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The purpose of this paper is to compare data from national censuses on specialist inpatient service use by people with learning disabilities across England, Scotland, Wales and Northern Ireland.

National statistics (England, Scotland, Wales, Northern Ireland) reporting inpatient service censuses including people with learning disabilities were accessed, with data extracted on trends over time, rate of service use, young people and length of stay.

The number and rate of people with learning disabilities in specialist inpatient services varied across the UK: 230 people in Scotland (rate 4.88 per 100,000 population); 3,250 people in England (5.48); 183 people in Wales (5.90); 144 people in Northern Ireland (7.82). The number of people in inpatient services in Northern Ireland halved over four years, in other areas reductions were modest. Between 5 and 8 per cent of people in inpatient services were children/young people. Median length of stay in the person’s current inpatient service varied: 19 months in England; 33 months in Scotland; three to five years in Northern Ireland.

Different parts of the UK vary in the scale of their specialist inpatient services for people with learning disabilities. With the exception of Northern Ireland, which may still be in the last stages of completing a “regular” deinstitutionalisation programme, strong policy prescriptions for substantial reductions in specialist inpatient services are currently only resulting in modest reductions.

This paper is a first attempt to compare national inpatient service statistics across the UK. With increasing divergence of health and social service systems, further comparative analyses of services for people with learning disabilities are needed.

The purpose of this paper is to analyse rates of inpatient admissions for people with learning disabilities in England and to identify factors associated with higher rates of inpatient admission.

Secondary analysis of data submitted as part of the Transforming Care programme in England.

2,510 people with learning disabilities in England were inpatients on 31st March 2016. Findings indicate that people with learning disabilities are at risk of higher rate of inpatient admission than can be explained by prevalence within the general population; this risk may be associated with areas where there are higher numbers of inpatient settings which provide assessment and treatment for people with learning disabilities.

Variability in the quality of the data submitted by commissioners across the 48 Transforming Care Plan areas mean that greater attention needs to be paid to determining the validity of the common reporting method. This would improve the quality of data and insight from any future analysis.

The study’s findings are consistent with the hypothesis that geographical variations in the risk of people with learning disabilities being admitted to inpatient services are not consistent with variations in prevalence rates for learning disability. The findings support the hypothesis that building alternatives to inpatient units should impact positively on the numbers of learning disabled people who are able to live independent lives.

This is the first study which examines the data which commissioners in England have reported to NHS England on the experience of people with learning disabilities who are admitted as inpatients and to report on the possible factors which result in higher rates of inpatient admission.

This study aims to assess whether patients [who receive community pharmacy services at locations where routine medication therapy management (MTM) care is reimbursed] who were adherent to their medications generated lower inpatient hospitalization expenses.

This is a retrospective, descriptive and cross-sectional study using administrative claims data drawn from 84 community pharmacies in North Dakota. The included patients were enrolled in a Blue Cross Blue Shield of North Dakota insurance plan and were taking one or more of eight groups of medications (metformin, antidepressants, anti-asthmatics, ACEs/ARBs, beta-blockers, calcium channel blockers, diuretics and statins) commonly prescribed to treat chronic conditions filled between July 1, 2014 and June 30, 2015. Community pharmacists used software that allowed the pharmacists to provide and bill for MTM services. Data from these sources were used to calculate medication adherence and inpatient costs.

Patients prescribed a beta blocker, a calcium channel blocker, and a diuretic or an anti-diabetic medication, and those who are fully adherent to their medications were associated with significantly lower inpatient hospitalization costs (as measured by insurance payments to hospitals) as compared to non-adherent patients. Patients who were fully adherent to their medications had no statistically significant differences in patient-specific costs compared to non-adherent patients.

Patients receiving services at a community pharmacy that offers MTM services and those who were adherent to their medication regimens generate lower health care expenses. Most of the savings come from lower hospitalization expenses, rather than patient-paid expenses.

The purpose of this paper is to examine the determinants of average health expenditures for inpatients in China with national data for period 2002-2010 and regional data during 2005-2010.

