labrador are treated at the Janeway Children's Health and Rehabilitation Centre (Janeway). This provided a population-based cohort of the total pediatric oncology patients in the 4 Atlantic provinces. Research Ethics Board approval was obtained from each institution.A database of all pediatric oncology patients treated at the IWK was created by amalgamating data from (i) Pediatric oncology hospital database (ii) Cancer in Young People in Canada registry (CYP-C) (iii) pharmacy database and (iv) hospital health records. A database of pediatric oncology patients treated at the Janeway was amalgamated from (i) Janeway written logs (ii) Hospital health records and (iii) CYP-C.Data on patient demographics, diagnosis and date of diagnosis were extracted. Status of every patient, date of last visit or date of death, on or up to December 31, 2015 was reviewed. Brain tumor patients were excluded due to the low incidence of thrombosis.The association between VTE and survival was examined using Kaplan-Meier plots and Cox Proportional Hazards regression. An exploratory survival tree analysis indicated an interaction between cancer type and VTE, and the analysis was therefore stratified by cancer type as group 1: leukemia, lymphoma, other and group 2: sarcoma. Models were adjusted for sex and age at diagnosis. The statistical analysis was performed using R version 3.3.2 and RStudio version 1.0.136.Results: Of the 943 patients included in the study, 70 were diagnosed with thrombosis (7%). The prevalence of thrombosis in group 1 and 2 was 6.9% (n=56) and 10% (n=14) respectively. Cancer types included leukemia (n=356, 38%), lymphoma (n=154, 16%), sarcoma (n=137, 15%), and other (n=296, 31%). Overall mortality was 14%. No patient died directly from VTE. Kaplan-Meier plots showed a showed inferior survival in the presence of VTE in patients in both groups 1 and 2 (Figure 1). Cox proportional hazard model showed a significantly decreased survival for patients in group 1 with a VTE (p<0.001), group 2 without a VTE (p<0.001) and group 2 with a VTE (p<0.001) as compared to patients in group 1 without VTE (Table 1). Patients with a sarcoma did not show a significant difference in patients with and without a VTE due to the overlapping confidence interval (with VTE CI: 4.53 to 20.75, without VTE CI 2.48 to 5.62). Age at diagnosis (p=0.498) and sex (p=0.300) were not associated with survival.Conclusion: In the present study, we demonstrated in a large multi-center population-based cohort of pediatric oncology patients that the survival outcome of patients with leukemia, lymphoma and other types of cancers who develop a VTE is significantly inferior as compared to that of patients who do not develop a VTE. Patients with sarcoma who developed a VTE showed a decrease in survival as compared to those who did not develop VTE. However the results were not statistically significant likely due to the small sample size of these patients. The role of possible confounders such as treatment intensity, chemotherapeutic agents, and central venous catheters were not assessed in the preset study but would be included in future research. Further larger studies are necessary to understand the association between VTE and survival outcome in pediatric oncology patients and determine the prognostic impact of VTE in them. [Display omitted] DisclosuresMoorehead:Baxalta: Honoraria, Speakers Bureau; Bayer: Honoraria; Pfizer: Speakers Bureau; Octapharma: Honoraria; Bioverativ: Honoraria.

Cooperation without Consensus: Midwives’ Collaborations across Political Distance

AbstractWhat happens when people not only talk to one another but collaborate closely and form strong relationships in conditions of political heterogeneity? This article analyzes data from ethnographic research in seven states with homebirth midwives who, reflecting the “strange coalition” of feminists and traditionalists that analysts have long described in this community, self-identify with a wide range of partisan political affiliations and with divergent positions on the key issue of professional midwifery licensure. Results show that this community’s use of a shared model of care as a boundary object to facilitate collaboration without consensus relies upon a focus on sameness and a bracketing of the ideological commitments that undergird practitioners’ investment in the model of care. When difference is directly engaged, collaboration across political difference becomes difficult to sustain. I argue that bridging ideological divides using boundary objects is politically costly. Collaborative relationships and coalitions are made precarious and risk depoliticizing shared concerns when they are bound by a weakly structured, network-level object whose use demands the allocation of attention to sameness and the bracketing of difference and political disagreement.

Shared-care model for complex chronic haematological malignancies.

Myeloproliferative neoplasms (MPNs) are a group of rare Philadelphia-negative chronic leukemias. Disease rarity has resulted in limited expertise concentrated in specialist centres. Patients are often referred to such expert centres for diagnostic issues, complex decision-making, access to novel drugs through clinical trials, and supportive care. Attending such appointments may increase financial and travel burden, increase caregiver stress, and negatively impact quality of life. To address this, the MPN program at Princess Margaret (PM) Cancer Centre has implemented a shared-care model, working with local healthcare providers to provide ongoing management, and supportive care for MPN patients closer to home. This decreases patient travel burden, while maintaining high-quality patient-centered care. In this article we share our experience implementing the shared-care model. This model is potentially applicable to other chronic hematological malignancies and rare chronic diseases. The ultimate goal of shared-care is not to centralize care, but instead to build a community of accessible care for the patient.

