Search

To analyze the research status of clinical governance (CG); the most productive authors, countries and organizations; connections among research themes. We used a 'funnel model', consisting of 3 layers describing various CG domains and settings. We retrieved bibliometric data from 1998 to 2021 from the Scopus database. Text mining, visual analysis, descriptive statistics and data visualization were performed. Citation bursts were detected. The total number of studies was 2429. On a global scale, there is a swinging trend in publications, with four peaks detected (2000, 2009, 2013, 2021). Citation burst keywords include: "national health service", "medical audit", "psychological aspect", "quality improvement" and "surveys and questionnaires". UK is the most productive and cited country. The most active organizations were in the UK, Australia, USA, Italy and Iran. The most productive journals and authors were identified. The most frequent keywords identified were 'health care quality', 'clinical governance', 'organization and management' and 'medical audit'. Research trends for each CG domain and setting type were reported. By using scientometric methodology, we created a thorough scientific picture on CG, including the mapping of pivotal concepts as a function of time. [ABSTRACT FROM AUTHOR]

Aim: Use of open abdomen (OA) remains an important life‐saving manoeuvre in the management of trauma and the abdominal catastrophe. The National Open Abdomen Audit (NOAA) is an audit project investigating the indications, management, and subsequent outcomes of OA treatment throughout the UK. The aim is to generate a snapshot of practice which will inform the management of future patients and potentially reduce the significant harm that can be associated with OA. Methods and analysis: NOAA is a collaborative, prospective observational audit recruiting patients from across Great Britain and Ireland. The study will open from July 2023 with rolling recruitment across participating sites. All adult patients who leave theatre with an OA will be included and followed‐up for 90 days. The primary objective is to prospectively audit the national variability in the management of the OA. Secondary outcomes include the treatment modality used for OA, indication, outcome of treatment and complications, including mortality and development of intestinal failure. All data will be recorded and managed using the secure REDCap electronic data capture and analysed using Stata (version 16.1). Results will be reported in accordance with the STROBE statement. Conclusion: Results will be used to formulate a practical clinical guideline on when to implement an OA along with a stepwise management plan once initiated to reduce the associated morbidity and mortality. It is hoped that participation in this study will facilitate education of surgeons with a "trickle down" effect on all members of the surgical team and remove variability in the management. [ABSTRACT FROM AUTHOR]

The prevention of hospital associated thrombosis in palliative care remains controversial yet many countries recommend the documented risk assessment and where appropriate pharmacological prophylaxis of inpatients with advanced cancer. To audit adherence to national guidelines which require hospitalised patients to be risk assessed and receive appropriate thromboprophylaxis. A one day "flash-mob" audit across multiple clinical inpatient sites across the United Kingdom. Inpatients receiving palliative care within hospitals, hospices and specialist palliative care units across the United Kingdom. Data were collected from 1125 patients (514 hospital and 611 hospice/specialist palliative care units). Appropriate thromboprophylaxis was observed in 90 % of hospital and 90 % hospice/specialist palliative care units. Documented risk assessment was only found in 79 % and 71 % of patient notes respectively. Pharmacological thromboprophylaxis was contraindicated in 88 % of hospice/specialist palliative care unit patients due to bleeding risk or receiving end-of-life care. Twenty-four percent of patients in hospital had contraindications due to receiving end of life care, bleeding risk and thrombocytopenia. Patients in hospice/specialist palliative care units were of poorer performance status prior to admission with a history of gradual deterioration. Hospitalised patients were more likely to have been admitted following an acute deterioration of previous good performance status. Thromboprophylaxis guidelines were followed correctly for the majority of patients. There were considerable differences in the demographics of patients according to place of admission. Patients admitted to hospice/specialist palliative care units were sicker and had more contraindications to prophylaxis than those admitted to hospital. Thromboprophylaxis focused research data conducted in hospices is unlikely to be applicable to the care of palliative care patients admitted acutely to hospital. [ABSTRACT FROM AUTHOR]

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

Background: Citalopram is a drug with many important safety considerations in prescribing including dosage adjustments, pre-prescription testing and multiple interactions. Because of this, the UK government issued advice regarding the prescription of citalopram and escitalopram in its Drug Safety Update Vol 5 Issue 5, Dec 2011,[1] and the expectation is that all prescribers adhere to this. Purpose/Aim: To establish the adherence to prescribing guidance of citalopram at the practice level, implement change to address the lack of adherence and then evaluate the effectiveness of the change using re-audit techniques. Methods: Patients were identified using data searching techniques on EMIS for February–April 2020. Parameters searched for included age, hepatic impairment, cardiac disease, known QT prolongation and concomitant use with other QT-prolonging medication. Following the first cycle teaching on the safer use of citalopram was delivered to all prescribers and an EMIS prompt was also set up. A second audit cycle was then carried out. Data was analysed using Statistical Package for Social Sciences software to assess the significance of the results. Results: Following the presentation of the first cycle findings and the introduction of the EMIS safety prompt, there was a statistically significant reduction in incorrect citalopram dose prescription in the over 65s (8 vs 1), a statistically significant reduction in the incidence of dangerous drug interactions involving citalopram (44 vs 8) and a significant reduction in the incidence of unsafe prescribing of citalopram overall (47 vs 9). Conclusion: The introduction of an EMIS prompt and one-off prescriber teaching resulted in a statistically significant reduction in incorrect prescriptions of citalopram when re-audited a year later. These interventions resulted in improved patient safety and more effective use of resources and could easily be replicated at other practices throughout the country both for citalopram and other drugs with multiple safety considerations. [ABSTRACT FROM AUTHOR]

Background: The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest because of existing knowledge gaps in this important topic. This applies in particular to cardiology patients receiving anaesthetic care, because numbers, types and complexity of minimally invasive interventional procedures requiring planned and unplanned anaesthesia in the cardiac intervention suite is increasing., Methods: We analysed collected data to determine the epidemiology, clinical features, management and outcomes of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures., Results: There were 54 reports of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures, accounting for 54/881 (6.1%) of all reports to NAP7. The estimated incidence (95%CI) of cardiac arrests in this group was 1/450 or 0.22 (0.17-0.29)%. These patients were older than other adult patients in the NAP7 population, with a notably high proportion of patients of Asian ethnicity when compared with the remaining NAP7 cohort (9/54, 17% vs. 35/709, 5%). Rates of extracorporeal membrane oxygenation cardiopulmonary resuscitation were low (3/53, 6%). A common theme was that of logistical issues and teamworking, with reporters commenting on the difficulties of remote and/or unfamiliar locations and communication issues between specialties, on occasion resulting in poor teamworking and a lack of focus. The NAP7 panel review identified several other common themes which included: cardiogenic shock; late involvement of anaesthesia in the case; and transcatheter aortic valve implantation., Conclusion: Cardiology procedures requiring anaesthesia care account for < 1% of anaesthesia activity but generate 6% of all peri-operative cardiac arrests. The incidence of cardiac arrest was disproportionately high in cardiological procedures requiring anaesthetic care. The nature of the cardiac arrest reports to NAP7 indicate that logistical and human factors in multidisciplinary teams in the cardiac intervention suite merit addressing to improve care., (© 2024 Association of Anaesthetists.)

