The routine use of entire radiological trauma series in alert pediatric patients with a normal physical examination has a very low yield. In these children, the localizing signs and symptoms can help us in determining the specific radiological examination to be utilized.

We write this letter as doctors and proud members of the Black, Asian and Minority Ethnic (BAME) community from a South Asian background. Recent Office for National Statistics (ONS) data suggest that the BAME population is disproportionately affected by Covid-19.1 Observations and experiences from within our family and wider community led us to explore how cultural aspects may account for these figures. Both intrinsic and extrinsic factors are likely to contribute to this unfortunate statistic. Intrinsic factors such as pre-existing health conditions and comorbidities e.g. cardiovascular risk factors, diabetes2 and diet are likely to play a role. Extrinsic factors such as living in overcrowded conditions,3 multigenerational households and a large proportion of this population being key/essential workers,4 which are often less likely to be amenable to remote working. Faith also plays a part and the large congregational gatherings in places of worship may add to the risk in this community, as does the tactile nature of greeting in BAME communities. One factor, which is often not recognised by the Western world is a general lack of trust in the medical profession and those in positions in authority. As in other UK communities, fake news stories and conspiracy theories are rife amongst South Asian communities. Increased usage of social media by older generations helps the spread of this. The recent adoption of these technologies by the older South Asian population may leave them vulnerable to these messages, in comparison to more digitally native younger and tech-savvy populations. One recent theory, amongst many, circulating in the Pakistani community, likely perpetuated by the high number of deaths within this community in London and the Midlands, is that when patients of Pakistani heritage are admitted to hospital, they never leave. The assumed belief is that medical staff want to eliminate this community by administering lethal doses of medication to euthanise these patients.5 The videos circulating amongst the South Asian community often appear authentic, using people with a professional title like doctor or nurse to deliver the message. They appeal to the audience by purporting to be sharing a hidden message not sanctioned by the authorities. It is easy to see how someone would fall into the trap of believing these messages and passing them onto family members and friends out of fear, who would themselves propagate this message, as it has come from a trusted source; their family! These absurd and often ridiculous theories, however, are based on one underlying message; the general distrust of those in positions of authority. Just as some sections of the West African population had a lack of trust in Western medical professionals delivering aid to them during the Ebola crisis,6 we are seeing a similar phenomenon happening in the UK by our own British citizens of South Asian heritage. This could result in patients not seeking help when they desperately require it, hence causing delayed presentations when they are left with no choice but to seek it. Years of prejudice and discrimination can lead to a community behaving in this manner. We can all do a little bit to help this situation from escalating. The government Covid-19 press conferences could be more accessible to those whom English is not their first language. In hospitals we could utilise faith chaplains to help dispel some of these rumours. Community leaders could help dispel some these false narratives and those of us who are able to, can continue to act as quality control for our family social media circles.

No abstract

A seven day safety net telephone service was developed in an acute medical unit at a university hospital in London. The service attempts to provide all patients discharged from acute medicine with patient activated access to a member of the acute medical team. This allows patients to flag deterioration triggering further review in the ambulatory clinic or to ask for advice on symptoms or medication. Here we evaluate the first sixteen months of the service and report on its benefits and limitations.

Introduction and aimChest X-rays form a vital part of the initial assessment and management of patients seen by medical practitioners. 1 During the acute medical take at University College Hospital (UCH), patients are referred to the medical team by the emergency department (ED) team or via their general practitioner. Due to logistical arrangements, patients may be transferred to the acute medical unit (AMU) without the chest X-ray that they require as beds become available. As a result, patients would then be transferred to the X-ray department at a later time or date to have this crucial investigation when it could have been performed in ED at the time of admission. This can lead to delays in diagnosis and management, as well as unnecessary disruption for the patient. This quality improvement project was designed to tackle these delays in obtaining chest X-rays between October 2018 and March 2019. MethodElectronic health records of 122 patients were analysed preintervention to determine the proportion that did not receive a chest X-ray prior to admission to the AMU. The delay in patients who had the X-ray after AMU admission was recorded. Two plan, do, study, act (PDSA) cycles with interventions focussed around improving communication between ED staff, acute medicine doctors and radiographers were performed. A further 135 patient records were analysed post-intervention to determine if there was any increase in the proportion of patients receiving an X-ray prior to admission and if that corresponded to a reduced delay.Tackling delays in patients requiring chest X-rays on the acute medical take Fig 1. Run chart demonstrating the improving proportions of patients receiving clinically indicated chest X-rays prior to their acute medical unit admission, with labels detailing timing of interventions and the corresponding plan, do, study, act cycle to which they belong.