Monday 21 September 2015

Health and Care Quality Systems in practice: A guide for local leaders

"This publication is intended as a practical guide for people who have leadership and oversight responsibility for the quality of services in their communities."

Health and Care Quality Systems in practice: A guide for local leaders
Local Government Association, Centre for Public Scrutiny, Think Local Act Personal 
September 2015

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Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

"The study found that annual screening of all patients for STDR [sight-threatening diabetic retinopathy] was not cost-effective. Screening this entire cohort every 3 years was most likely to be cost-effective."

Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening
PH Scanlon, SJ Aldington, J Leal , R Luengo-Fernandez, J Oke , S Sivaprasad , et al.
Health Technology Assessment 2015;19(74)

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Access, quality, and costs of care at physician owned hospitals in the United States

"Using a comprehensive list of POHs [physician owned hospitals] across the United States and contemporary data, we found no evidence that POHs systematically avoid poorer patients or those from ethnic and racial minority groups. POHs also performed equally to non-POHs on a wide array of measures of quality of care, costs, and payments for care. These findings indicate a need to re-examine existing public policies that target all hospitals with physician owners."

Access, quality, and costs of care at physician owned hospitals in the United States: observational study
DM Blumenthal, EJ Orav, AB Jena, DM Dudzinski, ST Le,  AK Jha, KT Li
BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4466


Read more here.

HSJ Commissioning supplement: The right services at the right time

"Commissioning within the NHS is being shaped by a variety of factors, ranging from technology to the third sector. This week’s supplement, produced in association with Skills for Health, IMS Health and the British Red Cross, looks at:

  • workforce planning 
  • gaining value from data 
  • benefitting from third sector organisations" 

HSJ Commissioning supplement: The right services at the right time
How data, workforce planning and the voluntary sector are shaping NHS commissioning
September 2015

Read more here.


Improving the completion of Quality Improvement projects amongst psychiatry core trainees

"Through the implementation and development of training sessions and simple, low cost and sustainable interventions over a 10 month period, two thirds of core trainees and over a half of the advanced psychiatry trainees in the School are now participating in 28 individual QI projects and QI project methodology is to become embedded in the core psychiatry training course. "

Improving the completion of Quality Improvement projects amongst psychiatry core trainees
L Ewins
BMJ Quality Improvement Report 2015;4: doi:10.1136/bmjquality.u205682.w2554

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Training in General Surgery Ward Call: A Resident-Student Buddy System

"There is a paucity of literature regarding medical student experiences of after hours hospital ward call. It was observed at our institution that medical students had minimal experience in ward call, yet were required to undertake such shifts as interns after graduation. We implemented a buddy system in which a medical student shadowed a general surgery resident for a ward call shift."

Training in General Surgery Ward Call: A Resident-Student Buddy System
A Maurice, A Hann
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u202587.w3786

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A multifaceted approach to prevention of delirium on intensive care

"Delirium is a frequent complication of critical illness with an increased risk of death which is difficult to treat effectively. We describe a seven year quality improvement programme that aimed to reduce rates of delirium on intensive care (ICU)."

A multifaceted approach to prevention of delirium on intensive care
J Hanison, D Conway
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u209656.w4000
 Programme

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Development and Implementation of a Catheter Associated Urinary Tract Infection 'Toolkit'

"This quality improvement project saw the development, testing and introduction within NHS Tayside of an evidenced based bundle of care. This was to standardise and drive quality care delivery for the insertion and maintenance of urethral urinary catheters with the intention of reducing catheter associated urinary tract infections in our patients." 

Development and Implementation of a Catheter Associated Urinary Tract Infection (CAUTI) 'Toolkit'
M Tatham, G Macfarlane, M MacRae, V Tully, K Craig
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u205441.w3668

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Improving induction of labour - a quality improvement project

"Induction of labour (IOL) in maternity care is often not an area of priority in maternity services, which often results in protracted delays, a poor patient experience, and patient complaints. Caesarean section (CS) rates among women undergoing IOL at this inner city district general hospital were noted to be higher than other units nationwide."

Improving induction of labour - a quality improvement project addressing Caesarean section rates and length of process in women undergoing induction of labour
S O'Dwyer, C Raniolo, J Roper, M Gupta
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u203804.w4027

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Moving healthcare closer to home

"Support for providers and commissioners to make evidence-based appraisals of how the benefits compare with the costs of various approaches to move care closer to home."

Moving healthcare closer to home
Monitor
September 2015

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Investigating the impact of out-of-hours GP services on A&E attendance rates

"The satisfaction with overall GP services is significantly associated with the level of attendance at A&E both overall and during out-of-hours only. A 1% increase in ‘patients satisfied with their GP practice’s opening hours’ is associated with a 1% reduction in A&E attendance."

