hospital

Co-design of interventions to improve acute care in hospital: A rapid review of the literature and application of the BASE methodology, a novel system for the design of patient centered service prototypes

Original Articles, Volume 21, Issue 4, Pages 165-208 (2022)

Co-design in acute care is challenged by the inability of unwell patients to participate in the process and the often transient nature of acute care.
We undertook a rapid review of the literature on co-design, co-production and co-creation of solutions for acute care that were developed with patients. We found limited little evidence for co-design methods in acute care.
We adapted a novel design driven method (BASE methodology) that creates stakeholder groups through epistemological criteria for the rapid development of interventions for acute care. We demonstrated feasibility of the methodology in two case studies:
A mHealth application with checklists for patients undergoing treatment for cancer and a patient held record for self-clerking on admission to hospital.

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Using trends in electronic recordings of vital signs to identify patients stable for transfer from acute hospitals

Original Articles, Volume 18, Issue 4, Pages 205 – 264 (2019)

Patients who are stable might not be required to remain in hospital. We aimed to create objective criteria to indicate stability based on vital signs. An index based on NEWS (NBI) was compared to a Patient Stability Index (PSI) algorithm created by random forest analysis.

Data from the VITAL II study was used to train the algorithm and data from the VITAL III study to validate it. Failure rate of the algorithms was set close to the rate of readmission to UK hospitals at 15%. After a training period of two days the NBI identified stability with acceptable failure rates only after a further 96 hours with a subsequent release of 2143 bed days compared to the PSI which identified stability after only 12 hours leading to potential earlier release of 2652 bed days.

Vital sign-based algorithms might be able to predict safe transfer from hospital and inform management of flow.

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The Team at Work – The Society for Acute Medicine’s Benchmarking Audit 2014 (SAMBA’14)

Research Audit and Clinical Practice, Volume 14, Issue 3, Pages 97 - 144 (2015)

Abstract

Background: The Society for Acute Medicine’s Benchmarking Audit (SAMBA) serves as a tool for Acute Medical Units to compare and improve their quality of care.

Aim: To audit the performance of Acute Medical Units against clinical quality indicators, standards by the Royal College of Physicians and Specialist Societies relevant to the practice of Acute Medicine.

Methods: An online survey of unit profiles and staffing levels on the audit day was followed by a 24-hour data collection on Thursday the 19th of June 2014 for all patients seen by the local Acute Medicine teams as part of the general medical take. Patients were followed-up for 72 hours. We reviewed the impact of staffing levels on performance indicators.

Results: 66 Acute Medical Units admitted 2333 patients during the 24-hour period. Compliance with the quality standards of SAM was as follows: 84% of patients had an early warning score recorded within 30 minutes of admission, 81% of patients had been seen by a competent decision maker within four hours and 73% of patients were seen by a consultant physician within the appropriate period of time. Only 56% of patients received a standard of care compatible with all three quality standards. We found no relation between unit characteristics, staffing and performance indicator.

Conclusion: There remains a gap between the standard described by the quality indicators and the performance of Acute Medical Units during a one-day audit.

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What errors can be identified by Pharmacy led medicines reconciliation? A prospective study

Original Articles, Volume 10, Issue 1, Pages 1 - 64 (2011)

Abstract

Aim: To establish the nature and frequency of discrepancies identified by pharmacy staff during medicines reconciliation.(MR)

Methods: Pharmacy staff collected data prospectively from 161 patients over a 1 week period, including information on any prescription errors identified.

Results: In total, 62 patients (48%) taking one or more medications prior to admission to hospital had one or more discrepancies found by pharmacy staff during MR. The most common discrepancy was omission of one or more drugs.

Conclusions: Pharmacy staff identified several unintentional discrepancies in prescribing of medications at admission to hospital. Doctors should ensure that intentional changes to patient prescriptions are clearly documented.

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‘State of the Nation’ – The Society for Acute Medicine’s Benchmarking Audit 2013 (SAMBA ’13)

Research Audit and Clinical Practice, Volume 12, Issue 4, Pages 185 - 252 (2013)

Abstract

Background: Benchmarking is important to improve quality of care.

Aim: To audit the performance of Acute Medical Units (AMUs) against the clinical quality indicators published by the Society for Acute Medicine (SAM).

Methods: 24-hour data collection on the 20th of June 2013 with follow-up data at 72 hours.

Results: 43 units submitted data on 1425 patients. 76% of patients had early warning scores recorded within 30 minutes of admission, 95% of patients had been seen by a competent decision maker within four hours. 79% of patients were seen by a consultant physicians within the appropriate period of time.

Conclusion: The difference in compliance with quality standards between UK units opens opportunities for learning. The reasons why some units perform better than others require further investigation.

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A Day in the Life of the AMU– The Society for Acute Medicine’s Benchmarking Audit 2012 (SAMBA ‘12)

Research Audit and Clinical Practice, Volume 12, Issue 2, Pages 65 - 124 (2013)

Abstract

Background: The absence of published data for benchmarking serves as a disincentive for Acute Medical Units to improve care.

Aim: To test feasibility of a national audit in Acute Medicine for compliance with common standards

Methods: On line questionnaire with summary data for patients admitted to participating Acute Medicine Units over a 24-hour-period.

Results: 30 units submitted summary data. The mean number of admission was 36 (SD 14). Compliance with standards around timing of junior and senior review was highly variable. In almost all other standards only a small number of units achieved high reliability with compliance of more than 90%.

Conclusion: SAMBA provides a data set that can be used for local and national benchmarking and quality improvement work. Annual audit might be beneficial to track improvements.

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Editorial

Editorials, Volume 12, Issue 2, Pages 65 - 124 (2013)

Much has been written in recent months about the challenges at the hospital’s front door; emergency departments and acute medical units have found themselves in the spotlight, while politicians and clinical leaders have debated where the causes for this crisis lie. As summer progresses and we continue to search for solutions, it is likely that some of the focus will shift from the emergency department to the processes of care which take place after a patient has been admitted. The Royal College of Physicians’ long awaited Future Hospital Commission report will be published later in the year; a key theme in this document is going to be the importance of continuity of care for patients in hospitals, ensuring the minimum numbers of patient transfers both within the hospital and between consultants. Inevitably this will open a key debate over the role of the ‘generalist’ in hospitals of the future. The last decade has seen a steady drift away from generalism, with increasing numbers of hospital clinicians retreating into their speciality enclaves, and withdrawing from the acute medical take. For some patients speciality-led care has been shown to be highly effective; however there remain significant numbers of patients whose problems cannot be neatly packaged into a single organ category. Acute physicians have taken on the management of this group of patients within the acute medical unit (AMU), but who should provide ongoing general medical care for patients who are transferred out of the Unit? A recent survey of members of the Society for Acute Medicine (SAM) has confirmed that the overwhelming majority of existing acute medicine consultants are accredited in General Internal Medicine (GIM), while a similar proportion of current acute medicine trainees expect to attain a certificate of completed training in GIM. Provided that hospitals can secure adequate numbers of new consultant appointments, acute physicians will be ideally placed to provide continuity of care for this patient group. The survey, which will soon be published on the SAM website, also indicates that most acute physicians would be happy to provide this service, as long as it was appropriately resourced and supported; furthermore a substantial proportion viewed a combination of GIM and acute medicine as their preferred model for their future job plan.

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