To evaluate referrals to our local Young Onset Dementia Assessment Service (YODAS), analyse referral trends and re-referral patterns between 2020 and 2024, and review reasons for non-acceptance of referrals at triage. A retrospective review of electronic referral records was undertaken using descriptive analysis.

Referrals to YODAS almost doubled over the study period, while non-acceptance rates remained relatively stable, rising from 52.6% in 2020 to 57.3% in 2024. Among 760 patients whose referrals were not accepted, the most common reasons for non-acceptance were: absence of features suggestive of neurodegeneration, cognitive symptoms better explained by mental health conditions, and insufficient referral information. Over one-quarter were re-referred, with two-thirds subsequently accepted. Only 6% of individuals whose referrals were initially not accepted later received a dementia diagnosis, indicating effective triage.

A rise in the demand for dementia assessment from a younger patient population requires a careful triage to ensure the individuals with possible features of neurodegeneration are appropriately assessed, and cases where alternative explanations are more likely are directed to more appropriate pathways.

Efficient triage in general practice is critical to optimize appointment allocation and minimize patient delays. Delays in receiving clinical information, such as photographs or symptom questionnaires, lead to unnecessary consultations and inefficiencies. This study evaluated the feasibility and impact of a structured pre-triage protocol requesting photos and questionnaires for common conditions (skin, eye, tonsillitis, and urinary tract infections).

A pre-post intervention quality improvement project was conducted in a UK general practice. Triage administrators were instructed to proactively request photographs for skin and eye complaints and symptom questionnaires for tonsillitis and UTIs at initial patient contact. Outcomes included process metrics (number of pre-triage requests, proportion of cases managed directly by the triage GP) and subjective measures of ease, speed, satisfaction, and confidence.

The protocol increased photo requests for skin (mean increase 4.0/session, Cohen’s d = 7.77) and eye (2.2/session, d = 4.09) conditions, while questionnaire requests remained unchanged. The proportion of skin cases managed directly by the triage GP increased significantly (from 0.2 to 2.2 cases/session, d = 1.65), and eye case management also improved. Questionnaire-based pathways showed minimal change in efficiency or direct management. Subjective feedback indicated a slight reduction in triage speed, but ease and satisfaction were maintained, while diagnostic confidence increased, particularly for photo-supported conditions.

A structured pre-triage protocol is feasible, acceptable, and potentially effective in enhancing triage efficiency, particularly for visually assessable conditions like skin and eye presentations. By enabling earlier access to essential information, such protocols may reduce unnecessary consultations, improve workflow, and support clinician confidence.

Pediatric acute care cardiology is a distinct subspecialty field within paediatric cardiology that has grown rapidly in recognition, with previously documented heterogeneity in its practice across 31 centres surveyed in 2017. Unit composition and care delivery across centres participating in the Paediatric Acute Care Cardiology Collaborative (PAC3) have not been formally reassessed and shared, despite significant growth in the field.

A 214-stem question Hospital Survey was created with 454 total response fields across eight domains important to paediatric acute care cardiology such a demographics, staffing, resources and therapies, and standard practices. PAC3 centres were surveyed in September 2023 via REDCap. Descriptive statistics were performed.

Surveys were completed by 100% (47/47) of PAC3 centers. Diverse unit composition exists with 37% of centres utilising a single, dedicated acute care cardiology unit, 28% using mixed-specialty acute care units, and 19% using acuity adaptable units, housing critical and acute care patients in one physical space. Since 2017, acute care cardiology-dedicated multidisciplinary staff has increased (physical therapy (PT): 0 to 4; occupational therapy (OT): 1 to 5; speech-language pathology (SLP): 0 to 4; PharmD: 7 to 26). There is heterogeneity in utilisation of many of the resources and therapies used in acute care cardiology, and use of ventricular assist devices on the acute care cardiology unit has increased.

Significant variability exists in unit structure and care delivery models across a diverse group of centres providing acute care cardiology services. The Hospital Survey may assist in identifying best practices for similar centres across PAC3.

Infants with single ventricle CHD commonly experience gross motor delays due to physiological and environmental factors, including increased risk for white matter injury, reduced aerobic capacity, restrictive post-operative protocols, and limited movement opportunities. These delays persist in adolescence, affecting physical and social development. This study examines a quality improvement initiative within the National Pediatric Cardiology Quality Improvement Collaborative to enhance gross motor development.

Fifteen centres participated. Gross motor skills were assessed using the Ages and Stages Questionnaires, Third Edition, at 6 and 12 months. A key driver diagram, Plan-Do-Study-Act cycles, baseline data, and ongoing process measures were collected. Interventions were implemented, including education, therapy support, and mobilisation protocols. Control charts were used to evaluate the data.

Scores from the Ages and Stages Questionnaires indicated delays in gross motor skills at baseline, with improvement over time. Participating centres showed a centerline shift from 41% to 89% of infants achieving on-target or improved motor scores, compared with 54% to 68% of infants at non-participating centres. Establishment of customised infant developmental plans increased from 62% to 74% for participating centres and from 53% to 61% for non-participating centres. Interventions included establishing processes for consistent screening, developmental plan administration, review of prone positioning, access to therapies, and early intervention referrals.

This targeted quality improvement project increased the use of inpatient practices to support gross motor development for infants with single ventricle CHD. Collaborative, interdisciplinary efforts remain critical for addressing neurodevelopmental challenges in this high-risk population.

This study sought to obtain the views of doctors associated with the Royal College of Psychiatrists on the use of outcome measures in mental health services. An online survey was developed by the College’s working group on outcome measures and widely disseminated to psychiatrists through College channels.

In total, 339 completed responses were received. Respondents were mostly consultant psychiatrists; based in England; and working in the National Health Service with working-age adults. Almost half said they used outcome measures routinely, with almost half finding outcome measures clinically useful. Lack of time and inadequate information technology systems were identified as the top barriers to using outcome measures.

Based on our results, psychiatrists are generally keen to use outcome measures, but are often prevented from doing so effectively by pressures on services and lack of appropriate support. The Royal College of Psychiatrists and other relevant organisations could enhance the use of outcome measures in mental health services through improved guidance, providing additional resources and integration of measures into electronic patient records.

Early placement of a ventricular access device (VAD) in premature post-hemorrhagic ventricular dilatation based on ventricular size criteria, coupled with an aggressive tapping regimen to control ventricular size, may improve developmental outcomes. As this treatment paradigm represents a significant departure from traditional care, we present results of an institutional quality improvement protocol implementation study focusing on safety and resource use for those seeking to implement a similar care pathway.

Infants treated under the new ventricular size-driven protocol were retrospectively compared to a historical cohort managed according to clinical symptomatology. Process and compliance measures related to protocol implementation were tracked, as were complications and measures of resource use.

Ventricular access device (VAD) placement occurred earlier and at a smaller ventricle size, but beyond the protocol-mandated timeframe. Although more resource-intensive than customary care, compliance with protocol-directed screening ultrasounds and VAD aspirations by trained clinicians was high. Intensive ultrasound surveillance altered the management of only one infant during their treatment course. An increased rate of complications related to earlier and more aggressive treatment in these fragile infants was not observed.

Protocol compliance was satisfactory and no safety issues were noted. Although VAD placement occurred sooner, a majority of infants received intervention outside of the mandated timeframe and at a ventricular size above the desired intervention threshold. Minimizing transfer delays from peripheral neonatal intensive care units and improving access to the operating room were identified as areas for improvement. It appears possible to decrease the frequency of ultrasound surveillance without compromising safety.