Objectives: To provide up-to-date complication rates for vasectomy in the UK using 15 years of data collected by the Association of Surgeons in Primary Care (ASPC)., Patients and Methods: Data were collected between 2007 and March 2022. A patient questionnaire was completed on the day of surgery and at 4 months postoperatively. Rates of early and late failure, infection, hospital admission or re-admission, haematoma and post-vasectomy pain syndrome (PVPS) were recorded. There were no specific exclusion criteria. Complication rates were compared to those published by major urological organisations. Descriptive statistics were utilised, without formal statistical analysis., Results: Over the 15-year study period, data from 105 393 vasectomies were collected, performed by >150 surgeons. In 2022, 94.4% of surgeons used one test to prove sterility. In all, 65% of patients used a postal sperm test after vasectomy to confirm sterility. Early failure rates were available for 69 500 patients. Early failure occurred in 648 patients (0.93%). Of 99 124 patients, late failure occurred in 41 (0.04%). Of 102 549 vasectomies, postoperative infection was reported in 1250 patients (1.22%), haematoma in 1599 patients (1.56%), and PVPS was reported in 139 patients (0.14%)., Conclusions: Vasectomy remains a safe and reliable contraceptive method. The rates of complication were generally lower than those published by major urological organisations. This large, prospective audit provides accurate, contemporaneous complication rates that can form the basis for pre-vasectomy counselling., (© 2024 BJU International.)

Background: We analysed the clinical practice of anaesthesia associates in the UK, as reported to the 7th National Audit Project of the Royal College of Anaesthetists, and compared these with medically qualified anaesthetists., Methods: We included data from our baseline survey, activity survey and case registry as with other reports from the project., Results: Among 197 departments of anaesthesia, 52 (26%) employed anaesthesia associates. Of 10,009 responding anaesthesia care providers, 71 (< 1%) were anaesthesia associates, of whom 33 (47%) reporting working nights or weekends (compared with 97% of medically qualified anaesthetists in training and > 90% of consultants). Anaesthesia associates reported less training and confidence in managing peri-operative cardiac arrest and its aftermath compared with medically qualified anaesthetists. Anaesthesia associates were less directly involved in the management and the aftermath of peri-operative cardiac arrest than medically qualified anaesthetists, and the psychological impacts on professional and personal life appeared to be less. Among 24,172 cases, anaesthesia associates attended 432 (2%) and were the senior anaesthesia care provider in 63 (< 1%), with indirect supervision in 27 (43%). Anaesthesia associates worked predominantly in a small number of surgical specialties during weekdays and working daytime hours. Complication rates were low in cases managed by anaesthesia associates, likely reflecting case mix. However, activity and registry case mix data show anaesthesia associates do manage high-risk cases (patients who are older, comorbid, obese and frail) with the potential for serious complications. Registry cases included higher risk cases with respect to the clinical setting and patient factors., Conclusion: Anaesthesia associates work in enhanced roles, relative to the scope of practice at qualification agreed by organisations. Recent changes mean the Royal College of Anaesthetists and Association of Anaesthetists do not currently support an enhanced scope of practice., (© 2024 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)

Background: Patients with inflammatory idiopathic myopathies (IIM) face elevated risks of osteoporosis and fragility fracture., Aim: To evaluate current practice relating to bone health in adult patients with IIM in the United Kingdom and Hong Kong (HK)., Methods: Patients were identified from IIM patient lists. Demographics, osteoporosis risk factors, DXA scans, and bone protection treatment were recorded. Adherence to regional standards was evaluated for each center. Following this, in the United Kingdom, up-to-date DXA scans were performed., Results: Of 136 patients identified, 51 met selection criteria (UK, n = 20, HK, n = 31). Mean age in the United Kingdom was 59 (IQR 54-66); in Hong Kong, 65 (IQR 52.5-70). Most were female (UK 70%; HK 77%), current or previous steroid treatment was common (UK 90%; HK 100%) and some had experienced fragility fracture (UK 15%; HK 9%). The mean daily dose of prednisolone that patients were prescribed during the study was 12.5 mg (UK) and 14.3 mg (HK). Some patients had had a DXA scan (UK 50%; HK 35%) though several were outdated. Among those with BMD measured (UK, n = 20; HK, n = 11), osteopenia prevalence was 35% (UK) and 36% (HK) while osteoporosis was 5% (UK) and 36% (HK). Notably, 25% (UK) and 64% (HK) exceeded treatment thresholds. Treatments included anti-osteoporotic agents (UK 55%; HK 15%), Vitamin D/calcium supplements (UK 95%; HK 52%), or no treatment (UK 5%, HK 15%)., Conclusion: Poor compliance with guidelines exists in both centers, particularly around investigation and monitoring of bone health for IIM patients. Integrated care models and increased resource allocation to bone health are imperative to improve management of this aspect of IIM., (© 2024 The Author(s). International Journal of Rheumatic Diseases published by Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Background: Although the rate of venous thromboembolism (VTE) after foot and ankle surgery is low, multiple factors influence risk for individual patients. Furthermore, there are no clear guidelines on which patients may benefit from chemical thromboprophylaxis. Our aim was to assess patients not treated with chemical thromboprophylaxis after foot and ankle surgery, and to report on their specific patient and surgical risk factors for VTE., Methods: This was a multicenter, prospective, national audit of patients undergoing foot and ankle surgery (including Achilles tendon ruptures) from 68 participating UK centers. The study was conducted between June 1, 2022, and November 30, 2022, with a further 3-month follow-up. Following data cleansing, 3309 patients were included who did not receive postoperative thromboprophylaxis., Results: Most patients were elective cases (2589 patients, 78.24%) with ASA grade I or II (2679 patients, 80.96%), fully weightbearing postoperatively (2752 patients, 83.17%), and either without ankle splintage, or splinted in a plantigrade boot (2797 patients, 84.53%). The VTE rate was 0.30% overall (11 cases), with no VTE-related mortality. No single demographic, surgical, or postoperative factor was associated with reduced risk of VTE. However, patients who had elective or trauma surgery not involving the ankle, who were ASA grade I or II and who were weightbearing immediately postoperatively (without splinting or in a plantigrade boot) had a VTE rate of 0.05% (1 of 1819 patients), compared with 0.67% (10 of 1490 patients, P  = .002)., Conclusion: Patients not receiving chemical thromboprophylaxis had a low incidence of symptomatic VTE, although they do represent a curated group considered lower risk. Within this group we describe characteristics associated with a substantially lower risk of VTE. All patients should be assessed on an individual basis, and further work is required to substantiate our findings., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online.

