2021:  BGS Autumn meeting platform presentation abstract

805 Clinical quality – clinical effectiveness

L Shaw; T Maggs; P Braude; D Shipway; S Srivastava; M Kelly 

Introduction

Upper limb fractures are the second most common fracture requiring admission to hospital after hip fracture [Jennison, 2019].  At 1-year 20.5% have died, compared to 29.5% in hip fracture [Wiedl, 2021].     Local Problems:  At North Bristol Trust most patients with upper limb fractures and a Clinical Frailty Score ≥ 5 are managed non-operatively on medical wards. Local service evaluation identified a long length of stay of 23 days.    Case note review revealed:  ∙ Delayed transfers of care (DTOCs) had been managed non-weight bearing in slings for 4-6 weeks.  ∙ Non-weight bearing status resulted in DTOC due to declined access to social care and rehabilitation due to perceived health needs.  ∙ A high rate of hospital-acquired complications and failure to rehabilitate.  ∙ Breakdown in interdisciplinary communication and ownership across the pathway.     

Methods

A multidisciplinary QI project was commenced.  Using local data through business analytics, clinician and patient feedback, a new Trust guideline was developed for older people with frailty and upper limb fractures. Data collected determined average length of stay before and after implementation of the service change.  A standard process control chart was created monitoring the effect of the changes in the pathway. The multidisciplinary team met regularly to make alterations during implementation.    The resulting intervention included:  ∙ Removal of functional restrictions; allow free use of limb as comfort permits.   ∙ Simplified slings and minimised light weight casts.  ∙ Proactive integration of orthopaedic plan into CGA documentation.  ∙ Proactive interdisciplinary communication across pathways.  ∙ Patient information leaflets.     

Results

Pre-intervention average length of stay was 23 days. Post-intervention was 14 days.     

Conclusion

Proactive, structured management of upper limb fractures in people with frailty is associated with significant reduction in acute hospital length of stay.  Next steps include a business case for a frailty trauma specialist therapist embedded into medicine.

Addendum 2023

Additional thanks for ongoing support from Tahid Alam,  Alasdair Bott, Andrew Riddick, Frances Verey, Lynn Hutchings, Nathanael Ahearn

This is a searchable database of information about tests offered by Severn Pathology. You can browse the index, enter a test name, part of a test name, abbreviation or clinical indication below.

The containers listed refer to those used to collect samples from adults locally in GP practices and hospital wards/outpatients. Details of the containers used for neonates, children and in the emergency zone (ED, AAU, ITU) can be found here Tube Guide and Recommended Order of Draw.

After performing a search for a specific test, the Reset button can be clicked to go back to the A-Z test list.

Please use Badger Notes - Self-refer your pregnancy to BNSSG and complete the form to arrange your first appointment with a midwife at North Bristol NHS Trust.

We recommend you complete the Badger Notes form as soon as you know you are pregnant; it should take approximately 10 minutes to complete.

We will contact you within three working days to offer you an appointment, this will be at the most suitable time to ensure that you are booked for your scan and screening tests within a recommended timeframe.

Appointments are occasionally offered in a neighbouring area to ensure that your appointment is at the optimum time. The first appointment is important and we would appreciate your flexibility to attend the offered appointment.

If you need help completing this form, please contact the booking team, Monday to Friday between 08:00 and 16:00 on 0117 414 6743.

Some pregnant people may require an early appointment:

• Are you known to be a carrier of sickle cell, abnormal haemoglobin or thalassaemia?
• Or have you had a pregnancy confirmed to have been affected by Down’s Syndrome, Edward’s syndrome, or Pataus’ syndrome?

If so, in addition to completing the self-referral form, please contact the Screening team for early screening advice on 0117 414 6739. 

You can find more information about Badger Notes on our dedicated page.

Welcome

Hello, I’m Kerry, the new Head of Patient Experience. I will be here whilst Emily is away. It's an honour to join such an amazing team of dedicated people who are committed to putting patients, carers and families at the heart of everything we do. I'm excited to be part of this journey with you and to support you in continuing to achieve great work in all aspects of patient and carer experience - listening to feedback, collaborating and focusing on what really matters to people in our communities.

