Research Report

A profile of Nurses working in acute medicine units: What is the future?

Research Report, Volume 9, Issue 2, Pages 53 - 96 (2010)

Abstract

A survey of registered nurses working in two acute medicine acute medicine units (AMUs) was conducted between May & September 2009 to enable a focussed understanding of nursing recruitment and retention, to guide nurse managers for future workforce planning. The NHS collects national information regarding recruitment, retention and leavers, but this is sporadic and hampered by a lack of feedback to clinical areas. In this study, fifty completed questionnaires were collated, totalling a response rate of 57.5%. The results demonstrate that while recruitment is currently buoyant, nurses with significant experience are becoming dissatisfied through lack of opportunity to advance. It concludes that further national research is required to inform a strategy fit for the future development of nursing in acute medicine.

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Training Requirements for Point of Care Ultrasound in Acute Medicine

Research Report, Volume 9, Issue 2, Pages 53 - 96 (2010)

Abstract

The aim of the study was to explore the ultrasound training requirements in acute medicine by comparing the ultrasound skill of an acute medicine trainee (AMT) with that of the radiology department following short ultrasound training.

Results: 43 participants (34 males and 9 females).The mean age was 58 (range 20-93 years). Liver: AMT reported 15/17 as normal (Specificity 88%) and diagnosed ascites in 100% (NPV 93%). Gallbladder: There was 100% sensitivity and NPV for excluding gallstone. CBD: Sensitivity and specificity of 83 and 95% for dilated CBD (NPV 95%). Kidneys: AMT identified 100% of normal kidneys. Spleen: Splenomegaly diagnosed with 95% specifity and NPV.

Conclusion: The AMT achieved a high level of accuracy in diagnosing and excluding gallstone, dilated CBD, ascites and splenomegaly.

CBD = Common Bile Duct, NPV=Negative Predictive Value.

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Lumbar Punctures in the Acute Medicine Department: indications and evaluation of use

Research Report, Volume 13, Issue 3, Pages 101 - 148 (2014)

Abstract

Aims:
• Evaluate the use of lumbar puncture (LP) in the Acute Medical Department of a typical urban district general hospital.
• Increase the proportion performed on appropriate patients.

Methodology: An observational, single-centre, retrospective examination of patients undergoing LP at Solihull Hospital over four consecutive months. Discussion of findings and LP indications with the Acute Medicine Department. Re-audit over four months.

Results: Total LPs performed fell by 65%. The proportion performed on patients presenting with red flags rose by 19% (p=0.0098). The proportion that yielded positive findings rose by 33% (p<0.0001). 72% of patients with red flags had negative LP. Conclusions: Awareness of indications and observation of practice reduces total LPs performed and increases the proportion performed on appropriate patients.

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Does a Post-take Ward Round Proforma Lead to Sustainable Improvements in Quality of Documentation for Patients Admitted to the Medical Assessment Unit?

Research Report, Volume 5, Issue 3, Pages 81 - 116 (2006)

Abstract

This study assessed the quality of post-take ward round (PTWR) documentation, specifically looking at twelve criteria, in the medical assessment unit (MAU) prior to, 3- months and 2-years after introducing a PTWR proforma. 216 case records were analysed; 40 prior to, 40 three-months and 146 two-years after introducing the PTWR proforma. There was a significant improvement in eight criteria threemonths after introducing the PTWR proforma. These improvements were sustained two-years later and significant improvements made in a further 3 criteria (1 at p < 0.05 and 2 at p < 0.01).

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Hospital Readmissions: Patient, Carer and Clinician Views

Research Report, Volume 5, Issue 3, Pages 81 - 116 (2006)

Abstract

Aim: To explore patients, carers, and clinician views and identify factors, which affect the likelihood of hospital readmission.

Methods: A cross sectional retrospective study of adult medical patients readmitted to hospital within 28 days of discharge. Medical and nursing records were reviewed and patients and their carers were interviewed regarding their views about their discharge and readmission. Data were collected regarding demographic, social and medical profiles.

Results: Seventy-seven patients were readmitted over a five-week period out of 1289 patients discharged during the previous five weeks, representing a 6% readmission rate. Mean (SD) age of readmitted patients was 71.3 (14.6) years. Forty patients (51.9%) were aged ≥75 and 39 (50.6%) were males. Mean (SD) number of comorbidities was 3.68 (1.82). Mean (SD) number of medications was 7.79 (4.14). Most common reasons for readmission were exacerbation of chronic obstructive pulmonary disease and acute coronary syndrome. Mean (SD) time to readmission was 11.6 (8.2) days. Fifty (64.9%) patients were readmitted within 14 days of discharge. Forty eight (62.3%) patients were readmitted with the same medical condition as their previous discharge. Fifty (64.9%) patients and 45 (66.2%) carers felt that discharge was appropriate. Forty five (58.0%) patients and 44 (57.0%) carers thought that readmission was unavoidable. Clinicians considered 56 (72.7%) discharges appropriate and 55 (71.5%) readmissions unavoidable. A trend towards higher readmission rate among patients ≥ 75 years was noted (7.2% vs 5.1%, p=0.1).

Conclusion: Although the majority of discharges are appropriate, up to a third of readmissions may be avoidable in the views of carers, patients and clinicians. Patients and carers should be consulted regarding readiness for discharge before leaving hospital.

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