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Weaver JMJ, Cooksley T. Response to: Immune-mediated toxicity leading to organ failure may achieve good outcomes from ICU admission. QJM 2024; 117:84. [PMID: 37471617 DOI: 10.1093/qjmed/hcad177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- J M J Weaver
- Department of Acute Medicine, The Christie, Wilmslow Road, Manchester, UK
- Department of Medical Oncology, The Christie, Wilmslow Road, Manchester, UK
| | - T Cooksley
- Department of Acute Medicine, The Christie, Wilmslow Road, Manchester, UK
- Department of Medical Oncology, The Christie, Wilmslow Road, Manchester, UK
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Cooksley T. Editorial - Acute Medical Care: "Exit block". Acute Med 2024; 23:2-3. [PMID: 38619163 DOI: 10.52964/amja.0965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
NHS urgent and emergency care (UEC) remains under immense and unsustainable pressure. This is increasingly causing harm to patients and emotional trauma to the staff striving to deliver basic standards of care.
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Affiliation(s)
- T Cooksley
- Editor-in-Chief, Consultant in Acute Medicine, Manchester University Foundation Trust and The Christie
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Atkin C, Knight T, Cooksley T, Holland M, Subbe C, Kennedy A, Varia R, Lasserson D. Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21): assessing national performance of acute medicine services. Acute Med 2022; 21:19-26. [PMID: 35342906 DOI: 10.52964/amja.0888] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21) took place on 17th June 2021, providing the first assessment of performance against the Society for Acute Medicine's Clinical Quality Indicators (CQIs) within acute medical units since the start of the COVID-19 pandemic. METHODS All acute hospitals in the UK were invited to participate. Data were collected on unit structure, and for patients admitted to acute medicine services over a 24-hour period, with follow-up at 7 days. RESULTS 158 units participated in SAMBA21, from 156 hospitals. 8973 patients were included. The number of admissions per unit had increased compared to SAMBA19 (Sign test p<0.005). An early warning score was recorded within 30 minutes of hospital arrival in 77.4% of patients. 87.4% of unplanned admissions were seen by a tier 1 clinician within 4 hours of arrival. Overall, the medical team performed the initial clinician assessment for 36.4% of unplanned medical admissions. More than a third of medical admissions had their initial assessment in Same Day Emergency Care (SDEC) in 25.4% of hospitals. 62.1% of unplanned admissions were seen by two other clinical decision makers prior to consultant review. Of those unplanned admissions requiring consultant review, 67.8% were seen within the target time. More than a third of unplanned admissions were discharged the same day in 41.8% of units. CONCLUSION Performance against the CQIs for acute medicine was maintained in comparison to previous rounds of SAMBA, despite increased admissions. There remains considerable variation in unit structure and performance within acute medical services.
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Affiliation(s)
- C Atkin
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, B15 2GW, UK. ORCiD ID = 0000-0003-0596-8515
| | - T Knight
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, B15 2GW, UK. ORCiD ID = 0000-0003-0596-8515
| | - T Cooksley
- Departments of Acute Medicine, Manchester University NHS Foundation Trust, UK, M23 9LT and The Christie, Manchester, M20 4BX, UK. ORCID ID: 0000-0001-6114-1956
| | - M Holland
- Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, BL3 5AB, UK. ORCID iD: 0000-0001-8336-5336
| | - C Subbe
- School of Medical Sciences, Bangor University & Consultant Acute, Respiratory & Critical Care Medicine, Ysbyty Gwynedd, Bangor, LL57 2PW, UK. ORCID iD: 0000-0002-3110-8888
| | - A Kennedy
- Department of Acute Medicine, Airedale Hospital NHS Foundation Trust, Keighley, West Yorkshire, BD20 6TD
| | - R Varia
- Department of Acute Medicine, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, L35 5DR
| | - D Lasserson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Atkin C, Knight T, Cooksley T, Holland M, Subbe C, Kennedy A, Varia R, Lasserson D. Length of stay in Acute Medical Admissions: Analysis from the Society for Acute Medicine Benchmarking Audit. Acute Med 2022; 21:27-33. [PMID: 35342907 DOI: 10.52964/amja.0889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Medical admissions to hospital represent a diverse range of patients, from those managed on ambulatory pathways through Same Day Emergency Care (SDEC) services, to those requiring prolonged inpatient admission. An understanding of current patterns of admission through acute medicine services and patient factors associated with longer hospital admission is needed to guide service planning and improvement. METHODS Data from the Society for Acute Medicine Benchmarking Audit (SAMBA) 2021 were analysed. Patients admitted to acute medicine services during a 24-hour period on 17th June 2021 were included, with data recording patient demographics, frailty score, acuity and follow-up of outcomes after seven days. RESULTS 8101 unplanned medical admissions were included, from 156 hospitals. 31.6% were discharged without overnight admission; the median hospital performance was 30.1% (IQR 19.3-39.3%). 22.1% of patients remained in hospital for more than 7 days. Those remaining in hospital for more than 48 hours and for more than seven days were more likely to be aged over 70, to be frail, or to have a NEWS2 of 3 or more on arrival to hospital. CONCLUSION The proportion of acute medical attendances receiving overnight admission varies between hospitals. Length of stay is impacted by patient factors and illness acuity. Strategies to reduce inpatient service pressures must ensure effective care for older patients and those with frailty.
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Affiliation(s)
- C Atkin
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, B15 2GW, UK. ORCiD ID = 0000-0003-0596-8515
| | - T Knight
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, B15 2GW, UK. ORCiD ID = 0000-0003-0596-8515
| | - T Cooksley
- Departments of Acute Medicine, Manchester University NHS Foundation Trust, UK, M23 9LT and The Christie, Manchester, M20 4BX, UK. ORCID ID: 0000-0001-6114-1956
| | - M Holland
- Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, BL3 5AB, UK. ORCID iD: 0000-0001-8336-5336
| | - C Subbe
- School of Medical Sciences, Bangor University & Consultant Acute, Respiratory & Critical Care Medicine, Ysbyty Gwynedd, Bangor, LL57 2PW, UK. ORCID iD: 0000-0002-3110-8888
| | - A Kennedy
- Department of Acute Medicine, Airedale Hospital NHS Foundation Trust, Keighley, West Yorkshire, BD20 6TD
| | - R Varia
- Department of Acute Medicine, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, L35 5DR
| | - D Lasserson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Affiliation(s)
- T McDonnell
- Department of Acute Medicine, Manchester University Hospital Trust, Southmoor Road, Manchester M23 9LT, UK
| | - Matthew Thornber
- Department of Acute Medicine, Manchester University Hospital Trust, Southmoor Road, Manchester M23 9LT, UK
| | - T Cooksley
- Department of Acute Medicine, Manchester University Hospital Trust, Southmoor Road, Manchester M23 9LT, UK
| | - S Jain
- Department of Radiology, Manchester University Hospital Trust, Southmoor Road, Manchester M23 9LT, UK
| | - S McGlynn
- Department of Acute Medicine, Manchester University Hospital Trust, Southmoor Road, Manchester M23 9LT, UK
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Lee RJ, Wysocki O, Bhogal T, Shotton R, Tivey A, Angelakas A, Aung T, Banfill K, Baxter M, Boyce H, Brearton G, Copson E, Dickens E, Eastlake L, Gomes F, Hague C, Harrison M, Horsley L, Huddar P, Hudson Z, Khan S, Khan UT, Maynard A, McKenzie H, Palmer D, Robinson T, Rowe M, Thomas A, Tweedy J, Sheehan R, Stockdale A, Weaver J, Williams S, Wilson C, Zhou C, Dive C, Cooksley T, Palmieri C, Freitas A, Armstrong AC. Erratum to 'Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome': [ESMO Open Volume 6, Issue 1, February 2021, 100005]. ESMO Open 2021; 6:100056. [PMID: 33545518 PMCID: PMC7842131 DOI: 10.1016/j.esmoop.2021.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- R J Lee
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK; Tumour Cell Biology Laboratory, The Francis Crick Institute, London, UK.
