Caring for acutely ill patients

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The King’s Fund has published Organising care at the NHS front line: who is responsible? 

The report looks at the reality of caring for acutely ill medical patients at the NHS front line and asks how care in hospitals can be improved. It comprises a series of essays by frontline clinicians, managers, quality improvement champions and patients, and provides detail about how clinical care is currently provided and how it could be improved.

The report highlights that providing safe and high-quality care for acutely ill medical patients has always been challenging but has become more so as the volume and complexity of work has increased. Amongst its recommendations is that there should be a much stronger focus on how care is organised on hospital wards and in clinics throughout the NHS and greater standardisation of care processes.

The full report can be downloaded here

Children should be more involved in healthcare decisions that affect them

Research at hospitals in Ireland revealed that children find it difficult to have their views heard | Imelda Coyne for The Conversation

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The children said that doctors and nurses were “nice” and “kind”, but some tended to carry out medical procedures without seeking their opinions or telling them beforehand. Some parents helped children to be included in talks about their care, but other parents answered questions on their behalf, told them to stay quiet and withheld information from them. Some parents also told their child to stay quiet and not annoy the doctor or nurse. Being excluded from discussions made some children feel sad, frustrated and angry. As one 14-year-old girl put it: “It made me feel like a piece of machinery; they weren’t actually talking to me.”

Read the full blog post here

Older People’s Care in Acute Settings

The Older People’s Care in Acute Setting project content has been developed in partnership with British Geriatric Society and  explores the pathway that people take through the acute hospital, beginning in A&E and assessment units, and moving through to inpatient wards and supported discharge teams | NHS Benchmarking

Three key messages have emerged from the 2016/17 project that impact on the quality of care delivered for older people;

  • the use of CGA is increasing;
  • readmission rates are rising;
  • delayed transfers of care continue to grow.
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Image source: NHS Benchmarking

Further findings from the Older People’s Care in Acute Settings 2016 project (2015/16) data include:

  • 40% of organisations have a dedicated geriatric team located in the A&E department. The average number of hours that these teams are available during the week is 9 hours, at weekends this reduces to 6 hours.
  • 77% of trusts delivered Comprehensive Geriatric Assessments on the elderly care wards, and 42% delivered these assessments on other specialty wards.
  • The ratio of qualified to unqualified nursing staff on the care of the elderly wards was found to be 55% registered and 45% unregistered. The RCN recommends a ratio of 65:35 skill mix for “ideal, good quality care,” and 50:50 for “basically safe care” across the participants (Safe staffing on older people’s wards, RCN, 2012).
  • 85% of trusts operate Early Supported Discharge schemes, and 77% of trusts have an Integrated Discharge team.
  • The average time for a continuing healthcare assessment to be undertaken is 10 days.
  • 74% of organisations set estimated discharge dates within 24 hrs of admission.
  • 83% of delayed transfers of care were attributable to people age 65 and over in 2015/16.
  • 56% of patients admitted to the care of older people wards had been admitted to hospital within the previous 12 months.
  • 14% of pay costs spent on bank & agency across the pathway.

The full report is available here

HEE: Significant work still to do to make junior doctors feel valued

Enhancing junior doctors’ working lives A progress report | Health Education England | National Health Executive

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Significant work must be done to make junior doctors feel valued for their hard work in the NHS, a report published by Health Education England (HEE), which has also identified a number of key areas for improvement, has warned.

HEE worked with other organisations including the British Medical Association (BMA) Junior Doctors’ Committee, the General Medical Council, NHS Employers, the Academy of Medical Royal Colleges and trainee representatives to create the review that has called for action to be taken to improve working conditions for juniors.

The ‘Enhancing Junior Doctors’ Working Lives’ report gives a comprehensive view of the struggles experienced by junior doctors which led to mass dissatisfaction and strike action last year, warning that improvements had to be made in a number of areas to reassure the workforce that their work was being appreciated by their employers.

Read more at National Health Executive

Download the full report here

How empowering is hospital care for older people with advanced disease?

Selman, L.E. et al .(2017) Age Ageing. 46(2) pp. 300-309.

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Background: patient empowerment, through which patients become self-determining agents with some control over their health and healthcare, is a common theme across health policies globally. Most care for older people is in the acute setting, but there is little evidence to inform the delivery of empowering hospital care.

Conclusions: empowering older people in the acute setting requires changes throughout the health system. Facilitators of empowerment include excellent staff–patient communication, patient-centred, relational care, an organisational focus on patient experience rather than throughput, and appropriate access to SPC. Findings have relevance for many high- and middle-income countries with a growing population of older patients with advanced disease.

Read the full abstract here

Mental health in general hospitals: Treat as One

Treat as One: Bridging the gap between mental and physical healthcare in general hospitals National Confidential Enquiry into Patient Outcome and Death (NCEOPD)

This report examines the quality of mental health and physical health care for patients aged 18 years or older with a significant mental disorder who are admitted to a general hospital.  It takes a critical look at areas where the care of patients might have been improved.

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework

Iwami M. et al. (2017) BMJ Open. 7:e012520

NHS Framework Documant 2008

Objective: (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice.

 

Results: National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management.

Conclusions: For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings.

Read the full article here