London North West Healthcare NHS Research Articles

Improving outcomes for patients discharged early using a home assessment scheme.

BackgroundWith increased delayed discharges from acute NHS hospitals, especially for older patients, solutions like the ‘Discharge to Assess’ (D2A) scheme aim to facilitate quicker discharge and improve experiences for patients and carers.SettingThis report examines the quality process from the patient perspective of the D2A scheme implemented in a London Northwest Healthcare NHS Trust (LNWHT). A retrospective audit was conducted using the first cohort of patients discharged through this pilot scheme from April to July 2017.QuestionA brief study to explore patient views of their experience of the D2A scheme.MethodsAn opportunistic audit comprised of brief telephone interviews with patients following discharge from hospital through the D2A scheme.Results30 patients who had been discharged with the D2A scheme, agreed to participate. Overall, patients were positive about their experience and valued the support and services provided. However, there were concerns on the issue of communication. The scheme effectiveness from the patient’s perspective improved over the duration of the evaluation.DiscussionPatients’ views about their experiences changed over time, which included patients’ perceptions of the discharge process, patients’ expectations and the way in which they were able to access services.

Use of a GP-endorsed 12 months’ reminder letter to promote uptake of bowel scope screening: protocol for a randomised controlled trial in a hard-to-reach population

IntroductionFlexible sigmoidoscopy (FS) screening is associated with reduced colorectal cancer incidence and mortality when offered as a one-off test to men and women aged 55–64. The test, also referred to...

Editorial-The sweet sixteen special!

Sixteen years! Our own Medical Journal of Shree Birendra Hospital is in the middle of charming teen years now. Yes, it is definitely sweet sixteen! And yes, it has definitely come a long way since its inception and we must congratulate ourselves and feel proud that we are here, and with more zeal to improve and learn. I would like to thank all our readers, authors, reviewers as well as editors and mentors of NepJol for their continuous support and love which has kept the journal alive and kicking for so many years!First of all, we are happy to share some news. We have recently updated our journal guidelines for authors. We have tried to simplify the whole process of submission. We hope that the simpler guidelines will make the authors more comfortable to submit their articles online. We have also been successful in adding many prominent national and international editors to our editorial board. We have added Dr Samir Lamichhane from Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal (Department of Pharmacology), Dr Manisha Bajracharya from KIST Medical College and Teaching Hospital, Imadole, Lalitpur (Department of Obstetrics and Gynaecology), Dr. Barsha Bajracharya from Shree Birendra Hospital, NAIHS, Kathmandu, Nepal (Department of Dental Surgery) as our Editorial Board members. We must consider ourselves very privileged that some reputed academicians have joined our team as international editors. We are extremely honored to have Prof. Dr. Babill Stray-Pederson, University of Oslo, Norway (Department of Obstetrics and Gynaecology), Prof. Dr. Deepak Batura from London North West Healthcare NHS, London, UK (Department of Urosurgery), Dr. Dipendra Raj Pandeya from Al Jouf University, Saudi Arabia (Department of Clinical Biochemistry), Dr. Santosh Pandit from Chalmers University of Technology, Sweden (Department of Biology and Biological Engineering) and Dr. Usman Mahboob from Khyber Medical University, Pakistan (Institute of Health Professions Education And Research) as international editors in our team. We are very excited to have such distinguished mentors as our team members. Thank you and welcome to all.With the vigor and enthusiasm of additional editors, we have set some goals for our journal. First and foremost, a journal has to be punctual. We need to maintain the punctuality of our journal. Presently, we have been lagging behind in publication of issues. With two consecutive future publications, we aim to publish further issues on specified time biannually (Jan and July).Secondly, with the guidance and support of additional editors, we hope that our journal would flourish more in the national as well as international field. For this, we expect that we shall be able to involve all the editorial board members in the journal equally and effectively. We are certain that their invaluable contribution would be vital for the progress of our journal. Thirdly, we have initiated steps towards indexing and hope that we shall soon get indexed into reputed indexing services. With better indexing, we believe that the overall scope of our journal will widen and we shall have broader and discerning audience. Fourthly, we aim to collaborate with different organizations and conduct regular training sessions for our authors in scientific manuscript writing. We firmly believe that training is imperative for the authors to improve their writing skills. With better quality of authors, needless to reiterate, we will get better articles and our journal would be at par with any other well-known medical journal that we look up to. But whatever we bring out, without feedback, we-the editorial team-too will not learn, nor grow. I would like to conclude by requesting all our readers, authors, reviewers, editors, as well as mentors to give us feedback and comments, so that we can strive continuously for betterment. Lastly, I would like to congratulate and express our gratitude to the editors who have come on board. Welcome and thank you all once again.