| | - O Wysocki
- The University of Manchester, Manchester, UK; Digital Experimental Cancer Medicine Team, Cancer Research UK Manchester Institute Cancer Biomarker Centre, The University of Manchester, Alderley Park, UK
| | - T Bhogal
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - R Shotton
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Tivey
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - A Angelakas
- University Hospitals of Morecambe Bay, Kendal, UK
| | - T Aung
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - K Banfill
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - M Baxter
- University of Dundee, Dundee, UK
| | - H Boyce
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - G Brearton
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - E Copson
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E Dickens
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - L Eastlake
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - F Gomes
- The Christie NHS Foundation Trust, Manchester, UK
| | - C Hague
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - L Horsley
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Huddar
- Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Z Hudson
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - S Khan
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK; Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - U T Khan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - A Maynard
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - H McKenzie
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Palmer
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - T Robinson
- Bristol Haematology and Oncology Centre, Bristol, UK; Sunrise Oncology Centre, Royal Cornwall Hospital, Truro, UK
| | - M Rowe
- National Institute for Biological Standards and Control, Potters Bar, UK
| | - A Thomas
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK; Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Tweedy
- Institute of Infection and Global Health, University of Liverpool and Tropical and Infectious Diseases Unit, Royal Liverpool Hospital, Liverpool, UK
| | - R Sheehan
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - A Stockdale
- Cancer Research UK Manchester Institute, Cancer Biomarker Centre, The University of Manchester, Alderley Park, UK
| | - J Weaver
- The Christie NHS Foundation Trust, Manchester, UK
| | - S Williams
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - C Wilson
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - C Zhou
- The University of Bristol, Bristol, UK
| | - C Dive
- The University of Bristol, Bristol, UK
| | - T Cooksley
- The Christie NHS Foundation Trust, Manchester, UK
| | - C Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - A Freitas
- The University of Manchester, Manchester, UK; Digital Experimental Cancer Medicine Team, Cancer Research UK Manchester Institute Cancer Biomarker Centre, The University of Manchester, Alderley Park, UK
| | - A C Armstrong
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
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7
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Lee RJ, Wysocki O, Bhogal T, Shotton R, Tivey A, Angelakas A, Aung T, Banfill K, Baxter M, Boyce H, Brearton G, Copson E, Dickens E, Eastlake L, Gomes F, Hague C, Harrison M, Horsley L, Huddar P, Hudson Z, Khan S, Khan UT, Maynard A, McKenzie H, Palmer D, Robinson T, Rowe M, Thomas A, Tweedy J, Sheehan R, Stockdale A, Weaver J, Williams S, Wilson C, Zhou C, Dive C, Cooksley T, Palmieri C, Freitas A, Armstrong AC. Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome. ESMO Open 2021; 6:100005. [PMID: 33399072 PMCID: PMC7808077 DOI: 10.1016/j.esmoop.2020.100005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome. PATIENTS AND METHODS Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann-Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method. RESULTS In total, 302 patients were included in three cohorts: Manchester (n = 67), Liverpool (n = 62), and UK (n = 173). In the entire cohort (N = 302), median age was 69 (range 19-93 years), including 163 males and 139 females; of these, 216 were diagnosed with a solid tumour and 86 with a haematological cancer. Preinfection lymphopaenia, neutropaenia and lactate dehydrogenase (LDH) were not associated with oxygen requirement (O2) or death. Lymphocyte count (P < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission. CONCLUSION Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity.
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Affiliation(s)
- R J Lee
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK; Tumour Cell Biology Laboratory, The Francis Crick Institute, London, UK.
| | - O Wysocki
- The University of Manchester, Manchester, UK; Digital Experimental Cancer Medicine Team, Cancer Research UK Manchester Institute Cancer Biomarker Centre, The University of Manchester, Alderley Park, UK
| | - T Bhogal
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - R Shotton
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Tivey
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - A Angelakas
- University Hospitals of Morecambe Bay, Kendal, UK
| | - T Aung
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - K Banfill
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - M Baxter
- University of Dundee, Dundee, UK
| | - H Boyce
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - G Brearton
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - E Copson
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E Dickens
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - L Eastlake
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - F Gomes
- The Christie NHS Foundation Trust, Manchester, UK
| | - C Hague
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - L Horsley
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Huddar
- Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Z Hudson
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - S Khan
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK; Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - U T Khan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - A Maynard
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - H McKenzie
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Palmer
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - T Robinson
- Bristol Haematology and Oncology Centre, Bristol, UK; Sunrise Oncology Centre, Royal Cornwall Hospital, Truro, UK
| | - M Rowe
- National Institute for Biological Standards and Control, Potters Bar, UK
| | - A Thomas
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK; Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Tweedy
- Institute of Infection and Global Health, University of Liverpool and Tropical and Infectious Diseases Unit, Royal Liverpool Hospital, Liverpool, UK
| | - R Sheehan
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - A Stockdale
- Cancer Research UK Manchester Institute, Cancer Biomarker Centre, The University of Manchester, Alderley Park, UK
| | - J Weaver
- The Christie NHS Foundation Trust, Manchester, UK
| | - S Williams
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - C Wilson
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - C Zhou
- The University of Bristol, Bristol, UK
| | - C Dive
- The University of Bristol, Bristol, UK
| | - T Cooksley
- The Christie NHS Foundation Trust, Manchester, UK
| | - C Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - A Freitas
- The University of Manchester, Manchester, UK; Digital Experimental Cancer Medicine Team, Cancer Research UK Manchester Institute Cancer Biomarker Centre, The University of Manchester, Alderley Park, UK
| | - A C Armstrong
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
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Berman R, Davies A, Cooksley T, Gralla R, Carter L, Darlington E, Scotté F, Higham C. Supportive Care: An Indispensable Component of Modern Oncology. Clin Oncol (R Coll Radiol) 2020; 32:781-788. [PMID: 32814649 PMCID: PMC7428722 DOI: 10.1016/j.clon.2020.07.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/14/2020] [Accepted: 07/29/2020] [Indexed: 12/15/2022]
Abstract
The advent of new cancer therapies, alongside expected growth and ageing of the population, better survival rates and associated costs of care, is uncovering a need to more clearly define and integrate supportive care services across the whole spectrum of the disease. The current focus of cancer care is on initial diagnosis and treatment, and end of life care. The Multinational Association of Supportive Care in Cancer defines supportive care as 'the prevention and management of the adverse effects of cancer and its treatment'. This encompasses the entire cancer journey, and necessitates involvement and integration of most clinical specialties. Optimal supportive care can assist in accurate diagnosis and management, and ultimately improve outcomes. A national strategy to implement supportive care is needed to acknowledge evolving oncology practice, changing disease patterns and the changing patient demographic.