The semi-parametric framework is established to identify the determinants of health expenditures with local-constant least squares (LCLS) and local-linear least squares (LLLS) techniques. The LCLS technique aims to identify correlative determinants among all considered variables, and LLLS technique aims to further distinguish linear decisive and nonlinear control variables among all correlative determinants.

First, root mean square error tends to decrease with irrelative variables smoothed out in regression model, validating the modelling reasonability of the semi-parametric approach. Second, the determinants of average health expenditures for inpatients exhibit considerable variation among regions despite the fact that governmental health expenditure, GDP per-capita, and urbanization do impact average health expenditures for inpatients to a certain extent. Third, both linear decisive and nonlinear control variables vary greatly with national, provincial, and regional data.

First, the illiteracy rate should be further reduced nationally. Second, urbanization development and the average treatment number of inpatients for each physician per day should be strictly controlled in region A and C, respectively, in order to control average health expenditure for inpatients.

First, the semi-parametric framework with LCLS and LLLS techniques allows for data structure-oriented model in regions rather than a uniform and definite model for underlying structure. Second, the research undertakes for the first time a comprehensive data analysis of the determinants of average health expenditures for inpatients with national and regional data in China.

The aims of this paper are to illustrate the use of Lean tools to reduce inpatient waiting time and to evaluate critical success factors of Lean implementation in an inpatient pharmacy in a Thai public hospital.

This study was carried out through action research methodology by following four key phases: identification of problems; planning action; taking action; and evaluation. In the “taking action” phase, Lean tools, including value stream mapping and 5S were implemented to improve dispensing process in an inpatient pharmacy. In the “evaluation phase”, the critical success factors of Lean implementation in an inpatient pharmacy were evaluated by the participants.

Lean methodology was successfully implemented to reduce the waiting time associated with a three days dose distribution system. As a result of Lean application, the average process time reduced from 8.81 to 7.2 min and the standard deviation reduced from 5.49 to 4.45 min. Moreover, the support of middle management and the leadership were the key success factors of Lean implementation in an inpatient pharmacy.

Hospitals can improve the dispensing process by using Lean tools which are easy to apply and use. This study is appropriate for hospital managers looking for changes in pharmacy services or other departments.

This is the first study that has applied Lean tools to improve the dispensing process in an inpatient pharmacy in Thai hospitals. This study offers important insights into the critical success factors of Lean employment in the inpatient pharmacy.

Inpatient colonoscopy bowel preparation quality is frequently suboptimal. This quality improvement (QI) intervention is focused on regimenting this process to impact important outcomes.

Define, Measure, Analyze, Improve and Control (DMAIC) methodology was employed, including generating a root-cause analysis to identify factors associated with inpatient bowel quality. These findings motivated the creation of a standardized electronic health record (EHR)-based order set with consistent instructions and anticipatory guidance for administering providers.

There were 264 inpatient colonoscopies evaluated, including 198 procedures pre-intervention and 66 post-intervention. The intervention significantly improved the adequacy of right colon bowel preparations (75.0 percent vs 86.9 percent, p = 0.04) but not overall preparation quality (73.7 percent vs 80.3 percent, p = 0.22). The intervention led to numerical improvement in the proportion of procedures in which the preparation quality interfered with making a diagnosis (10 percent–6 percent, p = 0.29) or resulted in an aborted procedure (3.5 percent–1.5 percent, p = 0.39). After the intervention, provider satisfaction with the ordering process significantly increased (23.3 percent vs 61.1 percent, p < 0.001).

The QI intervention significantly reduced the number of inpatient colonoscopies with inadequate preparation in the right colon, while also modestly improving the diagnostic yield and proportion of aborted procedures. Importantly, the standardized EHR order set substantially improved provider satisfaction, which should justify broader use of such tools.

Novel clinical outcomes such as ability to answer diagnostic questions were improved using this intervention. The results align with strategic goals to enhance provider experience and continuously improve quality of patient care.

There is evidence that novel psychoactive substances (NPS) are commonly used by people with severe mental illness. The purpose of this paper is to undertake a scoping survey to explore the inpatient mental health workers’ perceptions of NPS use by consumers.

