7-day Service Research Articles

Consultant job planning for a 7-day service

At a time of competing demands on the National HealthService (NHS), systematic consultant job planning is necessary to ensure that limited resources are being used productively, especially with the prospect of expanded 7-day services. Based on a presentation to the Royal College of Physicians Annual Conference in March 2016, a broad overview of job planning is presented, together with more specific examples relating to acute medicine and gastroenterology/general medicine.

Seven-day NHS unworkable without extra staff, leaked report reveals.

The NHS may lack enough nurses to make a 7-day service work properly, leaked Department of Health (DH) documents reportedly reveal.

Access to general practice in England: political, theoretical, and empirical considerations.

Access to general practice services in England has been a prominent theme in recent issues of the BJGP . Simpson and colleagues1 outlined the historical context of current policy to extend practice opening hours in the evenings and at weekends. Campbell and Salisbury2 examined the conceptual foundations of access to health care. Ford and colleagues3 reported empirical work on patient preferences for additional opening hours, while Scantlebury and colleagues4 modelled general-practice-level determinants of emergency department visits. We extend this discussion below, focusing on the UK government’s controversial commitment for all patients in England to be offered GP appointments between 8 am and 8 pm, 7 days a week, by 2020.5 Language used by the government when referring to its commitment to extend opening hours, in addition to that used for its wider political strategy, provides one means of analysing this policy. Relevant government press releases often refer to people with busy work and family lives who struggle to fit in GP appointments; the latest mentioned ‘7-day GP services for hardworking families’ and offering ‘hardworking taxpayers and families the security of care they need’ .6 In April 2015, at the launch of the Conservative Party manifesto for the last UK general election, David Cameron declared the Conservatives to be ‘the party of working people’ .7 In October 2015, after being re-elected as Prime Minister, he repeated this position at the Conservative Party conference: ‘The party of working people, the party for working people — today, tomorrow, always.’ 8 The consistent rhetoric, highlighting a focus on the employed, is one sign that the policy to extend opening hours cannot be divorced from wider political activity. The timing, source, and place of the government’s statements on this policy issue are also revealing. The Prime Minister, rather …

The magnitude and mechanisms of the weekend effect in hospital admissions: A protocol for a mixed methods review incorporating a systematic review and framework synthesis.

BackgroundGrowing literature has demonstrated that patients admitted to hospital during weekends tend to have less favourable outcomes, including increased mortality, compared with similar patients admitted during weekdays. Major policy interventions such as the 7-day services programme in the UK NHS have been initiated to reduce this weekend effect, although the mechanisms behind the effect are unclear. Here, we propose a mixed methods review to systematically examine the literature surrounding the magnitude and mechanisms of the weekend effect.MethodsMEDLINE, CINAHL, HMIC, EMBASE, EthOS, CPCI and the Cochrane Library were searched from Jan 2000 to April 2015 using terms related to ‘weekends or out-of-hours’ and ‘hospital admissions’. The 5404 retrieved records were screened by the review team, and will feed into two component reviews: a systematic review of the magnitude of the weekend effect and a framework synthesis of the mechanisms of the weekend effect. A repeat search of MEDLINE will be conducted mid-2016 to update both component reviews. The systematic review will include quantitative studies of non-specific hospital admissions. The primary outcome is the weekend effect on mortality, which will be estimated using a Bayesian random effects meta-analysis. Weekend effects on adverse events, length of hospital stay and patient experience will also be examined. The development of the framework synthesis has been informed by the initial scoping of the literature and focus group discussions. The synthesis will examine both quantitative and qualitative studies that have compared the processes and quality of care between weekends and weekdays, and explicate the underlying mechanisms of the weekend effect.DiscussionThe weekend effect is a complex phenomenon that has major implications for the organisation of health services. Its magnitude and underlying mechanisms have been subject to heated debate. Published literature reviews have adopted restricted scopes or methods and mainly focused on quantitative evidence. This proposed review intends to provide a comprehensive and in-depth synthesis of diverse evidence to inform future policy and research aiming to address the weekend effect.Systematic review registrationPROSPERO 2016: CRD42016036487Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0260-2) contains supplementary material, which is available to authorized users.

Improving patient safety in cardiothoracic surgery: an audit of surgical handover in a tertiary center.

