National Health Service Hospital Trusts Research Articles

Sarbecovirus disease susceptibility is conserved across viral and host models

BackgroundThe introduction of nursing associates in England (UK) in 2017 as a professional ‘bridging’ role aimed to mitigate chronic staffing shortages, enable career progression of healthcare assistants and release registered nurses to provide more complex care. Limited evidence exists about the alignment between the identity and purpose of nursing associate roles described by the UK independent regulator, the Nursing and Midwifery Council, and the expectations, obligations and team dynamics encountered in practice. PurposeInvestigate the perceptions of nursing associate roles through the views and experiences of role holders, registered nurses and healthcare assistants. SettingTwo National Health Service (NHS) Hospital Trusts in London, England (UK). MethodsFor this registered service evaluation, data were collected via in-person, semi structured interviews. Verbatim transcripts were coded inductively. An adapted framework analysis method, suitable for use with Excel, was applied to support the identification of cross cutting themes. We used the Standards for Reporting Qualitative Research (SRQR) checklist for this study. ResultsEleven registered nurses, five nursing associates and five healthcare assistants participated. Their experiences seldom reflected the policy vision of the nursing associate role in practice. Several likened the nursing associate role to the fable of the ‘Emperor's New Clothes’ in which expectations and reality diverge. With this defined as the over-arching theme, four sub-themes were identified: (1) preparedness of organisational infrastructure to support this role; (2) credibility of the role in practice; (3) perceived organisational “blindness” to the ambiguities of the role and (4) increasing task orientation and segmentation in care delivery. ConclusionThere is a discrepancy between the identity of the nursing associate role as imagined in the policy agenda and its reality in practice. There is a need for more protected and well-defined training, clear role boundaries and accessible career progression pathways. Moreover, honest dialogue at an organisational and policy level must continue, so that the challenges and opportunities of the NA role are properly realised

‘The Emperor's new clothes?’ Healthcare professionals’ perceptions of the nursing associate role in two UK National Health Service hospitals: A qualitative interview study

BackgroundThe introduction of nursing associates in England in 2017 as a professional ‘bridging’ role aimed to mitigate chronic staffing shortages, enable career progression of healthcare assistants and release registered nurses to provide more complex care. Limited evidence exists about the alignment between the identity and purpose of nursing associate roles described by the UK independent regulator, the Nursing & Midwifery Council, and the expectations, obligations, and team dynamics encountered in practice. PurposeInvestigate the perceptions of nursing associate roles through the views and experiences of role holders, registered nurses, and healthcare assistants. SettingTwo British National Health Service (NHS) Hospital Trusts in London, England (UK). MethodsFor this registered service evaluation, data were collected via in-person, semi-structured interviews. Verbatim transcripts were coded inductively. An adapted framework analysis method, suitable for use with Excel, was applied to support the identification of cross cutting themes. We used the Standards for Reporting Qualitative Research checklist for reporting this study. ResultsEleven registered nurses, five nursing associates, and five healthcare assistants participated. Their experiences seldom reflected the policy vision of the nursing associate role in practice. Several participants likened the nursing associate role to the fable of the ‘Emperor's New Clothes’ in which expectations and reality diverge. With this over-arching theme, four sub-themes were identified: (1) preparedness of organisational infrastructure to support this role; (2) credibility of the role in practice; (3) perceived organisational “blindness” to the ambiguities of the role and (4) increasing task orientation and segmentation in care delivery. ConclusionThere is a discrepancy between the identity of the nursing associate role as imagined in the policy agenda and its reality in practice. There is a need for more protected and well-defined training, clear role boundaries, and accessible career progression pathways for nursing associates. Moreover, honest dialogue at an organisational and policy level must continue, so that the challenges and opportunities of the nursing associate role are properly realised. Tweetable abstractEmperor's new clothes! Experiences and views of new nursing associate roles in NHS (UK) acute hospitals @CarolynSpring3.