Background: Significant resources are invested in the UK to collect data for National Clinical Audits (NCAs), but it is unclear whether and how they facilitate local quality improvement (QI). The perioperative setting is a unique context for QI due to its multidisciplinary nature and history of measurement. It is unclear which NCAs evaluate perioperative care, to what extent their data have been used for QI, and which factors influence this usage. Methods: NCAs were identified from the directories held by Healthcare Quality Improvement Partnership (HQIP), Scottish Healthcare Audits and the Welsh National Clinical Audit and Outcome Review Advisory Committee. QI reports were identified by the following: systematically searching MEDLINE, CINAHL Plus, Web of Science, Embase, Google Scholar and HMIC up to December 2019, hand-searching grey literature and consulting relevant stakeholders. We charted features describing both the NCAs and the QI reports and summarised quantitative data using descriptive statistics and qualitative themes using framework analysis. Results: We identified 36 perioperative NCAs in the UK and 209 reports of local QI which used data from 19 (73%) of these NCAs. Six (17%) NCAs contributed 185 (89%) of these reports. Only one NCA had a registry of local QI projects. The QI reports were mostly brief, unstructured, often published by NCAs themselves and likely subject to significant reporting bias. Factors reported to influence local QI included the following: perceived data validity, measurement of clinical processes as well as outcomes, timely feedback, financial incentives, sharing of best practice, local improvement capabilities and time constraints of clinicians. Conclusions: There is limited public reporting of UK perioperative NCA data for local QI, despite evidence of improvement of most NCA metrics at the national level. It is therefore unclear how these improvements are being made, and it is likely that opportunities are being missed to share learning between local sites. We make recommendations for how NCAs could better support the conduct, evaluation and reporting of local QI and suggest topics which future research should investigate. Trial registration: The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42018092993). [ABSTRACT FROM AUTHOR]

Purpose: Early in the global COVID-19 pandemic hospital eye departments had to alter their service delivery due to the imposed lockdown. During this period essential and high-priority contact lens cases still had to be seen. The aim of the audit was to evaluate how the pandemic and the ensuing lockdown affected the contact lens service for patients requiring contact lenses for extended-wear aphakia or bandage contact lens patients. Method: A retrospective audit was carried out at the Birmingham and Midland Eye Centre (BMEC) between March and July 2020 to assess essential contact lens services during the first phase of the UK lockdown. The essential patients were those requiring bandage contact lenses or those requiring extended-wear contact lenses due to aphakia. Details of the age of the patient, gender, lens type, presenting condition and frequency of attendance were extracted from the patient’s notes. As a comparator the same period from the previous year was audited to see how the pandemic affected the contact lens service for such contact lens patients. Results: A total of 101 patient episode visits were analysed in 2019 compared to 72 in 2020. Forty-eight per cent of episodes were for bandage contact lenses in 2019 whereas 52% of visits were for bandage contact lenses in 2020. The patients who had ‘trauma’, ‘no intraocular lens’ and ‘glaucoma’ were wearing contact lenses for aphakia for both years whereas ocular pathologies such as severe dry eyes or decompensated corneas were for bandage contact lenses. Most patients were asymptomatic at the time of the visits for both aphakic and bandage contact lens wearers. Over 90% of all patients during both years were seen within 1 week of their recommended recall appointment. Conclusion: This study highlighted that patient care for high-priority contact lens patients was not compromised due to the COVID-19 pandemic at BMEC optometry department. [ABSTRACT FROM AUTHOR]

Frailty increases peri-operative risk, but details of its burden, clinical features and the risk of, and outcomes following, peri-operative cardiac arrest are lacking. As a preplanned analysis of the 7th National Audit Project of the Royal College of Anaesthetists, we described the characteristics of older patients living with frailty undergoing anaesthesia and surgery, and those reported to the peri-operative cardiac arrest case registry. In the activity survey, 1676 (26%) of 6466 patients aged > 65 y were reported as frail (Clinical Frailty Scale score ≥ 5). Increasing age and frailty were both associated with increasing comorbidities and the proportion of surgery undertaken as an emergency. Except in patients who were terminally ill (Clinical Frailty Scale score 9), increasing frailty was associated with an increased proportion of complex or major surgery. The rate of use of invasive arterial blood pressure monitoring was associated with frailty only until Clinical Frailty Scale score 5, and then plateaued or fell. Of 881 cardiac arrests reported to the 7th National Audit Project, 156 (18%) were in patients aged > 65 y and living with frailty, with an estimated incidence of 1 in 1204 (95%CI 1 in 1027-1412) and a mortality rate of 1 in 2020 (95%CI 1 in 1642-2488), approximately 2.6-fold higher than in adults who were not frail. Hip fracture, emergency laparotomy, emergency vascular surgery and urological surgery were the most common surgical procedures in older patients living with frailty who had a cardiac arrest. We report a high burden of frailty within the surgical population, requiring complex, urgent surgery, and the extent of poorer outcomes of peri-operative cardiac arrest compared with patients of the same age not living with frailty., (© 2024 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)

