An evaluation of the impact of the key information summary on GPs and out-of-hours clinicians in NHS Scotland.

BACKGROUND AND AIMS: Key information summary is one of the first national shared electronic patient records enabling GPs to share clinical information with unscheduled care providers, including out-of-hours. Implemented during 2013, over 90,000 patient records have been created. This evaluation identified the impact of key information summary on healthcare services. METHODS: Evidence was collected using online questionnaires and structured telephone interviews. Opinions providing a numerical estimate of value were analysed using statistical methods, while qualitative responses were synthesised using thematic analysis. RESULTS: The vast majority of respondents from 441 GP practices and 33 out-of-hours clinicians show that key information summary enhances patient safety, improves clinical management, reduces hospital admissions, empowers clinicians, aids communication across services and enables decisions to be responsive to patients' wishes. CONCLUSIONS: Patients willingly consent to share data with unscheduled care clinicians. Patients benefitting include those with palliative, complex or multiple conditions, at high risk of using emergency services. Out-of-hours clinicians would welcome more key information summaries, all well-completed and including social care information. Improvements include software enhancements and wider sharing of information with all unscheduled care services.

The true malignancy risk of Bosniak III cystic renal lesions: Active surveillance or surgical resection?

INTRODUCTION: We sought to evaluate the pathological results of renal masses in comparison with Bosniak III renal cystic lesions to determine the actual malignancy risk. METHODS: A retrospective review of Bosniak III renal lesions identified by computed tomography (CT) or magnetic resonance imaging (MRI) were collected from our patients between August 1, 2013 and December 31, 2015 who underwent surgical excision. TNM stage, histology, Fuhrman grade, and maximum lesion size data was collected. Lesion size relationship with prevalence of malignancy was completed by two-tailed t-test, using the homogeneity hypothesis between malignant and benign groups. RESULTS: Fifteen of 25 (60%) of Bosniak III lesions were determined to be malignant. All malignant lesions were classified as either Fuhrman grade 1 or 2 with no evidence of progression to Bosniak IV. Average size of malignant lesions was smaller than those of benign pathology (3.52±1.99 cm vs. 5.66±2.53 cm; p=0.041). Smaller lesions (size <4 cm) were more likely to be malignant than lesions of a larger size (p=0.047). CONCLUSIONS: The malignancy risk of Bosniak III renal lesions was 60% in our study. All Bosniak III lesions were of low Fuhrman grade with no evidence of progression. No patient in this study developed metastatic disease within the three-year followup period. Smaller (<4 cm) Bosniak III cysts were more likely to be malignant and lesion size should be taken into consideration when considering management of complex cysts. Active surveillance may be a reasonable option for Bosniak III cystic lesions, regardless of overall size, based upon their universal low grade and no patient developing metastatic disease.

An economic analysis of the national shared Emergency Care Summary in Scotland.

The Emergency Care Summary (ECS) in Scotland provides essential clinical and demographic information about patients needing unscheduled or emergency care. Information about patients' medications, adverse drug reactions and allergies is transferred twice every day from GP systems to the ECS. Access is then available to authorised health-care professionals at the national help line, at out-of-hours services and in accident and emergency departments. An economic analysis of the ECS implementation showed that annual benefits exceeded annual costs after about seven years. Approximately 77% of the benefits were non-financial and 23% from redeployed finance. No cash savings were planned and none were realised. As ECS utilisation increased from 2006, the net benefits became positive. This relationship between utilisation and net benefits is a common feature of successful e-health investment.