Improving care pathways in adults and children最新文献

{"title":"P123 Don’t forget your PE kit – improving thrombolysis decision making in a district general hospital (DGH)","authors":"J. Ayling-Smith, E. Grant, H. Cranch, E. Kealaher, S. Eccles, C. Williams","doi":"10.1136/thorax-2021-btsabstracts.232","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.232","url":null,"abstract":"P124 Figure 1 Correct documentation of LA agents Poster sessions Thorax 2021;76(Suppl 2):A1–A205 A133 on F ebuary 6, 2022 by gest. P rocted by coright. httphorax.bm jcom / T hrax: frst pulished as 10.113orax-2021-B T S abscts.233 on 8 N ovem er 221. D ow nladed fom 3. Introduction of specific LA fields on our online bronchoscopy reporting system. Bronchoscopy and EBUS reports were re-audited following each intervention (total 19 cases). Results Maximum recommended dose of midazolam in 70yrs (3.5mg), was exceeded in 19% of EBUS cases and 5% of bronchoscopy cases pre-intervention. Following virtual teaching, 0% exceeded maximum recommended dose. Maximum recommended dose of fentanyl (50mcg) was exceeded in 22% of EBUS and 4% of bronchoscopy cases pre-intervention. Following virtual teaching, maximum dose was exceeded in 1.6% of EBUS and 0% of bronchoscopies. Pre-interventions, 1% and 2% lidocaine use was correctly documented in 17% of procedures and instillagel use was correctly documented in 33% of procedures. Following poster implementation, 1% lidocaine use was correctly documented in 75% of procedures, 2% lidocaine use was correctly documented in 88% of procedures and instillagel use was correctly documented in 60% of procedures. Following LA-field implementation, 1% lidocaine use was correctly documented in 91% of procedures, 2% lidocaine use was correctly documented in 91% of procedures, and instillagel use was correctly documented in 66% of procedures. (figure 1) Conclusions Virtual teaching for bronchoscopists increased awareness of safe PSA, thus reducing previously exceeded recommended doses of sedatives. Implementation of a bronchoscopy suite poster, and specific recording fields for LA, has improved documentation practices. Methods introduced continue to be used in our trust’s bronchoscopy suite. REFERENCE 1. BTS Quality Standards for Diagnostic Flexible Bronchoscopy in Adults (2014) https://www.brit[1]thoracic.org.uk/document-library/clinical-information/bronchoscopy/bts-quality-standards-for-flexible[1]bronchoscopy-2014 P125 AUDIT OF COMPLICATIONS OF PERCUTANEOUS CT GUIDED LUNG BIOPSIES CARRIED OUT AT ROYAL ALEXANDRA HOSPITAL AND INVERCLYDE ROYAL HOSPITAL IN 2019 AND 2020 AD Pilkington. University of Glasgow, Glasgow, UK 10.1136/thorax-2021-BTSabstracts.234 Background Percutaneous CT guided lung biopsy (PCLB) is used for histological diagnosis of pulmonary disease and is preferred to surgical biopsy due to its fewer complications. The British Thoracic Society (BTS) recommend that operators audit their practise to calculate complication rates to inform patients about risks. Complication rates should be similar to, or lower than those from the national survey: pneumothorax (20.5% of biopsies), pneumothorax requiring chest drain (3.1%), haemoptysis (5.3%), and death (0.15%). Aims This audit aims to calculate whether the complication rates of percutaneous CT guided lung biopsy were acceptable when compared to the aforementioned BTS guideli","PeriodicalId":363081,"journal":{"name":"Improving care pathways in adults and children","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129534298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P121 Does methacholine challenge test improve asthma diagnostic certainty in children age 5–16yr?","authors":"L. Healy, A. Hargreaves, R. Wang, S. Drake, L. Willmore, R. Tudge, J. Mitchell, L. Lowe, G. Kerry, M. Porter, S. Fowler, A. Simpson, C. Murray","doi":"10.1136/thorax-2021-btsabstracts.230","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.230","url":null,"abstract":"P124 Figure 1 Correct documentation of LA agents Poster sessions Thorax 2021;76(Suppl 2):A1–A205 A133 on Jauary 6, 2022 by gest. P rocted by coright. httphorax.bm jcom / T hrax: frst pulished as 10.113orax-2021-B T S abscts.231 on 8 N ovem er 221. D ow nladed fom","PeriodicalId":363081,"journal":{"name":"Improving care pathways in adults and children","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123997502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P120 The effect of medical face mask on adolescent children’s oxygen saturation during 6-minute walk test","authors":"A. Ahmad, M. Fatima, MZ Equabal","doi":"10.1136/thorax-2021-btsabstracts.229","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.229","url":null,"abstract":"","PeriodicalId":363081,"journal":{"name":"Improving care pathways in adults and children","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128351922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P126 Ambulatory pneumothorax with the pleural vent in a DGH in the North East of England","authors":"K. Jackson, A. Aujayeb","doi":"10.1136/thorax-2021-btsabstracts.235","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.235","url":null,"abstract":"","PeriodicalId":363081,"journal":{"name":"Improving care pathways in adults and children","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129710989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P124 Improving safe sedation practices in bronchoscopy at a district general hospital","authors":"AE Leadbetter, R. Beckett, C. Marchand, S. Sturney","doi":"10.1136/thorax-2021-btsabstracts.233","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.233","url":null,"abstract":"","PeriodicalId":363081,"journal":{"name":"Improving care pathways in adults and children","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127364499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P122 An evaluation of the transition service between paediatric and adult regional severe asthma care in Leeds","authors":"C. Doyle, E. Godinho, A. Adams, I. Clifton, E. Guy","doi":"10.1136/thorax-2021-btsabstracts.231","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.231","url":null,"abstract":"","PeriodicalId":363081,"journal":{"name":"Improving care pathways in adults and children","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134316055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P129 Getting it right in a digital age – robust patient selection to an early supported discharge service","authors":"R. Colclough, R. Wagstaff, S. Rees, K. Breese, C. Nicholls, S. Porter, G. Reeves, S. Gompertz","doi":"10.1136/thorax-2021-btsabstracts.238","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.238","url":null,"abstract":"P130 Figure 1 Features of COVID-19 on the CT were very common in hospitalised patients and were related to all-cause mortality one year following hospitalisation Poster sessions A136 Thorax 2021;76(Suppl 2):A1–A205 on N ovem er 9, 2021 by gest. P rocted by coright. httphorax.bm jcom / T hrax: frst pulished as 10.113orax-2021-B T S abscts.239 on 8 N ovem er 221. D ow nladed fom CTT; 78 (25%) had consolidation and 274 (88%) had PE (figure 1). Patients from Asian, Black and Other ethnic minority groups had a higher prevalence and severity of multifocal ground glass changes on CTT compared to those from White groups (severe ground glass changes for White: 15 [6%]. Asian: 6 [14%], Black 2 [11%], Other 8 [47%], p<0.001). After one year, 104 (33%) patients died. On univariable analysis, multifocal ground glass changes and consolidation were related to all-cause mortality at one year. In a model consisting of age; ethnicity; gender; number of comorbidities; admission National Early Warning Score-2; admission lymphocyte count; C-reactive protein and urea, the addition of worsening ground glass changes on CTT were related to all-cause mortality at one year (aHR: 1.29, 95% CI 1.08–1.55, p=0.005 and Figure) and boosted the model’s cumulative discrimination (Harrell’s c statistic 0.75 from 0.69, p<0.001). Conclusion Evidence of COVID-19 pneumonia on CTT is more common and severe in patients from ethnic minority groups and is independently associated with worse prognosis following hospitalisation. P131 THE DEGREE OF ACUTE RESPIRATORY SUPPORT WITH COVID-19 PNEUMONIA, SMOKING STATUS ON ADMISSION AND NON-RESOLVING CT FEATURES AT THREE MONTHSARE THERE LINKS? H Karimzadeh, R Penfold, U Nnajiuba, A Wight.Wirral Lung Unit, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK 10.1136/thorax-2021-BTSabstracts.240 Introduction and Objectives BTS guidelines suggest radiological follow up at 12 weeks for patients with COVID-19 associated pneumonia. It is suggested development of post-covid fibrotic changes is more prevalent with severity of illness. We compared illness severity based on maximal respiratory support with non-resolving changes on CT imaging at >12 weeks. Smoking status at time of admission was also collected. Methods Retrospective analysis of COVID-19 patients surviving to follow up identified either by CVCX1 coded CXR or CVCX2 coded CXR and positive PCR between March 2020January 2021. This identified 912 patients reviewed at 12 weeks with CXR ± CT imaging. 