Secular trends and evaluation of complex interventions

"Understanding the rising tide phenomenon is important for a more nuanced interpretation of null results arising in the context of system-wide improvement. Recognition that a rising tide may have predisposed to a null result in one health system cautions against generalising the result to another health system where strong secular trends are absent."

Secular trends and evaluation of complex interventions: the rising tide phenomenon
YF Chen, K Hemming, AJ Stevens, RJ Lilford
BMJ Quality and Safety 2016;25:303-310 doi:10.1136/bmjqs-2015-004372

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User road testing of a draft version of SQUIRE 2.0

"Our findings show that writing scholarly healthcare improvement work requires a specific knowledge base, and this knowledge is not universally held. We now know some of the specific gaps that should be addressed to help SQUIRE 2.0 reach its goal of improving the reporting of improvement work. The findings should be helpful not just for the development of SQUIRE 2.0 but also in the education of the next generation, for whom exposure to improvement work is now becoming standard."

Findings from a novel approach to publication guideline revision: user road testing of a draft version of SQUIRE 2.0
L Davies, KZ Donnelly, DJ Goodman, G Ogrinc
BMJ Quality and Safety 2016;25:265-272 doi:10.1136/bmjqs-2015-004117

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Sleep deprivation and starvation in hospitalised patients

"In our personal experience as surgeons at a busy tertiary hospital, the goal of avoiding unnecessary malnutrition and sleep deprivation in our patients has all too often been forgotten or prioritised far behind other more technical goals of surgical care. But keeping a patient strong and rested is a critical goal towards the same end."

Sleep deprivation and starvation in hospitalised patients: how medical care can harm patients
T Xu, C Wick, MA Makary
BMJ Qual Saf 2016;25:311-314 doi:10.1136/bmjqs-2015-004395

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Half-life of a printed handoff document

"In this report, we identify a very high potential for inaccurate information in printed handoff documents. If a handoff document is printed at the start of a night shift, it is reasonable to assume that within 6 h the document will contain inaccuracies on half of the patients. The field most likely to contain inaccuracies is the medication lists, followed by code status."

Half-life of a printed handoff document

G Rosenbluth, R Jacolbia, D Milev, AD Auerbach

BMJ Quality and Safety, 2016;25:324-328 doi:10.1136/bmjqs-2015-004585

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Catalyst or distraction? The evolution of devolution in the English NHS

"Focusing primarily on devolution in the NHS, the report considers the potential implications for health and care outcomes in England and how policy could best evolve. It draws on analysis of the Devolution Deals agreed to date, relevant literature, and international experience with a focus on four European decentralised health systems."

Catalyst or distraction?: The evolution of devolution in the English NHS
F Dormon, H Butcher, R Taunt
The Health Foundation
April 2016

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Developing a Complex Care Case Management Service within Primary Care

"Analysis of the Slough CCG patient population demonstrated that 5% (7,500) of people consume 43% of healthcare resources.  In an attempt to realise cost savings and improve quality of service, efforts were made to target those at higher risk of an emergency admission or A&E attendance."

Slough CCG: Developing a Complex Care Case Management Service within Primary Care
S Saran, A Thompson, R Chana
RightCare
February 2016

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Management of urinary incontinence in women

"Regular teaching sessions in primary care using NICE guidance on the management of urinary incontinence in women and regular multidisciplinary team reviews improve clinical outcomes. Compliance with NICE guidance results in reduced referral to secondary care." 

Management of urinary incontinence in women (Quality and Productivity case study)
Royal Cornwall Hospitals NHS Trust
NICE
February 2016

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Electronic blood transfusion: Improving safety and efficiency of transfusion systems

"Transfusion errors are an important, avoidable, serious hazard. Wrong transfusion is one of the two leading causes of death from transfusion reported to Serious Hazards of Transfusion (SHOT) in the United Kingdom (SHOT steering committee 2011). The initiative ‘re-engineers’ hospital transfusion services using new technology."

