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A Quality Improvement Project: Improving the Presentation of Assessments Within a Liaison Psychiatry Department
- Shivali Jain, Natalie Maalouf, Khalil Hassanally, Raman Rashwany, Asha Faldu, Krishna Amin
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S107
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Aims
This Quality Improvement Project (QIP) was undertaken within a Liaison Psychiatry (LP) department at a district general hospital in North West London. The current service model has LP nurses and junior doctors providing first contact with patients, and subsequently discussing assessments with the team psychiatrists. A need for effective communication when presenting clinical cases has emerged given high rates of staff turnover. The aims of this QIP were; (1) To assess the quality of presentations within the multidisciplinary team (2) to deliver a targeted teaching session focused on frameworks for assessment presentation and (3) to evaluate the effectiveness of the intervention.
MethodsThe ‘SBAR: Situation, Background, Assessment, Recommendation’ communication tool already used widely within healthcare was adapted for LP by an MDT including doctors, senior nurses and pharmacist.
A survey was designed with MDT input to collect data about the content of presentations using adapted Likert scales, a quantitative global score and qualitative data highlighting areas for improvement. Over two weeks, senior team members completed surveys for every patient discussion.
A targeted teaching session was delivered on the adapted LP SBAR including: presenting complaint, current medical issues, referral question, psychiatric background, mental state examination, delirium/cognitive screening, risk assessment, impression and management plan. The session included breakout groups with clinical vignettes to practice presenting. All team members filled in a pre- and post-intervention surveys rating their confidence in presenting assessments and received copies of teaching materials.
Data were collected over a 2-week period post-intervention using the same methodology as pre-intervention. Post-intervention data were presented to the MDT and feedback was sought for improvement in the next cycle.
ResultsPre-intervention data (n=30) indicated a risk assessment, impression and plan were often missed from presentations.
Following targeted teaching, team members felt more confident presenting assessments, formulating impressions, and management plans. Post-intervention data (n=22) showed an improvement in inclusion of all key information covered in the LP SBAR except management plans. The percentage of presentations with a global score ≥7 increased from 41% to 57%.
ConclusionThis ‘Plan, Do, Study, Act’ cycle has modestly improved the quality of assessment presentations within LP and has identified a critical need for communication tools within LP. We will perform another cycle in February 2023 given the high turnover of staff and continue to seek feedback from the MDT on the effectiveness of this targeted teaching session to continue to improve the presentation of assessments in LP.
Rapid recovery of tigers Panthera tigris in Parsa Wildlife Reserve, Nepal
- Babu Ram Lamichhane, Chiranjibi Prasad Pokheral, Shashank Poudel, Dipendra Adhikari, Sailendra Raj Giri, Santosh Bhattarai, Tek Raj Bhatta, Rob Pickles, Rajan Amin, Krishna Prasad Acharya, Maheshwar Dhakal, Uba Raj Regmi, Ashok Kumar Ram, Naresh Subedi
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Information on density and abundance of globally threatened species such as tigers Panthera tigris is essential for effective conservation as well as to evaluate the success of conservation programmes. We monitored tigers in Parsa Widlife Reserve, Nepal, using camera traps, in 2013, 2014 and 2016. Once believed to be a sink for tigers from adjacent Chitwan National Park, Parsa now provides a new hope for tigers. Spatially explicit capture–recapture analysis over 3 survey years revealed an increase in tiger density from 0.78 to 1.38 individuals per 100 km2 from 2013 to 2016. The tiger abundance was estimated to be seven (6–13), 11 (10–16) and 17 (17–20) in 2013, 2014 and 2016, respectively. Resettlement of communities from the core area, reduced anthropogenic pressure, and improved security have made Parsa Wildlife Reserve a suitable habitat for tigers. Tiger abundance increased considerably within a 5 km radius of the evacuated village sites, from two in 2013 to eight in 2014 and 10 in 2016. Population turnover has remained moderate (< 30% per year), with persistence of individuals in multiple years. Dispersing tigers from Chitwan's source population accounted for a large portion (c. 40%) of the tigers detected in Parsa. Conservation efforts along with annual monitoring should be continued in Parsa to sustain the increase and monitor the persistence of tigers. The Chitwan–Parsa complex should be managed as a single ecological unit for conserving the Endangered tiger and other wide-ranging species.