BackgroundNovel research has revealed that the relative risk of death increased by 10% and 15% for admissions on a Saturday and Sunday, respectively. With an imminent threat of 7-day services in the National Health Service, including weekend operating lists, handover plays a pivotal role in ensuring patient safety is paramount. This audit evaluated the quality, efficiency, and safety of surgical handover of pre- and postoperative cardiothoracic patients in a tertiary center against guidance on Safe Handover published by the Royal College of Surgeons of England and the British Medical Association.MethodsA 16-item questionnaire prospectively audited the nature, time and duration of handover, patient details, operative history and current clinical status, interruptions during handover, and difficulties cross-covering specialties over a month.ResultsJust over half (52%) of the time, no handover took place. The majority of handovers (64%) occurred over the phone; two-thirds of these were uninterrupted. All handovers were less than 10 minutes in duration. About half of the time, the senior house officer had previously met the registrar involved in the handover, but the overwhelming majority felt it would facilitate the handover process if they had prior contact. Patient details handed over 100% of the time included name, ward, and current clinical diagnosis. A third of the time, the patient’s age, responsible consultant, and recent operations or procedures were not handed over, potentially compromising future management due to delays and lack of relevant information. Perhaps the most revealing result was that the overall safety of handover was perceived to be five out of ten, with ten being very safe with no aspects felt to impact negatively on optimal patient care.ConclusionThese findings were presented to the department, and a handover proforma was implemented. Recommendations included the need for a new face-to-face handover. A reaudit will evaluate the effects of these changes.

Predicted shortage of vascular surgeons in the United Kingdom: A matter for debate?

BackgroundVascular surgery became a new independent surgical specialty in the United Kingdom (UK) in 2013. In this matter for debate we discuss the question, is there a “shortage of vascular surgeons in the United Kingdom?” Materials and methodsWe used data derived from the “Vascular Surgery United Kingdom Workforce Survey 2014”, NHS Employers Electronic Staff Records (ESR), and the National Vascular Registry (NVR) surgeon-level public report to estimate current and predict future workforce requirements. ResultsWe estimate there are approximately 458 Consultant Vascular Surgeons for the current UK population of 63 million, or 1 per 137,000 population. In several UK Regions there are a large number of relatively small teams (3 or less) of vascular surgeons working in separate NHS Trusts in close geographical proximity. In developed countries, both the number and complexity of vascular surgery procedures (open and endovascular) per capita population is increasing, and concerns have been raised that demand cannot be met without a significant expansion in numbers of vascular surgeons. Additional workforce demand arises from the impact of population growth and changes in surgical work-patterns with respect to gender, working-life-balance and 7-day services. ConclusionsWe predict a future shortage of Consultant Vascular Surgeons in the UK and recommend an increase in training numbers and an expansion in the UK Consultant Vascular Surgeon workforce to accommodate population growth, facilitate changes in work-patterns and to create safe sustainable services.

Can the NHS make the efficiency savings it needs to survive?

British Journal of NursingVol. 24, No. 14 RegularsCan the NHS make the efficiency savings it needs to survive?Alan GlasperAlan GlasperSearch for more papers by this authorAlan GlasperPublished Online:23 Jul 2015https://doi.org/10.12968/bjon.2015.24.14.752AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Boffey D (2014) NHS spending on agency nurses soars past £5.5bn. Guardian online. Saturday 1 November 2014 (accessed 10 July 2015) Google ScholarDepartment of Health (2015) Review of Operational Productivity in NHS providers. DH, London Google ScholarGlasper A (2015) Can the NHS become a 7-day service for all? Br J Nurs 24(13): 706–707 Link, Google ScholarMoon JC, Flett AS, Godman BB, Grosso AM, Wierzbicki AS (2010) Getting better value from the NHS drug budget. BMJ 341: c6449 Crossref, Medline, Google ScholarMytton OT, Clarke D, Raynor M (2012) Taxing unhealthy food and drinks to improve health. BMJ 344: e2931 Crossref, Medline, Google ScholarNursing Times (2015) Buying smarter, buying safer. NursingTimes.net. http://tinyurl.com/nlhk367 (accessed 10 July 2015) Google ScholarRoyal College of Nursing (2015a) 6. Workforce planning. http://tinyurl.com/pwotsnw (accessed 10 July 2015) Google ScholarRoyal College of Nursing (2015b) Nursing shortage preventing access to crucial training, says RCN. http://tinyurl.com/bqo6yz4 (accessed 10 July 2015) Google ScholarRoyal College of Nursing (2015c) Small Changes, Big Differences. http://tinyurl.com/o6qdae4 (accessed 10 July 2015) Google ScholarScarborough P, Bhatnagar P, Wickramasinghe KK, et al. (2011) The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006–07 NHS costs. J Public Health 33(4): 527–35 Crossref, Google ScholarTriggle N (2015) Simple steps ‘could save NHS £5bn’. BBC online. http://www.bbc.co.uk/news/health-33071066 (accessed 10 July 2015) Google Scholar FiguresReferencesRelatedDetails 23 July 2015Volume 24Issue 14ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 23 July 2015 Published in print 23 July 2015 Information© MA Healthcare LimitedPDF download