Investigating the impact of out-of-hours GP services on A&E attendance rates: multilevel regression analysis
National Audit Office
September 2015

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A patient-initiated voluntary online survey of adverse medical events

"This large voluntary survey of medical harm highlights the potential efficacy of patient-initiated surveys for providing meaningful feedback and for guiding improvements in patient care."

A patient-initiated voluntary online survey of adverse medical events: the perspective of 696 injured patients and families
FS Southwick, NM Cranley, JA Hallisy
BMJ Quality and Safety 2015;24:620-629 doi:10.1136/bmjqs-2015-003980

Read more here.

Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes

"We propose that an integration of empowerment evaluation with quality improvement approaches is likely to enhance the quality of healthcare delivery by increasing the ability of practitioners to improve as well as implement well"

Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes
A Wandersman, KA Alia, B Cook, R Ramaswamy
BMJ Quality and Safety 2015;24:645-652 doi:10.1136/bmjqs-2014-003525

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NHS Atlas of Variation in Healthcare 2015

"Improving value across the NHS landscape is the central aim of providing the information in Atlas 3.0. As in maps of health, these maps of healthcare show us where to focus efforts to improve health and healthcare while holding the line on costs."

NHS Atlas of Variation in Healthcare 2015: Reducing unwarranted variation to
increase value and improve quality
NHS England
September 2015

Access the Atlas here

Wednesday 16 September 2015

Communications in health care improvement - a toolkit

"This toolkit is for health care professionals working in improvement who want to understand and use communications to better plan, implement and spread their work."

Communications in health care improvement - a toolkit
The Health Foundation

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Tuesday 15 September 2015

A dietetic-led coeliac service incorporating group education

"This example describes our service redesign to increase patient capacity within existing dietetic provision, whilst also aiming to improve service quality."

A dietetic-led coeliac service incorporating group education
Gloucestershire Hospitals NHS Foundation Trust
NICE Shared Learning example
September 2015

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Integrated care clinical Pharmacist GSTT@home service

"The ICCPs have made a significant impact in the overall quality of care that the GSTT @home service patients have received, and have also had a positive effect on the overall medicines optimisation of the service in general."

Integrated care clinical Pharmacist GSTT@home service
Guys & St Thomas NHS Foundation Trust (Community Health Services) NHS Specialist Pharmacy services

NICE Shared Learning examples
September 2015

Read more here.

Tobacco return on investment tool

"The tool evaluates a portfolio of tobacco control interventions and models the economic returns that can be expected in different payback timescales. Different interventions, including pharmacotherapies and support and advice, can be mixed and matched to see which intervention portfolio or package provides the best 'value for money', compared with 'no-services' or any other specified package."

Tobacco return on investment tool
NICE
August 2015

Read more here

Improving the management of sepsis by implementing the 'Sepsis Six'

"Overall, we found there to a be a steady improvement in the delivery of the Sepsis Six bundle in septic patients with 63% of patients receiving appropriate care within one hour, compared to 29% prior to our interventions. However this did not translate to an improvement in patient mortality."

Improving the management of sepsis in a district general hospital by implementing the 'Sepsis Six' recommendations
P Kumar, M Jordan, J Caesar, S Miller
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u207871.w4032

Read more here.

Improving the efficacy of elderly patients' hospital discharge

"After several months of sustained effort, the average time to complete eDANs fell by over an hour resulting in discharge medication dispensed earlier in the day and improved patient safety."

Improving the efficacy of elderly patients' hospital discharge through multi-professional safety briefings and behavioural change
J Corrado, K Topley, A Cracknell
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u209431.w3871

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Simple interventions can greatly improve clinical documentation

"In conclusion, simple, cost effective measures in streamlining medical notes, improves the quality of documentation, facilitates the filing and ultimately improves patient care."

Simple interventions can greatly improve clinical documentation: a quality improvement project of record keeping on the surgical wards at a district general hospital
P Glen, N Earl, F Gooding, E Lucas, N Sangha, S Ramcharitar
BMJ Quality Improvement 2015;4: doi:10.1136/bmjquality.u208191.w3260

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Improving patient outcomes with technology and social media in paediatric diabetes

"The digital initiatives at Southport and Ormskirk Hospital NHS Trust provide strong evidence that the effective use of information technology and social media can significantly improve patient outcomes."

Improving patient outcomes with technology and social media in paediatric diabetes
S May Ng
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u209396.w3846

Read more here.

Improving the productivity and efficiency of vascular surgery and radiology multidisciplinary meetings

"The changes made to the process have resulted in a real reduction in the time spent preparing each weekly meeting. As a result of careful and thoughtful improvement cycles, it has been possible to increase the proportion of patients discussed at each meeting by approximately two thirds."