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Affiliation(s)
- R Berman
- The Christie NHS Foundation Trust, Manchester, UK.
| | - A Davies
- Royal Surrey NHS Foundation Trust, Guildford, UK
| | - T Cooksley
- The Christie NHS Foundation Trust, Manchester, UK
| | - R Gralla
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - L Carter
- The Christie NHS Foundation Trust, Manchester, UK
| | - E Darlington
- The Christie NHS Foundation Trust, Manchester, UK
| | - F Scotté
- Gustave Roussy Cancer Institute, Interdisciplinary Cancer Course Department (DIOPP), Villejuif, France
| | - C Higham
- The Christie NHS Foundation Trust, Manchester, UK
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De Bie Dekker AJR, Dijkmans JJ, Todorovac N, Hibbs R, Boe Krarup K, Bouwman AR, Barach P, Fløjstrup M, Cooksley T, Kellett J, Bindels AJGH, Korsten HHM, Brabrand M, Subbe CP. Testing the effects of checklists on team behaviour during emergencies on general wards: An observational study using high-fidelity simulation. Resuscitation 2020; 157:3-12. [PMID: 33027620 DOI: 10.1016/j.resuscitation.2020.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Clinical teams struggle on general wards with acute management of deteriorating patients. We hypothesized that the Crisis Checklist App, a mobile application containing checklists tailored to crisis-management, can improve teamwork and acute care management. METHODS A before-and-after study was undertaken in high-fidelity simulation centres in the Netherlands, Denmark and United Kingdom. Clinical teams completed three scenarios with a deteriorating patient without checklists followed by three scenarios using the Crisis Checklist App. Teamwork performance as the primary outcome was assessed by the Mayo High Performance Teamwork scale. The secondary outcomes were the time required to complete all predefined safety-critical steps, percentage of omitted safety-critical steps, effects on other non-technical skills, and users' self-assessments. Linear mixed models and a non-parametric survival test were conducted to assess these outcomes. RESULTS 32 teams completed 188 scenarios. The Mayo High Performance Teamwork scale mean scores improved to 23.4 out of 32 (95% CI: 22.4-24.3) with the Crisis Checklist App compared to 21.4 (20.4-22.3) with local standard of care. The mean difference was 1.97 (1.34-2.6; p < 0.001). Teams that used the checklists were able to complete all safety-critical steps of a scenario in more simulations (40/95 vs 21/93 scenarios) and these steps were completed faster (stratified log-rank test χ2 = 8.0; p = 0.005). The self-assessments of the observers and users showed favourable effects after checklist usage for other non-technical skills including situational awareness, decision making, task management and communication. CONCLUSIONS Implementation of a novel mobile crisis checklist application among clinical teams was associated in a simulated general ward setting with improved teamwork performance, and a higher and faster completion rate of predetermined safety-critical steps.
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Affiliation(s)
- A J R De Bie Dekker
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - J J Dijkmans
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - N Todorovac
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - R Hibbs
- Integral Business Support Ltd, Wrexham, United Kingdom
| | - K Boe Krarup
- Department of Anesthesiology, Odense University Hospital, Odense, Denmark
| | - A R Bouwman
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - P Barach
- Department of Anesthesiology and Critical care, Wayne State University School of Medicine, Detroit; Jefferson College of Population Health, PA, USA
| | - M Fløjstrup
- Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - T Cooksley
- Department of Acute and Internal Medicine, The Christie Hospital, Manchester, United Kingdom
| | - J Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - A J G H Bindels
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - H H M Korsten
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - M Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark; Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - C P Subbe
- Department of Acute Medicine, Ysbyty Gwynedd and Bangor University, Bangor, United Kingdom
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Tivey A, Shotton R, Lee R, Zhou C, Banfill K, Hague C, Gomes F, Weaver J, Armstrong A, Cooksley T. 1722P Longitudinal analysis of biochemical and haematological features of cancer patients with COVID-19. Ann Oncol 2020. [PMCID: PMC7506351 DOI: 10.1016/j.annonc.2020.08.1786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Nannan Panday RS, Wang S, Schermer EH, Cooksley T, Alam N, Nanayakkara PWB. Septic patients with cancer: Do prehospital antibiotics improve survival? A sub-analysis of the PHANTASi trial. Neth J Med 2020; 78:3-9. [PMID: 32043473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sepsis in patients with cancer is increasingly common and associated with high mortality. To date, no studies have examined the effectiveness of prehospital antibiotics in septic patients with cancer. This study aimed without and to evaluate the effect of prehospital antibiotics in septic patients with cancer. METHODS We conducted a post-hoc sub-analysis of the PHANTASi (PreHospital ANTibioitcs Against Sepsis) trial database: a randomised controlled trial which enrolled patients with suspected sepsis who were transported to the emergency department by ambulance. Patients in the intervention group were administered prehospital intravenous antibiotics while those in the control group received usual care. We compared patients who had cancer to those who did not. Primary outcome was 28-day mortality; among the secondary outcomes, we included in-hospital mortality and 90-day mortality. RESULTS 357(13.4%) of the 2658 included patients had cancer in the past five years, of which, 209 (58.5%) were included in the intervention and 148 (41.5%) usual care groups; 28-day mortality was significantly higher in patients who were diagnosed with cancer in the past five years than those without cancer in the past five years: 15.2% vs. 7.1%, respectively (p < 0.001). Prehospital antibiotics in the group of patients with cancer in the last five years yielded no significant effect on survival. There were however, significantly fewer 30-day readmissions (p = 0.031) in the intervention group of cancer patients (12.2% vs 5.7%). CONCLUSION Prehospital antibiotics did not improve overall survival. However, there was a significant reduction in 30-day readmissions.