Can the NHS become a 7-day service for all?

Can the NHS become a 7-day service for all?

What are the Costs and Benefits of Providing Comprehensive Seven-day Services for Emergency Hospital Admissions?

The English National Health Service is moving towards providing comprehensive 7-day hospital services in response to higher death rates for emergency weekend admissions. Using Hospital Episode Statistics between 1st April 2010 and 31st March 2011 linked to all-cause mortality within 30 days of admission, we estimate the number of excess deaths and the loss in quality-adjusted life years associated with emergency weekend admissions. The crude 30-day mortality rate was 3.70% for weekday admissions and 4.05% for weekend admissions. The excess weekend death rate equates to 4355 (risk adjusted 5353) additional deaths each year. The health gain of avoiding these deaths would be 29 727-36 539 quality-adjusted life years per year. The estimated cost of implementing 7-day services is £1.07-£1.43 bn, which exceeds by £339-£831 m the maximum spend based on the National Institute for Health and Care Excellence threshold of £595 m-£731 m. There is as yet no clear evidence that 7-day services will reduce weekend deaths or can be achieved without increasing weekday deaths. The planned cost of implementing 7-day services greatly exceeds the maximum amount that the National Health Service should spend on eradicating the weekend effect based on current evidence. Policy makers and service providers should focus on identifying specific service extensions for which cost-effectiveness can be demonstrated.

Applying Just Four Words to Occupational Therapy

based on clinical evidence. The impressions of occupational therapy, positive or negative, ultimately originate from occupational therapists themselves, who have influence to manage and shape perceptions. When you discuss occupational therapy, make every contact you have with any consultancy, client, director, or the public meaningful. Make it count. Let’s have the courage to break down barriers to change, to discuss the opportunities for generic working or 7-day services, and where old habits may be hard to break, let’s discuss when it is just time to move on. Have the courage to question clinical practice and professional behaviour in others, so that your clients receive the level of service you would expect in their situation. Use this courage with a focus on occupation, function, and quality in all interventions. Maintain compassion for your clients and your colleagues. It’s tough out there, when the next cost saving may hit your team and practice hard, and making service change is inevitable. But small, everyday things and acts of human kindness that add meaning to everyone’s day can make all the difference. It may not be the diagnosis that is the most meaningful to the client today; it may be achieving a small step in independence in self-care that turned their level of acceptance and quality of life around. Communicate — with your clients, your managers, with everyone: let’s just talk and respect one another. Occupational therapy is changing and we as occupational therapists need to hold on to core values, build on innovative practice, and inspire others to understand the impact of occupational therapy services. Ask, listen, and understand in relation to the changes around you. These are the core values and behaviours that are needed for practice, as underpinned by the Francis report (2013), and they could be driven by just four words.

Using Big Healthcare Data for ILI Situational Awareness in Georgia

We describe how high-volume electronic healthcare reimbursement claims from providers' offices and retail pharmacies can be used to provide timely and accurate influenza-like illness (ILI) situational awareness at state and CBSA levels. We focused on the 2006-2010 influenza seasons and the 39 CBSAs in the State of GA. A sufficient proportion of claims for services within any 7-day service period can be accumulated from both providers' offices and retail pharmacies to generate useful CBSA-level ILI metrics, dispelling the common perception that claims data accumulate too slowly to be useful for public health decision making in sub-state geographic areas.

