Setting up a Peer-to-Peer (P2P) Staff Listening Service at an Acute University Teaching Hospital

Local Purchasing of Journals is Required in Addition to a Nationally Purchased Collection to Meet the Information Needs of NHS Staff

Identify organizational factors associated with high clinical litigation rates among acute National Health Service (NHS) trusts in England. Cross-sectional analysis using routine data. NHS trusts in England. A total of 235 NHS trusts used the NHS Clinical Negligence Scheme in 2016-17. Ninety-seven trusts (41.3%) with no maternity services, 2 (0.9%) providing specialized services and 3 (1.2%) without clinical negligence claims were excluded. Hence, the remaining 133 trusts (56.6%) were included. None. Rate of clinical litigation by trust per 100 000 occupied bed days. The mean rate of clinical litigation was 25.4 per 100 000 occupied bed days. In univariable analyses, higher values of summary hospital-level mortality indictor, staff sickness, written complaints, patient safety incidents and being in the North of England led to increased clinical litigation rates. Conversely, higher patient admissions, NHS Staff Survey overall engagement score and occupied bed days led to decreased clinical litigation rates. In the multivariable model, factors associated with increased clinical litigation rates were as follows: summary mortality hospital-level indicator (SHMI) (0.9 increase in litigation rate per 0.05 increase in SHMI; P = 0.012); new written complaints (0.62 increase per 50 complaints higher; P < 0.001); located in the North of England compared to London (5.22 higher; P < 0.001). Conversely, a higher number of occupied bed days (-0.64 change per 50 000 days higher; P = 0.007) was associated with lower clinical litigation rates. This study identified organizational factors associated with clinical litigation, which will be of interest to clinicians and the NHS. This research also highlights areas for further investigation.

Implementing cultural change and aligning organizational cultures could enhance innovation, quality, safety, and job satisfaction. The authors conducted this mixed-methods study to assess academic physician-scientists' perceptions of the current and preferred future organizational culture at a university medical school and its partner health system. In October 2010, the authors surveyed academic physicians and scientists jointly employed by the University of Oxford and its local, major partner health system. The survey included the U.S. Veterans Affairs Administration's 14-item Competing Values Framework instrument and two extra items prompting respondents to identify their substantive employer and to provide any additional open-ended comments. Of 436 academic physicians and scientists, 170 (39%) responded. Of these, 69 (41%) provided open-ended comments. Dominant hierarchical culture, moderate rational and team cultures, and underdeveloped entrepreneurial culture characterized the health system culture profile. The university profile was more balanced, with strong rational and entrepreneurial cultures, and moderate-to-strong hierarchical and team cultures. The preferred future culture (within five years) would emphasize team and entrepreneurial cultures and-to a lesser degree-rational culture, and would deemphasize hierarchical culture. Whereas the university and the health system currently have distinct organizational cultures, academic physicians and scientists would prefer the same type of culture across the two organizations so that both could more successfully pursue the shared mission of academic medicine. Further research should explore strengthening the validity and reliability of the organizational culture instrument for academic medicine and building an evidence base of effective culture change strategies and interventions.

Barriers to evidence-based practice.

Responsibility for managing healthcare-associated infections: where does the buck stop?

IntroductionTreating tobacco dependency in patients admitted to acute care National Health Service (NHS) trusts is a key priority in the NHS 10-year plan. This paper sets out the results of...