Improving the productivity and efficiency of vascular surgery and radiology multidisciplinary meetings
Gary Dobson, Declan Neeson
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208416.w3332
Programme

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Improving the recording of surgical drain output

"We have demonstrated that the introduction of a simple and well-designed drain chart can significantly improve the documentation of drain output, thereby improving patient safety and discharge efficiency."

Improving the recording of surgical drain output
Nicholas Lyons, Paul Heron, Rob Bethune
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u209264.w3964

Read more here.

Improving paediatric prescribing practice in a district general hospital

"A driver diagram identified three components contributing to prescribing errors and relevant tests of change were developed. The three primary drivers included education and communication, practical prescribing changes, and medicine reconciliation."

Improving paediatric prescribing practice in a district general hospital through implementation of a quality improvement programme
P Donnelly, S Lawson, C Watterson
BMJ Quality Improvement Report2015;4: doi:10.1136/bmjquality.u206996.w3769
 
Read more here.

Improving efficiency management of radiopharmaceutical materials

"The high cost of radiopharmaceuticals is a significant part of the annual budget of PET/CT unit and nuclear medicine department in general. In fact, it is a valuable target for quality improvement projects that aims to reduce the percentage of wastes and improves resource management at work site."

Improving efficiency management of radiopharmaceutical materials at a nuclear medicine department
A Al Ahmed, K Al-Surimi
BMJ Quality Improvement Reports, 2015;4: doi:10.1136/bmjquality.u208970.w3709

Read more here.


Atrial fibrillation care improvement collaborative

"Interdepartmental collaboration and care standardization offer opportunities to improve quality of care and reduce costs for patients with atrial fibrillation. These patients are able to avoid inpatient hospitalization, benefit from a new anticoagulation option, and follow up more closely with their primary care providers in order to address long term care plans."

 Atrial fibrillation care improvement collaborative
P Robelia, S Kopecky, T Thacher
BMJ Quality Improvement Reports, 2015;4: doi:10.1136/bmjquality.u208947.w3629

Read more here.

 

Improving discharge communication between secondary and primary care

"Discharge communication is an essential component of transition from secondary to primary care. Our study identifies sub-optimal discharge communication at the OUH Trust, which is likely to be reflected in other trusts. In particular, the areas of concern include medication reconciliation and follow-up plans."
Mind the gap: Improving discharge communication between secondary and primary care
A Cresswell, M Hart, O Suchanek, T Young, L Leaver, S Hibbs
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u207936.w3197

Read more here.

Improving length of stay: what can hospitals do?

"This report on length of stay by the Nuffield Trust is part of a larger project undertaken by Monitor which aims to find the best ways to improve quality of care across the health system in light of recent pressures on urgent and emergency care."
Improving length of stay: what can hospitals do?
N Edwards, R Lewis Nuffield Trust
September 2015

Read more here.

Thursday 10 September 2015

Challenging the NHS to innovate

"George Freeman, Minister for Life Sciences, explains how the NHS will make the most of research and innovation."

Challenging the NHS to innovate (speech)
Department of Health, George Freeman MP and Office for Life Sciences
Delivered on: 3 September 2015

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Using technology to improve delivery of health and care services (speech)

"Life sciences minister George Freeman on how integrated data and technology can improve the delivery of effective health and care services."

Using technology to improve delivery of health and care services (speech)
Department of Health, National Information Board, Office for Life Sciences and George Freeman MP
Delivered on: 3 September 2015

Read more here.

Using FRAM to align work-as-imagined with work-as-done when implementing clinical guidelines

"Using FRAM to reconcile differences between work-as-imagined and work-as-done when implementing a guideline can reduce the need for clinicians to adjust performance and create workarounds, which may be detrimental to both safety and quality, once the guideline is introduced."

Where the rubber meets the road: using FRAM to align work-as-imagined with work-as-done when implementing clinical guidelines

Robyn Clay-Williams, J Hounsgaard, E Hollnage
Implementation Science 2015, 10:125  doi:10.1186/s13012-015-0317-y

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Health Foundation Representation to the 2015 Comprehensive Spending Review

"This document contains the submission from the Health Foundation to the 2015 Comprehensive Spending Review"

Health Foundation Representation to the 2015 Comprehensive Spending Review
The Health Foundation
September 2015

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How should we think about value in health and care?

"With this paper, we aim to articulate a new understanding of the value of engaging individuals and communities in health and care, and to discuss the challenges in progressing this."

How should we think about value in health and care?: Realising the Value
NESTA
September 2015

Read more here.