We have a lot coming up this spring including national Patient Experience Week at the end of April and national Volunteers Week at the start of June. We have our first Carers Awareness Training Session, Gypsy Roma Traveller History Month and more! From April we will be sharing all our Patient Experience social media content under one account. Make sure you are following: NBT Patient Experience Team (@NBTPatient) / X and  North Bristol NHS Trust (@north_bristol_nhs) • Instagram photos and videos

Kerry Than, Head of Patient Experience 

Volunteer Services

Bwalya Treasure, Volunteer Operational Lead 
Kat Tudor-Thomas, Volunteer Strategic Lead

It’s been an exciting few months, from our wonderful League of Friends funding the purchase of dedicated Carers Chairs, to our volunteers taking part in Learning Disability training. We have also been finalising our Volunteer Services Strategy for the next three years. With a huge amount of input, we will be focusing on ensuring our volunteer offer is welcoming to all. We are excited to launch this. 

We are also looking forward to celebrating Volunteers Week at the beginning of June. We are lucky enough to have two UWE photography students doing a volunteer placement with us and taking photos of lots of different volunteers. These photos will form an exhibition in the Brunel building launching during Volunteers Week. This will be a chance to celebrate everything so far, whilst also looking ahead to the next three years!

Guest feature 

Ingrid Barker, Joint Chair 

It was a pleasure to spend some time with the Patient and Carer Partnership Group recently. We discussed how we can support, amplify and act on the voices of the people we serve as we form our Group with UHBW and begin reshaping some of our clinical services under our Joint Clinical Strategy. 

The group have championed for patients for over 11 years and they help us break down barriers and make improvements. We celebrated all their achievements so far and how we will enhance this going forward. 

It is key, as with everything we do, we ensure we are listening to the people we serve and carers and this group along with our other feedback and outreach, helps to ensure we are moving in the right direction. 

Thank you to all our volunteers, experts by experience and carers who support us in delivering an outstanding experience.

Fresh Arts

Art on wards

Donna Baber, Fresh Arts Manager

In summer 2024, Fresh Arts commissioned Jennifer Mills, a visual artist who works with collage and sewing, and Claire Williamson, a creative writer and poet, to collaborate with patients, visitors, and staff on a series of workshops. The aim was to create inspiring and healing artwork for individual bedrooms on ward 26A. 

Themes began to emerge around calming images that can soothe patients; these included a lighthouse, water, beach, and park scenes. Jennifer created four sample images and Claire asked staff to create original words to pair with the images to make each final design unique. In addition to these patient-focused designs, two further artworks were created for the staff rest room which incorporate imagery and text that celebrate the team’s work and culture. 

The artworks were installed in January 2025. Sonia, a patient on the ward, was delighted that the artwork was installed while she was there. She said, “it was an utter joy for me to have the artwork installed in my room. I now have a picture of the beach; the colours of the sea, the sky, the sand are all my favourite colours. I’m using it for meditation and visualisation to help heal and get better. It incorporates everything that is ‘me’ and that would be the place that I would go to; the beach is my happy place. It really is so special to me. It couldn’t have been better timing and it has been a lifeline.”

Photo: First Avenue Photography

Patient Feedback & Engagement

Hearing all voices

Troy Crompton, Patient Experience Manager

Whilst we have many ways patients can provide feedback such as the Friends and Family Test (FFT), the Patient Advice and Liaison Service (PALS), complaints and other surveys, we also actively engage with patients to ensure we speak to and hear all voices.

A few areas we have been focusing on recently include; 

• outreach with our Gypsy, Roma, Traveller communities including bringing a patient story video to Trust board of their experiences
• patient conversations on wards and over the phone, recent focus on speaking to people with a learning disability and/or autism
• gaining feedback on access from people experiencing homelessness
• outreach to local visual loss groups with a survey on our work so far
• understanding the experiences of those who do not speak English

The feedback and insights are shared with the respective areas and steering groups to shape and drive improvements to patient and carer experience.