BackgroundPatient medicines helplines provide a means of accessing medicines-related support following hospital discharge. However, it is unknown how many National Health Service (NHS) Trusts currently provide a helpline, nor how they are operated. Using the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), we sought to obtain key data concerning the provision and use of patient medicines helplines in NHS Trusts in England. This included the extent to which the delivery of helplines meet with national standards that are endorsed by the Royal Pharmaceutical Society (standards pertaining to helpline access, availability, and promotion).MethodsAn online survey was sent to Medicines Information Pharmacists and Chief Pharmacists at all 226 acute, mental health, specialist, and community NHS Trusts in England in 2017.ResultsAdoption: Fifty-two percent of Trusts reported providing a patient medicines helpline (acute: 67%; specialist: 41%; mental health: 29%; community: 18%). Reach: Helplines were predominantly available for discharged inpatients, outpatients, and carers (98%, 95% and 93% of Trusts, respectively), and to a lesser extent, the local public (22% of Trusts). The median number of enquiries received per week was five. Implementation: For helpline access, 54% of Trusts reported complying with all ‘satisfactory’ standards, and 26% reported complying with all ‘commendable’ standards. For helpline availability, the percentages were 86% and 5%, respectively. For helpline promotion, these percentages were 3% and 40%. One Trust reported complying with all standards. Maintenance: The median number of years that helplines had been operating was six. Effectiveness: main perceived benefits included patients avoiding harm, and improving patients’ medication adherence.ConclusionsPatient medicines helplines are provided by just over half of NHS Trusts in England. However, the proportion of mental health and community Trusts that operate a helpline is less than half of that of the acute Trusts, and there are regional variations in helpline provision. Adherence to the national standards could generally be improved, although the lowest adherence was regarding helpline promotion. Recommendations to increase the use of helplines include increasing the number of promotional methods used, the number of ways to contact the service, and the number of hours that the service is available.

ObjectiveOutpatient parenteral antimicrobial therapy (OPAT) provides opportunities for improved cost savings, but in the UK, implementation is patchy and a variety of service models are in use. The slow uptake...

An audit of the use of isolation facilities in a UK National Health Service trust

Background Transitions from hospital to home are a risky time for older people (aged 75 years and older). Unplanned and often avoidable hospital re-admissions are therefore high in this group. This research aimed to understand if increased involvement of older people in their care in hospital would improve the safety and experience of care transitions. Objectives In six work packages we set out to: understand patient and carer involvement in and experience of care transitions explore staff experiences of delivering good transitional care develop and validate a new measure (the Partners at Care Transitions Measure) to assess patient experience and safety during care transitions create a theory and logic model to inform the co-designed transitions intervention followed by a formative evaluation test the feasibility of delivering a trial to evaluate the intervention evaluate the clinical- and cost-effectiveness of the transitions intervention with a parallel process evaluation. Design Qualitative methods (1 and 2), literature reviewing, Delphi techniques and validation testing (3), co-design (4), cluster feasibility trial (5) and cluster randomised controlled trial (6). Settings National Health Service acute hospital trusts, general practices, patients and carer homes across the north of England, United Kingdom. Participants Patients aged 75 years and older and their caregivers. National Health Service staff working in acute National Health Service trusts on wards delivering the intervention. Intervention ‘Your Care Needs You’ intervention to support patient and carer involvement in hospital care in preparation for returning home. This comprised fixed components: a booklet, an advice sheet for managing at home and a film; and flexible components: ongoing staff involvement of patients through multiple approaches. Implementation included a nominated lead, staff training and posters. Main outcome measures Primary outcome was unplanned 30-day hospital re-admissions. Secondary outcomes included: unplanned 60- and 90-day hospital re-admissions; quality of transition; health-related quality of life (EuroQol-5 Dimensions, five-level version); and self-reported healthcare resource use. Data sources National Health Service Secondary Use Services data and Hospital Episodes data for work package 2 and routinely recorded National Health Service acute trust hospital data on re-admissions for work packages 5 and 6. Review methods Systematic narrative review for preparatory work on patient involvement; narrative meta review of transitions interventions; scoping review of transitions measures. Results Work package 1: Six themes relating to patient experience of care transitions. Patient involvement in hospital care found to be challenging ‘work’ that was often invisible to staff. Work package 2: National Health Service staff reported that high-quality care transitions were facilitated primarily through trust and strong relationships. Work package 3: A measure of quality and safety of care transitions (Partners at Care Transitions Measure) developed and validated with good internal reliability and internal consistency. Work package 4: An intervention called ‘Your Care Needs You’ that required revisions to support implementation. Work package 5: Primary outcome data were collected for 90% of participants. Follow-up questionnaire response rates were lower than anticipated (75% vs. 85%). Information on the acceptability, usability and implementation of the intervention informed iterations to the intervention and implementation package. Work package 6: 4947 participants from 39 hospital wards took part in the main trial. Six hundred and thirteen participants from 35 wards took part in the nested cohort. No differences were observed in the primary outcome of unplanned re-admission (Y/N) at 30 days post discharge [17% experienced re-admission within 30 days in the ‘Your Care Needs You’ group, 18% in care-as-usual, odds ratio: (0.93; 95% confidence interval, 0.78 to 1.10; p = 0.372)], and also at 60 and 90 days post discharge but all results were in favour of the intervention with a reduction in total re-admissions of 13% over 90 days [incidence rate ratio: 0.87 (0.76 to 0.99), p = 0.039]. There was a statistically significant reduction in Partners at Care Transitions Measure safety concerns at 30 days post discharge. The intervention is likely to be cost-effective. Limitations The main trial was conducted during the COVID-19 pandemic which exacerbated staffing challenges and limited opportunities to enhance and support implementation of the intervention. Participant recruitment to the nested study was challenging, resulting in fewer patients than planned and a less diverse sample than that included in the primary cohort. Therefore, while our primary cohort is representative of the patients in the hospital during the trial period, the nested cohort may suffer from some bias. Conclusions The ‘Your Care Needs You’ intervention offers a way to support staff and patients/families to facilitate greater involvement in care. This research demonstrates that increased involvement in hospital care has the potential to improve safety at transitions. Finding ways to support staff to encourage better patient involvement could lead to even more benefits being realised. Future work Hospitals could consider involving volunteers in supporting greater patient and family involvement. There was some indication that the component of the intervention most favoured was the patient advice for discharge. Trial registration This trial is registered as Current Controlled Trials ISRCTN51154948 (WP5) and ISRCTN17062524 (WP6). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: RP-PG-1214-20017) and is published in full in Programme Grants for Applied Research; Vol. 13, No. 4. See the NIHR Funding and Awards website for further award information.