Electronic blood transfusion: Improving safety and efficiency of transfusion systems (Quality and Productivity case study)
Oxford University Hospitals
NICE
February 2016

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Routine 72-96 hour replacement of peripheral venous catheters - Do not do

"This Cochrane systematic review concluded that there is insufficient evidence to support the routine replacement of patients’ peripheral intravenous catheters every 72 to 96 hours. Clinical teams should inspect catheter insertion sites for signs of infection at each shift change and adopt a policy of replacing catheters only when clinically indicated. Such a policy would lead to significant cost savings and prevent unnecessary discomfort for patients associated with routine catheter replacement."

Routine 72-96 hour replacement of peripheral venous catheters (Quality and Productivity case study)
The UK Cochrane Centre and NICE
March 2016

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Fetal and umbilical doppler ultrasound in normal pregnancy - Do not do

"Existing data do not provide robust enough evidence that the use of routine umbilical artery Doppler ultrasound, or combination of umbilical and uterine artery Doppler ultrasound in low risk or unselected populations benefits either mother or baby. Until further research can support new practices, Doppler ultrasound examination should be reserved for use in high-risk pregnancies (Alfirevic et al, 2013)."

Fetal and umbilical doppler ultrasound in normal pregnancy (Quality and Productivity case study)
The UK Cochrane Centre and NICE
March 2016


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Alcohol Care Teams: to reduce acute hospital admissions and improve quality of care

"The principal component of this initiative is for a multidisciplinary Alcohol care team in each district hospital, led by a consultant with designated sessions, who will collaborate across hospitals and primary care, to develop a coordinated alcohol treatment and prevention programme. This team would organise systematic interventions and alcohol specialist nurses."

Alcohol Care Teams: to reduce acute hospital admissions and improve quality of care (Quality and Productivity case study)
The British Society of Gastroenterology and the Royal Bolton Hospital NHS Foundation Trust
NICE
March 2016

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Mechanical thrombectomy for large vessel occlusion stroke: improving clinical outcomes and reducing cost

"There have been significant cost-saving benefits to the NHS and social care providers from reduced hospital bed stay and reduced disability. There is no additional burden to the NHS because the majority of patients are admitted directly to the Stroke Unit after the procedure without the need for ITU support." 

Mechanical thrombectomy for large vessel occlusion stroke: improving clinical outcomes and reducing cost (Quality and Productivity case study)
Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust
NICE
March 2016

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A project to reduce the number of PIMs (potentially inappropriate medications) on an elderly care ward

"A systematic approach to ward rounds with a ward round checklist offers a rigorous method to reduce the prevalence of PIMs, and the frequency of adverse drug events. This has important implications in the wider context of growing pressures to deliver higher standards of cost effective clinical care."

Less is more: a project to reduce the number of PIMs (potentially inappropriate medications) on an elderly care ward
T H Aung, A J Beck, T Siese, R Berrisford
BMJ Quality Improvement Reports 2015;5: doi:10.1136/bmjquality.u207857.w4260

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Behavioural factors in person and community-centred approaches for health and wellbeing

"This report provides health and care audiences with a framework for understanding the drivers of behaviour, plus five factors that show how different behavioural mechanisms interact and play out. These factors seek to provide approaches that can help those grappling with how to encourage behaviour change for health to happen. These approaches can be hard-wired into the design of services, programmes, community initiatives, and indeed to the very lives of the people who engage with them."

Making the change: Behavioural factors in person and community-centred approaches for health and wellbeing
H Burd, M Hallsworth, The Behavioural Insights Team
March 2016

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Workforce policy in the English NHS

"This report gives an overview of the components of workforce policy in the English NHS and the bodies which shape it. The report proposes ways in which workforce policy could be strengthened to improve the quality and productivity of care."

Fit for purpose?: Workforce policy in the English NHS
The Health Foundation
March 2016

Read more here.