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1.
BMJ ; 368: m517, 2020 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-32205307

RESUMO

The studyPowell J, Atherton H, Williams V, et al. Using online patient feedback to improve NHS services: the INQUIRE multimethod study. Health Serv Deliv Res 2019;7:38.This project was funded by the NIHR Health Services and Delivery Research programme (project number HS&DR 14/04/48).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000861/online-patient-feedback-is-mostly-positive-but-is-not-being-used-effectively.


Assuntos
Retroalimentação , Satisfação do Paciente , Medicina Estatal , Participação da Comunidade , Humanos , Medicina Estatal/normas , Reino Unido
2.
Br J Nurs ; 29(5): 324-325, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32167818

RESUMO

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses two patient safety reports, which stress the importance of taking proper action when patient safety incidents occur.


Assuntos
Segurança do Paciente , Qualidade da Assistência à Saúde , Medicina Estatal , Humanos , Medicina Estatal/normas , Reino Unido
5.
Br J Nurs ; 29(4): 250-251, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32105535

RESUMO

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses some recent patient reports and crisis events.


Assuntos
Relatórios Anuais como Assunto , Segurança do Paciente , Medicina Estatal/legislação & jurisprudência , Comitês Consultivos , Feminino , Humanos , Serviços de Saúde Materna/normas , Gravidez , Qualidade da Assistência à Saúde , Medicina Estatal/normas , Reino Unido
6.
Br J Nurs ; 29(3): 174-175, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32053432

RESUMO

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses a Healthwatch report showing that improvements need to take place in the way the NHS reports on patient complaints.


Assuntos
Satisfação do Paciente , Medicina Estatal/organização & administração , Humanos , Cultura Organizacional , Segurança do Paciente , Qualidade da Assistência à Saúde , Medicina Estatal/normas , Reino Unido
8.
Br J Nurs ; 29(1): 75, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31917946

RESUMO

Sam Foster, Chief Nurse, Oxford University Hospitals, considers the need for nurse leaders to champion progress in digital technology and information-sharing with the aim of providing better care.


Assuntos
Registros Eletrônicos de Saúde/organização & administração , Enfermeiras Administradoras/psicologia , Medicina Estatal/normas , Inglaterra , Humanos
10.
Int J Med Inform ; 134: 104030, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31864097

RESUMO

BACKGROUND: A recent review of primary care serious incidents suggests that diagnosis and assessment problems, underpinned by communication failures, involving the UK telephone triage service, NHS 111, may contribute to patient harm. METHODS: The present study utilised conversation analysis to address the lack of evaluative research examining the NHS 111 system and in particular interactions between system components (call handler, computerized decision support system, patients/caller). RESULTS: Analysis of audio recorded call interactions revealed interactional misalignment across four mapped call phases (eliciting caller details, establishing reason for call, completing the Pathways assessment, and agreeing the outcome). This misalignment has the capacity to increase the risk of system failure, particularly in relation to assessment problems and issues related to the accurate transfer of care advice. Our analysis suggests that efforts to enhance the NHS 111 system, similar telehealth services, and patient safety management more generally, should shift their focus from a limited set of individual components towards a system-specific interactionist perspective encompassing all elements. CONCLUSIONS: Further evaluative research is required in order to build a comprehensive evidence-base concerning the multiple interacting factors influencing patient safety in the NHS 111 system.


Assuntos
Comunicação , Assistência à Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/normas , Medicina Estatal/normas , Telefone/normas , Triagem/normas , Humanos , Atenção Primária à Saúde/normas , Telefone/estatística & dados numéricos , Triagem/métodos , Reino Unido
11.
Br J Nurs ; 28(22): 1492-1493, 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31835946

RESUMO

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses some recent patient safety crises, litigation claims and a new patient safety publication from NHS Resolution.


Assuntos
Segurança do Paciente/normas , Medicina Estatal/normas , Saúde Global , Humanos , Liderança , Imperícia/legislação & jurisprudência , Medicina Estatal/legislação & jurisprudência , Reino Unido
13.
BMJ ; 367: l6090, 2019 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-31722875

