Thursday 28 May 2015

Health Service Journal - Integration

"Integrated care has been a goal for the NHS almost since it was founded. Now that it is finally top of the agenda, can local and national leaders seize the opportunity to deliver it?"

Integration
Health Service Journal supplement
10 April 2015

Read more here.

Learning from high-performing health care organisations

The King's Fund have released videos and presentations of their one day conference which "explored how the NHS can learn from high performers in England and abroad".

Learning from high-performing health care organisations (videos)
The King's Fund
21 April 2015

Access the videos here.

The practice of system leadership

"In this report, Nicholas Timmins draws on the stories of 10 senior leaders to identify the skills needed to work in this way. These leaders were selected because of their proven experience of delivering improvements in the NHS and related services without necessarily having formal authority over others. "

The practice of system leadership: Being comfortable with chaos
N Timmins
The King's Fund
May 2015

Read more here.

CQUIN audit for prescription of antibiotics for urinary tract infections in an acute medical assessment unit

"The interventions we introduced appeared to have dramatic results over a short space of time, with an improvement of compliance with the antibiotic guidelines to 100% and also documentation improving to 100% accuracy."
CQUIN audit for prescription of antibiotics for urinary tract infections in an acute medical assessment unit
M Oppenheimer, N Rezwan
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208446.w3374

Read more here.

Standardising the organisation of clinical equipment on surgical wards

"By implementing, a very simple common-sense intervention with multidisciplinary engagement, supportive managers, and a versatile adaptive strategy we achieved a measured reduction in the time-taken to locate clinical equipment."

Standardising the organisation of clinical equipment on surgical wards at North Bristol NHS Trust: a quality improvement initiative
J Ward, R Spencer, E Soo, K Finucane
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208308.w3441

Read more here.


Improving the quality of discharge summaries

"Moving to one electronic discharge summary system and designing a new template has led to a significant improvement in the quality of discharge summaries at Epsom and St Helier University Hospitals NHS Trust. "

Improving the quality of discharge summaries: implementing updated Academy of Medical Royal Colleges standards at a district general hospital
H May-Miller et al.
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u207268.w2918

Read more here.

Introduction of a Venous Thromboembolism Prophylaxis Protocol for Older Adult Psychiatric Patients

"Overall the results have shown that introduction of a VTE prophylaxis assessment protocol on an Older Adult Psychiatric ward has increased the number of patients that received a VTE risk assessment."

Introduction of a Venous Thromboembolism Prophylaxis Protocol for Older Adult Psychiatric Patients
A Croxford, A Clare, K McCurdy
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u205852.w3226

Read more here.

Improving feedback from outpatient medical appointments attended by escorted psychiatric patients

"It is therefore vital that good communication channels exist between specialties and that there is a change of culture in psychiatric hospitals where patients’ physical health is considered as important as their mental health."

Improving feedback from outpatient medical appointments attended by escorted psychiatric patients in the North London Forensic Service
K McCurdy, A Croxford
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u205791.w2356

Read more here.

Monday 18 May 2015

A New Priority for Mental Health

"The IAPT programme costs commissioners nothing. This is because people with depression and anxiety disorders cost the NHS a huge amount in terms of their physical healthcare. Thus people with long-term physical conditions cost the NHS around £6,000 per year in physical healthcare if they are mentally ill, but only £4,000 if they are not mentally ill. This difference of £2,000 compares with the cost per person treated in IAPT of around £650 – a one-off cost. "

A New Priority for Mental Health
R Layard
Centre for Economic Performance
London School of Economics and Political Science
May 2015

Read more here.

Commissioning Guide: Cataract Surgery

"Commissioning of cataract care should encompass the whole cataract care pathway from initial assessment and treatment planning to final postoperative review"

Commissioning Guide: Cataract Surgery
The Royal College of Ophthalmologists
February 2015

Read more here.