The Need for a 7-day Therapy Service on an Emergency Assessment Unit

This practice analysis acknowledges the changing nature of healthcare, recognizing the need for a 7-day therapy service on an Emergency Assessment Unit within the acute sector. A critical reflection on practice is offered to share the experiences of trialling a 7-day therapy service as a solution to managing today's political, economic, and demographic challenges. A 12-month pilot of 4-hour therapy shifts at the weekend demonstrated therapists could discharge 40% of patients assessed on the Emergency Assessment Unit; thus evidencing the need for a permanently funded 7-day service to sustain these results long term. Improved access to therapy on a Saturday and Sunday enhances equality of service provision, patient outcomes and weekend discharge rates. The findings are relevant to all occupational therapists and physiotherapists working in the acute sector.

Effect of weekend physiotherapy provision on physiotherapy and hospital length of stay after total knee and total hip replacement.

The aim of the present study was to investigate a change in physiotherapy provision from a 5- to 7-days-a-week service on both physiotherapy and hospital length of stay (LOS) after total knee (TKR) and total hip (THR) replacement. A retrospective analysis of a clinical database was conducted for patients who received either a TKR or THR between July 2010 and June 2012 in one regional hospital. There was a significant decrease in physiotherapy LOS from 5.0 days (interquartile range (IQR) 5.0-6.0 days) for a 5-day physiotherapy service, to 5.0 days (IQR 4.0-5.0 days) for 7-day physiotherapy service (U=1443.5, z=-4.62, P=0.001). However, hospital LOS was not reduced (P=0.110). For TKR, physiotherapy LOS decreased significantly by 1 day with a 7-day physiotherapy service (U=518.0, z=-4.20, P=0.001). However, hospital LOS was again no different (P=0.309). For THR there was no difference in physiotherapy LOS (P=0.060) or hospital LOS (P=0.303) between the 5- and 7-day physiotherapy services. Where physiotherapy LOS was less than hospital LOS, delayed discharge was due primarily to non-medical issues (72%) associated with hospital organisational aspects. Increasing the provision of physiotherapy service after TKR provides an increase in physiotherapy sessions and has the potential to reduce hospital LOS. To be effective this must align with other administrative aspects of hospital discharge.

The development of a 7-day community specialist palliative care service

The author worked as a clinical nurse specialist (CNS) in community palliative care in the Central Lancashire area of England when the CNS service was extended to a 9am-to-5pm 7-day service. A project group was set up to canvas some of the key stakeholders for their views on the extension of the service. The group undertook a literature search, a telephone survey of services in other areas that were providing this level of service, and interviews to ascertain the views of district nurses in the locality of the proposed service extension. The extension of service has long been advocated and was one of the key recommendations in the UK Department of Health's peer-review process. Such an extension was implemented following the research phase and was then evaluated by the project lead and the community services manager. The extension was found to be effective in the ongoing monitoring and support of patients. Anecdotally, the CNS team also felt it had been proactive in preventing unnecessary hospital admissions, although this specific aspect is difficult to quantify. This article looks at how the service was developed, how it has evolved over time, and how it works today. Consideration is also given to benefits and limitations.

PTU-037 Improving Acute upper GI Bleeding Services in a District General Hospital

IntroductionColchester General Hospital (CGH) serves a population of 360,000. Approximately 300–350 patients present with acute upper gastrointestinal bleeding (UGIB) per annum. NICE guidelines recommend gastroscopy (OGD) within 24 hours of...

Experiences implementing a 6-month pilot of a 7-day community CNS service in an urban hospice in Scotland

Patients and carers may face challenges in the out-of-hours period, with inadequate support and variations in service provision, including access to specialist palliative care. A pilot was undertaken to extend availability of the community clinical nurse specialist (CNS) team to include weekends and public holidays. To examine the need for a 7-day community CNS service. Activity data was collected for 6 months and feedback was sought from service users and the CNS team. There were 132 out-of-hours telephone contacts in the 6-month period, generating 35 home visits. Almost two thirds of these calls were proactive, 'planned' contacts. Most unplanned calls (68%) were from a carer for advice about symptom management and support as the patient's condition changed. The pilot demonstrated the need for a CNS service 7 days a week, and the service is now embedded in practice. Seven-day working benefits patients and families while being valued by the professional team.

Face value? Can a face-to-face specialist palliative care team at weekends add value to a tertiary centre?

BackgroundCurrent NICE Guidelines recommend that acute hospitals should provide access to face to face specialist palliative care assessments, 9 am–5 pm, 7 days per week. Continuity of specialist palliative care...