Aims: This audit examined UK vulvar cancer practice from March 2018 to January 2019 and compared it to standards from national and international recommendations. Follow-up data collection in 2020 examined patient outcomes and toxicity., Materials and Methods: Audit standards were based on Royal College of Radiologists (RCR) guidance and published literature. A web-based questionnaire was sent to the audit leads at all cancer centres in the UK. Prospective data collection included patient demographics, tumour characteristics, radiotherapy indications, dosimetry, timelines, and follow-up data. The audit targets were 95% compliance with the RCR dose/fractionation schemes in definitive and adjuvant patients, 40% use of intensity modulated radiotherapy (IMRT), 100% of radical patients treated as category 1, and 95% use of gap compensation for category 1 patients., Results: 34/54 UK radiotherapy centres (63%) completed data entry for 152 patients. 23 out of 34 (68%) centres submitted follow-up data for 94 patients. One indicator exceeded the audit target: 98% of radical patients received IMRT. The indicators of RCR dose/fractionation compliance for adjuvant/definitive radiotherapy were achieved by 80%/43% for the primary, 80%/86% for elective lymph nodes, and 21%/21% for pathological lymph nodes. The use of concomitant chemotherapy with radical radiotherapy in suitable patients was achieved by 71%. Other indicators demonstrated that 78% were treated as category 1 and 27% used gap compensation. Acute toxicity was mostly related to skin, gastrointestinal, and genitourinary sites. Grade 3 and Grade 4 toxicities were seen at acceptable rates within the radical and adjuvant groups. Late toxicity was mostly grade 0., Conclusion: This audit provides a comprehensive picture of UK practice. IMRT is widely used in the UK, and treatment-related toxicity is moderate. The dose fractionation was very heterogeneous. The designation of vulvar cancer as category 1 was not regularly followed for radical/adjuvant patients, and there was minimal gap compensation during treatment., (Copyright © 2024 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Aims: The Royal College of Radiologists (RCR) audit of radical radiotherapy (RR) for patients with non-small cell lung cancer (NSCLC) in 2013 concluded that there was under-treatment compared to international comparators and marked variability between cancer networks. Elderly patients were less likely to receive guideline recommended treatments. Access to technological developments was low. Various national and local interventions have since taken place. This study aims to re-assess national practice., Materials and Methods: Radiotherapy departments completed one questionnaire for each patient started on RR for 4 weeks in January 2023., Results: Ninety-three percent of centres returned data on 295 patients. RR has increased 70% since 2013 but patients on average wait 20% longer to start treatment (p = 0.02). Staging investigations were often outside a desirable timeframe (79% of PET/CT scans). Advanced planning techniques are used more frequently: 4-dimensional planning increased from 33% to 90% (P < 0.001), cone beam imaging from 67% to 97% (p < 0.001) and colleague led peer review increased from 41% to 73% (P < 0.001)., Conclusion: There have been significant improvements in care. There has been a considerable increase in clinical oncology workload with evidence of stress on the system that requires additional resourcing., (Copyright © 2024 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest. An activity survey estimated UK paediatric anaesthesia annual caseload as 390,000 cases, 14% of the UK total. Paediatric peri-operative cardiac arrests accounted for 104 (12%) reports giving an incidence of 3 in 10,000 anaesthetics (95%CI 2.2-3.3 per 10,000). The incidence of peri-operative cardiac arrest was highest in neonates (27, 26%), infants (36, 35%) and children with congenital heart disease (44, 42%) and most reports were from tertiary centres (88, 85%). Frequent precipitants of cardiac arrest in non-cardiac surgery included: severe hypoxaemia (20, 22%); bradycardia (10, 11%); and major haemorrhage (9, 8%). Cardiac tamponade and isolated severe hypotension featured prominently as causes of cardiac arrest in children undergoing cardiac surgery or cardiological procedures. Themes identified at review included: inappropriate choices and doses of anaesthetic drugs for intravenous induction; bradycardias associated with high concentrations of volatile anaesthetic agent or airway manipulation; use of atropine in the place of adrenaline; and inadequate monitoring. Overall quality of care was judged by the panel to be good in 64 (62%) cases, which compares favourably with adults (371, 52%). The study provides insight into paediatric anaesthetic practice, complications and peri-operative cardiac arrest., (© 2024 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)

Background: Since national roll out in 2016, there has been little data available to assess service delivery for At-risk Mental State (ARMS) services embedded within UK Early Intervention Teams.Methods: An audit benchmarked a local ARMS service to assess compliance and service quality against UK National Institute for Clinical Excellence (NICE) standards. Data were collected using an audit tool for all users accepted to an ARMS service over a two-year period.Results: Service standards complied 100% with two of the three relevant NICE standards and there was 95% compliance with the remaining standard. Weeks engaged in service, uptake of CBT (58%) and discharge rates to primary 15 and secondary services was evaluated. A transition rate of 19% to First Episode Psychosis was recorded within the sample. Further analysis investigated three separate age ranges categorised within the sample across standards.Conclusions: The evidence provided showed the service meets national stan- dards, allowing a good provision of care. However, limitations were found in the interpretation of national standards, ability to meet the needs of all service users meeting criteria for ARMS services and service efficiency. The findings also lend themselves to wider conversations around the concept of ARMS services. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence (AI) technologies are increasingly used in clinical practice. Although there is robust evidence that AI innovations can improve patient care, reduce clinicians' workload and increase efficiency, their impact on medical training and education remains unclear. Methods: A survey of trainee doctors' perceived impact of AI technologies on clinical training and education was conducted at UK NHS postgraduate centers in London between October and December 2020. Impact assessment mirrored domains in training curricula such as 'clinical judgement', 'practical skills' and 'research and quality improvement skills'. Significance between Likert-type data was analysed using Fisher's exact test. Response variations between clinical specialities were analysed using k-modes clustering. Free-text responses were analysed by thematic analysis. Results: Two hundred ten doctors responded to the survey (response rate 72%). The majority (58%) perceived an overall positive impact of AI technologies on their training and education. Respondents agreed that AI would reduce clinical workload (62%) and improve research and audit training (68%). Trainees were skeptical that it would improve clinical judgement (46% agree, p = 0.12) and practical skills training (32% agree, p < 0.01). The majority reported insufficient AI training in their current curricula (92%), and supported having more formal AI training (81%). Conclusions: Trainee doctors have an overall positive perception of AI technologies' impact on clinical training. There is optimism that it will improve 'research and quality improvement' skills and facilitate 'curriculum mapping'. There is skepticism that it may reduce educational opportunities to develop 'clinical judgement' and 'practical skills'. Medical educators should be mindful that these domains are protected as AI develops. We recommend that 'Applied AI' topics are formalized in curricula and digital technologies leveraged to deliver clinical education. [ABSTRACT FROM AUTHOR]

Introduction and Background: Obesity has become one of the most commonly occurring risk factors in obstetric practice with 21.3% of the antenatal population being obese. Pregnant women with high BMI are at greater risk of a variety of complications compared to women of normal BMI. Objective: To assess the quality of care and management of obese pregnant women at Scunthorpe Hospital, United Kingdom. Design: Retrospective audit study. Standards and Criteria: All pregnant women should have their height, weight, and BMI recorded during first antenatal visit. All women should also be reweighed in the third Trimester. All pregnant women with booking BMI of 30kg/m2 or greater should receive information about anaesthesia and analgesia. All pregnant women with booking BMI of 40kg/m2 or more have an antenatal anaesthetic review by a senior anaesthetist and plan documented in the notes. Methods: Medical records for all patients with BMI of 30kg/m2 or more with delivery dates between November 2017 to January 2018. Participants: Pregnant women with BMI 3 Okg/m2 or more (N=3 6). Results: Booking BMI was recorded in 100% of women. BMI was recalculated in third trimester in less than 50% of women. 5 out of 14 women with BMI of 40kg/m2 or more had Pre-anaesthetic assessment by a senior anaesthetist. [ABSTRACT FROM AUTHOR]

