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BackgroundLupus is a severe, autoimmune disease that is very rare in children and young people. As a regional service and the UK’s only ‘Centre of Excellence for Childhood Lupus’, our patients live across a large geographical area. Many have never met another young person with lupus and report how isolating this could feel. The psychological impact of chronic illnesses are well-known and potentially debilitating.AimsWe aimed to develop a series of day-long multidisciplinary workshops for young people with lupus and their families. As part of a stepped-care model of psychological support, we wanted to intervene proactively to promote resilience and coping as well as responding to an individual’s difficulties as they arouse.Method7 families participated in the first workshop which focused on managing fatigue and research participation.Fatigue was highlighted as a frequent area of concern by young people and their parents when completing a routinely preclinic screening tool.All participants completed a range of standardised psychological measures as well as a workshop feedback form.ResultsParticipant participated in exercises designed to encourage sharing of experiences as well hearing examples of strategies to manage fatigue. High levels of fatigue were identified among lupus patients (mean score on the fatigue severity scale 5.1 (range 4–5.8) where people scoring above 3 points are considered to suffer with fatigue). Young people and their families reported increased confidence in managing fatigue when pre- and post-workshop data were compared. Information about local and national research in paediatric lupus was shared in an interactive session.There was considerable variation in the extent to which young people were coping with lupus.Attendees reported finding the workshop helpful and convenient to attend. Support for siblings, medication, and symptom knowledge were identified as potential future workshop topics.ConclusionThe ‘Lupus and You’ workshop allowed young people and their families to share experiences of managing lupus, to develop supportive relationships while also developing resilience and practical strategies for living life fully despite lupus.

AimDischarge summary is the primary mode of communication between secondary and primary care. It is vital that this document is successfully completed and transmitted in a timely manner to ensure safe discharge and prevent unnecessary readmissions. All patients admitted to secondary care require a discharge summary including patients attending the Children’s Assessment Unit (CAU). It has been recognised that discharge summaries are not always completed promptly in our unit. Our aim of this audit is to improve the delay of the completion of discharge summaries in CAU.MethodWe audited patients who have been reviewed by a doctor and discharged from CAU during 19th–25thSeptember 2016. The delay between discharge and completion of discharge summary was reviewed using our hospital’s electronic system (Nexis). We then introduced interventions including: 1. Encouraging nursing staff to prompt doctors to complete discharge summary before the patient leaves CAU; 2. Encouraging nursing staff to complete discharge check list including the question about completion of discharge summary; 3.To educate doctors on the importance of discharge summary completion by presenting in a local teaching session and displaying posters. We then re-audited over 21st–27thNovember looking at the delay of discharge summary completion. Our standard was that 100% of discharge summaries should be completed on the day of discharge. We compared the pre-intervention and post-intervention results using a Chi-squared test.ResultThere were 80 patients in the pre-intervention period and 74 in the post-intervention period. Overall the discharge summary completion rate improved from 85% pre-intervention to 88% post-intervention, and of the discharges that were completed the longest delay has reduced from 30 days to 21 days after intervention. During the pre-intervention period, 12 (15%) patients had their discharge summary completed on the same day of discharge compared with 34 (46%) the post-intervention period (p<0.001).ConclusionWe have successfully improved the efficiency in discharge summary completion in CAU using simple prompting and education strategies. To further this we will introduce direct individualised feedback to improve performance and positive encouragement for doctors who have completed discharge summaries promptly.

AimGood handover is well recognised as integral to patient safety. NHS England advises a process should be in place for discharged patients to ensure that test results are reviewed promptly. It is recognised that this is not always happening on our Children’s Assessment Unit (CAU). Our aim was to audit how many outstanding investigation results we follow up on CAU. We then put in place an intervention and re-audited following introducing the intervention.MethodsWe reviewed all patients discharged from CAU from 19th–25th September 2016, determining whether there were any outstanding results by reviewing the day of attendance on the electronic ordering system (Cyberlab). We then reviewed the electronic ward handover (the only system in place at the time). We then implemented a ‘CAU outstanding results follow-up book’. This was placed on CAU to provide an easy system to highlight any outstanding results. This book is reviewed daily by the CAU FY1 doctor. We then re-audited between 21st–27th November looking at the electronic handover and the CAU follow-up book to determine if outstanding results were followed up. Our standard was that 100% of outstanding investigation results should be followed up. We compared the pre-intervention and post-intervention results using a Chi-squared test.ResultsThere were 80 patients in the pre-intervention period and 74 in the post-intervention. 17 patients in the pre-intervention group had outstanding results requiring follow-up, of these 6 were highlighted through the electronic handover (35.3%) compared with 7/18 highlighted in the CAU book (38.9%), in the post-intervention group (p=0.048). This disappointing result may be because we ran this jointly with a more successful initiative to improve the number of discharge letters completed within 24 hours. We promoted this initiative more strongly with significant improvement 15.0% vs 45.9% (p<0.001). This demonstrates change can be achieved. We now plan to present results locally with a drive to improve on the follow-up of outstanding investigations.ConclusionsWe have introduced an intervention aiming to improve patient safety through ensuring that all outstanding investigation results are followed-up. So far, results have been disappointing but we hope to improve this with further promotion of the initiative.