Spiritual, Pastoral and Religious Care (SPaRC) 

Chaplaincy Volunteers Training Course

Mack Kholowa, Team Chaplain

One of our aims for 2025 is to be more inclusive and diverse in our volunteer recruitment. Supported by the chaplaincy team, I (Mack Kholowa), ran a 4-week SPaRC training course in January and February. This was attended by nine new volunteers, all from a range of faith, cultural and ethnic backgrounds. 

In March, the volunteers will undertake accompanied ward visits for 3 weeks where they shadow a chaplain and are then observed and supported in their own role. The Volunteers have been allocated to visit Elgar 1, Elgar 2, 25A ,27A, 28B, 6B and Rosa Burden wards. We hope volunteers will start their roles in April 2025. 

The SPaRC Chaplaincy team is hopeful that the new volunteers will support our commitment to providing the best patient experience. By having a wide range of volunteers this will help us support all our patients.

Would you like to take part in a study about planned caesarean birth?

If you are pregnant with one baby and have chosen to have a caesarean birth at Southmead Maternity Unit, you may be able to take part.

If you would like to request a pdf version of our study information, please email the Study team at: TTT@nbt.nhs.uk

Summary of the study

Why is this study being done?

Why have I been invited to take part?

Why are you testing a Time-to-Transition Caesarean Birth?

What is a Time-to-Transition Caesarean Birth?

What does Time-to-Transition mean for me and my baby?

What are the potential benefits of taking part?

Are there any risks?

What will the study involve?

Can my birth partner be involved?

Can I have a copy of the video?

What is the recovery time?

Who is doing the study?

How is this study funded?

Who has reviewed this study?

What happens next?

What if I change my mind?

How will my information be used?

Where can I find more about how my information will be used?

What if there are any problems?

Who should I contact if I have any questions?

If you are birth partner to someone who has chosen to take part in the Time-to-Transition Caesarean Birth Study, you may be able to take part in this questionnaire study.

If you would like to request a pdf version of our study information, please email the Study team at: TTT@nbt.nhs.uk

What is a Time-to-Transition Caesarean Birth?

Why have I been invited to take part?

Are there any benefits to taking part?

Are there any risks?

How much time will it take?

Who is doing the study?

How is this study funded?

Who has reviewed this study?

What happens next?

What if I change my mind?

How will my information be used?

Where can I find more about how my information will be used?

What if there are any problems?

Who should I contact if I have any questions?

Time to Transition Caesarean Birth: A new study is taking place to determine if a Time-to-Transition caesarean birth improves the health of new born babies.

What is this feasibility study about? And why are we doing it?

Background: 

In the womb, a baby’s lungs are filled with fluid, which helps them develop. During labour and birth, most of this fluid goes away, and the baby adapts to breathing air.

When babies are born quickly by caesarean, they may not have enough time to clear the fluid, so the lungs remain “wet”, making it harder to breathe. They breathe faster and shallower, a condition called Transient Tachypnea of the Newborn (TTN), and often need antibiotics, breathing support, and a stay in a Neonatal Intensive Care Unit.

Reducing TTN could reduce the need for this extra care.

This study will assess a new ‘Time-to-Transition Caesarean Birth’. 

Rather than being born rapidly after opening the womb, the doctor will deliver the baby’s head, keeping the body inside the womb until the baby starts to cry (for a maximum of 2 minutes). This extra time may help the baby transition to breathing air and reduce the risk of TTN.

As with any caesarean, the mother and baby will be closely monitored. If there are any concerns the baby will be immediately delivered. Everything else about the birth and recovery remain unchanged.

How will the research be carried out?

Methods: 

We will recruit 34 women to have a “Time-to-Transition Caesarean Birth”.

Women can take part if they are:

• pregnant with one baby
• planning a Caesarean birth
• and if baby’s position is “head-down”

We will:

• video the births, to learn from them.
• collect information about mother and baby from their medical records
• ask the views of mothers, birth partners, and clinicians

Future Direction

If this study demonstrates that it’s feasible and is acceptable, we will undertake a large-scale study comparing newborn outcomes after “Time-to-Transition” and “standard” caesarean births.

