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To assess the quality of anticoagulation control at an out‐patient clinic and to investigate patterns of deviation from therapeutic ranges.

Records for 36,157 clinic visits (2,050 patients) were studied. The quality of anticoagulation control was assessed by comparing the measurement of pro‐thrombin time recorded at each clinic visit, expressed as an international normalised ratio (INR), with the target therapeutic range for that patient, also recorded at the time of the clinic visit. Each INR measurement was classified according to the relevant patient's therapeutic range and the signed difference between the INR measurement and the centre of the therapeutic range was calculated. For each patient the percentage of their INR measurements that lay within their therapeutic range was calculated.

Of the measurements, 52.3 per cent were within the relevant therapeutic range. The proportion of individual patients' INR measurements within range varied greatly (median 52 per cent, inter‐quartile range 40‐65 per cent). The quality of anticoagulation control, as measured by the proportion of patients within their therapeutic range, changed little with patient follow‐up time.

The quality of anticoagulation control reported is comparable with that at other centres. The vast majority of patients spend periods outside the therapeutic range for their condition. There may be considerable room for improvement.

The needs of complex patients with chronic conditions can be unpredictable and can strain resources. Exploring how tasks vary for different patients, particularly those with complex needs, can yield insights about designing better processes in healthcare. The purpose of this paper is to explore the tasks required to manage complex patients in an anticoagulation therapy context.

The authors analyzed interviews with 55 staff in six anticoagulation clinics using the Systems Engineering Initiative for Patient Safety (SEIPS) work system framework. The authors qualitatively described complex patients and their effects on care delivery.

Data analysis highlighted how identifying complex patients and their effect on tasks and organization, and the interactions between them was important. Managing complex patients required similar tasks as non-complex patients, but with greater frequency or more intensity and several additional tasks. After complex patients and associated patient interaction and care tasks were identified, a work system perspective was applied to explore how such tasks are integrated within clinics and the resulting implications for resource allocation.

The authors present a complex patient management framework to guide workflow design in specialty clinics, to better support high quality, effective, efficient and safe healthcare.

The complex patient framework presented here, based on the SEIPS framework, suggests a more formal and integrated analysis be completed to provide better support for appropriate resource allocation and care coordination.

Internationally, healthcare systems are moving towards delivering care in an integrated manner which advocates a multi-disciplinary approach to decision making. Such an approach is formally encouraged in the management of Atrial Fibrillation patients through the European Society of Cardiology guidelines. Since the emergence of new oral anticoagulants switching between oral anticoagulants (OACs) has become prevalent. This case study considers the role of multi-disciplinary decision making, given the complex nature of the agents. The purpose of this paper is to explore Irish General Practitioners’ (GPs) experience of switching between all OACs for Arial Fibrillation (AF) patients; prevalence of multi-disciplinary decision making in OAC switching decisions and seeks to determine the GP characteristics that appear to influence the likelihood of multi-disciplinary decision making.

A probit model is used to determine the factors influencing multi-disciplinary decision making and a multinomial logit is used to examine the factors influencing who is involved in the multi-disciplinary decisions.

Results reveal that while some multi-disciplinary decision-making is occurring (64 per cent), it is not standard practice despite international guidelines on integrated care. Moreover, there is a lack of patient participation in the decision-making process. Female GPs and GPs who have initiated prescriptions for OACs are more likely to engage in multi-disciplinary decision-making surrounding switching OACs amongst AF patients. GPs with training practices were less likely to engage with cardiac consultants and those in urban areas were more likely to engage with other (non-cardiac) consultants.

For optimal decision making under uncertainty multi-disciplinary decision-making is needed to make a more informed judgement and to improve treatment decisions and reduce the opportunity cost of making the wrong decision.

Primary care practitioners in the UK today undertake more responsibility for the management of chronic diseases than ever before, including the monitoring of medications initiated in the secondary care setting. This has not necessarily been accompanied by the introduction of guidelines or additional funding. Examining the aminosalicylate group of drugs (sulfasalazine, mesalazine, olsalazine and balsalazide), it was found that despite their potential to cause life‐threatening adverse reactions, there is no agreed protocol on the most appropriate type and frequency of monitoring. A search of the literature confirmed that there is a paucity of evidence from which to construct a guideline. An audit of one family practice suggests current levels fall short of a minimal standard. Based on the current best available evidence, a protocol is suggested for aminosalicylate monitoring. Other groups of drugs warrant similar attention in primary care, and issues regarding funding for the responsibility and cost of monitoring need addressing.

The purpose of this paper is to organize and compare benchmark information gathered during the development of the National Academies of Science, Engineering, and Medicine (NASEM) consensus report Facilities Staffing Requirements for Veterans Health Administration (VHA) – Resource Planning and Methodology for the Future and other publicly available facility engineering staffing benchmarks and rules-of-thumb information.

