Introduction Improving efficiency in healthcare delivery while maintaining patient safety is central to providing high quality patient care, improved patient satisfaction and creates a culture of improved training for future paediatricians. Poor communication during patient handovers has been cited as being one of the most dangerous interventions that clinicians put patients through. The SBAR handover tool has been recognised by the WHO as well as the National Health Service Institute of Innovation and Improvement as a simple and standardised tool that encourages the clinicians to present patient information in a concise and focused fashion that has been shown to improve patient safety. SBAR is an acronym which stands for Situation, Background, Assessment and Recommendation. Aim To evaluate the impact of time spent by paediatric trainees on the morning patient handover before and after the introduction of SBAR within the department. Method The handovers involved discussing patients who were on the ward, the ED department, and ambulatory unit. An additional note was made of patients for whom there was a significant psycho-social element to their handover. Information on the time spent discussing each patient using a conventional, semi-structured handover process, was recorded for 7 days (over two consecutive weeks). This was followed by conducting the exercise again after the entire department had undergone SBAR training and a 2 month period of daily practise. Data was then gathered for a 14 day period over three consecutive weeks. Results Prior to commencing the use of SBAR, each handover was taking an average of 55.7 min (range 40 to 73) with 22 patients being discussed per handover on average. Post SBAR, it took an average of 32 min for each handover (range 19 to 49) with 21 patients being discussed per handover. Pre SBAR, it took an average of 2.57 min to handover a patient compared to 1.54 min post SBAR. This represents a 60% reduction in time using SBAR (p<0.0003). Conclusions This significant reduction in handover times using SBAR demonstrates improved efficiency. This has several benefits including enabling time to be generated for ‘micro-teach’ sessions and improved paediatric training or increasing departmental productivity.
Background/introduction We describe a case of a 34 yr old Black African women fully suppressed on HAART for 9 yrs presenting with recurrent episodes of HIV encephalopathy with abnormal MRI brain scan and detectable HIV in CSF. Following ARV switch her cognitive function and scans had improved and remains undetectable in CSF. Aim(s)/objectives Started HAART in 2005 and remained asymptomatic and fully suppressed on (Kivexa/Atvr/rit) CD4 > 500 mm. Presented initially in 2014 to Neurology with acute confusion, headaches and convulsions. CSF revealed pleocytosis with V/L 811 copies and neg for infective screen. MRI scan revealed diffuse non-specific signals consistent with HIV encephalopathy. On recovery she was monitored in clinic and remained virologically controlled but with residual neurocognitive impairment characterised by short term memory loss and difficulty concentrating. She then represented 9 months later with focal motor signs and confusion resolving within 48 hrs MRI scan no focal lesion. Rpt CSF revealed V/L of 960 copies. Results In view of persistant CSF viraemia she was switched to higher CPE score (from 7 to 12) HAART regimen of Trizivir/ Maraviroc. Subsequently she fully recovered cognitive function and rpt CSF at 3/12 confirmed full suppressed VL with resolving brain scan. Discussion/conclusion This case demonstrates that in well controlled pts on HAART who develop presumptive neuro-HIV and in absence of other potential causes, the value of CSF V/L in in constructing a HAART regimen with improved CSF penetration can result in significant improvement in both clinical and objective markers such as MRI scans.
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