Healthcare professionals’ views on opioid stewardship interventions in postoperative, opioid-naive patients: a qualitative service evaluation

Abstract Introduction Overuse of opioids has led to an opioid crisis.[1] Opioid stewardship interventions have been developed in some countries. However, there are currently no uniform guidelines that can be used to implement opioid stewardship interventions in the United Kingdom. Prescribing opioids postoperatively is a key risk area of opioid use.[2] To the best of our knowledge, no previous study has explored healthcare professionals’ (HCPs’) views on opioid stewardship interventions in postoperative, opioid-naive patients. Aim To explore hospital HCPs’ views on opioid stewardship interventions for postoperative patients who were not taking opioids before surgery. Methods Semi-structured interviews were conducted with pharmacists, doctors, and nurses in one National Health Service hospital trust as a service evaluation. Participants were recruited through purposive sampling and asked about their opinions on opioid stewardship interventions in postoperative, opioid-naive patients. Interviews were audio-recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. Results Interviews were conducted with 3 doctors, 3 nurses and 4 pharmacists of diverse grades. All participants were involved in clinical opioid practice, with 9 responsible for elective surgery and 1 for trauma surgery. The main themes identified were HCPs’ knowledge and attitudes, decision-making processes, communication with patients, and discharge management. In terms of HCPs’ knowledge and attitudes, most participants were unaware of opioid stewardship. However, during the interviews, the pharmacists used their knowledge of antimicrobial stewardship to help them conceptualise opioid stewardship. Most participants were unaware of the risks associated with opioid-naive patients. Although many available resources about opioid stewardship were identified by participants, they suggested that these were not used in practice. Decision-making processes for opioid prescribing were reported as being heavily reliant on individual clinical judgment due to the absence of standardised guidelines. In addition, decisions were primarily made by anaesthetists rather than by the ward staff responsible for postoperative care. Shared decision-making with patients was limited, primarily occurring postoperatively. Time limitations, complex medical information, and patients’ lack of knowledge about opioids were reported to hinder effective communication and information exchange between HCPs and patients. HCPs reported giving patients information verbally, with minimal use of educational materials. In terms of discharge management, HCPs stressed the importance of providing clear and comprehensive information. After patients were discharged from the hospital, HCPs had no further contact with them or the primary healthcare system, leaving follow-up to GPs. Conclusion To the best of our knowledge, this is the first study to explore HCPs’ knowledge in postoperative opioid stewardship practice. Our findings suggest that although pharmacists have some knowledge of the concept of stewardship generally, many HCPs are unaware of opioid-naive patients’ risks, suggesting that more training may be needed. We identified the underutilisation of available resources and reliance on clinical judgment due to the lack of guidelines. Limited shared decision-making and communication challenges were also identified. This study was limited to a small number of participants in one hospital trust, which may compromise the generalisability and representativeness of our findings. Further work should include anaesthetists and other specialists, as well as patients and carers.

Qualitative Insights Into Patients' and Family Members’ Experiences of In-Hospital Medication Management After a Critical Care Episode

BackgroundPatient recovery after a critical illness can be protracted, requiring a care continuum that extends along a patient pathway from the critical care unit, hospital ward and into the community care setting. High-quality care on patient transfer from critical care, including medication safety, is facilitated by education for patients and families, family engagement, support systems and healthcare professional-patient communication. Currently, there is uncertainty on how healthcare professionals can and should engage with critical care patients and family members about their medication. Research QuestionWe aimed to explore the views and experiences of critical care patients and family members about their involvement, communication, understanding, and decision making related to their medication following transfer from critical care to the hospital ward. Study Design and MethodsQualitative study, using semi-structured interviews, conducted with critical care patients and family members after transfer from critical care to a hospital ward in a large National Health Service hospital Trust. Anonymized transcripts of interviews were thematically analysed using a coding framework developed from understandings of patient and family engagement in their medication. ResultsTwenty-seven participants (15 patients and 12 family members of patients) completed the interviews. We identified five themes and 15 sub-themes, providing an overview of patients and family members’ views on their medication management during their acute illness and ongoing recovery. Themes identified were: Impact of acute illness and treatment burden on pre-existing illness; Pre-existing knowledge and capability; Beliefs about persons roles and expectations; Care continuity and individualised information exchange; and Engagement in practice. InterpretationCritical care patients and family members want to engage with healthcare professionals about their medication. Health care professionals must take an individualized approach to communication and timing, acknowledging the dynamic interplay between patients and family members, using multimodal forms of communication.

