Assessing the impact of the introduction of an electronic hospital discharge system on the completeness and timeliness of discharge communication: a before and after study.

BACKGROUND: Hospital discharge summaries are a key communication tool ensuring continuity of care between primary and secondary care. Incomplete or untimely communication of information increases risk of hospital readmission and associated complications. The aim of this study was to evaluate whether the introduction of a new electronic discharge system (NewEDS) was associated with improvements in the completeness and timeliness of discharge information, in Nottingham University Hospitals NHS Trust, England. METHODS: A before and after longitudinal study design was used. Data were collected using the gold standard auditing tool from the Royal College of Physicians (RCP). This tool contains a checklist of 57 items grouped into seven categories, 28 of which are classified as mandatory by RCP. Percentage completeness (out of the 28 mandatory items) was considered to be the primary outcome measure. Data from 773 patients discharged directly from the acute medical unit over eight-week long time periods (four before and four after the change to the NewEDS) from August 2010 to May 2012 were extracted and evaluated. Results were summarised by effect size on completeness before and after changeover to NewEDS respectively. The primary outcome variable was represented with percentage of completeness score and a non-parametric technique was used to compare pre-NewEDS and post-NewEDS scores. RESULTS: The changeover to the NewEDS resulted in an increased completeness of discharge summaries from 60.7% to 75.0% (p < 0.001) and the proportion of summaries created under 24 h from discharge increased significantly from 78.0% to 93.0% (p < 0.001). Furthermore, five of the seven grouped checklist categories also showed significant improvements in levels of completeness (p < 0.001), although there were reduced levels of completeness for three items (p < 0.001). CONCLUSION: The introduction of a NewEDS was associated with a significant improvement in the completeness and timeliness of hospital discharge communication.

Improving acute care for older people at scale - the Acute Frailty Network.

Older people form a growing proportion and volume of those accessing urgent care. Non-specific presentations, multiple comorbidities and functional decline make assessment and management of this cohort challenging. Comprehensive Geriatric Assessment offers an evidence based framework to assess and mange older people, especially those with frailty. In this article we describe the CGA approach, underpinned by specific examples illustrating some of the key competencies required, and describe the role of the Acute Frailty Network (AFN). The AFN is a national improvement collaborative designed to support hospitals in delivering evidence based care for older people with frailty and urgent care needs. We describe the principles underlying the approach of the AFN, derived from working with over 20 hospitals, and some of the early successes.

Influence of cadmium and mycorrhizal fungi on the fatty acid profile of flax (Linum usitatissimum) seeds.

BACKGROUND: The soil environment can affect not only the quantity of crops produced but also their nutritional quality. We examined the combined effects of below-ground cadmium (0, 5, and 15 ppm) and mycorrhizal fungi (presence and absence) on the concentration of five major fatty acids within flax seeds (Linum usitatissimum). RESULTS: Plants grown with mycorrhizal fungi produced seeds that contained higher concentrations of unsaturated (18:1, 18:2 and 18:3), but not saturated (16:0 and 18:0) fatty acids. The effects of mycorrhizal fungi on the concentration of unsaturated fatty acids in seeds were most pronounced when plant roots were exposed to 15 ppm Cd (i.e. the concentrations of 18:1, 18:2 and 18:3 increased by 169%, 370% and 150%, respectively). CONCLUSIONS: The pronounced effects of mycorrhizal fungi on the concentration of unsaturated fatty acids at 15 ppm Cd may have been due to the presence of elevated levels of Cd within seeds. Our results suggest that, once the concentration of cadmium within seeds reaches a certain threshold, this heavy metal may improve the efficiency of enzymes that convert saturated fatty acids to unsaturated fatty acids.