Constructive comfort: accelerating change in the NHS

"To achieve change at the pace and scale now needed in the NHS requires much careful thinking about the mechanisms employed to effect change. In this report we have focused how best to design national policy on the NHS to accelerate improvements to health care."

Constructive comfort: accelerating change in the NHS 
C Allcock, F Dormon, R Taunt, J Dixon
February 2015

Read more here.

Keeping patients with epilepsy safe

"While there is no proven intervention or national surveillance of epilepsy mortality, the safety checklist is a simple and practical tool that can be used to demonstrate effective clinical and corporate governance while enhancing patient safety. It can also help give some assurance to bereaved families that every effort was made to reduce risk and prevent a fatality."

Keeping patients with epilepsy safe: a surmountable challenge?
R Shankar et al.
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208167.w3252

Read more here.

Improving the handover and care of acute urological admissions

"The 3 simple changes made to our practice both inwardly and outwardly have made great improvements to the care of our patients. Our handovers are more successful and the middle grade urologists are involved in the care of their patients at a much earlier stage much more commonly."

Improving the handover and care of acute urological admissions
E Bass, S Patel
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u204762.w3422

Read more here.

The use of conscious sedation in elective external direct current cardioversion

"Hospitals that are still using general anaesthesia for patients undergoing DC cardioversion for atrial fibrillation / atrial flutter should consider switching to the use of conscious sedation. This can improve efficiency, cut costs, and reduce waiting times for patients, resulting in improved clinical outcomes."

The use of conscious sedation in elective external direct current cardioversion: a single centre experience
R Lobo, T Kiernan
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208437.w3377

Read more here.

Tuesday 12 May 2015

The cost-effectiveness of testing strategies for type 2 diabetes: a modelling study

"Based on the multiethnic LEADER population, among individuals currently attending NHS Health Checks, it is more cost-effective to screen for diabetes using a HbA1c test than using a FPG test. However, in some localities, the prevalence of diabetes and high risk of diabetes may be higher for FPG relative to HbA1c than in the LEADER cohort."

The cost-effectiveness of testing strategies for type 2 diabetes: a modelling study 
Gillett M, Brennan A, Watson P, Khunti K, Davies M, Mostafa S, et al.
Health Technology Assessment 2015;19(33)

Read more here.

Towards a framework for enhancing procurement and supply chain management practice in the NHS

"Those doing procurement in Clinical Commissioning Groups and NHS hospitals need to gain a greater understanding of how this activity is done in commercial settings to improve their skills in the NHS. This study reviews research that has been done in this area already, presents an overview of it and uses it to suggest ways that clinicians and managers in the NHS can carry out their procurement role better."

Towards a framework for enhancing procurement and supply chain management practice in the NHS: lessons for managers and clinicians from a synthesis of the theoretical and empirical literature
J Sanderson , C Lonsdale , R Mannion , T Matharu 
Health Service Delivery & Resesearch 2015;3(18)

Read more here.

Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services

"Black and minority ethnic patients in contact with psychiatric services tend to have less than optimal experiences and outcomes. This report presents the findings of a detailed review of research into interventions to improve communications between black and minority ethnic patients and professionals working in psychiatric services in order to benefit patients’ mental health."

Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness
K Bhui, RW Aslam, A Palinski, R McCabe, MR Johnson,S Weich, et al.
Health Technology Assessment 2015;19(31)

Read more here.

Service user engagement and health service reconfiguration

"Patients and the public could be engaged through a wide variety of methods. In selecting which methods to employ locally, decision-makers should take into account the nature of the local population and of the proposed service changes. Problems often arose because decision-makers paid insufficient attention to issues considered important by the public."

Service user engagement and health service reconfiguration: a rapid evidence synthesis 
J Dalton, D Chambers, M Harden, A Street, G Parker, A Eastwood
Health Services and Delivery Research 2015;3(17)

Read more here.