Evaluating mental health decision units in acute care pathways (DECISION): a quasi-experimental, qualitative and health economic evaluation.

People experiencing mental health crises in the community often present to emergency departments and are admitted to a psychiatric hospital. Because of the demands on emergency department and inpatient care, psychiatric decision units have emerged to provide a more suitable environment for assessment and signposting to appropriate care. The study aimed to ascertain the structure and activities of psychiatric decision units in England and to provide an evidence base for their effectiveness, costs and benefits, and optimal configuration. This was a mixed-methods study comprising survey, systematic review, interrupted time series, synthetic control study, cohort study, qualitative interview study and health economic evaluation, using a critical interpretive synthesis approach. The study took place in four mental health National Health Service trusts with psychiatric decision units, and six acute hospital National Health Service trusts where emergency departments referred to psychiatric decision units in each mental health trust. Participants in the cohort study (n = 2110) were first-time referrals to psychiatric decision units for two 5-month periods from 1 October 2018 and 1 October 2019, respectively. Participants in the qualitative study were first-time referrals to psychiatric decision units recruited within 1 month of discharge (n = 39), members of psychiatric decision unit clinical teams (n = 15) and clinicians referring to psychiatric decision units (n = 19). Primary mental health outcome in the interrupted time series and cohort study was informal psychiatric hospital admission, and in the synthetic control any psychiatric hospital admission; primary emergency department outcome in the interrupted time series and synthetic control was mental health attendance at emergency department. Data for the interrupted time series and cohort study were extracted from electronic patient record in mental health and acute trusts; data for the synthetic control study were obtained through NHS Digital from Hospital Episode Statistics admitted patient care for psychiatric admissions and Hospital Episode Statistics Accident and Emergency for emergency department attendances. The health economic evaluation used data from all studies. Relevant databases were searched for controlled or comparison group studies of hospital-based mental health assessments permitting overnight stays of a maximum of 1 week that measured adult acute psychiatric admissions and/or mental health presentations at emergency department. Selection, data extraction and quality rating of studies were double assessed. Narrative synthesis of included studies was undertaken and meta-analyses were performed where sufficient studies reported outcomes. Psychiatric decision units have the potential to reduce informal psychiatric admissions, mental health presentations and wait times at emergency department. Cost savings are largely marginal and do not offset the cost of units. First-time referrals to psychiatric decision units use more inpatient and community care and less emergency department-based liaison psychiatry in the months following the first visit. Psychiatric decision units work best when configured to reduce either informal psychiatric admissions (longer length of stay, higher staff-to-patient ratio, use of psychosocial interventions), resulting in improved quality of crisis care or demand on the emergency department (higher capacity, shorter length of stay). To function well, psychiatric decision units should be integrated into the crisis care pathway alongside a range of community-based support. The availability and quality of data imposed limitations on the reliability of some analyses. Psychiatric decision units should not be commissioned with an expectation of short-term financial return on investment but, if appropriately configured, they can provide better quality of care for people in crisis who would not benefit from acute admission or reduce pressure on emergency department. The systematic review was registered on the International Prospective Register of Systematic Reviews as CRD42019151043. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/49/70) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 25. See the NIHR Funding and Awards website for further award information.

Trends in diagnostic tests ordered for children: a retrospective analysis of 1.7 million laboratory test requests in Oxfordshire, UK from 2005 to 2019

ObjectiveTo better understand testing patterns in children, we measured temporal trends in paediatric testing from 2005 to 2019 in Oxfordshire, UK.DesignDescriptive study of population-based secondary data.SettingOxfordshire University Hospitals National Health...

A Single-center Exploration of Attitudes to Deceased Organ Donation Over Time Among Healthcare Staff in Intensive Care.

