Search results

1 – 10 of over 1000
To view the access options for this content please click here
Article
Publication date: 5 October 2015

Chris Johnstone, Rachel Harwood, Andrew Gilliam and Andrew Mitchell

Early access to senior decision makers and investigations has improved outcomes for many conditions. A surgical clinical decisions unit (CDU) was created to allow rapid…

Abstract

Purpose

Early access to senior decision makers and investigations has improved outcomes for many conditions. A surgical clinical decisions unit (CDU) was created to allow rapid assessment and investigation by on-call senior surgical team members to facilitate decision making and, if appropriate, discharge within a set time frame (less than four hours). The purpose of this paper is to compare outcomes for unscheduled general surgery admissions to the hospital before and after commissioning this unit.

Design/methodology/approach

Prospectively collected hospital episode statistics data were compared for all general surgical admissions for one year prior to (July 2010-June 2011) and two years after (July 2011-June 2013) the introduction of the CDU. Statistical analysis using the Mann Whitney U-test was performed.

Findings

More patients were discharged within 24 hours (12 per cent vs 20 per cent, p < 0.001) and total hospital stay decreased (4.6 days vs 3.2 days, p < 0.001) following introduction of CDU. Admission via A & E (273 vs 212, p < 0.01) was also decreased. Overall there was a 25.3 per cent reduction in emergency surgical admissions. No difference was noted in 30-day readmission rates (47 vs 49, p=0.29).

Originality/value

The introduction of a CDU in has increased early discharge rates and facilitated safe early discharge, reducing overall hospital stay for unscheduled general surgical admissions. This has decreased fixed bed costs and improved patient flow by decreasing surgical care episodes routed through the emergency department (ED). In all, 30-day readmission rates have not been influenced by shorter hospital stay. Service redesign involving early senior decision making and patient investigation increases efficiency and patient satisfaction within unscheduled general surgical care. Not original but significant in that the model has not been widely implemented and this is a useful addition to the literature.

Details

Clinical Governance: An International Journal, vol. 20 no. 4
Type: Research Article
ISSN: 1477-7274

Keywords

To view the access options for this content please click here
Article
Publication date: 1 January 2014

Kirsten McArdle, Edmund Leung, Neil Cruickshank and Veronique Laloe

The Royal College of Surgeons published Standards for Unscheduled Surgical Care in response to variable clinical outcomes for emergency surgery. The purpose of this study…

Abstract

Purpose

The Royal College of Surgeons published Standards for Unscheduled Surgical Care in response to variable clinical outcomes for emergency surgery. The purpose of this study is to assess for feasibility of a district hospital providing care in accordance to the recommendations.

Design/methodology/approach

A total of 100 consecutive patient unscheduled episodes of care were prospectively included. Information regarding demographics, timeliness of investigations, operations, consultant input and clinical outcomes was collated. All patients were risk-adjusted for mortality. The data were compared to the guidelines.

Findings

A total of 91 patients were included; 80 patients underwent surgery. There were 18 deaths (22.5 per cent), eight (10 per cent) post-operative within 30 days. There was no statistical difference between deaths and day of admission or surgery. There were 39 critically-ill patients, none were reviewed by a consultant within the recommended 30 minutes. Of the critically-ill patients, 23 underwent CT scanning, none within the recommended 30 minutes. All patients were operated within the recommended timeframe by urgency grading. For those predicted mortality rate >5 per cent, a consultant was present in theatre for 97 per cent of cases. All patients had a consultant review within 24 hours of admission.

Originality/value

To the authors' knowledge this is the first evaluation of the practical difficulties in achieving consultant delivered care in surgery in a district general hospital. These results are interesting to clinicians and service planners involved in developing emergency services. Adhering to these guidelines would require significant re-allocation of resources in most hospitals and may require centralisation of services.

