2024

PRH ED Waiting Room Improvements (2024)

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Type of publication:

Service improvement case study

Author(s):

*Laura Wild

Citation:

SaTH Improvement Hub, August 2024

Abstract:

Improve the quality of care provided to patients as measured by an increase in compliance to observations, analgesia provision, reduction in interruptions and improvement in patient feedback by 31/07/2024.

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SATH Children’s Assessment Unit Improvement Programme (2024)

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Type of publication:

Service improvement case study

Author(s):

*Rachel Triggs

Citation:

SaTH Improvement Hub, October 2024

Abstract:

To facilitate a core group of Registered children's nurses who work in the Children’s Assessment Unit (CAU) to become competent in conducting a Triage on all paediatric patients referred to the unit using the Manchester Triage system.

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AMA Seated Area Test of Change (2024)

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Type of publication:

Service improvement case study

Author(s):

*Rebekah Tudor

Citation:

SaTH Improvement Hub, November 2024

Abstract:

  • Improve the Length of stay (LoS) in the RSH Emergency Department (for medical patients) during the test of change weeks (by 25/10/2024)
  • Improve the LoS in the AMA Seated Area at RSH during the test of change weeks (by 25/10/2024)
  • Improve the number of discharges (all discharge destinations) from the RSH acute floor during the test of change weeks (by 25/10/2024)

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Mucus plugging and mucolytics in patients admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD); investigating impact on short term mortality (2024)

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Type of publication:

Conference abstract

Author(s):

*Abugassa E.; *Bosher O.; *Makan N.; *Crawford E.; *Saleem M.A.; *Srinivasan K.; *Moudgil H.

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2024. Vienna Austria. 64(Supplement 68) (pp PA3010), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Background: Although mucus plugging occluding medium to large sized airways in COPD is associated with increased long term all-cause mortality, acute exacerbations require further investigation, particularly where, despite reducing morbidity and improving quality of life, long-term use of mucolytics remains controversial. Objectives were (1) to quantify chest CT evidence of mucus plugging, (2) relate findings to mucolytics, and (3) investigate mucus plugging association with short term mortality.

Method(s): Retrospective review of 100 patients admitted with exacerbation of COPD (105 admissions).comparative analysis by chi square (x2) and logistic regression, significant p<.05.

Result(s): Mean (SD, range) age was 74.7 (10.5, 41-97) years with 54% male; mean FEV1/FVC 55% with FEV1 1.2(0.59, 0.4-3.6) litres at 49% predicted. 23 were on long term oxygen (LTOT). Mean stay was 6.3 (1-41) days. 24 died in the first 6 months. Where a historical or admission chest CT was available (n=82), 12 (15%) had mucus plugging with mucolytics prescribed to 6 (50%) compared to 32/70 (46%) without plugging (x2 0.057, NS). 9/56 (16%) with mucus plugging vs 3/26 (12%) without (x2 0.2921, NS) had emphysema and 3/13 (23%) vs 9/69 (13%) without (x2 1.016, NS) bronchiectasis. Regression investigating mortality at 6 months showed adverse outcomes for male sex, lower FEV1, and LTOT.

Conclusion(s): 15% with acute COPD admissions have current or historical evidence of mucus plugging. Mucolytics are prescribed for 45% irrespective of prior CT radiology. Mortality (24%) at 6 months is high but not shown related to mucus plugging or reduced by mucolytics.

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Cost of Tuberculosis (TB) screening and contact tracing an Eastern European immigrant population seasonally employed at an agricultural farm in the United Kingdom (2024)

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Type of publication:

Conference abstract

Author(s):

*George S.; *Moudgil H.;

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2024. Vienna Austria. 64(Supplement 68) (pp PA1475), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Background: Economic data inform public health measures; a co-ordinated approach to TB contact tracing, guided by Public Health England (PHE), was undertaken assessing a non English speaking Eastern European immigrant population seasonally employed at an agricultural farm and we (1) report direct costs, (2) identify cultural issues and risks employing such a population Methods: After an initial pilot study of work-based contacts of an index case, contact lists incorporating workforce in every shift pattern back-dated two years to his UK entry were identified. Direct costs included T-spot testing (Oxford Immunotec) and translators (Romanian, Polish, Lithuanian, Italian) along with secondary care charges at tariff with uniform cross-charge among providers. TB drug costs (managing latent or disease) were from the British National Formulary.
Result(s): 258/331 (78%) workers took up testing. 80 (31%) were then referred for contact screening; of these, 47 had latent and 3 active disease. 16 defaulted, 5 declined, 4 were pregnant, and 5 lost moved elsewhere. Most had no registered General Practitioner and no pre-employment health check, BCG or radiology. Anecdotally, several returned to their parent countries for healthcare advice despite measures to overcome language barriers. Main direct costs (51,497-52) equated to 199-60/person screening and 1029-95/person treated for either latent or TB disease.
Conclusion(s): Language and cultural barriers are challenges to TB screening/contact tracing. Direct costs are 200 (UK pound sterling = 1.17 Euro) per patient screened and five times this amount treating latent or active disease.

