The introduction of a Parkinson's disease email alert system to allow for early specialist team review of inpatients.

BACKGROUND: Patients with Parkinson's disease (PWP) have complex healthcare needs, and compared to the general population, are more likely to have an unplanned emergency department (ED) attendance to hospital, along with poorer outcomes. Innovative methods of notification, when patients have an ED attendance are needed to allow for earlier specialist team interventions. This study describes the introduction of an email alert (e-alert) for a specialist Parkinson's team. In addition, the reason for admission, specialist team interventions, length of stay, frequency of readmission, discharge destination, mortality and the bed cost per ED attendance or admission episode will be explored. METHODS: The e-alert was developed in collaboration with academics, a Parkinson's specialist team and hospital Information technology (IT) specialists, by employing existing software and IT system platforms. Patients were identified from an existing hospital patient administration and a specialist movement disorder database. Specific variables along with routine patient data were collected including demographics, clinical variables, specialist team interventions, reason for admission, length of stay, discharge destination, unscheduled readmission, mortality and bed cost per day. RESULTS: The initial programming and setup of the e-alert was estimated to be around £3000. In its first six months, the e-alert identified 75 ED attendances, with the most common reasons being, falls and infections. The overall mean LOS was 6.8 days, with 25/75 patients being readmitted within 28 days. The most common specialist team clinical interventions were changes in medication, assessment for postural hypotension, neuropsychiatric and swallowing assessments. The majority of patients (92%) were discharged to their normal place of residence. The crude mortality rate for the cohort was approximately twice that of the hospital average. The total ED and acute bed cost was estimated to be £354,805.88, with exponential rises in healthcare costs when LOS was greater than one day. CONCLUSIONS: The Parkinson's e-alert was found to a useful adjunct to existing hospital data systems in identifying PWP who have unplanned emergency attendances. Additionally, this system can also be employed as a service evaluation tool. However, further evaluation is needed to determine if this system can improve patient outcomes during their unplanned emergency attendance to hospital.

Improving the quality of electronic discharge summaries from medical wards: A quality improvement project.

INTRODUCTION: The electronic discharge (e-discharge) summary forms an essential component of communication between secondary and primary care. However, its content and quality can often be substandard due to inadequate or inaccurate information. METHOD: Two retrospective audits were completed with intervening e-discharge workshops. Local general practitioners were involved in identifying areas for improvement and assisted with the workshops. Crib sheets were emailed to all junior staff and posted on all medical wards. RESULTS: There was an improvement in the quality of e-discharges with particular improvements on the documentation of test results and patient progress and outcome. Those who attended the workshops produced better quality e-discharges and none recommended unnecessary actions for general practitioners. CONCLUSIONS: E-discharge workshops are effective in improving the overall quality of discharge summaries from medical wards. Introduction of mandatory e-discharge training sessions during hospital induction and junior doctor rotations would be beneficial to teach this important yet challenging skill.

The contributions of NHS healthcare workers who are shielding or working from home during COVID-19.

During the COVID-19 pandemic, many healthcare staff and others who work for the NHS have been working from home (WFH) or shielding due to various health conditions, including pregnancy. While emphasis has been given to the support and wellbeing of those working at the frontline, little is known about the contribution of those who are working remotely. This online survey attempts to throw some light on how these healthcare workers have been contributing to the NHS while WFH, the resources they may or may not have to undertake their remote duties, their perception of whether their contribution is valued at the workplace, and their views on whether the new ways of working would influence the manner in which they would work in the future.