Holistic review of people with diabetes and chronic kidney disease reveals important multimorbidity and unmet clinical need: The ENHIDE diabetes renal telehealth pilot study.

Diabetes and kidney disease commonly coexist and management is complex given frequent additional comorbidity. The East and North Herts Institute of Diabetes and Endocrinology (ENHIDE) renal diabetes telehealth project examined the feasibility of data extraction from primary care records for virtual consultant review as a prelude to a telehealth case-based discussion with primary care teams. Data extraction identified 2,356 cases from 16 general practices, of which 14 took part in a skype telehealth case-based discussion session. The service was well received by primary care as a workable means of delivering patient care. In addition, significant unmet clinical needs were identified with opportunities to empower patient self-management of acute metabolic and foot issues, and better coordination of care between specialist diabetes and renal teams. The increasing clinical burden in all care settings and the commitment in the NHS plan for wider use of digital healthcare and streamlining of outpatient care highlight the need for service reconfiguration.

A seven-day diabetes service for inpatients and the emergency department in an acute hospital setting - the East and North Herts Diabetes Outreach Team (DOT).

There is evidence that all hospital-based care needs to improve across 7 days. Inpatients with diabetes require better specialist attention and improved clinical outcomes. The East and North Herts inpatient diabetes service has responded to this challenge with care now delivered by consultants and diabetes nurses, 365 days per year. We set out to provide a prospectively measurable improvement in ascertainment of appropriate patients alongside a 'care bundle' to ensure they receive a better quality experience. We also set out to document quantifiable changes in clinical data. A seven-day service is now in place and provides a variety of benefits to both professionals and patients alike.

Discharge criteria: 'just in case'.

According to the Association of Anaesthetists of Great Britain and Ireland (AAGBI 2002) the increasing complexity of surgical procedures has increased the need for improved monitoring of the postoperative patient. 'Recovery' of a patient has moved from a brief period of observation towards one of assessment and evaluation during the immediate postoperative phase. The purpose of this article is to explore current practice with a focus on the application and importance of discharge criteria. Critical analysis will highlight the responsibilities and accountability of the recovery practitioner (a registered nurse (RN) or operating department practitioner (ODP)) when discharging the patient. Conversely, the article will also explore the tensions in relation to effective application of the discharge criteria and the recovery practitioner's professional accountability. The term 'recovery practitioner' will be used throughout this paper to refer to those who are chiefly employed to care for patients in the recovery room, or more contemporarily referred to as the post anaesthetic care unit (PACU).

Extubation reflectivity.

The purpose of this article is to share a recovery room practitioner's experience using reflection and to explore the issues surrounding extubation in the post anaesthetic care unit (PACU). Currently there are no national standards of practice for practitioners' learning and safe practice of extubation techniques within the PACU. Therefore, the possibility of an adverse incident is significantly increased, potentially causing harm to the patient and damage to any hospital's reputation as well as the practitioners' profession. The authors wish to identify the concerns by citing a clinical incident that lead to reflection and sharing of the experience through this article.

Extubation Reflectivity.

The purpose of this article is to share a recovery room practitioner's experience using reflection and to explore the issues surrounding extubation in the post anaesthetic care unit (PACU). Currently there are no national standards of practice for practitioners' learning and safe practice of extubation techniques within the PACU. Therefore, the possibility of an adverse incident is significantly increased, potentially causing harm to the patient and damage to any hospital's reputation as well as the practitioners' profession. The authors wish to identify the concerns by citing a clinical incident that lead to reflection and sharing of the experience through this article.