Medics recognised for work on risks of common bile duct stents

Imperial medical students have been commended for a project that seeks to reduce the risks associated with using common bile duct stents long-term.

Third-year medicine students Solomon White, Rachel Hawthorne, Basim Ali and Christopher Loyn have been recognised for their work on reducing complications associated with prolonged use of common bile duct stents.

Common bile duct stents are used in patients where the flow of bile into the intestines might have been blocked by tumours, gallstones or strictures (narrowing) of the bile duct.

The team of four, based at West Middlesex University Hospital, put forward a proposal for reducing complications from stents remaining in situ following a detailed investigation into a real case study.

The students’ work is part of the third year of Imperial’s MBBS programme, where they work in groups on a clinical quality improvement project. Students select specific areas for quality improvement—for example, effectiveness of the system, patient safety or patient satisfaction—and subsequently design improvement strategies.

These are presented at the end of their hospital attachment in the form of a poster presentation. Each NHS Trust puts forward the winning poster for a final conference at Imperial College Business School, where White, Hawthorne, Ali and Loyn’s work, ‘Reducing inadvertent prolongation of common bile duct stenting’, was awarded first-prize last week.

Their poster details a case study of an elderly patient who presented to West Middlesex University Hospital and was found to have inflammation of a bile duct due to ‘crusting’ of a stent, which had slowly become blocked with clots.

The stent had been in place since 2011, even though such long-term use is discouraged. Stents such as these are intended as a temporary measure and with research demonstrating that the risk of complications increases in a straight line over time, the students were keen to define the extent of this problem and design safeguards to reduce the likelihood of future complications.

Their proposal recommended ensuring patients are aware of the stent and can pass this information on, even if their clinical care team changes. They also suggested changes to written communication with patients and the way that the procedure is documented in electronic records.

The second prize in the competition went to a team from Northwick Park Hospital, with their presentation ‘Are you moist enough?’ looking at the placement of hand cream dispensers next to gel sanitisers so that skin dryness does not discourage frequent hand-washing.

Third place was awarded to the Ealing Hospital team who argued for ‘An improved approach to special precautions for side rooms’, improving labelling instructions so that all staff and visitors are aware of access restrictions.

The third-year students’ clinical quality improvement projects are led by Mr Colin Bicknell, a consultant vascular surgeon at St Mary’s Hospital. Judging the competition were Dr Laura Hopkins, gastroenterology registrar at Chelsea and Westminster Hospital NHS Foundation Trust; Dr Jo Harris, deputy head of undergraduate medicine at Imperial’s School of Medicine; and Professor Dorothy Griffiths, former dean of Imperial College Business School.