Patient survey examining the experience of care of a hospital-based opt-out tobacco dependency treatment service (the CURE Project).

INTRODUCTION: Treating tobacco dependency in patients admitted to hospital is a key priority in the National Health Service long-term plan. This service evaluation assessed the perception, needs and experience of care within an opt-out hospital-based tobacco dependency treatment service (the Conversation, Understand, Replace, Experts and Evidence Base (CURE) team) in North-West England. METHODS: A survey was offered to all eligible patients between 1 July 2020 and 30 September 2020. Eligibility criteria were adult patients identified as an active smoker being approached by the CURE team as part of the standard opt-out service model, on a non-covid ward without a high suspicion of COVID-19 infection and able to read and write in English. RESULTS: 106 completed surveys were evaluated. Participants demonstrated high levels of tobacco dependency with an average of 37 years smoking history and 66% describing the onset of cravings within 30 min of hospital admission. The average number quit attempts in the previous 12 months was 1.3 but only 9% had used the most effective National Institute for Health and Care Excellence (NICE) recommended treatments. 100% felt the opt-out service model was appropriate and 96% stated the treatment and support they had received had prompted them to consider a further quit attempt. 82% of participants rated their experience of care as 9/10 or 10/10. Participants wanted a broad range of support post discharge with the most popular option being with their general practitioner. 66% and 65% of participants would have been interested in a vaping kit as stop smoking intervention and support vaping-friendly hospital grounds respectively. CONCLUSION: These results suggest this hospital-based, opt-out tobacco dependency treatment service delivers high-quality experience of care and meets the needs of the patients it serves. It also highlights the opportunity to enhance outcomes by providing access to NICE recommended most-effective interventions (varenicline, vaping and combination nicotine replacement therapy) and providing flexible, individualised discharge pathways.

Creating national trainee-led resources for shielding trainees during COVID – A collaborative model for the future

BackgroundThe SARS-Cov2 pandemic impacts postgraduate medical training in all specialties, including paediatrics. However, those advised to ‘shield’ or stringently socially distance have been particularly affected personally and professionally. Despite the emerging situation, trainee voices must be heard to provide valuable contributions to local and national processes affecting them.ObjectivesWe describe the model used and outcomes from the Supported Return to Training programme (SuppoRTT) Shielding Trainee Advisory Group (S-STAG) in collaboration with Health Education England (HEE) to design and implement pathways and resources for these trainees.MethodsLed by HEE fellows, the group was recruited from varied specialties, providing broad representation of community and hospital-based, medical and craft specialties, including paediatrics. The group met virtually fortnightly during the first wave of the pandemic. Collaborative work was completed using shared documents online.Trainee challenges and experiences raised within the group and via wider trainee networks allowed a targeted approach to providing resources and guidance. Good practice from different regions, Royal College guidance and advocacy of displaced trainees was shared across multiple platforms.Results272 live attendees of four webinar episodes represented all HEE regions and Northern Ireland. 96% found the series ‘useful’ with 86% rating the psychological support sessions as ‘useful’ or ‘very useful’. Recorded sessions continue to be viewed.ResourcesA pathway was designed to help trainees and supervisors navigate their new circumstances and identify learning contributing to training progression despite significant changes to clinical roles. We designed a nationally available toolkit, freely available via the national/regional HEE SuppoRTT websites including: suggested activities, resource signposting, peer-support models, trainers guidance and advice on returning to face-to-face working.Four recorded webinars were delivered with country-wide involvement of professionals including a clinical psychologist, exploring the impact of shielding on identity and purpose. Bringing people experiencing similar challenges together developed support and a framework to understand the emotional impact of shielding and negotiate the challenges of abrupt changes. Peer-support groups were set up in many regions.Collaboration continues to inform further guidance as the situation evolves.Information DisseminationStrong connections developed with SuppoRTT Regional offices and HEE national communication teams assisted in identifying, receiving feedback from and disseminating information to affected trainees whilst maintaining confidentiality. Utilising social media, formal publication in journals and digital media facilitated rapid dissemination of resources.ChallengesThe pandemic presents unique challenges: Trainee occupational health is provided by the employer, not HEE or a training body, resulting in potential disconnect and lack of institutional awareness. Each trainee has individual circumstances requiring a bespoke approach. Formal national guidance and resources were not immediately available, constantly changing case rates in different geographies impaired making guidance universally available and appropriate. S-STAG is aware that for some, these resources were not prompt enough, despite best efforts. In future, these resources could be adapted and earlier advocacy initiated.ConclusionsOur group has successfully demonstrated a collaborative approach between trainees from a broad range of specialties and educational leaders with an interest in welfare and trainee support, working in a rapidly changing environment to produce a range of relevant resources.