As a quality improvement tool, clinical audit has been extensively described in the medical literature. There is scant literature on the use of clinical audit in the farm animal veterinary setting. This study describes the process and feasibility of prospective and retrospective data collection for farm animal clinical audit performed at three different farm animal practices in the United Kingdom. Retrospective clinical audit was difficult in all three practices due to barriers in establishing diagnosis and patient identity from clinical records. Prospective data collection proved feasible but depended on adequate case accrual and practitioner engagement. The decision to conduct clinical audit retrospectively or prospectively will depend on the topic to audit, the availability of data and the wishes of the team members involved. Further work is required looking at the use of clinical coding and alternatives to using practice management software to improve retrospective data availability for clinical audit. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to audit current United Kingdom (UK) practice of Head and Neck Cancer (HNC) post‐treatment surveillance against national guidelines and determine the outcomes of these practices in detecting recurrence. Design: National cross‐sectional study of current HNC surveillance practice. Setting: UK HNC outpatient departments. Participants: HNC patients reviewed for post‐treatment surveillance. Main outcome measures: Compliance with UK multidisciplinary guidelines and rates of cancer recurrence detection by time, clinic type and symptoms. Results: Data were analysed from 5,123 consultations across 89 UK centres. 30% of consultations were in dedicated multidisciplinary clinics, with input from allied health professionals (AHPs) available on the day in 23% of all consultations. Recurrence was suspected in 344 consultations and investigated with MRI in 29.6% (n = 102) and PET‐CT in 14.2% (n = 49). Patient education regarding recurrence symptoms, and smoking and alcohol advice, was provided in 20.4%, 6.2% and 5.3% of cases, respectively. Rates of recurrence detected were 35% in expedited appointments and 5.2% in planned follow‐ups (P =.0001). Of the expedited appointments, 63% were initiated by patients and 37% by clinicians. Recurrence was higher in those with new symptoms (7.1% versus 2.2%). The strongest predictors of recurrence were dyspnoea (positive predictive value (PPV)=16.2%), neck pain (PPV = 10.4%) and mouth/throat pain (PPV = 9.2%). Conclusions: Dedicated multidisciplinary clinics comprise a minority of consultations for HNC surveillance in the UK, with low availability of AHPs. PET‐CT and MRI were underutilised for the investigation of suspected recurrence. There may be scope for greater emphasis on patient education and consequent patient‐initiated symptom‐driven follow‐up. [ABSTRACT FROM AUTHOR]

Objective: This study describes the baseline clinical characteristics, predictors of successful extubation at referring hospitals and short-term outcomes of children intubated for status epilepticus and referred to United Kingdom (UK) paediatric critical care transport teams (PCCTs)., Design: Multicentre audit with case-control analysis, conducted between 1 September 2018 and 1 September 2020., Setting: This study involved 10 UK PCCTs., Patients: Children over 1 month of age intubated during emergency management for status epilepticus (SE), referred to UK PCCTs. Patients with trauma, requiring time-critical neurosurgical intervention or those with a tracheostomy were excluded., Interventions: No interventions were implemented., Measurements and Main Results: Out of the 1622 referrals for SE, 1136 (70%) were intubated at referral. The median age was 3 years (IQR 1.25-6.54 years). Among the intubated children, 396 (34.8%) were extubated locally by the referring team, with 19 (4.8%) requiring reintubation. Therefore, the overall rate of successful extubation was 33% (377/1136). There was significant variation between PCCTs, with local extubation rates ranging from 2% to 74%. Multivariable analyses showed region/PCCT, contributing diagnosis, acute changes on CT, preceding encephalopathy and type of continuous sedation (midazolam) used postintubation were significantly associated with transfer to a critical care unit., Conclusion: This study highlights wide regional variation in early extubation practices. Regions with high successful extubation rates have established extubation guidelines from PCCTs. Successful extubation represents critical care transports that have been avoided., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

The use of tourniquet is common in orthopaedic surgeries as it reduces blood loss, enhances visualization of the operating field, and leads to quicker procedures. However, the use of tourniquet has certain risks which can be avoided by following guidelines like British Orthopaedic Association Standards for Trauma (BOAST) guidelines for safe use of tourniquet. This audit study was done in a District general hospital to check the compliance of two trauma theatres with BOAST guidelines. The audit found that there was poor documentation of tourniquet details in the operation notes (10%). Regarding tourniquet time and pressure, the compliance in the two theatres was 95 % & 97.5 %. The recommendations of this audit were to use a template to improve documentation of tourniquet details in the operation notes and training of theatre staff on BOAST guidelines for safe use of tourniquet.

Background and Objective: Machine learning (ML) is a subset of artificial intelligence that uses data to build algorithms to predict specific outcomes. Few ML studies have examined percutaneous nephrolithotomy (PCNL) outcomes. Our objective was to build, streamline, temporally validate, and use ML models for prediction of PCNL outcomes (intensive care admission, postoperative infection, transfusion, adjuvant treatment, postoperative complications, visceral injury, and stone-free status at follow-up) using a comprehensive national database (British Association of Urological Surgeons PCNL)., Methods: This was an ML study using data from a prospective national database. Extreme gradient boosting (XGB), deep neural network (DNN), and logistic regression (LR) models were built for each outcome of interest using complete cases only, imputed, and oversampled and imputed/oversampled data sets. All validation was performed with complete cases only. Temporal validation was performed with 2019 data only. A second round used a composite of the most important 11 variables in each model to build the final model for inclusion in the shiny application. We report statistics for prognostic accuracy., Key Findings and Limitations: The database contains 12 810 patients. The final variables included were age, Charlson comorbidity index, preoperative haemoglobin, Guy's stone score, stone location, size of outer sheath, preoperative midstream urine result, primary puncture site, preoperative dimercapto-succinic acid scan, stone size, and image guidance (https://endourology.shinyapps.io/PCNL&#95;Demographics/). The areas under the receiver operating characteristic curve was >0.6 in all cases., Conclusions and Clinical Implications: This is the largest ML study on PCNL outcomes to date. The models are temporally valid and therefore can be implemented in clinical practice for patient-specific risk profiling. Further work will be conducted to externally validate the models., Patient Summary: We applied artificial intelligence to data for patients who underwent a keyhole surgery to remove kidney stones and developed a model to predict outcomes for this procedure. Doctors could use this tool to advise patients about their risk of complications and the outcomes they can expect after this surgery., (Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Introduction: Child protection has become a very poignant subject in the UK. The Laming report into the death of Victoria Climbié led to the implementation of multidisciplinary safeguarding policies and training for healthcare professionals, social services staff and police. However, many dental practitioners, as well as other healthcare professionals, have little confidence when reporting their concerns and reducing the 'gap' between suspicion and reporting (Laming in The victoria climbie inquiry: report of an inquiry by Lord Laming, 2003. https://www.gov.uk/government/publications/the-victoria-climbie-inquiry-report-of-an-inquiry-by-lord-laming). Our audit aimed to identify and address the barriers of reporting safeguarding concerns amongst the hospital team. Materials and methods: Questionnaires were distributed to staff at Surrey and Sussex Healthcare National Health Service Trust with a valid Safeguarding Children Level 3 certificate in order to assess their knowledge of safeguarding children. Changes to traditional safeguarding training (Group 1) were implemented to include a broader range of speakers, each speaking for shorter times with more personal and focused presentations (Groups 2 and 3). Three cohorts of participants were assessed including healthcare assistants, nurses, dentists, and doctors. Results: Group 1 (n = 100) reported 64% experience of reporting compared with group 2 (n = 100) 43% and group 3 (n = 76) 51%. Confidence was higher in those with more experience in child protection. The most common barrier was the uncertainty of diagnosis. More barriers to reporting existed in the new style of training in groups 2 and 3. The scenarios were answered with appropriate concern and reporting by groups 1 and 2, however, less for group 3. Discussion: Experienced and trained practitioners are more likely to refer children to child protection teams when they have concerns of abuse or neglect. Personalising training was shown to be less effective and the focus should be more on diagnosis and local protocols. Early training from undergraduate level was a unanimous request. Conclusion: Focused training on diagnosis and local protocols, accompanied by bespoke teaching for specific specialties would be the most constructive tool for safeguarding children. Exploring modern methods such as simulation-based training could be effective. Structured forms and local policies that are familiar to clinicians prevent omissions and encourage professional awareness. [ABSTRACT FROM AUTHOR]