Project Details:

Chief Investigator: Dr Joanna Crofts, Consultant Obstetrician

Planned End Date: July 2024

Local Ref: 5238 

More than 55 million people have dementia worldwide with nearly 10 million new cases every year.

Researchers have learned that changes in the brains of people with Alzheimer’s disease start as many as 20 years before they notice symptoms like memory problems.

Amyloid is a protein that builds up in the brains of people who have AD. This build-up of amyloid protein in the brain is called “amyloid plaque” and may lead to impairment in memory and thinking. Research studies suggest that people with normal memory performance who have elevated levels of brain amyloid are at increased risk for memory problems, but not every person with amyloid build up will develop memory problems or AD dementia.

At NBT we are one of 100 sites world-wide who are asking volunteers between the age of 55 to 80 years of age to take part in the AHEAD A-45 study, to see if a study treatment with BAN2401 (also known as lecanemab)  can help reduce the risk of developing Alzheimer’s disease.

The Bristol Brain Centre is one of the only brain health clinical services in the country. It has a strong research ethic offering research opportunities to people with and without dementia.

The research focuses on early diagnosis of dementia, understanding how memory is stored in the brain and how this can be enhanced through clinical trials.

We were privileged to interview Rob, who is taking part in the study and shares with us his experiences and hopes for the future.

Video Script

I'm Rob and I'm a retired enjoying my time in retirement so it's given me the chance to do all sorts of new things and get involved in activities I love walking I celebrated my retirement by walking a thousand miles around the coast of Wales with a tent on my back and just to prove that I was fit and I have done various long distance paths in the in the country.

So to take part in the study you you've got to have a degree of Alzheimer's dementia and which indeed they found,  and to take part you've got to be prepared for that discovery to be made and take it from there I believe,  that I ought to be doing everything  I can to help any research into dementia as something that's important to me.

The actual assessment process encompasses various tests and things, that obviously  makes you cause you to wonder what they're going to discover about you.  But, in fact I wasn't  too worried about that or concerned. Everybody was extremely caring and at every stage everything that they were doing was explained clearly and the reassurance at every level was good.  As I have said before at any stage I  was encouraged to withdraw if I had the slightest concern about doing something I wasn't comfortable doing.

Having been accepted onto the trial it was a moment of excitement for me. I was very pleased to do it and pleased that I've been accepted.

I think the major thing about once you are accepted and being able to be accepted is that you've got to be prepared to commit time. It's a four-year study and you are required to go to the brain Centre in Southmead for once a month for several hours and that for me was my major consideration rather than any consideration about my own health.

I attend the Bristol Brain Centre every month for a few hours and I receive an infusion of the drug or a placebo I don't know which. I also have regular cognitive tests health checks and a MRI brain scan every three months.

To not know whether you're having the actual drug or the placebo is rather strange to begin with but you get you get used to the Cloak and Dagger bits of the actual liquid being covered in a black bag so that nobody knows what's happening it's all quite exciting really.

It's made clear at the beginning of the trial that you will never know and you have to accept that as part of the condition of taking part. To anyone thinking of taking part in this study and not necessarily this one, just be open about it I think I'd recommend anybody to put themselves forward for assessment.

You lose nothing by being assessed you perhaps gain something by finding something out about yourself as long as you're prepared for that to happen.

The big decision about whether to take part in the trial comes after the assessment, so, yes you could consider it. I would encourage you to do so.

I hope my participation and those of the other people taking part in the trial across the world that at least the quality of life for people who suffer in dementia can be improved. Ends

AAC Assessment (Training for Local Paediatric and Local Adult Learning Disability Teams)

We are pleased to be able to offer this free online training course via Microsoft Teams.  

The course is a full day and consists of both theory and practical exercises outlining models, tools and access considerations for assessing children and adults with learning difficulties. 

We will ask those attending to bring a case study with them to share and relate their learning to. A template for case studies will be sent out to attendees a week before the course date. There will be opportunities to ask any specific questions you have and learn more about the service AAC WEST offers.

Available dates:

Tuesday 15th October 2024 - Book here with Eventbrite