Changes to deceased organ donation in the United Kingdom, including establishment of the specialist nurse for organ donation (SNOD) role, have resulted in increased numbers of donations. Have increasing numbers of donations altered attitudes among intensive care unit (ICU) healthcare professionals (ICU staff) to organ donation over time? A written survey of ICU staff at Nottingham University Hospitals National Health Service Trust was conducted across 2 wk in 2015, 2018, and 2020 (pre-COVID-19). Participants were asked to submit descriptors (words/phrases) they associated with 3 aspects of donation: donation after brain death (DBD), donation after circulatory death (DCD), and SNOD role. Three independent and blinded assessors categorized the descriptors as positive or negative in favorability. Thematic analysis was used to identify trends within each group of descriptors. Across the 3 surveys, 281 responses were returned, containing a total of 2095 descriptors. Positive descriptors were found in 65% of DBD responses, 46% of DCD responses, and 92% of SNOD role. Over time, there was some evidence of increased polarization of opinion for DCD and to a smaller degree DBD. Attitude toward the SNOD role remained consistently highly favorable over time. Thematic analysis was correlated with the assessor favorability ratings to identify specific factors for positive or negative attitudes; this demonstrated the themes that were the most common causes of positive or negative attributions for each aspect of organ donation. ICU staff were found to be highly favorably positive toward the SNOD role, positive toward DBD, and negative toward DCD. Although we found broadly positive perceptions of the benefits of deceased organ donation, negative attitudes toward DCD centered on timescale and complexity of the donation process. Measurement of staff attitudes to organ donation may allow targeted interventions that support staff and improve patient and family care through the organ donation process.

How do emergency department staff respond to behaviour that challenges displayed by people living with dementia? A mixed-methods study

ObjectivesTo investigate staff experiences of, and approaches to behaviour that challenges displayed by patients with dementia in the emergency department (ED). Behaviour that challenges is defined as ‘actions that detract...

P366 Developing an in-house and integrated sweat testing service for the routine management of adults with cystic fibrosis

Since 1959, the sweat test has become an essential diagnostic test for cystic fibrosis (CF). In 2012, the CFTR potentiator, ivacaftor became available on the National Health Service (NHS) in England. Commissioning guidance advised that all eligible patients should have a sweat test within 6 months of starting treatment and then at least annually. Historically at Leeds Teaching Hospitals NHS Trust, sweat tests were performed by the biomedical team.

Hospital workforce engagement, satisfaction, burnout and effects on patient mortality: Findings from the English national health service staff surveys.

Previous studies of healthcare organizations' workforces and their performance have focused on burnout and its impact on care. The aim of this research is to expand on this and examine the association of positive organizational states, engagement and recommendation of employer as a place to work, in comparison to burnout on Hospital performance. Methods: This was a panel study of the respondents to the 2012-2019 yearly Staff Surveys of the English National Health Service (NHS) hospital Trusts with hospital performance measured by the adjusted inpatient Summary Hospital-level Mortality Indicator (SHMI). Results: In univariable regression, all three organizational states significantly and negatively correlated with SHMI, with recommendation and engagement showing a nonlinear effect. In multivariable analysis, all three states remained significant predictors of SHMI. Engagement and recommendation showed mutual correlation, with engagement being a more prevalent state than recommendation. Conclusion: Our study indicates that organizations could benefit from monitoring multiple workforce variables to preserve or enhance workforce well-being, while optimizing organizational performance. The surprising finding that higher burnout was associated with improved short-term performance requires further investigation, as does the finding of less frequent staff recommendation of work compared to staff engagement with their work.

Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study

ObjectivesThe Computer-Aided Risk Score for Mortality (CARM) estimates the risk of in-hospital mortality following acute admission to the hospital by automatically amalgamating physiological measures, blood tests, gender, age and COVID-19...

Implementation of a novel shared decision-making intervention in women with chronic hypertension in pregnancy: multiple-site multiple-method investigation.

Many women with chronic hypertension are conflicted about antihypertensive medication during pregnancy and some are non-adherent to prescribed medication. Codesign, implement and evaluate a novel shared decision-making (SDM) intervention for use with pregnant women with chronic hypertension. Pregnant women with chronic hypertension and their principal healthcare professionals (obstetricians, midwives, and physicians), at three National Health Service hospital trusts with different models of care. The RE-AIM framework guided the evaluation. Primary: Decisional conflict scale, medication intention survey and women's acceptability. Secondary: Healthcare professionals' acceptability and the barriers and facilitators to SDM implementation with pregnant women with chronic hypertension. Fifty women participated. Nearly half (46%; n=23) of women were from Black and Asian backgrounds. The SDM intervention was effective at reducing decisional conflict (mean reduction from baseline 42%, 95% CI 35-49, p≤0.05). In 36 women (72%), the reduction was of clinical importance. 24 women (48%) were uncertain about or planned not to take antihypertensives prior to the SDM intervention, compared to two women (4%) after the intervention. The intervention was acceptable to women and healthcare professionals. 10 of 14 healthcare professionals felt that the in-consultation aid facilitated SDM in current antenatal contexts, a similar proportion (10/14) felt the length of consultations hindered SDM. A novel codesigned SDM intervention reduced decisional conflict and increased women's intention to take antihypertensive agents during pregnancy. This intervention could be adopted into practice for women making pregnancy decisions where there is uncertainty around the medication management option.

