ObjectivesThere is an increased reliance on online referral systems (ORS) within neurosurgical departments across the UK. Opinions of neurosurgeons on ORS are extensively reported but those of referrers have hardly been sought. Our study aims at ascertaining our referring colleagues’ views on our ORS and its impact on patient care, their opinions on neurosurgeons and how to improve our referral process.Setting14 district general hospitals and one teaching hospital.Participants641 healthcare professionals across a range of medical and surgical specialties including doctors of all grades, nurses and physiotherapists. Survey responses were obtained by medical students using a smartphone application.ResultsAlthough 92% of respondents were aware of the ORS, 74% would routinely phone the on-call registrar either before or after making referrals online. The majority (44%) believed their call to relate to a life-threatening emergency. 62% of referrers considered the ORS helpful in informing patients’ care and 48% had a positive opinion of their interaction with neurosurgical registrars. On ways to improve the ORS, 50% selected email/text confirmation of response sent to referrers and 16% to referring consultants.ConclusionOur results confirm that referrers feel that using our ORS positively impacts patient care but that it remains in need of improvement in order to better suit our colleagues’ needs when it comes to managing neurosurgical patients. We feel that the promotion of neurosurgical education and mitigation of the effects of adverse workplace human factors are likely to achieve the common goal of neurosurgeons and referrers alike: a high standard in patient care.

Background The prevalence of self-harm among children and young people in the UK is increasing, with few accessing formal support. Drivers of self-harm remain poorly understood, and evidence-based opportunities to intervene are scarce. We aimed to identify factors associated with self-harm in young people to inform local action. MethodsIn this retrospective, observational study, we identified 196 residents of the south London Borough of Lambeth, aged 12-26 years, presenting to two emergency departments for injuries related to self-harm in the 2015-16 financial year (April 1, 2015, to March 31, 2016). A pragmatic sample size of 100 was selected via computer randomisation for further analysis. Electronic mental health records were retrospectively analysed using a data collection protocol that was validated with researchers before data collection. Demographics and psychiatric history were obtained from pre-coded databases linking electronic mental health records and Hospital Episode Statistics data on emergency department attendance for self-harm. Presentation details and social risk factors were derived from assessment of case notes pertaining to the 2 weeks after first presentation; we noted any risk factors that had been positively recorded. Data relating to the individual's first presentation within the study period were used; subsequent attendances were not included in the sample. We analysed the data using descriptive statistics. Ethical approval for data access and linkage was granted by the Oxford Research Ethics Committee C (18/SC/0372), Clinical Records Interactive Search system Oversight Committee (project numbers 14-026 and 19-004), and the National Health Service (NHS) Health Research Authority Confidentiality Advisory Group (reference ECC 3-04(f)/2011). This study received approval as an audit project through Southwark Operational Directorate in the South London and Maudsley Foundation NHS Trust.

AimsAnalysis of paediatric burns, including pre-hospital care, presentation and management to the Urgent Care Centre and Accident and Emergency in a district hospital over the course of twelve months for quality improvement.MethodsThe audit was undertaken in partnership with consultant medical staff. A data collection form was produced to collect data on all paediatric burn presentations to emergency care services. Mode of presentation, first aid management and pre-hospital care, patient statistics, description and documentation of the incident, including safeguarding protocols, and management in hospital were documented. 145 cases were recorded, over a twelve month period between 1/11/2014–31/10/2015, with a varied distribution in site and severity of burn.Results63% of patients carried out some form of first aid prior to hospital attendance, but of these only 8.7% completed the STOP protocol, as recommended on National Burns Awareness day. 15% of patients had a clear description of the burn, including parameters such as size, severity and percentage documented patient notes, but 9.7% of documentation of severity was incorrect, and 46.9% had no documentation. Only 1.4% of patients and their guardians received written guidance after presentation on burn aftercare and prevention with 37.9% receiving no information, written or verbal.ConclusionsThe audit revealed three targets of improvement:Public education detailing pre hospital care using the STOP protocol, and after care management.Education of staff, highlighting correct documentation and grading of burns.A policy of provision of written information to patients post presentation.Adoption of these suggestions could affect emergency department attendance and long term prognosis of paediatric burns.

No abstract