Details

Clinical Governance: An International Journal, vol. 19 no. 1
Type: Research Article
ISSN: 1477-7274

Keywords

To view the access options for this content please click here
Article
Publication date: 1 November 2018

Rebecca Feo, Frank Donnelly, Åsa Muntlin Athlin and Eva Jangland

Globally, acute abdominal pain (AAP) is one of the most common reasons for emergency admissions, yet little is known about how this patient group experiences the delivery…

Abstract

Purpose

Globally, acute abdominal pain (AAP) is one of the most common reasons for emergency admissions, yet little is known about how this patient group experiences the delivery of fundamental care across the acute care delivery chain. The purpose of this paper is to describe how patients with AAP experienced fundamental care across their acute care presentation, and to explicate the health professional behaviours, reported by patients, that contributed to their positive experiences.

Design/methodology/approach

A qualitative descriptive study, using repeated reflective interviews, was analysed thematically (n=10 patients).

Findings

Two themes were identified: developing genuine, caring relationships with health professionals and being informed about one’s care. Patients reported that health professionals established genuine professional–patient relationships despite the busy care environment but perceived this environment as impeding information-provision. Patients were typically accepting of a lack of information, whereas poor professional–patient relationships were seen as inexcusable.

Practical implications

To provide positive fundamental care experiences for patients with AAP, health professionals should establish caring relationships with patients, such as by using humour, being attentive, and acknowledging patients’ physical pain and emotional distress; and should inform patients about their care, including allowing patients to ask questions and taking time to answer those questions.

Originality/value

This is the first Australian study to explore the experiences of patients with AAP across the acute care delivery chain, using a novel method of repeated interviews, and to demonstrate how fundamental care can be delivered, in clinical practice, to ensure positive patient experiences.

Details

Journal of Health Organization and Management, vol. 33 no. 1
Type: Research Article
ISSN: 1477-7266

Keywords

To view the access options for this content please click here
Article
Publication date: 20 June 2008

Janet M. Scott and Peri Hawkins

This paper aims to explore the unintentional formation of internal functional barriers, (organisational silos) during moves towards departmental efficiency, within an…

Downloads
1305

Abstract

Purpose

This paper aims to explore the unintentional formation of internal functional barriers, (organisational silos) during moves towards departmental efficiency, within an acute trust, and the subsequent effects on the discharge process in elderly patients.

Design/methodology/approach

This paper presents some of the findings from a qualitative study examining the role of the nurse in the discharge process. Semi‐structured interviews were conducted with a purposively selected cohesive sample of 28 registered nurses, from the medical and elderly care wards in an NHS Acute Trust. The interviews were taped, transcribed and their content analysed.

Findings

The problems associated with patient discharge were frequently operational. Each part of the process was hindered, often inadvertently, by attempts on the part of individuals, departments and services to make themselves efficient, without regard for the resulting organisational consequences. This left the ward nurses attempting to overcome the obstacles in an attempt to effectively discharge patients, within a required period of time.

Research limitations/implications

It is recognised that, the perceptions of those not participating in the study may have been different to those who did participate. As a small study in one trust the results may not be generalisable.

Practical implications

It is imperative that evaluation of operational changes is undertaken, with particular regard to the consequences of change, for other services, patients and clients.

Originality/value

This type of study can provide a method of diagnosing organisational problems, especially in areas that are reliant on inter‐professional and departmental collaboration

Details

Journal of Health Organization and Management, vol. 22 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

To view the access options for this content please click here
Article
Publication date: 20 June 2016

Davina Allen

The purpose of this paper is to underline the importance of taking work practices into account for quality improvement (QI) purposes, highlight some of the challenges of…

Downloads
3245

Abstract

Purpose

The purpose of this paper is to underline the importance of taking work practices into account for quality improvement (QI) purposes, highlight some of the challenges of doing so, and suggest strategies for future research and practice. Patient status at a glance, a Lean-inspired QI intervention designed to alleviate nurses of their knowledge mobilisation function, is deployed as an illustrative case.

Design/methodology/approach

Ethnographic data and practice-based theories are utilised to describe nurses’ knowledge mobilisation work. The assumptions about knowledge sharing embedded in patient status at a glance white boards (PSAGWBs) are analysed drawing on actor network theory.

Findings

There is a disparity between nurses’ knowledge mobilisation practices and the scripts that inform the design of PSAGWBs. PSAGWBs are designed to be intermediaries and to transport meaning without transformation. When nurses circulate knowledge for patient management purposes, they operate as mediators, translating diverse information sources and modifying meaning for different audiences. PSAGWBs are unlikely to relieve nurses of their knowledge mobilisation function and may actually add to the burdens of this work. Despite this nurses have readily embraced this QI intervention.