Developing person-centred consultation skills within a UK hospital pharmacy service: evaluation of a pilot practice-based support package for pharmacy staff

A person-centred approach to care is central to NHS England’s health policy agenda and a standard for pharmacy practice from the General Pharmaceutical Council. Health coaching is a method of...

Evaluation of a newly introduced tonsillectomy operation record for the analysis of regional post-tonsillectomy bleed data: a quality improvement project at the London North West Healthcare NHS Trust

The primary objective of this audit and quality improvement project was to retrospectively analyse regional post-tonsillectomy haemorrhage data as per national recommendations. However, this process highlighted the need for high-quality routinely collected data; something that was not always available via retrospective audit and thus does not enable formal aetiological factor analyses. We therefore created further secondary objectives to facilitate our primary audit objective. These secondary objectives were (1) to introduce a standardised tonsillectomy operation proforma to improve completeness and quality of routinely collected data and (2) to evaluate and validate proforma use and usefulness in improving using routine data collection to help with a repeated audit of post-tonsillectomy haemorrhages with the eventual aim to help improve operative outcomes by identifying potential associated factors. The retrospective audit component, the prospective audit and the quality improvement component were all carried out at the Northwick Park Hospital and Central Middlesex Hospital (London North West Healthcare NHS Trust). First, 642 tonsillectomy records (2012–2014) were retrospectively reviewed. Free-text operative documentation and, where possible, potential factors associated with post-tonsillectomy haemorrhages were analysed. In addition, completeness of data available before and after the introduction of (A) a new paper-based and (B) electronic surgical record proforma was reviewed (2014–2015). Over a 2-year period, 62 of the 642 (9.7%) audited tonsillectomy patients had a post-tonsillectomy haemorrhage, and 19 of these (2.9%) had to return to theatre for surgical arrest of the haemorrhage. Bipolar diathermy was the most commonly used technique. During this period, data available from routine operative documentation in the surgical operation notes were variable and thus did not allow identification of potential factors associated with post-tonsillectomy haemorrhage. The completeness and quality of data significantly improved after the introduction of a standardised paper-based proforma with sections for required details based on known risk factors for post-tonsillectomy haemorrhage and required operative details. Quality and completeness of data was further improved after the introduction of an electronic version. This electronic proforma will allow prospective spiral auditing results, early identification of raised bleeding rate, and provide individual surgeon audit results.

Deriving a management algorithm for emphysematous pyelonephritis: Can we rely on minimally invasive strategies or should we be opting for earlier nephrectomy?