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Affiliation(s)
- R S Nannan Panday
- Section Acute Medicine, Department of Internal Medicine, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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12
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Lyngholm L, Nickel CH, Kellett J, Chang S, Cooksley T, Brabrand M. Normal gait, albumin and d-dimer levels identify low risk emergency department patients: a prospective observational cohort study with 365-day 100% follow-up. QJM 2020; 113:86-92. [PMID: 31504931 DOI: 10.1093/qjmed/hcz226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND If survival could be reliably predicted many patients could be safely managed outside of hospital in an ambulatory care setting. AIM Comparison of common laboratory findings, co-morbidities, mobility and vital signs as predictors of mortality of acutely ill emergency department (ED) attendees. DESIGN Prospective observational study. METHODS Secondary analysis of 1334 consenting acutely ill patients attending a Danish ED. RESULTS 67 (5%) out of 1334 patients died within 100 days. After logistic regression seven predictors of 100 days mortality remained significant: an albumin level ≤34 gm/l, D-dimer level >0.51 mg/l, an Asadollahi score (based on admission laboratory data and age) ≥12, a platelet count <159 X 1000/ml, impaired mobility on presentation, a respiratory rate ≥30 bpm and a Charlson co-morbidity index ≥3. Only 5 of the 442 without any of these variables died within 365 days. Only one of the 517 patients with a stable independent gait and normal d-dimer and albumin levels died within 100 days, none died within 30 days of assessment and 12 died within 365 days. Of the remaining 817 patients 66 (8%) died within 100 days. CONCLUSION These findings suggest that normal gait, albumin and d-dimer levels are the most parsimonious way of identifying low risk ED patients.
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Affiliation(s)
- L Lyngholm
- From the Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - C H Nickel
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - J Kellett
- From the Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - S Chang
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
- Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark
| | - T Cooksley
- Department of Acute Medicine, University Hospital of South Manchester, Manchester, UK
| | - M Brabrand
- From the Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
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Halkyard E, Alsayed T, Angus F, Barnes J, Bayman N, Blackhall F, Cooksley T, Kasipandian V, Monaghan P, Trainer P, Higham C. Salt ‘n’ Safe: introduction of guidelines for the management of hyponatraemia at a specialist oncology treatment centre. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30225-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Atkin C, Knight T, Subbe C, Holland M, Cooksley T, Lasserson D. Acute care service performance during winter: report from the winter SAMBA 2020 national audit of acute care. Acute Med 2020; 19:220-229. [PMID: 33215175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Winter Society for Acute Medicine Benchmarking Audit (SAMBA) provides the first comparison of performance within acute medicine against clinical quality indicators during winter, a time of increased pressure and demand on acute services. 105 hospitals participated in Winter SAMBA, collecting data over 24-hours on 30th January 2020. 5626 patients were included. Participating units saw a median of 48 patients (range 13-131). Comparison between Winter SAMBA and SAMBA19 found less patients had an early warning score within 30 minutes during winter (74.3% vs 78.9%) and less were seen by a clinical decision maker within four hours (84.9% vs 87.9%). Unplanned admissions represented a higher proportion of workload (92.5% vs 90.1%). Patients were more likely to have a NEWS2 score of 3 or higher (30.1% vs 25.7%). Performance is poorer in winter, and patients are more unwell, needing prompt treatment. Services should ensure high quality care can be maintained through times of increased pressure, including winter.
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Affiliation(s)
- C Atkin
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - T Knight
- Department of Acute Medicine, Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham, United Kingdom
| | - C Subbe
- School of Medical Sciences, Bangor University & Consultant Acute, Respiratory & Critical Care Medicine, Ysbyty Gwynedd, Bangor, United Kingdom
| | - M Holland
- Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, United Kingdom
| | - T Cooksley
- Departments of Acute Medicine, Manchester University NHS Foundation Trust, United Kingdom
| | - D Lasserson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Holland M, Subbe C, Atkin C, Knight T, Cooksley T, Lasserson D. Society for Acute Medicine Benchmarking Audit 2019 (SAMBA19): Trends in Acute Medical Care. Acute Med 2020; 19:209-219. [PMID: 33215174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The eighth Society for Acute Medicine Benchmarking Audit (SAMBA19) took place on Thursday 27th June 2019. SAMBA gives a broad picture of acute medical care in the UK and allows individual units to compare their performance against their peers. METHOD All UK hospitals were invited to participate. Unit and patient level were collected. Data were analysed against published Clinical Quality indicators (CQI) and standards. This was the biggest SAMBA to date, with data from 7170 patients across 142 units in 140 hospitals. RESULTS 84.5% of patients had an Early Warning Score measured within 30 minutes of arrival in hospital (SAMBA18 84.1%), 90.4% of patients were seen by a competent clinical decision maker within four hours of arrival in hospital (SAMBA18 91.4 %) and 68.6% of patients were seen by a consultant within the timeframe standard (SAMBA18 62.7%). Ambulatory Emergency Care is provided in 99.3% of hospitals. 61.8% of patients are initially seen in the Emergency Department (ED). Since SAMBA18 death rates and planned discharge rates, while the use of NEWS2 increased from 2.5% to 59.2% of hospitals. CONCLUSION SAMBA19 highlighted the evolving complexity of acute medical pathways for patients. The challenge now is to increase sample frequency, assess the impact of SAMBA open a broader debate to define optimal CQIs.
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Affiliation(s)
- M Holland
- Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, United Kingdom
| | - C Subbe
- School of Medical Sciences, Bangor University & Consultant Acute, Respiratory & Critical Care Medicine, Ysbyty Gwynedd, Bangor, United Kingdom
| | - C Atkin
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom
| | - T Knight
- Department of Acute Medicine, Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham, United Kingdom
| | - T Cooksley
- Departments of Acute Medicine, Manchester University NHS Foundation Trust, United Kingdom
| | - D Lasserson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Affiliation(s)
- T Cooksley
- Department of Acute Medicine and Critical Care, The Christie, Wilmslow Road, Manchester, UK
- Manchester University Foundation Trust, Wythenshawe Hospital, Southmoor Road, Manchester, UK
| | - W Marshall
- Manchester University Foundation Trust, Wythenshawe Hospital, Southmoor Road, Manchester, UK
| | - A Gupta
- Department of Acute Medicine and Critical Care, The Christie, Wilmslow Road, Manchester, UK
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17
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Lyngholm LE, Nickel CH, Kellett J, Chang S, Cooksley T, Brabrand M. A negative D-dimer identifies patients at low risk of death within 30 days: a prospective observational emergency department cohort study. QJM 2019; 112:675-680. [PMID: 31179506 DOI: 10.1093/qjmed/hcz140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/27/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the ability of a normal D-dimer level (<0.5 mg/l) to identify emergency department (ED) patients at low risk of 30-day all-cause mortality. DESIGN In this prospective observational study, D-dimer levels of adult medical patients were assessed at arrival to the ED. Data on 30-day survival status were extracted from the Danish Civil Registration System with complete follow-up. SETTING The Hospital of South West Jutland. PATIENTS All patients aged 18 years or older who required any blood sample on a clinical indication on arrival to the ED. Participants were required to give written informed consent before enrollment. MAIN RESULTS The study population of 1 518 patients with median age 66 years of which 49.4% were female. Of the 791 (52.1%) patients with normal D-dimer levels, 3 (0.4%) died within 30 days; one death resulted from an unrelated traumatic accident. Of the 727 (47.9%) patients with abnormal D-dimer levels (≥0.50 mg/l), 32 (4.4%) died within 30 days. Patients with normal D-dimer levels had a significantly lower 30-day mortality compared to patients with abnormal D-dimer levels (odds ratio 0.08, 95% CI 0.02-0.28): of the 35 patients who died within 30 days, 19 (54.3%) had normal or near normal vital signs when first assessed. CONCLUSION Normal D-dimer levels identified patients at low risk of 30-day mortality. Since most patients who died within 30 days presented with normal or near normal vital signs, D-dimer levels appear to provide additional prognostic information.