Artificial intelligence (AI) software including Brainomix "e-CTA" which detect large vessel occlusions (LVO) have clinical potential. We hypothesized that in real world use where prevalence is low, its clinical utility may be overstated. In this single centre retrospective service evaluation project, data sent to Brainomix from a medium size acute National Health Service (NHS) Trust hospital between January 3, 2022 and January 3, 2023 was reviewed. 584 intracranial computed tomography angiogram (CTA) datasets were analysed for LVO by e-CTA. The e-CTA output and radiology report were compared to ground truth, defined by a consultant radiologist with fellowship neuroradiology training, with access to subsequent imaging and clinical notes. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Of 584 cases (45% female, mean age 70 ± 16 years), 9% (n = 50) had LVO. e-CTA had a sensitivity of 0.78 (95% CI 0.64-0.88), specificity of 0.93 (0.9-0.95), PPV of 0.5 (0.42-0.58), and NPV of 0.98 (0.96-0.99). e-CTA had an error rate of 9% (52/584). Erroneous cases were categorized into causes for error. Common causes for false positives included incorrect anatomy (21%, 8/39) and other pathology (13%, 5/39), with several uncategorizable cases (39%, 15/39). Common causes for false negatives included LVO within the terminal internal carotid artery (ICA) (55%, 6/11) and uncategorizable (18%, 2/11). We demonstrated that PPV of e-CTA is poor in consecutive cases in a real-world NHS setting. We advocate for local validation of AI software prior to clinical use. Common AI errors were due to anatomical misidentification, presence of other pathology, and misidentifying LVO in the terminal ICA.

