NHS Improvement| April 2019 | Same day emergency care
NHS Improvement have produced a new section on its website relating to same day emergency care along with links to relevant resources. Same day emergency care (SDEC) is one of the many ways the NHS is working to provide the right care, in the right place, at the right time for patients.
The resources are available from NHS Improvement’s website
Chen, K. F., Tsai, M. Y., Wu, C. C., & Han, S. T. |2019| Effectiveness of Treatments and Diagnostic Tools and Declining Mortality in Patients With Severe Sepsis: A 12-Year Population-Based Cohort Study| Journal of intensive care medicine|0885066619827270.
The Journal of Intensive Care Medicine has published the findings of a study that looks at the effectiveness of treatments and diagnosis tools on patients with severe sepsis.
Sepsis is a major cause of morbidity and mortality worldwide. With the advance of medical care, the mortality of sepsis has decreased in the past decades. Many treatments and diagnostic tools still lack supporting evidence. We conducted a retrospective population-based cohort study with propensity score matched subcohorts based on a prospectively collected national longitudinal health insurance database in Taiwan. Severe sepsis-associated hospital admissions from 2000 to 2011 based on International Classification of Diseases, Ninth Revision, Clinical Modification codes of infections and acute organ dysfunction were identified. To compare the effectiveness of treatment and diagnostic tool, propensity scores were generated to match the comparable control groups. During the 12-year period, 33 375 patients and 50 465 hospitalizations of severe sepsis were identified. The age-standardized 28-day in-hospital mortality decreased significantly from 21% in 2008 to 15% in 2011 with increasingly implemented treatment and diagnostic tool. After propensity score matching, procalcitonin and lactate testing, transfusion of packed red blood cell, albumin, balanced crystalloid, and use of dopamine were found to be significantly associated with lower mortality rate. However, inconsistent findings need to be further validated.
The Strategy Unit & NHS Midlands and Lancashire Commissioning Support Unit | February 2019 | Waiting Times and Attendance Durations at English A&E Departments
A new report from The Strategy Unit presents a detailed view of presents a detailed review of the demand-side, supply-side, practice and emergent factors that lead to 4-hour breaches with a particular focus on changes that have taken place since 2010.
Waiting Times and Attendance Durations at English A&E Departmentsreviews both commonly cited causal factors and a range of more novel hypotheses. It sets out the causal theories underpinning each factor and seeks statistical evidence in support of them. Finally, the analysis scales the relative impact of each causal factor and aims to provide an explanation for the recent deterioration in A&E waiting times within the limits of national datasets. New insights emerge which have the potential to reshape the received wisdom about the performance of A&E departments, carrying important implications for healthcare policy and system leadership (Source: The Strategy Unit).
NHS England | January 2019 | Clinical guidelines for major incidents and mass casualty events
This guidance has been developed on behalf of the NHS to establish and share best practice in the clinical management of major incidents and mass casualty events, using experience from both military and civilian practice and lessons identified after the recent incidents, and to assist clinicians in managing these patients.
The intention is that this guidance will be regularly reviewed and re-issued as new developments based on an ever-increasing evidence base and experience emerge (Source: NHS England).
University of Newcastle| November 2018 |Almost half of sport injury-related A&E attendances are children
New research indicates that children under the age of eighteen are the highest burden of sports-related injury to A&E. With 12 year-old females, and 14-year-old males being the most at risk of sustaining a sports injury. The research involved analysis of injury attendance data at two hospitals, one in Oxford and the other in Banbury, from January 2012 – March 2014. Attendances recorded totalled almost 64,000 (63,877), of these 11,676 were sport-related, with 5,533 of these in children and young people aged 0-19.
The research conducted by researchers at the University of Newcastle and University of Oxford, found the most injurious sports activities for girls were trampolining, netball and horse riding; for boys this was rugby union, rugby league and football.
Graham Kirkwood, senior research associate at Newcastle University, said: “These figures are equivalent to 68 boys and 34 girls in every thousand attending NHS emergency departments in a year. This is a heavy burden on the NHS and on children and families from sport-related injury.”
He added: “Children need to be physically active but making organised sports as safe as possible needs to be part of any effective child obesity strategy.” (Source: University of Newcastle)
To analyse and report on sports-related injuries using enhanced injury data collected by the testbed for the NHS emergency care injury data set and admissions data collected from inpatients.
Ecological study design. Setting
Two Oxfordshire NHS England hospitals. Participants
Emergency department attendees and inpatients aged 0–19 years with sports injuries.