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Affiliation(s)
- L E Lyngholm
- Department of Emergency Medicine, Hospital of South West Jutland, Denmark
| | - C H Nickel
- Emergency Department, University Hospital Basel, Switzerland
| | - J Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Denmark
| | - S Chang
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark
- Department of Clinical Biochemistry, Hospital of South West Jutland, Denmark
| | - T Cooksley
- Department of Acute Medicine, University Hospital of South Manchester, UK
| | - M Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Denmark
- Department of Emergency Medicine, Odense University Hospital, Denmark
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18
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De Bie AJR, Subbe CP, Bezemer R, Cooksley T, Kellett JG, Holland M, Bouwman RA, Bindels AJGH, Korsten HHM. Differences in identification of patients' deterioration may hamper the success of clinical escalation protocols. QJM 2019; 112:497-504. [PMID: 30828732 DOI: 10.1093/qjmed/hcz052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/22/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Timely and consistent recognition of a 'clinical crisis', a life threatening condition that demands immediate intervention, is essential to reduce 'failure to rescue' rates in general wards. AIM To determine how different clinical caregivers define a 'clinical crisis' and how they respond to it. DESIGN An international survey. METHODS Clinicians working on general wards, intensive care units or emergency departments in the Netherlands, the United Kingdom and Denmark were asked to review ten scenarios based on common real-life cases. Then they were asked to grade the urgency and severity of the scenario, their degree of concern, their estimate for the risk for death and indicate their preferred action for escalation. The primary outcome was the scenarios with a National Early Warning Score (NEWS) ≥7 considered to be a 'clinical crisis'. Secondary outcomes included how often a rapid response system (RRS) was activated, and if this was influenced by the participant's professional role or experience. The data from all participants in all three countries was pooled for analysis. RESULTS A total of 150 clinicians participated in the survey. The highest percentage of clinicians that considered one of the three scenarios with a NEWS ≥7 as a 'clinical crisis' was 52%, while a RRS was activated by <50% of participants. Professional roles and job experience only had a minor influence on the recognition of a 'clinical crisis' and how it should be responded to. CONCLUSION This international survey indicates that clinicians differ on what they consider to be a 'clinical crisis' and on how it should be managed. Even in cases with a markedly abnormal physiology (i.e. NEWS ≥7) many clinicians do not consider immediate activation of a RRS is required.
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Affiliation(s)
- A J R De Bie
- Department of Internal Medicine and Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- Department of Electrical Engineering, University of Technology, Eindhoven, The Netherlands
| | - C P Subbe
- Department of Acute Medicine, Ysbyty Gwynedd and Bangor University, Penrhosgarnedd, Bangor LL57 2PW, UK
| | - R Bezemer
- Department of Electrical Engineering, University of Technology, Eindhoven, The Netherlands
- Philips Research, Eindhoven, The Netherlands
| | - T Cooksley
- Department of Acute and Internal Medicine, The Christie Hospital, Manchester, UK
| | - J G Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - M Holland
- Department Acute Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - R A Bouwman
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - A J G H Bindels
- Department of Internal Medicine and Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - H H M Korsten
- Department of Electrical Engineering, University of Technology, Eindhoven, The Netherlands
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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19
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Lasserson DS, Subbe C, Cooksley T, Holland M. SAMBA18 Report - A National Audit of Acute Medical Care in the UK. Acute Med 2019; 18:76-87. [PMID: 31127796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
SAMBA18 took place on Thursday 28th June 2018 with follow up data at 7 days. Acute medical teams from 127 Acute Medical Units (AMUs) across the UK collected data relating to operational performance, clinical quality indicators and standards from NHS Improvement. Data was collected from 6114 patients.
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Affiliation(s)
- D S Lasserson
- Professor of Ambulatory Care, University of Birmingham, UK
| | - C Subbe
- Consultant in Acute Medicine, Ysbyty Gwynedd Hospital, Bangor, Wales
| | - T Cooksley
- Consultant in Acute Medicine, Manchester Hospitals University Trust and The Christie, Manchester, UK
| | - M Holland
- Consultant in Acute Medicine, Salford Royal Hospital, UK
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20
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Brabrand M, Kellett J, Opio M, Cooksley T, Nickel CH. Should impaired mobility on presentation be a vital sign? Acta Anaesthesiol Scand 2018; 62:945-952. [PMID: 29512139 DOI: 10.1111/aas.13098] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/31/2018] [Accepted: 02/10/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Vital signs are routinely used to assess acutely ill patients, but they do not detect all patients at risk of death. This retrospective multicenter cohort study compares the prediction of death by impaired mobility with age, co-morbidities, and vital sign changes. METHODS On first assessment, patients from a combined cohort of 9684 Danish and Irish patients and a separate cohort of 1010 Ugandan patients were stratified by impaired mobility on presentation (IMOP), vital sign changes assessed by the National Early Warning Score (NEWS), the Charlson Co-morbidity Index, and age. RESULTS Fourteen percent of Danish and Irish patients had IMOP compared with 42% of Ugandan patients. The odds ratios of IMOP for 7-day mortality were similar for both cohorts (i.e. 11.8, 95% CI 5.8-24.0 for Ugandan patients versus 6.7, 95% CI 5.0-9.0 for Danish and Irish patients). Univariate analysis of Ugandan patients showed that none of the parameters tested (i.e. low blood pressure, pulse, elevated respiratory rate, hypothermia, low oxygen saturation, old age, and coma) had a statistically higher odds ratio for either 7-day mortality than IMOP. Multivariate logistic regression analysis of Danish and Irish patients also showed that none of these parameters or the Charlson Co-morbidity Index had a statistically higher odds ratio than IMOP for either 7-day or 30-day mortality. CONCLUSION Immobility on presentation is a vital sign and predicts mortality for acutely ill patients independently of the traditional vital signs, age, and co-morbidities.
