A report of two cases of sepsis in patients with spinal cord injuries.

Sepsis is a common presentation to the emergency department (ED) with the main aim of treatment being prompt antibiotics, source identification and control, all preferably within the initial golden hour. In the majority of patients, a good history and examination is adequate to elicit the most likely source of infection and thus target therapy appropriately. However it is well known that this can be difficult in some patient groups. In this report we present two patients with sepsis with spinal cord injury (SCI) where both the history and examination were unhelpful in identifying the source of infection and demonstrate why the unique physiology and risk factors in SCI patients must be considered early in their work up. Both patients were admitted with vague, nonspecific constitutional symptoms. Both had no evidence of abdominal or flank pain or any objective tenderness. One of the patients had a long-term suprapubic catheter and one intermittently self catheterised meaning that urine dip stick results were unreliable. In both instances, the patients were found to have obstructed renal stones with associated infection and both had good outcomes after surgical intervention.

Improving Clinical Handover on an Electronic Communication Platform: A Quality Improvement Project.

Background National guidance stipulates the essential components of a safe handover. Shift-based work and the COVID-19 pandemic has led to an increased turnover and re-deployment of staff into new clinical areas, creating challenges in delivering effective handovers. Aim The aim of this quality improvement project (QIP) was to improve adherence to a local standardised handover proforma to improve the quality and consistency of handovers. Methods Handovers were assessed by measuring the completion rates of the essential components of a safe handover as outlined in the national guidance. Data were collected from an electronic handover system which follows the Situation, Background, Assessment and Recommendations (SBAR) structure, and percentage completion rates obtained for each component assessed. Following baseline measurement, four Plan-Do-Study-Act (PDSA) cycles were completed between August 2020 and February 2021 across two junior doctor rotations and during a COVID surge rota. Results A total of 710 handovers were assessed across the four PDSA cycles. There were overall improvements in the percentage completion rates of each component compared to baseline: Under 'Situation', admission dates increased by 13.7%, estimated discharge date by 33.3% and 100% completion rate maintained for the presenting complaint. Under 'Background', past medical history remained static, with a 12.1% increase in documentation of a social history. Under 'Assessment', escalation status increased by 335%, issues list by 242% and important updates by 35.2%. Under 'Recommendations', completion rate for plans was maintained at 100%. Conclusions Our findings demonstrated an overall improvement in the majority of components of the handover proforma. Challenges remain with the rotation of junior doctors through different specialties leading to a loss of institutional knowledge and reduced longevity of the intervention's effect, exacerbated by the introduction of the COVID surge rota. A long-lasting improvement may require a shift to a completely electronic patient records system (ePR) which incorporates a handover tool.