Quality Improvement of a Hip Injection Service.

Background Osteoarthritis is a substantive burden on the population and National Health Service (NHS) in the United Kingdom. A recent systematic review suggests that intra-articular steroid injections are an efficacious conservative treatment modality. The NHS Constitution states that "patients should wait no longer than 18 weeks from GP referral to treatment."An NHS hospital trust failed to meet this standard in a quarter of patients waiting for an intra-articular steroid injection of the hip. Strategies were considered to improve the time from referral to treatment (RTT). The aim of this quality improvement project was to improve the efficiency and capacity of the injection list. Materials and methods Patients who underwent an injection on a list between January and April 2019 were identified. Data were retrospectively collected and included the sites of injection and waiting times. Proformas for documentation and discharge summaries were introduced. Time taken for each appointment pre- and post-intervention were compared with the aim to increase the number of patients per list. Results Thirty-six (26%) of 138 patients experienced delays beyond 18 weeks from RTT. The mean (standard deviation [SD]) number of weekswaiting for an injection from the time of referral was 14 (6). The mean (SD) time for each appointment was 12 minutes 36 seconds (7 minutes 36 seconds) pre-intervention and 8 minutes 36 seconds (3 minutes 12 seconds) post-intervention. Discussion and conclusion Our standardized proformas led to an improvement in efficiencyby reducing the time taken for documentationand capacityby subsequently increasing the number of patients per list.

Resilience Enhancement Online Training for Nurses (REsOluTioN): Protocol for a Pilot Randomized Controlled Trial.

BackgroundGlobally, nurses are facing increased pressure to provide high-quality complex patient care within environments with scarce resources in terms of staffing, infrastructure, or financial reward. The strain and demand on the psychological health and well-being of nurses during COVID-19 has been substantial, with many experiencing burnout; as such, interventions to enhance resilience within the workplace are required. A face-to-face resilience enhancement training program for nurses that was effective in improving resilience levels was translated into a 4-week online training program, Resilience Enhancement Online Training for Nurses (REsOluTioN), to enable greater accessibility for nurses.ObjectiveThis study aims to compare levels of resilience, psychological health, and well-being in nurses before and after the online resilience training compared to a wait list control group. It will also explore participants’ engagement with the trial and their acceptability of the online training.MethodsThis is a two-arm, parallel, randomized controlled trial with a 6-week follow-up period. Up to 100 registered nonagency nurses working at a National Health Service hospital trust in South England will be recruited. Four cohorts will run, and participants will be randomized into a wait list control group or to REsOluTioN. Pre- and postonline surveys will collect study outcome measure data. In the REsOluTioN arm, data will be collected on the perceived usefulness of the online training via an online survey. Institutional and health research authority approvals have been obtained.ResultsREsOluTioN will aim to empower nurses to maintain and enhance their resilience while working under challenging clinical conditions. The online training will be interactive with input from mentors, health care leaders, and peers to promote engagement and enhanced communication, and will create a forum where nurses can express their views and concerns, without hierarchical infrastructures inhibiting them. This can increase self-knowledge and learning around workplace resilience coping strategies and provide a safe space to validate feelings through mentorship and peer support. Findings will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The trial is now finished and was conducted between August 2021 and May 2022.ConclusionsThe REsOluTioN trial will enable preliminary data to be gathered to indicate the online training’s effectiveness in enhancing nurses’ resilience in the workplace, with the potential for larger scale follow-up studies to identify its value to nurses working across a range of health care settings.Trial RegistrationClinicalTrials.gov NCT05074563; https://clinicaltrials.gov/ct2/show/NCT05074563International Registered Report Identifier (IRRID)DERR1-10.2196/37015

Prospective comparison of two methods for assessing sarcopenia and interobserver agreement on retrospective CT images.