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Affiliation(s)
- M. Brabrand
- Department of Emergency Medicine; Hospital of South West Jutland; Esbjerg Denmark
- Department of Emergency Medicine; Odense University Hospital; Odense Denmark
| | - J. Kellett
- Department of Emergency Medicine; Hospital of South West Jutland; Esbjerg Denmark
| | - M. Opio
- Department of Medicine; Kitovu Hospital; Kitovu Uganda
| | - T. Cooksley
- Department of Acute Medicine; University Hospital of South Manchester; Manchester UK
| | - C. H. Nickel
- Emergency Department; University Hospital Basel; Basel Switzerland
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21
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Atkins TEH, Öhman MC, Cooksley T, Brabrand M. Acute medical risk scores: is MARS out of this world? QJM 2018; 111:511. [PMID: 29660075 DOI: 10.1093/qjmed/hcy085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- T E H Atkins
- From the Department of Emergency Medicine, Hospital of South West Jutland, Finsensgade 35, 6700 Esbjerg, Denmark
| | - M C Öhman
- From the Department of Emergency Medicine, Hospital of South West Jutland, Finsensgade 35, 6700 Esbjerg, Denmark
| | - T Cooksley
- Department of Acute Medicine, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, Manchester
| | - M Brabrand
- From the Department of Emergency Medicine, Hospital of South West Jutland, Finsensgade 35, 6700 Esbjerg, Denmark
- Department of Emergency Medicine, Odense Universitetshospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
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22
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Higham CE, Olsson-Brown A, Carroll P, Cooksley T, Larkin J, Lorigan P, Morganstein D, Trainer PJ. SOCIETY FOR ENDOCRINOLOGY ENDOCRINE EMERGENCY GUIDANCE: Acute management of the endocrine complications of checkpoint inhibitor therapy. Endocr Connect 2018; 7:G1-G7. [PMID: 29930025 PMCID: PMC6013692 DOI: 10.1530/ec-18-0068] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/27/2018] [Indexed: 01/10/2023]
Abstract
Immunotherapy treatment with checkpoint inhibitors (CPI) (CTLA-4 and PD-1 inhibitors) significantly improves survival in a number of cancers. Treatment can be limited by immune-mediated adverse effects including endocrinopathies such as hypophysitis, adrenalitis, thyroiditis and diabetes mellitus. If endocrinopathies (particularly hypocortisolemia) are not recognized early, they can be fatal. The diagnosis and management of endocrinopathies can be complicated by simultaneous multi-organ immune adverse effects. Here, we present Endocrine Emergency Guidance for the acute management of the endocrine complications of checkpoint inhibitor therapy, the first specialty-specific guidance with Endocrinology, Oncology and Acute Medicine input and endorsed by the Society for Endocrinology Clinical Committee. We present algorithms for management: endocrine assessment and management of patients in the first 24 hours who present life-threateningly unwell (CTCAE grade 3-4) and the appropriate management of mild-moderately unwell patients (CTCAE grade 1-2) presenting with features compatible with an endocrinopathy. Other important considerations in relation to hypohysitis and the maintenance of glucocorticoid therapy are discussed.
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Affiliation(s)
- C E Higham
- Department of EndocrinologyChristie Hospital NHS Foundation Trust, Manchester, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - A Olsson-Brown
- The Clatterbridge Cancer CentreBebbington, Wirral, UK
- The University of LiverpoolBrownlow Hill, Liverpool, UK
| | - P Carroll
- Department of EndocrinologyGuy's & St. Thomas' NHS Foundation Trust, London, UK
| | - T Cooksley
- Department of Acute MedicineUHSM and Christie Hospital NHS Foundation Trust, Manchester, UK
| | - J Larkin
- Skin UnitRoyal Marsden Hospital, London, UK
| | - P Lorigan
- Department of Medical OncologyChristie Hospital NHS Foundation Trust, Manchester, UK
| | - D Morganstein
- Department of EndocrinologyChelsea and Westminster Hospital, London, UK
| | - P J Trainer
- Department of EndocrinologyChristie Hospital NHS Foundation Trust, Manchester, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Abstract
BACKGROUND There has been a significant increase in the number of patients presenting with cancer related emergencies and potentially requiring critical care admission. AIM To analyse the short and long-term outcomes of patients with solid tumours requiring unplanned medical admission to a specialist cancer intensive care unit (ICU). DESIGN An unplanned cohort study. METHODS A retrospective analysis of patients admitted to a UK specialist tertiary oncology CCU between September 2009 and September 2015. The primary outcome measures were survival to CCU discharge and 1-year survival. RESULTS 687 patients had an unplanned medical admission. The most frequent primary tumours were lymphoma (22.1%), lung (15.2%) and colorectal (13.0%), and 181 (44.4%) were known to have metastases. The median Acute Physiology and Chronic Health Evaluation (APACHE) II and Intensive Care National Audit and Research Centre (ICNARC) scores were 21 and 17, respectively. ICU mortality was 26.7%, with total hospital mortality of 41.9%. The median survival of the total cohort was 56 days after ICU admission, with 107 patients surviving 365 days. Patients with metastatic disease were almost twice as likely to die within the year following ICU admission compared with their counterparts without metastases. Only pancreatic and lung primaries were shown to have a statistically significant impact on survival at 1 year. Pneumonia carried with it the worst prognosis (cumulative survival 0.11), followed by sepsis (0.25) and non-infective respiratory disease (0.26). CONCLUSIONS The stage and type of cancer appear to have minimal impact on short-term ICU outcomes and only confer poorer long-term prognosis related to the disease.
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Affiliation(s)
- K Murphy
- University of Manchester, Manchester, UK
| | - T Cooksley
- Department of Acute Medicine and Critical Care, The Christie, Wilmslow Road, Manchester, UK
| | - P Haji-Michael
- Department of Acute Medicine and Critical Care, The Christie, Wilmslow Road, Manchester, UK
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Abstract
BACKGROUND The Medical Admission Risk System (MARS) uses 11 physiological and laboratory data and had promising results in its derivation study for predicting 5- and 7- day mortality. AIM To perform an external independent validation of the MARS score. DESIGN An unplanned secondary cohort study. METHODS Patients admitted to the medical admission unit at The Hospital of South West Jutland were included from 2 October 2008 until 19 February 2009 and 23 February 2010 until 26 May 2010 were analysed. Validation of the MARS scores using 5- and 7- day mortality was the primary endpoint. RESULTS Patients of 5858 were included in the study. Patients of 2923 (49.9%) were women with a median age of 65 years (15-107). The MARS score had an area under the receiving operator characteristic curve of 0.858 (95% CI: 0.831-0.884) for 5-day mortality and 0.844 (0.818-0.870) for 7 day mortality with poor calibration for both outcomes. CONCLUSION The MARS score had excellent discriminatory power but poor calibration in predicting both 5- and 7-day mortality. The development of accurate combination physiological/laboratory data risk scores has the potential to improve the recognition of at risk patients.