Introduction: In the UK, guidelines from the Royal College of Pathologists (RCPath) facilitate consistent and reproducible reporting and classification of fine needle aspiration cytology (FNAC) thyroid specimens. The aim was to audit our department against RCPath guidelines to refine and improve our reporting process. Methods: Two‐cycle retrospective observational audit of all patients undergoing thyroid FNAC over a 2‐year period (1 year for each cycle). Final histology was correlated. The positive predictive value (PPV) for malignant neoplastic lesions was calculated; for Thy1, Thy1c, Thy2 and Thy2c all cases without final histology were assumed to be benign, while for Thy3a, Thy3f, Thy4 and Thy5 samples the PPV calculation was based only on those cytology samples with corresponding histology. False positive and false negative cases were reviewed. Results: In total, 288 cytology samples were included in the first cycle; 96 (33.3%) had corresponding histology. There were 287 samples included in the second cycle; 119 (41.5%) had follow‐up histology. The rate of non‐diagnostic samples (Thy1/1c) decreased from 39.6% to 30.0%. The PPV for malignant neoplastic lesions was Thy1/1c 2.6%, Thy2/2c 0.0%, Thy3a 40.0%, Thy3f 19.4%, Thy4 75.0%, Thy5 100.0% (first cycle); Thy1/1c 4.7%, Thy2/2c 0.7%, Thy3a 13.3%, Thy3f, 7.7%, Thy4, 50.0%, Thy5 100.0% (second cycle). Conclusions: Our department was able to reduce the rate of non‐diagnostic FNAC samples and improve the diagnostic accuracy of FNAC. Auditing local outcomes helps refine and improve the reporting process. Review of false positive and false negative cases helps examine potential pitfalls of cytology. This article describes an audit within a diagnostic cytology department against national guidelines for the reporting of thyroid cytology specimens. This helped to reduce the rate of non‐diagnostic samples and improve the diagnostic accuracy. Case review of 'false positive' and 'false negative' samples helps improve reporting and classification of thyroid cytology samples. [ABSTRACT FROM AUTHOR]

The Renal Association UK Renal Registry (UKRR), established in 1995, has reflected the development of Nephrology within the NHS over 25 years. It has been gradually enlarged to provide a formal agency for a range of consensus initiatives. It remains the source of the national epidemiology of renal replacement, feeding NHS infrastructures and Health Services Research. An extension into acute and chronic kidney disorders is in hand. As a template for medical audit it has contributed to a quality improvement ethos derived from several methodologies. It now offers a multifaceted virtual platform for special interest groups and patient-centricity. Its transformation demonstrates one of the compromises that have permitted specialty development within the inconstant envelope of the NHS.If not always a bellwether, the clarity, form and scale of kidney disease provision still qualifies the UKRR as a demonstrator of healthcare possibilities to Medicine, Clinical Informatics and the NHS. [ABSTRACT FROM AUTHOR]

Background: Rates of blood testing have increased over the past two decades. Reasons for testing cannot easily be extracted from electronic health record databases., Aim: To explore who requests blood tests and why, and what the outcomes of testing are in UK primary care., Design and Setting: A retrospective audit of electronic health records in general practices in England, Wales, Scotland, and Northern Ireland was undertaken., Method: Fifty-seven clinicians from the Primary care Academic CollaboraTive (PACT) each reviewed the electronic health records of 50 patients who had blood tests in April 2021. Anonymised data were extracted including patient characteristics, who requested the tests, reasons for testing, test results, and outcomes of testing., Results: Data were collected from 2572 patients across 57 GP practices. The commonest reasons for testing in primary care were investigation of symptoms (43.2%), monitoring of existing disease (30.1%), monitoring of existing medications (10.1%), and follow up of previous abnormalities (6.8%); patient requested testing was rare in this study (1.5%). Abnormal and borderline results were common, with 26.6% of patients having completely normal test results. Around one-quarter of tests were thought to be partially or fully unnecessary when reviewed retrospectively by a clinical colleague. Overall, 6.2% of tests in primary care led to a new diagnosis or confirmation of a diagnosis., Conclusion: The utilisation of a national collaborative model (PACT) has enabled a unique exploration of the rationale and outcomes of blood testing in primary care, highlighting areas for future research and optimisation., (© The Authors.)