Non-medical prescribing nurses in primary care: a positive response to restructuring

This article examines a shared care model used in a primary care alcohol and drugs service, with experienced clinical staff trained as non-medical prescribing nurses. Shared care based around the resource of the non-medical prescribing nurse situated in primary care can be a solution in a time of scare resources. Non-medical prescribing is illustrated further by a patient case study in a London borough to show its potential for treating patients. There needs to be good governance and supervision of this role to be effective and safe for patients, and this article discusses how this can be achieved by detailing a safe process.

Cross-sectoral communication by bringing together patient with cancer, general practitioner and oncologist in a video-based consultation: a qualitative study of oncologists’ and nurse specialists’ perspectives

Shared care models in the field of cancer aim to improve care coordination, role clarification and patient satisfaction. Cross-sectoral communication is pivotal. Involvement of patients may add to intended mechanisms.A...

Primary Care Physician Perspectives on Low Risk Prostate Cancer Management: Results of a National Survey.

Primary care providers can collaborate with urologists to ensure men with low risk prostate cancer on active surveillance receive followup testing and adhere to the management strategy, yet primary care provider attitudes about active surveillance and their roles remain unknown. We surveyed 1,000 primary care providers (347/741 eligible primary care providers responded). We assessed primary care provider support for and beliefs about active surveillance, and attitudes about and preferences for their role in various aspects of low risk prostate cancer management. We then examined associations between 1) primary care provider support for and primary care provider beliefs about active surveillance; and 2) primary care provider attitudes and preferences for their role. Nearly 50% of primary care providers strongly supported active surveillance for all low risk men, and 81% strongly agreed that active surveillance allows men to avoid side effects, while 57% strongly agreed it caused worry. Primary care providers who strongly supported active surveillance were less likely to strongly agree that active surveillance contributes to worry (50.3% vs 63.7% respectively, p=0.01). Half of the primary care providers strongly agreed that primary care providers can provide cancer-related care (50.5%), and the majority preferred a shared care model to ordering prostate specific antigen tests (60.1%). Primary care providers who strongly agreed that primary care providers can provide cancer-related care were more likely to prefer a primary care provider-led (79.3% vs 20.7%) or shared care (53.9% vs 46.1%) model vs urologist-led for ordering prostate specific antigen tests (p <0.01). While many primary care providers supported active surveillance for low risk prostate cancer, primary care providers still had concerns with it as the primary management strategy. Understanding primary care providers perspectives on low risk prostate cancer management can inform strategies to improve high quality active surveillance care.

Care of Older People in Surgery for general surgery: a single centre experience.

Older patients undergoing emergency surgery experience higher mortality and morbidity. 'Care of Older People in Surgery' (COPS) is a comprehensive geriatric care model developed for acute surgical units (ASU) to improve clinical outcomes in older general surgical patients. This study aimed to evaluate the impact of COPS on clinical and health service outcomes in an Australian hospital. The before-and-after study was conducted in the ASU, at Nepean Hospital. Data from patients ≥75 years admitted for >24 h into the ASU during the intervention period between April 2017 and March 2018 were compared to patients admitted in the previous year (April 2016 to March 2017) prior to the COPS intervention (n=212). Health service outcomes measured include the average stay length, medical emergency team response, unplanned intensive care unit admission and 28-day readmission rates. The COPS group (n=214) suffered significantly fewer medical complications, including less acute kidney injuries, arrhythmias and urinary tract infections compared to the pre-intervention cohort (n=212). Medical emergency team activation was significantly reduced after COPS model implementation and the average length of stay decreased. However, the incidence of postoperative delirium and acute coronary syndrome were higher in COPS cohort. Our study demonstrated that comprehensive geriatric assessment and care delivered through a shared model of care in older general surgical patients improved clinical outcome and patient safety measures.

Evaluating multidisciplinary glaucoma care: visual field progression and loss of sight year analysis in the community vs hospital setting.