Research limitations/implications

The study is limited by its focus on a single case and by the inferential (rather than the empirical) nature of its conclusions.

Originality/value

This paper illustrates the importance of taking practice into account in healthcare QI, points to some of the challenges of doing so and highlights the potential of practice-based approaches in supporting progress in this field.

Details

Journal of Health Organization and Management, vol. 30 no. 4
Type: Research Article
ISSN: 1477-7266

Keywords

To view the access options for this content please click here
Article
Publication date: 1 October 2004

Paul Walley and Ben Gowland

Problem‐solving teams, involving front‐line staff, are widely used to achieve continuous process improvement. Approaches such as “plan‐do‐study‐act” (PDSA) cycles, are now…

Downloads
8702

Abstract

Problem‐solving teams, involving front‐line staff, are widely used to achieve continuous process improvement. Approaches such as “plan‐do‐study‐act” (PDSA) cycles, are now a core element of many health‐care improvement initiatives. This paper evaluates the use of PDSA improvement cycles within the UK National Health Service, using emergency care improvement activity as a source of research evidence. It was found that, despite an abundance of information on how to implement this type of change, many senior professionals still misinterpret how this should work. This has implications for how such methodologies are implemented. There is a long way to go in allowing greater employee involvement, moving much further away from the “management committee” style of change. Care has to be taken to ensure that empowered employees are working to consistent and appropriate objectives. It is important that senior personnel develop process understanding alongside the workforce, rather than simply providing distant support.

Details

International Journal of Health Care Quality Assurance, vol. 17 no. 6
Type: Research Article
ISSN: 0952-6862

Keywords

To view the access options for this content please click here
Article
Publication date: 5 August 2014

Kate Silvester, Paul Harriman, Paul Walley and Glen Burley

– The purpose of the paper is to investigate the potential relationships between emergency-care flow, patient mortality and healthcare costs using a patient-flow model.

Downloads
1017

Abstract

Purpose

The purpose of the paper is to investigate the potential relationships between emergency-care flow, patient mortality and healthcare costs using a patient-flow model.

Design/methodology/approach

The researchers used performance data from one UK NHS trust collected over three years to identify periods where patient flow was compromised. The delays’ root causes in the entire emergency care system were investigated. Event time-lines that disrupted patient flow and patient mortality statistics were compared.

Findings

Data showed that patient mortality increases at times when accident and emergency (A&E) department staff were struggling to admit patients. Four delays influenced mortality: first, volume increase and mixed admissions; second, process delays; third, unplanned hospital capacity adjustments and finally, long-term capacity restructuring downstream.

Research limitations/implications

This is an observational study that uses process control data to find times when mortality increases coincide with other events. It captures contextual background to whole system issues that affect patient mortality.

Practical implications

Managers must consider cost-decisions and flow in the whole system. Localised, cost-focused decisions can have a detrimental effect on patient care. Attention must also be paid to mortality reports as existing data-presentation methods do not allow correlation analysis.

Originality/value

Previous studies correlate A&E overcrowding and mortality. This method allows the whole system to be studied and increased mortality root causes to be understood.

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 7
Type: Research Article
ISSN: 0952-6862

Keywords

To view the access options for this content please click here
Article
Publication date: 13 August 2018

Esmat Swallmeh, Vivienne Byers and Amr Arisha

Assessing performance and quality in healthcare organisations is moving from focussing solely on clinical care measurement to considering the patient experience as…

Abstract

Purpose

Assessing performance and quality in healthcare organisations is moving from focussing solely on clinical care measurement to considering the patient experience as critical. Much patient experience research is quantitative and survey based. The purpose of this paper is to report a qualitative study gathering in-depth data in an emergency department (ED).

Design/methodology/approach

The authors used empirical data from seven focus groups to understand patient experience as participants progressed through a major teaching hospital in an Ireland ED. A convenience sampling technique was used, and 42 participants were invited to share their perceptions and outline key factors affecting their journey. A role-playing exercise was used to develop improvement themes. Data were analysed using thematic analysis and data analysis software (NVivo 10).