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Affiliation(s)
- M C Öhman
- Department of Emergency Medicine, The Hospital of South West Jutland, Finsensgade 35, 6700 Esbjerg, Denmark
| | - T E H Atkins
- Department of Emergency Medicine, The Hospital of South West Jutland, Finsensgade 35, 6700 Esbjerg, Denmark
| | - T Cooksley
- Department of Acute Medicine, University Hospital of South Manchester, Southmoor Road, M23 9LT, Wythenshawe, Manchester
| | - M Brabrand
- Department of Emergency Medicine, The Hospital of South West Jutland, Finsensgade 35, 6700 Esbjerg, Denmark
- Department of Emergency Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
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25
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Raby S, Weaver J, Cooksley T. EP-1706: Does hyperlactaemia predict prognosis in cancer patients with sepsis? A retrospective review. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Khan M, Little M, Campbell G, Laasch HU, Cooksley T. Emphysematous cholecystitis in a patient with metastatic pancreatic neuroendocrine tumour. QJM 2017; 110:235-236. [PMID: 28062742 DOI: 10.1093/qjmed/hcx012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Khan
- From the Department of Acute Oncology
| | - M Little
- From the Department of Acute Oncology
| | | | - H-U Laasch
- Department of Radiology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
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van Galen LS, Cooksley T, Merten H, Brabrand M, Terwee CB, H Nickel C, Subbe CP, Kidney R, Soong J, Vaughan L, Weichert I, Kramer MHH, Nanayakkara PWB. Physician consensus on preventability and predictability of readmissions based on standard case scenarios. Neth J Med 2016; 74:434-442. [PMID: 27966437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Policy makers struggle with unplanned readmissions as a quality indicator since integrating preventability in such indicators is difficult. Most studies on the preventability of readmissions questioned physicians whether they consider a given readmission to be preventable, from which conclusions on factors predicting preventable readmissions were derived. There is no literature on the interobserver agreement of physician judgement. AIM To assess the degree of agreement among physicians regarding predictability and preventability of medical readmissions. DESIGN An online survey based on eight real-life case scenarios was distributed to European physicians. METHODS Physicians were requested to rate from the first four (index admission) scenarios whether they expected these patients to be readmitted within 30 days (the predictability). The remaining four cases, describing a readmission, were used to assess the preventability. The main outcome was the degree of agreement among physicians determined using the intra class correlation coefficient (ICC). RESULTS 526 European medical physicians completed the survey. Most physicians had internal medicine as primary specialism. The median years of clinical experience was 11. ICC for predictability of readmission was 0.67 (moderate to good) and ICC for preventability of readmission was 0.13 (poor). CONCLUSION There was moderate to good agreement among physicians on the predictability of readmissions while agreement on preventability was poor. This study indicates that assessing preventability of readmissions based solely on the judgement of physicians is far from perfect. Current literature on the preventability of readmissions and conclusions derived on the basis of physician opinion should be interpreted with caution.
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Affiliation(s)
- L S van Galen
- Department of Internal Medicine, VU University Medical Centre, Amsterdam, the Netherlands
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Fluitman KS, van Galen LS, Merten H, Rombach SM, Brabrand M, Cooksley T, Nickel CH, Subbe CP, Kramer MHH, Nanayakkara PWB. Exploring the preventable causes of unplanned readmissions using root cause analysis: Coordination of care is the weakest link. Eur J Intern Med 2016; 30:18-24. [PMID: 26775179 DOI: 10.1016/j.ejim.2015.12.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/18/2015] [Accepted: 12/28/2015] [Indexed: 11/23/2022]
Abstract
IMPORTANCE Unplanned readmissions within 30days are a common phenomenon in everyday practice and lead to increasing costs. Although many studies aiming to analyze the probable causes leading to unplanned readmissions have been performed, an in depth-study analyzing the human (healthcare worker)-, organizational-, technical-, disease- and patient-related causes leading to readmission is still missing. OBJECTIVE The primary objective of this study was to identify human-, organizational-, technical-, disease- and patient-related causes which contribute to acute readmission within 30days after discharge using a Root-Cause Analysis Tool called PRISMA-medical. The secondary objective was to evaluate how many of these readmissions were deemed potentially preventable, and to assess which factors contributed to these preventable readmissions in comparison to non-preventable readmissions. DESIGN Cross-sectional retrospective record study. SETTING An academic medical center in Amsterdam, The Netherlands. PARTICIPANTS Fifty patients aged 18years and older discharged from an internal medicine department and acutely readmitted within 30days after discharge. MAIN OUTCOME MEASURES Root causes of preventable and unpreventable readmissions. RESULTS Most root causes for readmission were disease-related (46%), followed by human (healthcare worker)- (33%) and patient- (15%) related root causes. Half of the readmissions studied were considered to be potentially preventable. Preventable readmissions predominantly had human-related (coordination) failures. CONCLUSION AND RELEVANCE Our study suggests that improving human-related (coordinating) factors contributing to a readmission can potentially decrease the number of preventable readmissions.
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Affiliation(s)
- K S Fluitman
- Department of Internal Medicine, Section Acute Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - L S van Galen
- Department of Internal Medicine, Section Acute Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - H Merten
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - S M Rombach
- Department of Internal Medicine, Section Acute Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - M Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - T Cooksley
- Department of Acute Medicine, University Hospital of South Manchester, Manchester, UK
| | - C H Nickel
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | | | - M H H Kramer
- Department of Internal Medicine, Section Acute Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - P W B Nanayakkara
- Department of Internal Medicine, Section Acute Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
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Cooksley T, Nanayakkara PWB, Nickel CH, Subbe CP, Kellett J, Kidney R, Merten H, Van Galen L, Henriksen DP, Lassen AT, Brabrand M. Readmissions of medical patients: an external validation of two existing prediction scores. QJM 2016; 109:245-8. [PMID: 26163662 DOI: 10.1093/qjmed/hcv130] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hospital readmissions are increasingly used as a quality indicator with a belief that they are a marker of poor care and have led to financial penalties in UK and USA. Risk scoring systems, such as LACE and HOSPITAL, have been proposed as tools for identifying patients at high risk of readmission but have not been validated in international populations. AIM To perform an external independent validation of the HOSPITAL and LACE scores. DESIGN An unplanned secondary cohort study. METHODS Patients admitted to the medical admission unit at the Hospital of South West Jutland (10/2008-2/2009; 2/2010-5/2010) and the Odense University Hospital (6/2009-8/2011) were analysed. Validation of the scores using 30 day readmissions as the endpoint was performed. RESULTS A total of 19 277 patients fulfilled the inclusion criteria. Median age was 67 (range 18-107) years and 8977 (46.6%) were female. The LACE score had a discriminatory power of 0.648 with poor calibration and the HOSPITAL score had a discriminatory power of 0.661 with poor calibration. The HOSPITAL score was significantly better than the LACE score for identifying patients at risk of 30 day readmission (P < 0.001). The discriminatory power of both scores decreased with increasing age. CONCLUSION Readmissions are a complex phenomenon with not only medical conditions contributing but also system, cultural and environmental factors exerting a significant influence. It is possible that the heterogeneity of the population and health care systems may prohibit the creation of a simple prediction tool that can be used internationally.