Background: The British Gynaecological Cancer Society (BGCS) has highlighted the disparity of ovarian cancer outcomes in the UK compared to other European countries. Therefore, cancer quality assurance audits and subspecialty training are important in improving the UK standard of care for these patients. The current workforce crisis afflicting the NHS creates difficulty in dedicating teams of clinicians to these audits. We present a single institution study to evaluate if NLP-generated code can improve the efficiency of ovarian cancer and subspeciality reaccreditations audits. We used the chat bot Google Bard to write Visual Basic Applications algorithms that utilise Excel files from electronic health records., Methods: Primary ovarian cancer data from 2019 to 2022 was retrospectively collected from the Cambridge University Hospital electronic health records. The surgical subspecialty reaccreditation audit analysed the 2022 surgical database. A modular coding approach with Google Bard was applied to generate audit algorithms. The time to complete these current audits was compared against the 2016 ovarian cancer and 2020 subspeciality reaccreditation audits., Results: The previous ovarian cancer audit conducted in 2016 required 3 clinicians for the 135 cases and data collection required 1800 min. Data analysis was completed in 300 min. The current ovarian cancer audit allocated 2 clinicians to the 600 surgical cases. Data collection was completed in 3120 min, 3360 min for code development and 720 min for testing. The 2020 subspecialty reaccreditation audit was completed in 360 min. The 2022 subspecialty reaccreditation audit was completed in 1680 min, with 960 min for code development, 240 for debugging and 480 min for testing., Conclusion: We have demonstrated that NLP-generated code can significantly increase the efficiency of surgical quality assurance audits by eliminating the need for manual data analysis. With the current trajectory of NLP development, increasingly complex algorithms can be developed with minimal programming knowledge., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Performance within acute medicine services is impacted by ongoing pressures on acute care services. Data from the Society for Acute Medicine Benchmarking Audit 2023 (SAMBA23), was used to assess performance of acute medicine services compared to key clinical quality indicators, comparing performance by initial assessment location. Data was analysed for 8213 unplanned attendances across 161 hospitals. Comparing by initial assessment location, performance against the clinical quality indicators was unchanged from 2022. Only 29% of daytime arrivals assessed within the Emergency Department received consultant review within target times. Delays were seen in transfer between acute care locations. 29% of patients requiring admission were not admitted to the AMU. There is ongoing variation in acute medical service performance nationally, with significant delays in patient access to appropriate assessment locations.

Purpose: Rectal cancer staging with magnetic resonance imaging (MRI) allows accurate assessment and preoperative staging of rectal cancers. Therefore, complete MRI reports are vital to treatment planning. Significant variability may exist in their content and completeness. Template-style reporting can improve reporting standards, but its use is not widespread. Given the implications for treatment, we have evaluated current clinical practice amongst specialist gastrointestinal (GI) radiologists to measure the quality of rectal cancer staging MRI reports.Materials and Methods: Sixteen United Kingdom (UK) colorectal cancer multi-disciplinary teams (CRC-MDTs) serving a population over 5 million were invited to submit up to 10 consecutive rectal cancer primary staging MRI reports from January 2016 for each radiologist participating in the CRC-MDT. Reports were compared to a reference standard based on recognised staging and prognostic factors influencing case management RESULTS: Four hundred ten primary staging reports were submitted from 41 of 42 (97.6%) eligible radiologists. Three hundred sixty reports met the inclusion criteria, of these, 81 (22.5%) used a template. Template report usage significantly increased recording of key data points versus non-template reports for extra-mural venous invasion (EMVI) status (98.8% v 51.6%, p < 0.01) and circumferential resection margin (CRM) status (96.3% v 65.9%, p < 0.01). Local tumour stage (97.5% v 93.5%, NS) and nodal status (98.8% v 96.1%, NS) were reported and with similar frequency.Conclusion: Rectal cancer primary staging reports do not meet published standards. Template-style reports have significant increases in the inclusion of key tumour descriptors. This study provides further support for their use to improve reporting standards and outcomes in rectal cancer.Key Points: • MRI primary staging of rectal cancer requires detailed tumour descriptions as these alter the neoadjuvant and surgical treatments. • Currently, rectal cancer MRI reports in clinical practice do not provide sufficient detail on these tumour descriptors. • The use of template-style reports for primary staging of rectal cancer significantly improves report quality compared to free-text reports. [ABSTRACT FROM AUTHOR]

Acute oncology services (AOS) manage acute cancer-related presentations alongside acute medical teams. This study assessed AOS provision against national peer review measures and the burden of acute cancer-related admissions. The 2022 Society for Acute Medicine Benchmarking Audit surveyed UK hospitals, collecting hospital-level and patient-level data for all medical admissions over a 24-h period. Logistic regression models were constructed to identify differences in patient outcomes for cancer-related admissions. Most hospitals (n = 120 or 91.6%) reported having an AOS. There was heterogeneity in AOS provision, with many failing to meet peer-review measures. Of the 7,116 patients, 542 (7.6%) were cancer-related admissions. Cancer-related admissions had greater clinical acuity (p<0.05), length of stay (p<0.001) and 14-day mortality (adjusted odds ratio (OR)=3.54, 95% confidence interval (CI): 2.41-5.22, p<0.001) compared with other medical admissions. Increasing availability of AOS with integration of ambulatory pathways are vital next steps to improving care for acute cancer-related admissions., (© Royal College of Physicians 2023. All rights reserved.)

This national audit demonstrated discrepancies between actual practice and that indicated by clinic policies following enquiry about alcohol, recreational drugs and chemsex use. Clinics were more likely to enquire about risk behaviour if this was clinic policy or routine practice. Previous testing was the most common reason for refusing HIV testing, although 33% of men who have sex with men had a prior test of more than three months ago. Of the group declining due to recent exposure in the window period, 21/119 cases had an exposure within the four weeks prior to presentation, but had a previous risk not covered by previous testing. Recommendations include provision of risk assessments for alcohol, recreational drug use and chemsex, documenting reasons for HIV test refusal, provision of HIV point-of-care testing, follow-up for cases at higher risk of HIV and advice about community testing or self-sampling/testing. [ABSTRACT FROM AUTHOR]

Regular service audits since 2008 gave a stoma care department confidence in the service it provides. In 2016 the department undertook a new audit to benchmark its services, using the Association of Stoma Care Nurses (ASCN) UK Revised Stoma Care Nursing Standards and Audit Tool (2015). Of the 60 questionnaires given out, 43 were returned (71%). The results highlighted areas of good practice with positive patient feedback. However, it also identified that the team needed to improve documentation when offering patients the opportunity to meet a former patient with a stoma preoperatively and when discussing lifestyle issues. The results demonstrated poor preoperative compliance; this was lower than expected and did not concur with department statistics. The audit highlights the importance of clarity when developing a questionnaire to ensure all respondents not only interpret its meaning in the same way, but also only answer the questions specific to them. [ABSTRACT FROM AUTHOR]

