Risk management

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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Developing Occupational Therapy Best Practice Guidelines for Acute Medical Services

Society Pages, Volume 7, Issue 2, Pages 61 - 104 (2008)

Occupational Therapists began exploring their role in Acute Medicine in the late 1990’s.1 A decade later the presence of Occupational Therapists in accident & emergency departments and acute medical units is seen as routine. The literature and evidence base to support this, however, has not progressed as rapidly. With few guidelines to support practice the authors produced a document locally to promote standardisation of good practice and equity of treatment within all relevant NHS Lothian and NHS Borders sites. A table illustrates the specialist skills necessary for Occupational Therapy in Acute Medicine and appendices outline components of various assessments. It is hoped that as therapists progress through the flow chart they can utilise further sections of the guidelines related to specific assessments.

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