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Affiliation(s)
- T Cooksley
- From the Department of Acute Medicine, University Hospital of South Manchester, Manchester, UK,
| | | | | | | | | | - R Kidney
- St. James' Hospital, Dublin, Ireland and
| | - H Merten
- VU University Medical Center, Amsterdam, Netherlands
| | - L Van Galen
- VU University Medical Center, Amsterdam, Netherlands
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Abstract
BACKGROUND Early consultant review has been shown to improve outcomes in patients presenting to the Acute Medical Unit (AMU). The Society for Acute Medicine (SAM) clinical quality indicators use the time of arrival on the AMU for target rather than arrival in the Emergency Department (ED) although this is where most acute medical patients present. AIM To determine the effect of a 7-day Consultant Acute Physician model on patient waiting times and assess the impact of starting the clock for medical patients at time of ED arrival. DESIGN We performed an audit at a University Hospital AMU in the North West of England. METHODS Data were collected prospectively for 15 consecutive days in May-June 2013 for all patients presenting to the AMU at University Hospital of South Manchester and were repeated for the same time period in 2014 following the introduction of a new Consultant working model. RESULTS Four hundred and five patients were admitted to the AMU in the 2013 cohort compared to 456 in the 2014 cohort. There was a significant improvement in the median waiting time for Consultant review from AMU admission to 5 h 53 min from 8 h 15 min (P < 0.001). The compliance with the SAM quality indicator for Consultant review improved from 88.7 to 93.7% (P = 0.022). CONCLUSION A 7-day Acute Physician working model is improving performance with regards to patient waiting times. We suggest that starting the clock for acute medical patients in the ED is a better measure of performance than on arrival to the AMU.
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Affiliation(s)
- S Lang
- From the Department of Acute Medicine, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - T Cooksley
- From the Department of Acute Medicine, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - P Foden
- From the Department of Acute Medicine, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - M Holland
- From the Department of Acute Medicine, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
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Shuttleworth E, Sawyer R, Holland M, Cooksley T. The perils of Grandma's medication: colchicine toxicity causing pneumomediastinum. Acute Med 2014; 13:171-173. [PMID: 25521087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 19 year old male presented with a deliberate overdose of colchicine (50mg). He had no other significant medical history. 36 hours following admission he developed widespread surgical emphysema. An urgent CT scan of his chest and abdomen demonstrated mediastinal gas of lung origin. He also developed bone marrow suppression and disseminated intravascular coagulopathy. He was treated supportively with intravenous fluids, high flow oxygen and intravenous antibiotics and made a full recovery. Colchicine toxicity is a rare, but important presentation with high levels of morbidity and mortality. Pneumomediastinum is a potentially important complication. It may be appropriate to monitor patients in the later stages of the condition through an ambulatory setting.
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Affiliation(s)
- E Shuttleworth
- Departments of Acute Medicine and Radiology, University Hospital of South Manchester, Manchester
| | - R Sawyer
- Departments of Acute Medicine and Radiology, University Hospital of South Manchester, Manchester
| | - M Holland
- Departments of Acute Medicine and Radiology, University Hospital of South Manchester, Manchester
| | - T Cooksley
- Departments of Acute Medicine and Radiology, University Hospital of South Manchester, Manchester
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Clemans L, Cooksley T, Holland M. Palliative and end of life care on the Acute Medical Unit. Acute Med 2014; 13:12-15. [PMID: 24616898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Early and appropriate recognition of patients requiring palliative care is essential to delivering high quality management and Acute Medical Units have a pivotal role to play in ensuring its implementation. AIM To identify the prevalence of patients admitted to Acute Medical Unit (AMU) who met palliative criteria, the overall prevalence of terminal diagnoses and the frequency of appropriate referrals to the units Palliative Care in reach team. METHODS An audit was performed at a University Hospital AMU to examine these issues. The NHS Supportive and Palliative Care Tool (SPCIT) was used to identify palliative patients. 409 patients were admitted to the AMU during the study period. RESULTS 66 (16.1%) of patients were identified as palliative. Two-thirds of these patients had a non-malignant diagnosis. 30% of palliative patients were referred to the palliative care team of which 85.4% had a diagnosis of cancer. 88% of patients that received ongoing palliative care review had a diagnosis of cancer. CONCLUSION There is a high prevalence of patients with a terminal diagnosis presenting to the AMU reflecting an aging population and increasingly complex co-morbidities. Palliative patients with a non-cancer diagnosis are less likely to be referred to the palliative care team, which has the potential to disadvantage their care.
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Affiliation(s)
| | - T Cooksley
- Department of Acute Medicine, University Hospital of South Manchester, Manchester
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Parish B, Cooksley T, Haji-Michael P. Effectiveness of early antibiotic administration in septic patients with cancer. Acute Med 2013; 12:196-200. [PMID: 24364049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION First dose intravenous antimicrobial therapy should be administered within 1 hour of admission but this is achieved in a minority of patients. METHODS We performed a retrospective analysis at the largest Oncology hospital in Europe. Nurse-led administration of initial antibiotic therapy was introduced to the admissions unit. RESULTS The nurse led protocol increased compliance with the 1 hour target from 40% to 88.6%. There was a statistically significant decrease in the mean length of stay (p=0.045) which was more pronounced in the neutropenic population (p=0.006). There was a trend to improved 30 day mortality. CONCLUSIONS A nurse led protocol can be effective in improving compliance with the 1 hour target. Early administration of intravenous antibiotics in cancer patients with sepsis is associated with a shorter length of inpatient stay and a trend to decreased mortality.
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Affiliation(s)
| | - T Cooksley
- Consultant in Acute Medicine, University Hospital of South Manchester
| | - P Haji-Michael
- Consultant in Critical Care, The Christie Hospital, Manchester
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Cooksley T, Haji-Michael P. Posterior reversible encephalopathy syndrome associated with deoxycoformycin and alemtuzumab. J R Coll Physicians Edinb 2012; 41:215-7. [PMID: 21949916 DOI: 10.4997/jrcpe.2011.306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a combined clinical and radiological syndrome characterised by headaches, encephalopathy, seizures and visual loss. We present the case of a 55-year-old male who developed this condition following treatment with deoxycoformycin and alemtuzumab. We review the literature considering diagnosis, pathophysiology and optimal strategies for treatment of this condition.
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Affiliation(s)
- T Cooksley
- Department of Critical Care, The Christie, Manchester, UK.
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