Background Readmission rates after surgical procedures are viewed as a marker of quality of care and as a driver to improve outcomes in the United Kingdom, they are not remunerated. However, readmissions are not wholly avoidable. The aim of this study was to develop a regional overview of readmissions to determine the proportion that might be avoidable and to examine predictors of readmissions at a unit level. Methods We undertook a prospective multicenter audit of readmissions following National Health Service funded general surgical procedures in five National Health Service hospitals and three independent sector providers over a 2-wk period. Basic demographic and procedure data were captured. Readmissions to hospitals were identified through acute admissions lists. Reason for readmission was identified, and the readmission data assessed by a senior surgical doctor as to whether it was avoidable. Results We identified 752 operations in the study period with all followed up to 30 d. The overall rate of readmissions was 4.7%, with 40% of these judged as being potentially avoidable. Pain and wound problems accounted for the vast majority of avoidable readmissions. The number of unavoidable readmissions was correlated with the workload of each center ( r = 0.63, P = 0.06) and as with the higher (British United Provident Association) complexity of surgery ( r = 0.90, P = 0.01). Patient and demographic factors were not associated with readmissions. Conclusions This prospective audit describes readmission rates after general surgery. Volume and complexity of work are associated with readmission rates. A large proportion of readmissions could be reduced by attention to analgesia and outpatient arrangements for wound management. [ABSTRACT FROM AUTHOR]

Background: The Society for Acute Medicine's Benchmarking Audit (SAMBA) annually examines Clinical Quality Indicators (CQIs) of the care of patients admitted to UK hospitals as medical emergencies. Aim: The aim of this study is to review the impact of consultant specialty on discharge decisions in the SAMBA data-set. Design and methods: Prospective audit of patients admitted to acute medical units (AMUs) on 25 June 2015 to participating hospitals throughout the UK with subgroup analysis. Results: Eighty-three units submitted patient data from 3138 patients. Nearly 1845 (58%, IQR for units 50-69%) of patients were referrals from Emergency Medicine, 1072 (32%, IQR for units 24-44%) were referrals from Primary Care. The mean age was 65 (SD 20). One hundred and forty-one (4.5%) patients were admitted from care homes and 951 (30%) of patients were at least 'mildly frail' and 407 (13%) had signs of physiological instability. The median and the mean time to being seen by a doctor were 1 h 20min and 2h 3 min, respectively. The median and the mean time to being seen by senior specialist were 3h 55min and 5h 56 min, respectively. By 72 h, 29 (1%) patients had died in the AMU, 73 were admitted to critical care units, 1297 (41%) had been discharged to their own home and 60 to nursing or residential homes. For every 100 patients seen specialists in acute medicine discharged 12 more patients than specialists from other disciplines of medicine (P<0.001). The difference remained significant after adjustment for case mix. Conclusion: Specialist in acute care might facilitate discharge in a higher proportion of patients. [ABSTRACT FROM AUTHOR]

A retrospective clinical audit was performed to assess if the British HIV Association 2011 guidelines on routine screening for tuberculosis in HIV are being implemented in a large UK urban clinic, and if a tuberculosis-screening prompt on the electronic patient record for new attendees was effective. Of 4658 patients attending during the inclusion period, 385 were newly diagnosed first-time attendees and routine tuberculosis screening was recommended in 165. Of these, only 6.1% of patients had a completed tuberculosis screening prompt, and 12.1% underwent routine tuberculosis screening. This audit represents the first published UK data on routine screening rates for tuberculosis in HIV and demonstrates low rates of tuberculosis screening despite an electronic screening prompt designed to simplify adherence to the national guideline. Reasons why tuberculosis screening rates were low, and the prompt ineffective, are unclear. A national audit is ongoing, and we await the results to see if our data reflect a lack of routine tuberculosis screening in HIV-infected patients at a national level. [ABSTRACT FROM AUTHOR]

Background: UK National Guidelines (UKNG) advise HIV testing in clinically indicated neurological presentations. We audited the impact of our practical strategies to increase uptake of HIV testing at a regional acute neurology admissions unit. Methods: We audited HIV testing in 4 periods over 2 years: before we designed a UKNG-based “HIV testing in Neurology” protocol (“pre-protocol”); after dissemination of the protocol alone (“post-protocol”); post-protocol dissemination combined with both a tailored departmental admissions clerking proforma to prompt for HIV testing & consenting, and regular focussed tutorials to doctors on HIV testing in neurological patients (“post-proforma”); and finally one year after the post-proforma period (“+1 year”). We also looked at the total number of HIV tests sent from the unit during the two-year period. We assessed significance using Fisher’s exact test. Results: 47.8% of all acute neurology non-stroke admissions were eligible for HIV testing during all the audit periods. Testing rates were as follows: pre-protocol 21.9%; post-protocol 36.6%; post-proforma 83.3%; and at +1 year 65.4% (p<0.05 for both post-protocol and +1 year when compared to pre-protocol). Documentation of consent for HIV testing improved from 25% to 67.6% with the HIV-tailored clerking proforma. The total number of HIV tests requested from the unit doubled in the post-proforma period compared to pre-protocol (p<0.05). Conclusion: In conclusion: the combination of an HIV testing protocol, a tailored departmental clerking proforma and regular focussed teaching to doctors on indications for HIV testing led to a sustained increase in HIV testing uptake in our regional acute neurology admissions unit. [ABSTRACT FROM AUTHOR]

Objectives: Cases of antimicrobial resistance are increasing, partly due to inappropriate prescribing practices by dentists. The purpose of this study was to investigate the prescribing practices and knowledge of dentists with regards to antibiotics. Moreover, this study aimed to determine whether the prescriptions comply with the recommended guidelines and whether clinical audit can alter the prescribing practices of dentists leading to better use of antibiotics in the dental service. Materials and Methods: A clinical audit (before/after non-controlled trial) was carried out in two dental clinics in the northeast of England. Retrospective data were collected from 30 antibiotic prescriptions, analysed and compared with the recommended guidelines. Data collected included age and gender of patients, type of prescribed antibiotics and their dosage, frequency and duration, clinical condition and reason for prescribing. The principles of appropriate prescribing based on guidance by the Faculty of General Dental Practice in the United Kingdom (UK), FGDP, were discussed with the dental clinicians. Following this, prospective data were collected and similarly managed. Pre and post audit data were then compared. Changes were tested for significance using McNemar's test and P value<0.05 was considered statistically significant. Results: After intervention, data revealed that antibiotic prescribing practices of dentists improved, as there was an increase in the percentage of prescriptions that were in accordance with the FGDP (UK) guidelines. Conclusion: In view of the limited data collected, this study concludes that there are inappropriate antibiotic prescribing practices amongst general dental practitioners and that clinical audit can address this situation, leading to a more rational use of antibiotics in dental practice. [ABSTRACT FROM AUTHOR]

The improvement of patient safety has been a long-term aim of healthcare organisations and following recent negative events within the UK, the focus on safety has rightly increased. For over twenty years, clinical audit has been the tool most frequently used to measure safety-related aspects of healthcare and when done so correctly, can lead to sustained improvements. This paper explains how clinical audit is used as a safety improvement tool in an English dental hospital and gives several examples of projects that have resulted in long-term improvements in secondary dental care. [ABSTRACT FROM AUTHOR]