RESUMO

OBJECTIVES: To quantify post-colonoscopy colorectal cancer (PCCRC) rates in England by using recent World Endoscopy Organisation guidelines, compare incidence among colonoscopy providers, and explore associated factors that could benefit from quality improvement initiatives. DESIGN: Population based cohort study. SETTING: National Health Service in England between 2005 and 2013. POPULATION: All people undergoing colonoscopy and subsequently diagnosed as having colorectal cancer up to three years after their investigation (PCCRC-3yr). MAIN OUTCOME MEASURES: National trends in incidence of PCCRC (within 6-36 months of colonoscopy), univariable and multivariable analyses to explore factors associated with occurrence, and funnel plots to measure variation among providers. RESULTS: The overall unadjusted PCCRC-3yr rate was 7.4% (9317/126 152), which decreased from 9.0% in 2005 to 6.5% in 2013 (P<0.01). Rates were lower for colonoscopies performed under the NHS bowel cancer screening programme (593/16 640, 3.6%), while they were higher for those conducted by non-NHS providers (187/2009, 9.3%). Rates were higher in women, in older age groups, and in people with inflammatory bowel disease or diverticular disease, in those with higher comorbidity scores, and in people with previous cancers. Substantial variation in rates among colonoscopy providers remained after adjustment for case mix. CONCLUSIONS: Wide variation exists in PCCRC-3yr rates across NHS colonoscopy providers in England. The lowest incidence was seen in colonoscopies performed under the NHS bowel cancer screening programme. Quality improvement initiatives are needed to address this variation in rates and prevent colorectal cancer by enabling earlier diagnosis, removing premalignant polyps, and therefore improving outcomes.


Assuntos
Colonoscopia/métodos , Neoplasias Colorretais , Detecção Precoce de Câncer , Idoso , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Detecção Precoce de Câncer/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade/organização & administração , Fatores de Risco , Medicina Estatal/normas
14.
Br J Nurs ; 28(20): 1340-1341, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31714833

RESUMO

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses the Care Quality Commission's annual assessment of health care and social care in England.


Assuntos
Segurança do Paciente , Qualidade da Assistência à Saúde , Medicina Estatal/normas , Relatórios Anuais como Assunto , Inglaterra , Humanos
15.
BMJ ; 367: l5205, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578187

RESUMO

OBJECTIVES: To determine how clinicians vary in their response to new guidance on existing or new interventions, by measuring the timing and magnitude of change at healthcare institutions. DESIGN: Automated change detection in longitudinal prescribing data. SETTING: Prescribing data in English primary care. PARTICIPANTS: English general practices. MAIN OUTCOME MEASURES: In each practice the following were measured: the timing of the largest changes, steepness of the change slope (change in proportion per month), and magnitude of the change for two example time series (expiry of the Cerazette patent in 2012, leading to cheaper generic desogestrel alternatives becoming available; and a change in antibiotic prescribing guidelines after 2014, favouring nitrofurantoin over trimethoprim for uncomplicated urinary tract infection (UTI)). RESULTS: Substantial heterogeneity was found between institutions in both timing and steepness of change. The range of time delay before a change was implemented was large (interquartile range 2-14 months (median 8) for Cerazette, and 5-29 months (18) for UTI). Substantial heterogeneity was also seen in slope following a detected change (interquartile range 2-28% absolute reduction per month (median 9%) for Cerazette, and 1-8% (2%) for UTI). When changes were implemented, the magnitude of change showed substantially less heterogeneity (interquartile range 44-85% (median 66%) for Cerazette and 28-47% (38%) for UTI). CONCLUSIONS: Substantial variation was observed in the speed with which individual NHS general practices responded to warranted changes in clinical practice. Changes in prescribing behaviour were detected automatically and robustly. Detection of structural breaks using indicator saturation methods opens up new opportunities to improve patient care through audit and feedback by moving away from cross sectional analyses, and automatically identifying institutions that respond rapidly, or slowly, to warranted changes in clinical practice.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Anti-Infecciosos/uso terapêutico , Conjuntos de Dados como Assunto , Substituição de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos/uso terapêutico , Inglaterra , Medicina Geral/organização & administração , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Medicina Estatal/normas , Fatores de Tempo , Infecções Urinárias/tratamento farmacológico
17.
BMC Health Serv Res ; 19(1): 613, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470853