To compare the relationships between two CT derived sarcopenia assessment methods, and compare their relationship with inter-rater and intrarater validations and colorectal surgical outcomes. 157 CT scans were identified across Leeds Teaching Hospitals National Health Service Trust for patients undergoing colorectal cancer surgery. 107 had body mass index data available, required to determine sarcopenia status. This work explores the relationship between sarcopenia, as measured by both total cross sectional-area (TCSA) and psoas-area (PA) and surgical outcomes. All images were assessed for inter-rater and intrarater variability for both TCSA and PA methods of sarcopenia identification. The raters included a radiologist, an anatomist and two medical students. Prevalence of sarcopenia was different when measured by PA (12.2%-22.4%) in comparison to TCSA (60.8%-70.1%). Strong correlation exists between muscle areas in both TCSA and PA measures, however, there were significant differences between methods after the application of method-specific cut-offs. There was substantial agreement for both intrarater and inter-rater comparisons for both TCSA and PA sarcopenia measures. Outcome data were available for 99/107 patients. Both TCSA and PA have poor association with adverse outcomes following colorectal surgery. CT-determined sarcopenia can be identified by junior clinicians, those with anatomical understanding and radiologists. Our study identified sarcopenia to have a poor association with adverse surgical outcomes in a colorectal population. Published methods of identifying sarcopenia are not translatable to all clinical populations. Currently available cut-offs require refinement for potential confounding factors, to provide more valuable clinical information.

Prospective comparison of two methods for assessing sarcopenia and interobserver agreement on retrospective CT images

Purpose of the studyTo compare the relationships between two CT derived sarcopenia assessment methods, and compare their relationship with inter-rater and intrarater validations and colorectal surgical outcomes.Study design157 CT scans...

Rapid influenza molecular testing in secondary care and influenza surveillance in England: Any impact?

IntroductionThe use of rapid molecular testing for influenza diagnosis is becoming increasingly popular. Used at the point of care or in a clinical laboratory, these tests detect influenza A and B viruses, though many do not distinguish between influenza A subtypes. The UK Severe Influenza Surveillance System (USISS) collects surveillance data on laboratory‐confirmed influenza admissions to secondary care in England.This study set out to understand how rapid influenza molecular testing was being used and how it might influence the availability of subtyping data collected on influenza cases admitted to secondary care in England.MethodsAt the end of the 2017/2018 and 2018/2019 influenza seasons, a questionnaire was sent to all National Health Service Hospital Trusts in England to evaluate the use of rapid influenza testing. Surveillance data collected through USISS was analysed from 2011/2012 to 2020/2021.ResultsOf responding trusts, 42% (13/31) in 2017/2018 and 55% (9/17) in 2018/2019 used rapid influenza molecular tests, either alone or in combination with other testing. The majority of rapid tests used did not subtype the influenza A result, and limited follow‐up testing occurred.Surveillance data showed significant proportions of influenza A hospital and intensive care unit/high dependency unit admissions without subtyping information, increasing by approximately 35% between 2012/2013 and 2020/2021.ConclusionsThe use of rapid influenza molecular tests is a likely contributing factor to the large proportion of influenza A hospitalisations in England that were unsubtyped. Given their clear clinical advantages, further work must be done to reinforce these data for public health through integrated genomic surveillance.

Creating a Real-World Linked Research Platform for Analyzing the Urgent and Emergency Care System.