Adolescents leaving mental health or social care services

"Given that, in this report, psychosocial outcomes of young people leaving any services is substantially sub-optimal very serious consideration should be given to holistic improvement of transition policies and young adult services across adolescent service providers. "

Adolescents leaving mental health or social care services: predictors of mental health and psychosocial outcomes one year later
J Memarzia, MC St Clair, M Owens, IM Goodyer, VJ Dunn
BMC Health Services Research 2015, 15:185  doi:10.1186/s12913-015-0853-9

Read more here.

Thursday 7 May 2015

Direct costs of radiotherapy for rectal cancer

"Traditional radiotherapy for rectal cancer is relatively inexpensive. Moreover, significant savings may be achievable through service organization and provision changes. These results suggest that a strong economic argument can be made for expanding the use of radiotherapy in rectal cancer treatment."

Direct costs of radiotherapy for rectal cancer: a microcosting study

P Hanly, A Ó Céilleachair, M Skally, C O’Neill, L Sharp
BMC Health Services Research 2015, 15:184  doi:10.1186/s12913-015-0845-9

Read more here.

Are measurements of patient safety culture and adverse events valid and reliable?

"The aim of this cross sectional study was to explore associations between the safety culture
and adverse events, and evaluate the validity of the tools used for the measurements. "

Are measurements of patient safety culture and adverse events valid and reliable? Results from a cross sectional study
PG Farup
BMC Health Services Research 2015, 15:186  doi:10.1186/s12913-015-0852-x

Read more here.

Understanding staff perspectives of quality in practice in healthcare

"Quality in everyday practice relies upon staff values, motivations and behaviours and how staff interact with patients, putting both explicit and tacit knowledge into specific action."

Understanding staff perspectives of quality in practice in healthcare
M Farr, P Cressey
BMC Health Services Research 2015, 15:123  doi:10.1186/s12913-015-0788-1

Read more here.

The relationship between accounting and quality improvement in healthcare

"Accounting is often ineffective not because it is inherently incomparable with quality and the complexities of healthcare, but because its underlying characteristics have not been fully acknowledged or understood."

Accounting for quality: on the relationship between accounting and quality improvement in healthcare
D Pflueger
BMC Health Services Research 2015, 15:178  doi:10.1186/s12913-015-0769-4

Read more here.

Multiple sclerosis outpatient future groups: improving the quality of service improvement activities

"The Multiple Sclerosis Outpatient Future Group study aimed to explore how analogies and props can be used to facilitate rich interactions between staff and patients within these activities. This paper will consider how these interactions supported participants to share experiences, generate ideas and suggest service improvements."

Multiple sclerosis outpatient future groups: improving the quality of participant interaction and ideation tools within service improvement activities
A Thomson, C Rivas, G Giovannoni
BMC Health Services Research 2015, 15:105  doi:10.1186/s12913-015-0773-8

Read more here.

An ethnographic study of patient perceptions and influence on quality improvement

"When including patient voices in measuring and defining ‘quality’, governments and public health practitioners need to be aware of how neoliberal rationalities at the heart of the policy and services context could prevent patients from seeing themselves as subjects of rights to quality care and as actors “with ‘the right to claim rights” to quality care."

Developing patient-centred care: an ethnographic study of patient perceptions and influence on quality improvement
A Renedo, C Marston
BMC Health Services Research 2015, 15:122  doi:10.1186/s12913-015-0770-y

Read more here.

King’s Fund report into dermatology services in the UK

"Our work exposed major concerns about the current quality of commissioning for dermatology services and the lack of specialist knowledge among commissioners. Commissioning should facilitate the new models of care with tariffs that reflect and encourage new patient-centred ways of working."

King’s Fund report into dermatology services in the UK
British Association of Dermatologists
April 2015

Read more here.

Wednesday 6 May 2015

Enabling the local implementation of sustainable urgent and emergency care models

"To break the vicious circle resulting in increased pressures on A&Es, and ensure patients have access to the right care, in the right place at the right time, efforts should focus on building an effective community offer. This will require adequate investment to transform primary, community and social care – while ensuring that acute and emergency care remains sustainable."