RESUMO

BACKGROUND: The aim was to determine the feasibility of implementing a patient safety survey which measures patients' experiences of their own safety relating to a care transition. This included limited-efficacy testing, determining acceptability (to patients and staff), and investigating integration with existing systems and practices from the staff perspective. METHODS: Mixed methods study in 16 wards across four hospitals, from two English NHS Trusts and four clinical areas; cardiology, care of older people, orthopaedics, stroke. Limited-efficacy testing of a previously validated survey was conducted through collection of patient reports of safety experiences, and thematic comparison with staff safety incident reports. Patient acceptability was determined through analysis of survey response rates and semi-structured interviews. Staff acceptability and integration were investigated through analysis of survey distribution rates, semi-structured interviews and focus groups. RESULTS: Patients returned 366 valid surveys (16.4% response rate) from 2824 distributed surveys (25.1% distribution rate). Older age was a contributing factor to lower responses. Delays were the largest safety concern for patients. Staff incident report themes included five not present in the safety survey data (documentation, pressure ulcers, devices or equipment, staffing shortages, and patient actions). Patient interviews (n = 28) identified that providing feedback was acceptable, subject to certain conditions being met; cognitive-cultural (patient understanding and prioritisation of safety), structural-procedural (opportunities, means and ease of providing feedback without fear of reprisals), and learning and change (closure of the feedback loop). Staff (n = 21) valued patient feedback but barriers to collecting and using the feedback included resource limitations, staff turnover and reluctance to over-burden patients. CONCLUSIONS: Patients can provide meaningful feedback on their experiences and perceptions of safety in the context of care transitions. Providing this feedback was acceptable to some patients, subject to certain conditions being met. Safety experience feedback from patients was also acceptable to staff; quantitative data was perceived as useful to identify potential risks, and qualitative data informed types of changes required to improve care. However, patient feedback was not integrated into any quality improvement initiatives, suggesting there are still significant challenges to healthcare teams or organisations utilising patient feedback, particularly in relation to care transitions.


Assuntos
Segurança do Paciente/normas , Transferência de Pacientes/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Estudos de Viabilidade , Retroalimentação , Feminino , Grupos Focais , Hospitais/normas , Humanos , Aprendizagem , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Equipe de Assistência ao Paciente/normas , Participação do Paciente , Pacientes , Melhoria de Qualidade , Gestão de Riscos , Medicina Estatal/normas , Inquéritos e Questionários , Adulto Jovem
18.
Br J Nurs ; 28(17): 1152-1153, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31556735

RESUMO

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses the Annual Report and Accounts 2018-2019 of the health and social care regulator.


Assuntos
Comitês Consultivos , Relatórios Anuais como Assunto , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Inglaterra , Humanos , Medicina Estatal/normas
19.
Ann R Coll Surg Engl ; 101(8): 584-588, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31537105

RESUMO

INTRODUCTION: The National Institute for Health and Care Excellence published a draft consultation update on abdominal aortic aneurysm, which was expected to be published on 7 November 2018. This article analyses the readiness of NHS hospitals and their workforce to embrace the proposed guidelines. METHODS: The trust and individual surgeon-level anonymised data in the public domain for elective, rupture and complex abdominal aortic aneurysm cases were collected and analysed for all the acute care trusts providing these services from the Vascular Society of Great Briton and Ireland's prospective National Vascular Registry database. RESULTS: Of the 95 acute care trusts providing the service for the year 2017, the annual volume of infrarenal abdominal aortic aneurysm (both endovascular and open repairs) ranged between 0 and 137. Of these, 64 (67.36%) trusts had an annual volume of fewer than 60 cases. A total of 366 (approximately 75% of 490) vascular surgeons have performed 10 or fewer open abdominal aortic aneurysm repairs in three years (2014-2016) with a mean operating volume of 1.452 procedures per surgeon per three years (n = 254, median 0, interquartile range, IQR, 0-3, 0.484 procedures per surgeon per year) and about 51% of the vascular surgeons have only performed five or fewer procedures in those three years with a mean operating volume of 3.455 per surgeon per three years (n = 367, median 3, IQR 0-3, 1.151 per surgeon per year). CONCLUSION: The observations show that most UK acute hospitals lack the optimum case volume necessary to embrace the proposed change in the guideline.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Vasculares/normas , Aneurisma da Aorta Abdominal/epidemiologia , Ruptura Aórtica/epidemiologia , Ruptura Aórtica/cirurgia , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos/normas , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências , Medicina Baseada em Evidências/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Irlanda/epidemiologia , Sistema de Registros , Medicina Estatal/normas , Medicina Estatal/estatística & dados numéricos , Reino Unido/epidemiologia , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
20.
BMJ ; 366: l4912, 2019 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-31444168

RESUMO

The studyFeatherstone K, Northcott A, Harden J, et al. Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study. Health Serv Deliv Res 2019;7.This study was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 13/10/80).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000779/understanding-dementia-care-in-hospitals.


Assuntos
Demência/enfermagem , Demência/psicologia , Hospitalização , Cooperação do Paciente , Inglaterra , Humanos , Relações Profissional-Paciente , Medicina Estatal/normas , País de Gales
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