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Pleural infection presentation and timeline of events: Real-world data from a tertiary hospital in the UK (2024)

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Type of publication:

Conference abstract

Author(s):

Mannan S.; Waseem T.; Safwan N.; Ganaie M.;

Citation:

Pleural infection presentation and timeline of events: Real-world data from a tertiary hospital in the UK.

Abstract:

Background: Pleural infection remains a significant burden on mortality and morbidity in the Western world even with the advancement of clinical management.

Objective(s): This paper aims to study the clinical course of empyema thoracic patients managed in a tertiary hospital in the UK.

Method(s): We did a retrospective observational study of the hospital's electronic records of patients who were diagnosed and managed for empyema thoracic from January 2021 to December 2022.

Result(s): The total cohort was 104 empyema thoracic patients. The mean age was 60. The affected males were almost double than females (68 vs 36). We did a retrospective RAPID score of our cohort. The RAPID score could not be calculated for 35 patients due to the unavailability of pleural fluid data. High inpatient mortality (23%) was observed in the medium- risk (RAPID score 3-4) group and high 3-month mortality (25%) was observed in the high-risk (RAPID score 5-7) group. The majority of the patients were managed conservatively. No difference was noticed in the median length of hospital stay (11d) in all the risk groups. A high rate of (37%) surgical management was observed in the low-risk (RAPID score 0-2) group.

Conclusion(s): Our cohort's data comply with the predicted mortality risk of the RAPID score. We emphasize that RAPID score calculation can be a significant tool in the management of empyema thoracic patients.

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Ethnic disparity in the care and management of non-ST-segment elevation myocardial infarction and its impact on short-term and long-term survival: a long-term study of a national registry (2024)

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Type of publication:

Conference abstract

Author(s):

Yera H.; Weight N.; Moledina S.M.; Mamas M.A.;

Citation:

European Heart Journal. Conference: European Society of Cardiology Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no pagination), 2024. Date of Publication: 01 Oct 2024.

Abstract:

Background: Previous examination of data from the United Kingdom indicates no apparent ethnic disparity in the treatment of patients hospitalised with non-ST-segment elevation myocardial infarction (NSTEMI). However, it remains uncertain whether this lack of disparity results in similar long-term survival outcomes among ethnic minority groups, particularly those with multiple underlying risk factors for coronary artery disease, when compared to White patients.

Purpose(s): To assess the impact of quality of care on short-term and long-term survival among NSTEMI patients while examining disparities based on ethnicity.

Method(s): We analysed records of 252,964 individuals diagnosed with NSTEMI from the Myocardial Ischaemia National Audit Project database spanning 2005 to 2019, alongside Office of National Statistics data for mortality. Among them, 233,158 were identified as White patients, while 19,806 were categorised as belonging to ethnic minority groups (Asian, Black, and mixed ethnicity). Propensity score matching was used to compare average treatment effects between cohorts while survival was compared using Cox regression model.

Result(s): Ethnic minorities were younger (median age in years) (66 vs. 73, P < 0.001), predominantly male (70% vs. 63%, P < 0.001), and exhibited a higher prevalence of cardiovascular risk factors such as diabetes (52% vs. 24%, P < 0.001), hypertension (67% vs. 54%, P < 0.001), hypercholesterolemia (49% vs. 34%, P < 0.001), and chronic renal dysfunction (13% vs. 8%, P < 0.001). Ethnic minorities more frequently underwent invasive coronary angiography (80% vs. 68%, P < 0.001), percutaneous coronary intervention (53% vs. 44%, P < 0.001), and coronary artery bypass grafting (5% vs. 4%, P < 0.001). After conducting propensity score matching, both cohorts had no significant differences in in-hospital all-cause mortality [odds ratio (OR) 1.13, confidence interval (CI) 0.89 – 1.43; P = 0.268], cardiac mortality (OR 1.20, CI 0.89 – 1.54; P = 0.209), one-year mortality (OR 1.01, CI 0.89 – 1.13; P = 0.893) and major adverse cardiovascular events (OR 1.21, CI 0.95 – 1.48; P = 0.108). However, upon conducting a five-year survival analysis, ethnic minorities had better survival rates than their White counterparts (Hazard ratio (HR) 0.89, CI 0.86-0.92; P < 0.001).

Conclusion(s): Despite ethnic minorities being at a higher risk for coronary artery disease, our findings indicate that they experience better five-year survival rates than White patients. This suggests equitable access to care and potentially a more aggressive treatment approach in this relatively young patient cohort.

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