Data were analysed from 1 January 2012 to 30 March 2014 by age, gender sport, injury location, injury mechanism and diagnosis including concussion/post-concussion, bone fractures and ligament damage. Admissions data were analysed from 1 January 2012 to 24 January 2015.
Children and adolescents aged 0–19 years accounted for almost half (47.4%) of sports injury-related emergency department attendances and almost one-quarter (23.5%) of sports injury-related admissions for all ages. The highest rates of attendance occurred at 14 years for boys (68.22 per 1000 person-years) and 12 years for girls (33.72 per 1000 person-years). For male 0–19-year-olds the three main sports were (in order) football (soccer), rugby union and rugby league and for females, trampoline, netball and horse-riding. The largest gender differences were in netball where injuries were predominantly in females and in wheeled motorsports where injuries were predominantly in males. Almost one-quarter of emergency department sports-related injuries recorded were fractures, the highest percentage to the upper limbs.
Public health departments in local authorities and schools should consider target sports injury prevention at children in the first four years of secondary school. For younger age groups, trampolines in the home warrant improved safety. Rugby and horse-riding should also be a focus for interventions.
Full reference: Kirkwood, G., Hughes, T. C., & Pollock, A. M. |2018 | Results on sports-related injuries in children from NHS emergency care dataset Oxfordshire pilot: an ecological study|Journal of the Royal Society of Medicine| https://doi.org/10.1177/0141076818808430
The recommendations were agreed by delegates at an international summit in May 2018, hosted by NHS Clinical Commissioners and RI International. The ten recommendations, aimed at government, policymakers and those implementing health and social services, are to:
End the current fragmentation of care through an integrated, systematic approach to behavioural health crisis care at the national level.
Actively develop crisis service alternatives to the usual emergency measures of formal assessment and psychiatric inpatient care.
Include special consideration to cater for armed forces veterans.
Implement an integrated health information exchange capable technology solution to enable seamless care across organisations.
Develop balanced scorecard dashboards that display real-time, meaningful data and outcome measures that support continuous quality improvement.
Embed users, peers and carers should be embedded in the design and leadership of crisis systems; peer support staff should be trained and integrated in crisis service delivery.
The zero-suicide aspiration should be owned by governmental agencies, policy makers and those implementing health and social services.
Family and friends should be fully engaged in crisis care and inappropriate barriers created by confidentiality or privacy need to be sensitively overcome.
Implement a single national three-digit crisis hub number that drives easy access in which all callers are welcome, the crisis is defined by the caller, and which is promoted via intelligent social media to get the word out to those who need it.
Significant system-wide investment is needed to deliver these recommendations.
The report also concludes that the aim must be to provide 100% access to services to those in a behavioural health crisis and to aspire to zero suicide in healthcare settings. It calls for an approach equal to medical care to ensure an effective response to all in psychiatric emergency.
The Health Foundation | August 2018 | Reducing emergency admissions: unlocking the potential of people to better manage their long-term conditions
The Health Foundation has produced a briefing which looks at Patient Activation Measures scores, which assess four levels of knowledge, skill and confidence in self-management, for over 9,000 adults with long-term conditions.
This briefing summarises research that explores the link between how well patients feel able to manage their long-term conditions such as asthma, diabetes and depression and their use of health care.
The findings show the NHS could reduce avoidable health care use and improve people’s quality of life, if they were better supported to manage their long-term conditions.
The briefing points to solutions and calls for national policy makers and the local NHS to take action now, including by prioritising support for self-management in the NHS long-term plan.
Read the full press release from The Health Foundation here
Objective To quantify the association between patient self-management capability measured using the Patient Activation Measure (PAM) and healthcare utilisation across a whole health economy.
Results 12 270 PAM questionnaires were returned from 9348 patients. In the adjusted analyses, compared with the least activated group, highly activated patients (level 4) had the lowest rate of contact with a general practitioner, emergency department attendances, emergency hospital admissions and outpatient attendances. These patients also had the lowest relative rate (compared with the least activated) of ‘did not attends’ at the general practitioner, ‘did not attends’ at hospital outpatient appointments and self-referred attendance at emergency departments for conditions classified as minor severity, a significantly shorter average length of stay for overnight elective admissions, and a lower likelihood of 30- day emergency readmission, though this did not reach ignificance.
Conclusions Self-management capability is associated with lower healthcare utilisation and less wasteful use across primary and secondary care.
Barker I, Steventon A, Williamson R, et al| 2018| Self-management capability in patients with long-term conditions is associated with reduced healthcare utilisation across a whole health economy: cross-sectional analysis of electronic health records |