BackgroundA variety of shared care models have been developed, which aim to stratify glaucoma patients according to risk of disease progression. However, there is limited published data on the rate of glaucoma progression in the hospital vs community setting. Here we aimed to compare rates of glaucomatous visual field progression in the Cambridge Community Optometrist Glaucoma Scheme (COGS) and Addenbrooke’s Hospital Glaucoma Clinic (AGC).MethodsA retrospective comparative cohort review was performed. Patients with five or more visual field tests were included. Zeiss Forum software was used to calculate the MD progression rate (dB/year). Loss of sight years (LSY) were also calculated for both COGS and AGC.ResultsOverall, 8465 visual field tests from 854 patients were reviewed. In all, 362 eyes from the AGC group and 210 eyes from COGS were included. The MD deterioration rate was significantly lower in the COGS patients compared with the AGC group (−0.1 vs −0.3 dB/year; p < 0.0001). No patients in the COGS group were predicted to become blind within their lifetime by LSY analysis. Fifteen patients were at risk in the AGC group.ConclusionThis service evaluation shows that COGS is an effective scheme to stratify lower risk glaucoma patients, increasing the capacity within hospital eye services. COGS patients have a lower rate of visual field deterioration compared to AGC patients. Effective communication between community and tertiary schemes is essential to facilitate transfer of patients requiring further hospital management reliably and efficiently, with the potential for low-risk patients to be followed safely in the community.

Initiation of Noninvasive Surveillance for Allograft Rejection in a Cohort of Heart Transplant Patients >1 Year after Transplant: An Exploratory Analysis

Purpose Gene expression profiling (GEP) and donor-derived, cell-free DNA (dd-cfDNA) measurement are alternative methods to endomyocardial biopsy (EMB) to monitor for rejection following heart transplantation. Both tests were individually validated but the utility of the combined use is unclear, especially in patients >1-year post-transplantation. We aim to describe our use of GEP and dd-cfDNA in heart transplant recipients >1-year post-transplantation. Methods This is a retrospective study conducted at The Queen's Medical Center, a non-heart transplant center located in Hawai'i, which cares for heart transplant recipients in a shared-care model with transplant centers located on the mainland. A protocol for GEP and dd-cfDNA for our patients was started in July 2019. For patients who were >1-year post-transplantation and were clinically deemed to be at an elevated risk for rejection, we collected both GEP and dd-cfDNA every 3 months. Baseline characteristics including GEP, dd-cfDNA, rejection episodes, and number of EMB were obtained. Results Since July 2019, there were 18 patients being followed with GEP and dd-cfDNA who were >1-year post-transplantation. The majority were male (72%), the mean age was 57.3±12.8 years, the average time from transplantation was 7.2.±1.6 years. Since then, 9 EMBs had been performed due to reasons as follows; 3 for elevated GEP (≥ 34), 1 for elevated dd-cfDNA ( ≥ 0.20%), 2 for elevations of both GEP and dd-cfDNA, 2 for clinical rejection and 1 to follow up a post-rejection episode. Of the 2 biopsies due to elevations of both GEP and dd-cfDNA, 50% showed evidence of acute rejection (acute cellular rejection grade 2R). None of the other 4 biopsies due to either an elevation in the GEP or dd-cfDNA alone revealed any significant rejection. We also followed 18 patients >1-year post-transplantation without the routine use of GEP or dd-cfDNA. None experienced clinical episodes of rejection or had any EMB performed. Conclusion In this study, the use of both GEP and dd-cfDNA led to an increased number of EMB in patients >1-year post-transplantation. Patients were at higher risk of rejection if they have elevation of both GEP and dd-cfDNA. Further studies are needed to validate these findings and evaluate long-term consequences of these diagnostic tests in patients who are > 1-year post-transplantation.

Evaluating the need for an integrated geriatric service in older general surgery patients.

Despite the success of an orthogeriatric model in improving outcomes of older patients, there is a paucity of evidence in general surgical disciplines. The aim of this project was to assess the viability of acute kidney injury (AKI) as an indicator of the care of older patients admitted under general surgery. A retrospective review of the medical records of patients aged 75 years and older admitted under general surgery between 1 July 2015 and 30 June 2018 at the Royal Hobart Hospital was conducted. Twenty randomly selected cases were reviewed by an expert panel to assess the preventability of AKI. Of 314 patients, the most common diagnosis was small bowel obstruction. Less than half of all patients underwent a procedural intervention. There were 32 (10%) cases of AKI; 13 (4%) had pre-hospital and 19 (6%) had inpatient. Diabetes and bowel ischaemia were over-represented in patients with an AKI, otherwise there was no significant difference between the groups. Patients with an AKI were significantly more likely to die, require an unplanned intensive care unit admission and less likely to return to their original residence. Overall, the expert panel agreed that the AKI was foreseeable and mitigable. Our patients presented with diagnoses that often did not require surgical intervention but not infrequently experienced medical complications. These patients may benefit from a shared model of care and AKI could be a useful indicator to measure the efficiency of this service.