Audit and Quality Improvement of Physical Health of New Admissions to an Acute Inpatient Facility

Abstract

Aims

The poorer physical health of psychiatric versus non-psychiatric patients has been well-documented. Lifestyle and antipsychotic medications have an adverse effect on the cardiovascular system and are more likely to cause metabolic syndrome, obesity and diabetes. The purpose of this audit was to determine if Samphire ward is in 100% compliance with the Norfolk and Suffolk NHS Foundation Trust (NSFT) Physical Healthcare Policy (C84). The aim is to ensure minimum physical health investigations are requested within 24 hours of admission, including: 1) baseline blood tests, 2) physical examination, and 3) electrocardiogram (ECG). A re-audit was also completed, which aimed to determine if compliance improved following a quality improvement (QI) intervention.

Methods

A retrospective data collection (Lorenzo and WebICE) was compiled of all new patients admitted and transferred to Samphire ward from 01/06/21 to 03/10/21 (n=66). Data included baseline bloods, physical exam, and ECG documentation within 24 hours of admission. A QI intervention (A3 visual aid) was then placed on the ward. The policy was re-audited from 04/10/21 to 30/11/21, including all new patients admitted and transferred to Samphire ward (n=24).

Results

Initially, 34.5% of new admissions had a physical examination or a patient refusal to consent that was documented on the physical exam form (NSFT Physical Exam Form v2.0) on Lorenzo completed within 24 hours of admission; post-intervention, this increased to 47%. 53% of new admissions had an ECG or a documented refusal in the initial audit; this increased to 61%. 68% of patients had baseline blood tests taken or a documented refusal within 24 hours of admission but only 4.5% had the correct blood tests taken; this increased to 71% and 33%, respectively, following the QI intervention. All 3 components within the 24-hour time period were met 0% of the time during the baseline audit; this increased to 33% post-QI intervention.

Conclusion

Overall, there was still poor compliance noted for all 3 physical health components required upon admission and fell far below the minimum standard as set out in the NSFT Trust Physical Healthcare policy. Further analysis showed ward doctors adhered to the standard significantly more than duty doctors. Recommendations include teaching regarding the physical health standard at junior doctor induction training and encouraging accountability among junior medical staff. A re-audit is recommended that includes further elements of physical health, including venous thromboembolism (VTE), height/weight, and nursing elements.