Rip off the sticking plaster now: Enabling the local implementation of sustainable urgent and emergency care models in 2015/16
NHS Confederation, Urgent and Emergency Care Forum
April 2015

Read more here.

Scaling Up Improvement - applications for funding

The Health Foundation are looking for health care improvement projects in which to invest up to £3 million. Successful projects will demonstrate how improvements have been made on both a small and large scale, with the aim to promote wider adoption across the UK.

Find out more here.

Facing the Future Together for Child Health

"Facing the Future: Together for Child Health represents a standard of care which children and their parents and carers can expect from the healthcare professionals looking after them. We hope that healthcare professionals will see them not just as standards to strive toward, but as a lever to continue to improve the safety, quality and sustainability of services." 

Facing the Future Together for Child Health
Royal College of Paediatrics and Child Health, the Royal College of General Practitioners, Royal College of Nursing
April 2015

Read more here.

Do practice performance scores predict emergency admissions?

"We tested whether or not better-quality primary care, as assessed by the SMI [serious mental illness] quality indicators measured routinely in the Quality and Outcomes Framework (QOF) in English general practice, is associated with lower rates of emergency hospital admissions for people with SMIs"

Do higher primary care practice performance scores predict lower rates of emergency admissions for persons with serious mental illness? An analysis of secondary panel data 
R Jacobs et al.
Health Services and Delivery Research, (16), April 2015

Read more here.

Tuesday 5 May 2015

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment

"We aimed to explore if geographical variation in procedure rates is a marker of clinical uncertainty and might be used by local commissioners to identify procedures that are potential candidates for disinvestment."

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study
W Hollingworth et al.
Health Services Delivery and Research, 3(13), April 2015

Read more here.

Commissioning for Value Integrated care pathways packs

NHS England and RightCare have created Commissioning for Value packs to support integrated care pathways across CCGs.

Access the London packs here.

How is the NHS performing? April 2015

"As the NHS begins a new financial year and we move from one parliament to another, it is clear from the performance on key headline targets and standards and from our latest survey of finance directors that the NHS will face huge challenges this year – very possibly the most difficult for many years."

How is the NHS performing? April 2015: Quarterly monitoring report
J Appleby, J Thompson, J Jabbal
The King's Fund

Read more here.

Workforce planning in the NHS

"At local level, there is no single solution to address immediate workforce challenges. Rather, providers will need to consider a range of sustainable strategies – individually and in partnership with others in their local health economy."

Workforce planning in the NHS
R Addicott, D Maguire, M Honeyman, J Jabbal
The King's Fund
April 2015

Read more here.

Improving occupational physicians’ adherence to a practice guideline:

"Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians"

Improving occupational physicians’ adherence to a practice guideline: feasibility and impact of a tailored implementation strategy
MCW Joosen, KM van Beurden, B Terluin, J van Weeghel, EPM Brouwers, JJL van der Klink
BMC Medical Education 2015, 15:82  doi:10.1186/s12909-015-0364-8

Read more here.

Improving critical care discharge summaries

"An innovative form of enhanced capability critical care outreach called ‘iMobile’ is being provided at King’s College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries."

Improving critical care discharge summaries: a collaborative quality improvement project using PDSA
L Goulding et al.
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u203938.w3268

Read more here.

Improving the care of children with urinary tract infection

"Instituting the clinical decision proforma and its supporting educational programme was an extremely positive action as it has significantly improved the management of children with UTI at our unit."

Improving the care of children with urinary tract infection: use of a clinical decision proforma
D Leach
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208341.w3300

Read more here.

Enhanced recovery clinical education programme improves quality of post-operative care

"The Enhanced Recovery (ER) clinical education programme improved quality of post-operative care, leading to reduced length of stay with no increase in 28 day readmission rates."

Enhanced recovery clinical education programme improves quality of post-operative care
R McDonald
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208370.w3387

Read more here.