Tools & Techniques: PCI for acute MI tips and tricks

According to current guidelines, primary percutaneous coronary intervention (PPCI) is the preferred form of reperfusion treatment for patients with ST-segment elevation myocardial infarction (STEMI). This article focuses on technical aspects of PPCI and current recommendations for the use of antithrombotic and antiplatelet agents during interventional treatment of STEMI. Interventional STEMI treatment should be provided by experienced institutions offering 24 hours / 7-day PPCI service with acceptable transport delay. Patients referred from community non-PPCI hospitals as well as from ambulances should be accepted for mechanical reperfusion. As the clinical outcome after interventional treatment closely depends both on the experience of the operators and the PCI laboratory as a whole. The current guidelines unequivocally recommend that PPCI should be performed by skilled professionals within less than 90-120 minutes after first medical contact. Optimally, hub-spokes system based on PPCI-hospital and collaborating remote hospitals or ambulances referring STEMI patients should be established. Also, standard operating procedures for STEMI treatment for PCI-hospitals should be implemented. Comprehensive quality improvement program and monitoring of clinical outcomes and door-to-balloon times for PPCI-hospitals and STEMI treatment network as a whole should be obligatory. Administration of aspirin, unfractionated heparin and clopidogrel before transfer to PPCI is strongly recommended. Thereby, broader use of bivalirudin, as an alternative to the combination of unfractionated heparin and GPIIb/IIIa inhibitors, especially in patients with increased risk of bleeding, is recommended. It is also advisable to adjust treatment to the individual patient’s specific needs (type of pharmacotherapy, transport for PPCI versus fibrinolysis) based on the risk of infarction (duration of symptoms at presentation, infarct location, signs of heart failure), risk of bleeding (age) and a possibility of transport for PPCI (expected delay). Preferably the technique of direct stenting, with a broader use of drug-eluting stents during PPCI should be employed if possible. Use of simple manual aspiration in occluded arteries, as well as vessels with established flow and large thrombus burden, should be recommended. Aspiration should be started 2 cm before lesion with thrombus. Multiple slow-passage techniques should be used, with a stop on the thrombus site and continuation of suction distally to the site of occlusion (if possible). Two or three passages are recommended. Optimally, suction success should be confirmed by presence of thrombus on the filter. If passage with catheter through the lesion site is not possible, a low-pressure small balloon inflation is allowed to give a possibility of passing to the distal segments. Optimal technique of PPCI should be chosen after evaluation of IRA flow, thrombus burden and vessel size (Figure 1).

Innovations and Challenges in Reducing Maternal Mortality in Tamil Nadu, India

Although India has made slow progress in reducing maternal mortality, progress in Tamil Nadu has been rapid. This case study documents how Tamil Nadu has taken initiatives to improve maternal health services leading to reduction in maternal morality from 380 in 1993 to 90 in 2007. Various initiatives include establishment of maternal death registration and audit, establishment and certification of comprehensive emergency obstetric and newborn-care centres, 24-hour x 7-day delivery services through posting of three staff nurses at the primary health centre level, and attracting medical officers to rural areas through incentives in terms of reserved seats in postgraduate studies and others. This is supported by the better management capacity at the state and district levels through dedicated public-health officers. Despite substantial progress, there is some scope for further improvement of quality of infrastructure and services. The paper draws out lessons for other states and countries in the region.

Impact on Maternity Professionals of Novel Approaches to Clinical Audit Feedback

The authors compared three approaches to feedback of clinical audit findings relating to miscarriage in 15 Scottish maternity services (printed report alone; report plus action planning letter; report plus face-to-face facilitated action planning). Clinicians were surveyed to measure theory of planned behavior constructs (in the context of two audit criteria) before and after feedback (n = 253) and assessed perceptions of the audit through in-depth interviews (n = 17). Prefeedback, clinicians had positive attitudes and strong subjective norms and intentions to comply, although perceived behavioral control was lower. Generally, positive attitudes, subjective norms, and intentions increased after feedback but for one of the two criteria (providing a 7-day miscarriage service), perceived behavioral control decreased. No changes over time reached statistical significance, and analysis of covariance (adjusting for prefeedback scores) showed no consistent relationships between method of feedback and postfeedback construct scores. Interviews revealed positive perceptions of audit but frustration at lack of capacity to implement changes. Although interventions that increased intensity of feedback proved feasible and acceptable to clinicians, the authors were unable to demonstrate that they increased intention to comply with audit criteria.