The human experience comprises four interconnected dimensions: physical, psychological, social and spiritual. Our spirituality is evidenced in the need to make sense of and find meaning, to feel our lives have purpose, to feel we matter and to feel connected to ourselves, others, the natural world and the sacred or divine. Having a life-shortening or life-threatening condition threatens spiritual well-being and causes spiritual suffering. While health care aspires to be holistic, the evidence on meeting spiritual needs and spiritual care in healthcare settings is limited, particularly for neonatal and paediatric populations. To generate evidence to support evidence-informed approaches for the spiritual care of children/young people and their parents, including the role of chaplaincy. A mixed-method, multicomponent design was used with the quantitative and qualitative data collected. There were four work packages. Work package 1: survey of chaplaincy services in the National Health Service acute trusts in England (n = 98/136). Work package 2: focus groups with National Health Service chaplains across 13 acute trusts (n = 77). Work package 3: interviews with young people (12-25 years) (n = 19) and parents (n = 62). Work package 4: focus groups with National Health Service clinical staff and allied health professionals based in services caring for children with life-threatening or life-shortening conditions (n = 48). Multiple threats to children's/young people's and parents' spiritual well-being were identified. These included struggling to make sense and find meaning in their situation; existing belief systems (or personal philosophies) found wanting, existential worries and concerns; a sense of disconnectedness from others and 'normal life'; and a lack of pleasure and joy, moral distress and feelings of insignificance and invisibility. Almost all described hiding their spiritual distress from themselves and others. At the same time, parents and young people also spoke of wishing for people on whom they could unburden themselves: either at critical moments, or to 'journey' with them. For some, chaplains had provided this care and support. Many, including those identifying themselves as not religious, described drawing comfort from religious rituals and practices (e.g. prayer and blessings). For some, a religious faith protected against spiritual distress. For others, it was regarded as irrelevant or unhelpful. All work packages revealed barriers to children's/young people's and parents' spiritual needs being met. Healthcare staff's accounts revealed a lack of understanding and an uncomfortableness with raising and exploring religious needs and spiritual distress and, for some, a mistrust of chaplaincy services. Survey findings indicated that chaplaincy services are less likely to have a routine presence in paediatric compared to adult settings. Key reasons for this were staff capacity and gatekeeping by healthcare staff. Minority faiths are under-represented in the samples recruited to the qualitative components. Having a life-threatening or life-shortening condition brings multiple threats to the spiritual well-being and lived experiences of children/young people and their parents. There are a number of barriers to National Health Service staff recognising and responding to these needs. These include workforce training and adequate resourcing of chaplaincy services and ensuring spiritual care is integrated into care pathways. Priority topics for future research include effective training for clinical staff on spirituality and spiritual care and integrating spiritual care into care pathways. This study is registered as Current Controlled Trials ISRCTN41288313. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128468) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 16. See the NIHR Funding and Awards website for further award information.

ObjectiveWith one in five children in England living with obesity, we mapped the geographical distribution and format of child weight management services provided by acute National Health Service (NHS) trusts...

BackgroundRegistered nurses are ‘critical’ to population health, internationalresponses to emergencies, epidemics and disasters. Retention of registerednurses (RNs) is an international nursing priority. In England, RNs areencouraged to be involved in improving healthcare services. This benefitsquality of care, operational and financial performance. However, RNinvolvement in improvement may reduce RN retention. It is important tounderstand this relationship when developing effective RN retentionstrategies.AimThe purpose of this research is to describe possible relationships between RNinvolvement in improving healthcare services and RN retention, usingpublished 2018 data for National Health Service (NHS) Trusts in England.MethodsThe relationship between RN involvement in improving healthcare services andRN retention was explored using a correlational design, involving secondarydata from the annual NHS Staff Survey and Model Hospital.ResultsIn mental health NHS Trusts in England, a statistically significant, positivecorrelation of 0.24 was found between RN ‘ab(ility) to make suggestions forimprovement’ and RN retention. In mental health NHS Trusts, a statisticallysignificant correlation of 0.278 was found between RNs ‘making improvementshappen’ and RN retention. In acute NHS Trusts in England, a statisticallysignificant, negative correlation of −0.15 was identified between RNs‘mak(ing) improvements happen’ and RN retention.ConclusionsThe findings suggest that RN retention factors in mental health and acute NHSTrusts differ from community and specialist NHS Trusts in England. This isan important consideration for national RN retention programmes as a singleapproach to RN retention may not be effective across all healthcaresettings.

Tunbridge Wells Homeopathic Hospital outcome study