Presentations and transcripts were reviewed to identify pertinent facility engineering staffing benchmarks discussed in meetings and workshops held by the Committee on Facilities Staffing Requirements for Veterans Health Administration (VHA) while developing the NASEM consensus report: Facilities Staffing Requirements for VHA – Resource Planning and Methodology for the Future. Researchers also collected and reviewed sources not evaluated in the NASEM consensus report.

Compared to publicly available benchmarks for FE staffing, the VHA’s FE staffing levels are slightly higher. However, caution should be used when referencing these public benchmarks for the purpose of implementing a staffing model at the VHA. It is difficult to fairly compare VHA and publicly available FE staffing benchmarks because there can be large differences even between public benchmarks regarding similar work units. Other factors, such as average facility size, age and department structure can also vary, making it problematic to assume that these benchmarks are appropriate for the VHA’s unique facility conditions.

The findings can be used as a point of reference by VHA and other health-care systems for implementing staff modeling for the built environment workforce to support workforce planning and benchmarking.

This paper aims to compare anticoagulant management in secondary care for the year prior to the introduction of near‐patient testing in a general practice, and in the subsequent year after it was introduced.

This paper is a retrospective, paired before‐after study. Details of test results in the two‐year‐long periods on the 46 patients who met the inclusion criteria were collected and analysed pairwise.

Despite an increase in the frequency of testing this set of patients were controlled as well in general practice as they had been with a secondary‐care service, and better that in a number of studies in the literature.

This research reviews a recently introduced service at a single centre. Further research of patient satisfaction and adverse events in a multi‐centre longer‐term trial are desirable.

Technology now allows the increasing amount of individuals on anticoagualtion to be controlled with near‐patient testing in general practice. This study shows that satisfactory control can be maintained in patients who transfer from a secondary care‐based to a primary care‐based service.

This paper demonstrates that a single general practice can provide a high quality anticoagulant service using near‐patient testing and computer‐based decision support. This adds to the already available evidence and will hopefully encourage other practices to adopt the same.

Healthcare failure mode and effect analysis (HFMEA) identifies potential risks and defines preventive actions to reduce the effects of risks. In addition, a discrete event simulation (DES) could evaluate the effects of every improvement scenario. Consequently, a proposed integrated HFMEA-DES model is presented for quality improvement in a general hospital.

In the proposed model, HFMEA is implemented first. As any risk in the hospital is important and that there are many departments and different related risks, all defined risk factors are evaluated using the risk priority number (RPN) for which related corrective actions are defined based on experts' knowledge. Then, a DES model is designed to determine the effects of selected actions before implementation.

Results show that the proposed model not only supports different steps of HFMEA but also is highly in accordance with the determination of real priorities of the risk factors. It predicts the effects of corrective actions before implementation and helps hospital managers to improve performances.

This research is based on a case study in a well-known general hospital in Iran.

This study takes the advantages of an integrated HFMEA-DES model in supporting the limitation of HFMEA in a general hospital with a large number of beds and patients. The case study proves the effectiveness of the proposed approach for improving the performances of the hospital resources.

This study aimed to provide user-centered evidence for health professionals to make optimal use of images for the effective dissemination of health information on Facebook (FB).

Using an eye-tracking experiment and a survey method, this study examined 42 participants' reading patterns as well as recall and recognition outcomes with 36 FB health information posts having various FB post features.

The findings demonstrated that FB posts with text-embedded images received more attention and resulted in the highest recall and recognition. Meanwhile, compared to text-embedded images, visual only images yielded less effective recall of information, but they caught the viewers' attention; graphics tended to attract more attention than photos. For effective communication, the text features in FB posts should align with the formats of the images.

The findings of this study provide practical implications for health information disseminators by suggesting that text-embedded images should be used for effective health communication.

This study provided evidence of users' different viewing patterns for FB health information posts and the relationship between FB post types and recall and recognition outcomes.

The aim of this paper is to study pharmacy service impact on patient satisfaction and to determine what factors saliently link with pharmaceutical service performance at Hamad General Hospital.

A patient satisfaction questionnaire was designed using the literature and consultation with Hamad General Hospital medical experts. The questionnaire contained 22 items that focused on five influencing factors: promptness; attitude; supply; location; medication education; and respondent demographic aspects. A total of 220 respondents completed the questionnaire. An exploratory factor analysis was used to group items and a structural equation model was developed to test causality between five factors along with their influence on patient satisfaction.

The study establishes statistical evidence that patient satisfaction is positively influenced by service promptness, pharmacist attitude, medication counseling, pharmacy location and waiting area. Several socio‐demographic characteristics have statistically different effect on satisfaction, notably: gender; marital status; health status; age; educational level; and ethnicity. However, medication supply did not influence patient satisfaction.

Pharmaceutical services are recognized as an essential healthcare‐system component. Their impact on customer satisfaction has been investigated in many countries; however, there is no such study in Qatar.

The findings identify pharmaceutical service performance indicators and provide guidelines to improve Qatari pharmaceutical services.