BackgroundThis article describes the development of a system-based data platform for research developed to provide a detailed picture of the characteristics of the Urgent and Emergency Care system in 1 region of the United Kingdom.Data Set DevelopmentCUREd is an integrated research data platform that describes the urgent and emergency care system in 1 region of the United Kingdom on almost 30 million patient contacts within the system. We describe regulatory approvals required, data acquisition, cleaning, and linkage.Data Set AnalysesThe data platform covers 2011 to 2017 for 14 acute National Health Service (NHS) Hospital Trusts, 1 ambulance service, the national telephone advice service (NHS 111), and 19 emergency departments. We describe 3 analyses undertaken: 1) Analyzing triage patterns from the NHS 111 telephone helpline using routine data linked to other urgent care services, we found that the current triage algorithms have high rates of misclassifying calls. 2) Applying an algorithm to consistently identify avoidable attendances for pediatric patients, we identified 21% of pediatric attendances to the emergency department as avoidable. 3) Using complex systems analysis to examine patterns of frequent attendance in urgent care, we found that frequent attendance is stable over time but varies by individual patient. This implies that frequent attendance is more likely to be a function of the system overall.DiscussionWe describe the processes necessary to produce research-ready data that link care across the components of the urgent and emergency care system. Making the use of routine data commonplace will require partnership between the collectors, owners, and guardians of the data and researchers and technical teams.HighlightsThis article describes the development of a system-level data platform for research using routine patient-level data from the urgent and emergency care system in 1 region of the United Kingdom.The article describes how the data were acquired, cleaned, and linked and the challenges faced when undertaking analysis with the data.The data set has been used to understand patient use of the system, journeys once in the system, and outcomes following its use, for example, patterns of frequent use within urgent care and accuracy of referral decisions within the system.

A survey of ultrasound Quality Assurance implementation in the United Kingdom.

In England, Quality Assurance is a legal requirement, regulated by the Care Quality Commission; equipment in use may exhibit only minor deterioration. There is evidence that a significant number of ultrasound transducers in use exhibit major faults and this may lead to suboptimal imaging in a large number of examinations. There is limited evidence suggesting that the uptake of Quality Assurance in the United Kingdom is low; the aim of this study was to gather more information on current Quality Assurance practice. A questionnaire to establish the level of Quality Assurance in place in National Health Service Hospital Trusts in the United Kingdom was sent by email to 170 National Health Service Chief Executives. There were 60 responses to the survey from individual National Health Service organisations, only four respondents (7%) indicating that no Quality Assurance was performed in their organisation. Twenty-three percent of respondents conducted only annual Quality Assurance. Eighteen percent of respondents conducted only user Quality Assurance. In the worst case, if no non-respondents had a Quality Assurance programme, only 33% of National Health Service Trusts in the United Kingdom have a Quality Assurance programme. The true figure will be between 33% and 93%. Annual Quality Assurance alone is insufficient to detect faults in a timely manner and user Quality Assurance alone may not detect more subtle faults. It is easy and straightforward for ultrasound users to perform Quality Assurance every day, in the form of a rapid visual inspection and uniformity assessment before every use.

Volume-Outcome Associations for Parathyroid Surgery in England

Previous studies have suggested an association between surgical volume and patient outcomes for parathyroid surgery. However, most previous studies are relatively small and the literature is dominated by studies form the US, which might not be readily generalizable to other settings. To investigate volume-outcome associations for parathyroid surgery in England. Cohort study that included all National Health Service hospital trusts in England with secondary analysis of administrative data using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Participants included all adult, elective hospital admissions for parathyroid surgery without a diagnosis of multiple endocrine neoplasia, parathyroid cancer, or kidney disease over a 5-year period (April 2014-March 2019 inclusive). The number of procedures conducted in the year prior to the index procedure by each surgeon and each hospital trust. Repeat parathyroid surgery within 1 year of the index procedure. This study included data for 17 494 participants who underwent parathyroidectomies conducted across 125 hospital trusts. The median (IQR) age of patients was 62 (53-71) years, and 13 826 were female (79.0%). Across the period, the number of surgeons conducting parathyroid surgery changed little (280 in 2014-2015 and 2018-2019), although the number of procedures conducted rose from 3331 to 3848 per annum. Repeat parathyroid surgery at 1 year was significantly associated with surgeon volume (odds ratio [OR], 0.99; 95% CI, 0.98-0.99), but not trust volume, in the previous 12 months. Extended length of stay (OR, 0.98; 95% CI, 0.98-0.99), hypoparathyroidism/calcium disorder (OR, 1.0; 95% CI, 0.99-1.0), and postprocedural complications (OR, 0.99; 95% CI, 0.99-1.0) were also associated with lower surgeon volume. In this cohort study, higher surgeon annual volume was associated with decreased rates of repeat parathyroid surgery. A minimum volume threshold of 20 procedures per annum should improve patient outcomes, although possible negative effects on access to services should be monitored.