Findings

Capturing ED patient experience increases our understanding and process impact on the patient journey. Factors identified include information, access, assurance, responsiveness and empathy, reliability and tangibles such as surroundings, food and seating.

Research limitations/implications

Owing to the ED patient’s emergency nature, participants were recruited if triaged at levels 3–5 (Manchester Triage System). The study explored patients’ immediate rather than post hoc experiences where recollections may change over time.

Originality/value

To the authors’ knowledge, no study has examined in-depth, ED patient experience in Ireland using qualitative interviewing, obtaining critical process insights as it occurs. The potential to inform patient process improvements in Irish EDs is significant.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 7
Type: Research Article
ISSN: 0952-6862

Keywords

To view the access options for this content please click here
Article
Publication date: 22 February 2011

Manda Broekhuis and Dirk Pieter van Donk

The purpose of this paper is to investigate the impact of three different dimensions of customer‐induced uncertainty and task uncertainty on the mix of physicians'…

Downloads
1237

Abstract

Purpose

The purpose of this paper is to investigate the impact of three different dimensions of customer‐induced uncertainty and task uncertainty on the mix of physicians' coordination practices.

Design/methodology/approach

An improvement and research project are combined resulting in 16 case studies in different departments from one university hospital. The paper relies mainly on patient data from hospitals' registration systems and on 140 dialogues between two physicians reflecting on their coordination practices.

Findings

Hospital units rely on time‐structured oral communication supplemented with feedback in cases of high levels of input variety, whereas severity of illness and service intensity increase the use of unstructured oral coordination practices. High levels of customer‐induced uncertainty reduce coordination by standardization of work processes. Supplementing verbal communication with written medical records has become an inherent part of coordination practices. Non‐surgical units rely mostly on time‐structured meetings, whereas surgical units use both time‐structured and unstructured meetings to deal with customer‐induced uncertainty.

Research limitations/implications

The empirical part of this paper is limited to hospital units that are functionally organized. A further refinement and extension of measures for the contingency factors could help to better understand coordination practices.

Practical implications

The paper offers hospitals in‐depth understanding of how customer‐induced uncertainty and task uncertainty affect physicians' coordination practices.

Originality/value

The paper contributes to the knowledge on medical coordination from a contingency perspective. Further, the paper contributes to alternative methodologies in terms of data gathering as dialogues between organizational members are the main data source.

Details

International Journal of Operations & Production Management, vol. 31 no. 3
Type: Research Article
ISSN: 0144-3577

Keywords

To view the access options for this content please click here
Book part
Publication date: 24 October 2019

Susan P. McGrath, Irina Perreard, Joshua Ramos, Krystal M. McGovern, Todd MacKenzie and George Blike

Failure to rescue events, or events involving preventable deaths from complications, are a significant contributor to inpatient mortality. While many interventions have…

Abstract

Failure to rescue events, or events involving preventable deaths from complications, are a significant contributor to inpatient mortality. While many interventions have been designed and implemented over several decades, this patient safety issue remains at the forefront of concern for most hospitals. In the first part of this study, the development and implementation of one type of highly studied and widely adopted rescue intervention, algorithm-based patient assessment tools, is examined. The analysis summarizes how a lack of systems-oriented approaches in the design and implementation of these tools has resulted in suboptimal understanding of patient risk of mortality and complications and the early recognition of patient deterioration. The gaps identified impact several critical aspects of excellent patient care, including information-sharing across care settings, support for the development of shared mental models within care teams, and access to timely and accurate patient information.

This chapter describes the use of several system-oriented design and implementation activities to establish design objectives, model clinical processes and workflows, and create an extensible information system model to maximize the benefits of patient state and risk assessment tools in the inpatient setting. A prototype based on the product of the design activities is discussed along with system-level considerations for implementation. This study also demonstrates the effectiveness and impact of applying systems design principles and practices to real-world clinical applications.

Details

Structural Approaches to Address Issues in Patient Safety
Type: Book
ISBN: 978-1-83867-085-6

Keywords

1 – 10 of over 1000