50/912 patients (5.5%) had evidence of either established fibrotic change or ongoing pneumonitis on CT. Imaging was reviewed by radiologist using suggested scoring system for Covid-19 follow-up 2 based on sum of 0–5 severity in 5 lobes (total 0–25) for markers of fibrosis/pneumonitis. Results Comparison is shown in table 1. All patients requiring more than 60% oxygen therapy received advanced respiratory support. 10/50 patients (20%) required no supplementary oxygen and 6/10 were not a","PeriodicalId":363081,"journal":{"name":"Improving care pathways in adults and children","volume":"554 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131862576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P128 Development of a pulmonary nodule virtual pathway","authors":"S. Eccles, A. Harries, F. Sheel","doi":"10.1136/thorax-2021-btsabstracts.237","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.237","url":null,"abstract":"","PeriodicalId":363081,"journal":{"name":"Improving care pathways in adults and children","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114974987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P125 Audit of complications of percutaneous CT guided lung biopsies carried out at royal alexandra hospital and inverclyde royal hospital in 2019 and 2020","authors":"A. Pilkington","doi":"10.1136/thorax-2021-btsabstracts.234","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.234","url":null,"abstract":"P126 Table 1 Poster sessions A134 Thorax 2021;76(Suppl 2):A1–A205 on N ovem er 0, 2021 by gest. P rocted by coright. httphorax.bm jcom / T hrax: frst pulished as 10.113orax-2021-B T S abscts.235 on 8 N ovem er 221. D ow nladed fom pneumothoraces secondary to image guided biopsies. Table 2 shows the adverse events related to those vents. Total number of bed days saved are 267. Conclusions Complication rates are comparable RAMPP trial and commoner with PSP patients. There is no indication of the PV being unsafe in SSP, but our cohort is highly selective and thus at risk of significant bias. Our protocol works locally and we are happy to share it if needed. REFERENCES 1. https://doi.org/10.1016/S0140-6736(20)31043-6 2. https://erj.ersjournals.com/content/early/2020/11/26/13993003.03375-2020 P127 LANCASHIRE AND SOUTH CUMBRIA REGIONAL TRACHEOSTOMY TEAM: ANNUAL IMPACT OF A SPECIALIST COMMISSIONED SERVICE E Forster, K Youd, L Hughes. Lancashire Teaching Hospitals, Preston, UK 10.1136/thorax-2021-BTSabstracts.236 Evidenced annual impact of a specialist commissioned regional tracheostomy team aiming to reduce the risk of community tracheostomies. There are an increasing number of tracheostomies being inserted nationally with no national framework for ongoing review following discharge to the community setting. This has the potential to result in poor clinical outcomes and ongoing dependence on acute care services and high cost packages of care. Prior to this service innovation, community tracheostomy patients were managed primarily by GP’s with very few patients receiving specialist input. We found that this was resulting in repeated hospital admissions, lack of specialist review to assess for weaning potential and due to the lack of tracheostomy competent placements, was causing individuals to be relocated away from their families. £301,000 investment from regional Clinical Commissioning Groups (CCG’s) was secured in April 2020 to create a specialist Nurse/Allied Health Professional led team consisting of 2.5 team members: Nurse (Clinical Lead), Physiotherapist and Speech and Language Therapist. Quantitative and qualitative data was collected during the first year of substantive funding to evidence service impact including: number of community decannulations with associated continuing healthcare cost saving, reduced dependence on secondary care, improved access to community placements, hospital admission avoidances and lived patient experiences. A total cost saving of £405,050.68 with an additional cost avoidance of £2,700,000 from acute in-reach decannulations during the first 6-month COVID-19 wave was achieved over this 12month period. We have demonstrated the positive impact specialist tracheostomy services can have across primary and secondary care with the aim of this service model being used for national service provision pathway developments. Specialist tracheostomy services can achieve huge impact within the community setting both to improve clin","PeriodicalId":363081,"journal":{"name":"Improving care pathways in adults and children","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131605981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}