A cross-sectional online survey of mental health professionals is used in the study. The participants were opportunistically recruited through social media and professional networks.

A total of 98 participants (of 175 who started the survey) were included in the analysis. All reported that some patients had used NPS prior to admission. Over 90 per cent of participants reported observing at least one adverse event relating to NPS use in the previous month. The majority of participants reported that patients had used NPS during their inpatient admission. Three quarters were not clear if their workplace had a policy about NPS. Most wanted access to specific NPS information and training. The participants reported that they lacked the necessary knowledge and skills to manage NPS use in the patients they worked with.

Whilst the authors are cautious about the generalisability (due to methodological limitations), the findings provide useful insight into the perceptions of inpatient staff regarding the extent and impact of NPS use including concerns regarding the impact on mental and physical health, as well as ease of availability and a need for specific training and guidance.

Mental health professionals require access to reliable and up-to-date information on changing trends in substance use. Local policies need to include guidance on the safe clinical management of substance use and ensure that NPS information is included.

To the best of the authors’ knowledge, this is the first survey of the perceptions of mental health staff working in inpatient mental health settings regarding NPS. The findings suggest that NPS is a common phenomenon in inpatient mental health settings, and there is a need for more research on the impact of NPS on people with mental health problems.

This paper aims to explore inpatient staff experiences of seeking to meet the religious and cultural needs of Black, Asian and Minority Ethnic (BAME) inpatients on mental health wards.

Nine semi-structured interviews were undertaken with inpatient staff in one NHS Trust in England to explore their views and experiences of supporting BAME inpatients to meet their religious and cultural needs. Anonymised transcripts were analysed thematically.

Inpatient staff reported lacking the confidence and knowledge to identify and meet BAME inpatients’ religious and cultural needs, especially inpatients from smaller ethnic groups and newly emerging communities. There was no specific assessment used to identify religious and cultural needs and not all inpatient staff received training on meeting these needs. Concerns were raised about difficulties for staff in differentiating whether unusual beliefs and practices were expressions of religiosity or delusions. Staff identified the potential role of inpatients’ family members in identifying and meeting needs, explaining religious and cultural beliefs and practices, and psychoeducation to encourage treatment or medication adherence.

Potential ways to address this gap in the knowledge and confidence of inpatient staff to meet the religious and cultural needs of BAME patients include training for inpatient staff; the production and updating of a directory of common religious and cultural practices and needs; local resources which can help to support those needs; and religious and cultural practices and needs being documented by mental health practitioners in community teams such that this information is readily available for inpatient staff if a service user is admitted.

This is the first study to consider inpatient staff views on meeting the religious and cultural needs of BAME informal patients and patients detained under the Mental Health Act 1983.

The purpose of this study was to explore the predictive validity of the revised Problem Identification Checklist (PIC‐R) in predicting inpatient and community violence using a retrospective design. The Historical Scale (H‐Scale) of the HCR‐20 was employed to control for static risk factors. The predictive accuracy between predictors and outcome measures was evaluated using Receiver Operating Characteristics (ROC) analysis. The PIC‐R significantly predicted inpatient violence (AUC range 0.77‐0.92) over a 12‐month follow‐up period but did not predict community violence. Conversely, the H‐Scale significantly predicted community violence (AUC 0.82) but did not predict inpatient violence over a 12‐month follow‐up period. The findings offer preliminary validation for the predictive accuracy of the PIC‐R for violence in a UK inpatient population. Additionally, the findings suggest that short‐term risk of violence within a psychiatric inpatient population may be more related to dynamic and clinical risk variables rather than to static ones.

As the use of drugs and alcohol by clients accessing mental health services becomes increasingly common, members of staff working within psychiatric inpatient areas often encounter drug and alcohol misuse among their client group. The safe and effective management of this issue has become a priority for many inpatient services. This paper outlines a policy for the management of substance misuse on psychiatric inpatient wards developed by Manchester Mental Health and Social Care Trust. The fundamental principles underpinning the policy are highlighted, and the key sections of the policy are described. There is a detailed description of how the policy has been applied in practice by members of staff working on inpatient wards, with clinical examples being presented.