Multi Disciplinary Team Working

Introduction/Background: Teamwork is very important in hospitals where the medical on-call team manage the stroke and thrombolysis alert calls. In addition to technical skills, human factors play a very significant role in meeting a target door-to-needle time.

Aim: To improve door-to-needle time by improving human factors (leadership, understanding and delegation of roles and confidence in participation) and technical factors (quick NIHSS and efficient documentation of vital information on radiology request forms for urgent CT head).

Method: We conducted 6 simulation-based training sessions and de-briefing sessions (role-playing and education around technical and non-technical skills) starting from November 2022. We measured the participants’ responses before and after the sessions, with the help of Kirkpatrick’s four level training evaluation model. We measured and compared the thrombolysis breakdown data (total of 38 consecutive patients from May 2022 to February 2023) throughout the process. We used statistical process control (SPC) charts to calculate and visually represent median values to demonstrate the changes.

Results: Thrombolysis breakdown data revealed substantial improvement post intervention (November 2022) compared to data from May-October 2022. SPC charts demonstrated significant reduction and step change in median door-to-needle time (83.7 to 52.2 minutes) and CT imaging to reporting time (36.2 min to 19.5 min).

Conclusion: A series of simulation-based training sessions and debriefing sessions for stroke thrombolysis was able to demonstrate statistically significant improvement in door-to-needle time. We will continue the simulation sessions and will assess sustainability of the interventions.

References: 1. Ajmi SC, Advani R, Fjetland L, et al Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre. BMJ Quality & Safety 2019;28:939-948. 2. Chalwin, R.P. and Flabouris, A. (2013), Non-technical skills training for MET. Intern Med J, 43: 962-969. https://doi.org/10.1111/imj.12172

Introduction

The British Geriatric Society (BGS) highlighted the need for workforce improvement and development of a skilled multidisciplinary team (MDT) in older people’s healthcare in their 2024 roundtable, “Transforming care for older people”. This survey aimed to gather views from pharmacy professionals on career progression and how the BGS and UK Clinical Pharmacy Association (UKCPA) can support their advancement in this speciality.

Method

A Google Forms questionnaire was designed to collect data on demographics, education, working practices, and specialisation. Respondents were asked about the need for defined core competencies and an advanced curriculum for the speciality, as well as the support professional groups should provide. The survey was distributed through BGS and UKCPA communication channels.

Results

Thirty-eight pharmacy professionals responded, with pharmacists comprising the majority (n=37, 97%), working primarily in secondary (n=21, 55%) and primary care (n=12, 32%). Most respondents were female (n=31, 82%) and 61% (n=23) identified as white British. Over 80% (n=31) were at a senior level (band 8a or above), with 68% (n=26) having over 10 years’ experience. Many identified as specialists in care of older people (n=29, 76%). There was unanimous support for an advanced pharmacist curriculum specific to older people’s care for those seeking to credential at an advanced level, and 90% (n=34) agreed on the need for core competencies for all pharmacy staff in this area. Key themes to enable progression included structured support, mentorship, clear career pathways, accredited courses, and opportunities to share expertise.

Conclusion

The BGS and UKCPA are well-positioned to develop an advanced curriculum in older people’s healthcare, aligned with existing professional pathways already implemented by the Royal Pharmaceutical Society. Joint initiatives to provide structured development opportunities could enhance the specialist workforce, ensuring high-quality pharmacy services are provided routinely as part of multidisciplinary teams caring for older people.

Effect of Early Intervention By Physiotherapy And Occupational Therapy On Older Inpatient Population

S Kotak¹, C Miller ²

¹ Senior Physiotherapist, University Hospitals of Leicester NHS Trust

²Consultant Geriatrician, University Hospitals of Leicester NHS Trust

Background: Currently, on inpatient medical wards at University Hospitals of Leicester NHS Trust, the first contact by therapy teams (physiotherapy and occupational therapy) is made when patients become medically optimised for discharge. This is due to a number of reasons such as staffing and resource shortages.

Aim: Analyse the effects of early intervention by therapy on patients on a geriatric medicine inpatient ward at a large, teaching hospital. It is hypothesised that earlier intervention can improve patient and service outcomes.

Method: A data sheet was created to capture baseline information including mobility/care needs prior to admission, date of initial contact by therapy, mobility/care on discharge, length of stay and discharge destination. Data was collected over two phases; initial therapy contact at point of patient being medically optimised for discharge, and then with the planned intervention of proactive therapy input early in a patient’s admission.

Results: The data shows an improvement in all measured patient outcomes in the intervention group. The average time from admission to therapy first contact reduced from 6.4 days to 2 days. The average length of stay reduced from 16.3 days to 7.4 days in the intervention group. 70% of patients left the hospital with a reduction in their mobility status in the control group, whereas only 32% of patients left with worse mobility in the intervention group. 41% of patients in the control group left with new or increased care provision compared to 36% in the intervention group. The data also showed that a higher proportion of patients were mobilised by ward staff and less patient were discharged to 24 hour care settings in the intervention group.

Conclusion: Therapy (with the help of the wider multi-disciplinary team) should proactively identify patients in need of therapy input as soon as safely possible during an inpatient journey. This shows that adopting this approach leads to improvements for both our patients and our service.

BACKGROUND

A multidisciplinary (MDT) approach is increasingly recommended as the standard of care for patients with Parkinson’s disease (PD). Research has shown that an MDT approach can lead to better quality of life and improve patient outcomes in a number of domains depending on set up. We established an MDT clinic with a PD specialist physiotherapist and pharmacist to assess how this would improve patient outcomes at a DGH hospital.

METHOD

An MDT clinic led by a consultant geriatrician with a PD specialist pharmacist and a physiotherapist that could assess patients attending the clinic was established once weekly. This run alongside a pre-existing weekly PD clinic with only a consultant geriatrician. We analysed data from both clinics at one year and compared the outcomes regarding:- access to physiotherapy, rates of de-prescribing and medication side effects monitoring, and rates of falls and hospital attendances at six months and one year.

RESULTS

Overall, the results of the project were positive despite a smaller sample size than anticipated due to the covid pandemic. The results showed the presence of a physiotherapist in clinic not only leads to earlier access to physiotherapy, but may also lower the clinician threshold for referral leading to earlier identification of patients at risk. The results also showed a benefit to having a pharmacist in clinic especially in increasing the rates of documented side effect monitoring. Importantly, a chi-squared analysis showed a statistically significant reduction in the number of patients from the MDT clinic having a hospital attendance between 6-12 months. There were also smaller reductions in falls and hospital attendances across both time periods for patients in the MDT clinic. Further cycles are needed to solidify these associations and to analyse the mechanisms by which the effects especially the reduced attendance rates at 6-12 months occur.