To analyse the incidence and management of emphysematous pyelonephritis (EPN) in North West London and examine factors that influence immediate and 6-month outcomes with the aim of guiding future management. This work analyses EPN cases from the London North West Healthcare NHS Trust from October 2006 to July 2015 (population≈850,000). Diagnosis and stage were confirmed by computed tomography (CT). Demographic, clinical, biochemical and microbiological characteristics were assessed. Treatment modalities were medical management, minimally invasive management (MIM) and surgical. Immediate and 6-month outcomes were analysed. Thirteen cases were identified (f=8, m=5) from 5525 CT scans. EPN occurred in patients with diabetes mellitus (n=11, 84.6%), hypertension (n=10, 76.9%) or urinary tract calculi (n=7, 53.85%). Unilateral EPN occurred predominantly (n=11, 84.6%); 46.1% (n=6) were class 1 or 2 and 53.8% (n=7) class 3 or 4. Escherichia coli was most commonly cultured (n=5, 38.46%). All patients received antibiotics, and ten cases required MIM. Two patients had a delayed nephrectomy, both survived. Mortality was 15.4% (n=2, grade 1 and 3a), both died acutely post-MIM, neither underwent emergency nephrectomy. At 6months, eight patients had ongoing renal impairment. No specific poor prognostic factors were identifiable. Patients with low-grade EPN may also have a high mortality rate. In the two cases who died, earlier consideration for nephrectomy may have been prudent. It may be beneficial to have a low threshold for prompt emergency nephrectomy in severe cases and where MIM treatment has failed. We suggest a management algorithm to guide clinicians and minimise mortality.

Screening can reduce GBS risk.

Screening pregnant women for bacterial infection Group B Streptococcus (GBS) can cut the risk to newborns dramatically, a study from London North West Healthcare NHS Trust suggests.

'Learn from others by listening'.

Claire Taylor qualified as a nurse 30 years ago, gaining a Bachelor of Nursing degree at the University of Southampton. A Macmillan professional for more than 20 years, she has worked in a variety of clinical posts and been a lecturer in gastrointestinal (GI) nursing at King's College London. She has been Macmillan nurse consultant in colorectal cancer at London North West Healthcare NHS Trust since 2015.

An evaluation of a health visiting clinical academic hub in London

This case study outlines the process of setting up a clinical academic hub for health visiting and evaluates its effectiveness after being in existence for 18 months. The Health Visiting Clinical Academic Hub was created in north-west London in May 2014 to develop the health visiting workforce. This case study will discuss how the London North West Healthcare NHS (LNWH) Trust's Health Visiting Clinical Academic Hub was set up, what it aimed to do and its effectiveness to date. There is a need for more leadership, innovation and research in health visiting and these can be achieved through setting up a hub like this. This case study has been written so that others wanting to set up a clinical academic hub can follow this model and learn from it.

Beneath the tip of the iceberg: using electronic referrals to map the unquantified burden of clinical activity in a urology service.

The aim of this study was to inform health policy by demonstrating the benefits of an electronic referral (e-referral) system to study inpatient referrals to urology departments. London North West Healthcare NHS Trust has over 800 beds and several secondary and tertiary care services. In January 2014, we designed an e-referral form to requisition urology input for in-patients using the Integrated Clinical Environment™ (ICE) platform. We retrospectively reviewed e-referral records from February to December 2014 for patient demography, the referring service and disease groups triggering a referral. There were 1192 referrals. There was a median of 107 e-referrals per month (IQR 97-123, range 91-132) and 4 per day (IQR 2-6, range 0-12). Weekend e-referrals were 127 (median 1, IQR 0-2, range 0-5) with 1065 e-referrals on weekdays (median 4, IQR 3-6, range 0-12). A total of 848 (71.1%) patients were male, and 344 (28.9%) were female. Patients' mean age was 63 (SD 21) years. Almost half (550, 46%) were acute referrals. Amongst the acute referrals, the majority (466, 84.7%) arose from A&E. From the non-acute conditions, 381 (59.3%) patients were from the medical specialities and 246 (38.3%) from surgical disciplines. The three largest disease categories were urolithiasis (287, 24.1%), haematuria (185, 15.5%) and for ex-catheterisation (102, 8.6%). A qualitative review showed the strengths and weaknesses of the system, enabling improvements in operational efficiency. An e-referral system monitors activity accurately. Systemic improvement in referral pathways would lead to better patient care and enable services to factor in the unseen component of workload and prompt realistic staffing.