scholarly journals 464 - SURVEY OF THE ADEQUACY OF HOSPITAL DISCHARGE LETTERS FROM OLDER ADULT MENTAL HEALTH (OAMH) WARDS IN A SCOTTISH HEALTH REGION

2020 ◽  
Vol 32 (S1) ◽  
pp. 186-186
Author(s):  
Gary Stevenson ◽  
Sharon Munro ◽  
Connor McIntyre ◽  
Stephen Foster
Keyword(s):  
Clinical Information ◽  
Care Homes ◽  
Health Region ◽  
Care Services ◽  
Primary Care Services ◽  
Discharge Policy ◽  
Discharge Letter ◽  
Clinical Risks ◽  
Time Standard

Background:One form of communication deficiency leading to patient harm is failure to keep colleagues informed and to share appropriate levels of clinical information. The production of discharge letters is a clinical and professional requirement, deficiencies of which contribute to clinical risks, while failure to observe standards may be a focus of medico-legal enquiry.Objectives:To examine the adequacy of clinical discharge letters from the OAMH inpatient wards in one Scottish Health region (Fife, population 370,000) against the 14-day discharge policy, with focus on medication advice and follow-up arrangements.Methods:All discharge notifications from the five OAMH wards were examined retrospectively against the electronic records and case-files for the 7-month period ending 31st January 2020.Results:169 discharge notifications inclusive of 14 deaths were reduced to 123 after excluding brief inter-ward transfers. Female:male ratio of 1.05:1; average age 77 (range 60 -99) years, average inpatient duration 120 (range 2-934) days. There was no identified discharge letter in 20.3%. Direct admissions from Care Homes died more often (30%) than those admitted directly from home (2%), presumably a reflection of greater frailty. 29% patients were discharged to (19% admitted from) Care Homes. 59% patients had dementia, 20% an affective disorder, 7% a psychotic disorder, with 20% having multiple diagnoses. Antidepressants were the commonest (49%) regularly prescribed psychotropic medication on discharge both for those with (47%) or without (52%) dementia. 32% of all patients (25% in dementia) were discharged on antipsychotics, often without advice on monitoring, prescribing restrictions or risks. The 98 verified letters took 27 (range 0-168) days to verify, 67% failing the production-time standard. 53% discharges had multiple follow-up arrangements. Variabilities were noted in letter production according to the discharge ward (range 53-100%) and between consultant teams (verification rates 50-100%) where delays ranged 6-109 days and ability to produce letters within the standard ranged from 0-92% (average 33%).Conclusions:There appear significant failings in the timely transfer of clinical details between OAMH inpatient services and primary care services in this region that require intervention to minimise clinical risk and maximise patient safety. There were identified factors that are amenable to quality improvement.

scholarly journals Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care

2019 ◽  
Vol 69 (686) ◽  
pp. e595-e604 ◽  
Author(s):  
Victoria Hammersley ◽  
Eddie Donaghy ◽  
Richard Parker ◽  
Hannah McNeilly ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Technical Problems ◽  
Face To Face ◽  
Information Giving ◽  
Care Services ◽  
Primary Care Services ◽  
Quasi Experimental ◽  
Primary Care Clinicians

BackgroundGrowing demands on primary care services have led to policymakers promoting video consultations (VCs) to replace routine face-to-face consultations (FTFCs) in general practice.AimTo explore the content, quality, and patient experience of VC, telephone (TC), and FTFCs in general practice.Design and settingComparison of audio-recordings of follow-up consultations in UK primary care.MethodPrimary care clinicians were provided with video-consulting equipment. Participating patients required a smartphone, tablet, or computer with camera. Clinicians invited patients requiring a follow-up consultation to choose a VC, TC, or FTFC. Consultations were audio-recorded and analysed for content and quality. Participant experience was explored in post-consultation questionnaires. Case notes were reviewed for NHS resource use.ResultsOf the recordings, 149/163 were suitable for analysis. VC recruits were younger, and more experienced in communicating online. FTFCs were longer than VCs (mean difference +3.7 minutes, 95% confidence interval [CI] = 2.1 to 5.2) or TCs (+4.1 minutes, 95% CI = 2.6 to 5.5). On average, patients raised fewer problems in VCs (mean 1.5, standard deviation [SD] 0.8) compared with FTFCs (mean 2.1, SD 1.1) and demonstrated fewer instances of information giving by clinicians and patients. FTFCs scored higher than VCs and TCs on consultation-quality items.ConclusionVC may be suitable for simple problems not requiring physical examination. VC, in terms of consultation length, content, and quality, appeared similar to TC. Both approaches appeared less ‘information rich’ than FTFC. Technical problems were common and, though patients really liked VC, infrastructure issues would need to be addressed before the technology and approach can be mainstreamed in primary care.

scholarly journals Transition of care in stroke patients discharged home: a single-center prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. J. de Mooij ◽  
I. Ahayoun ◽  
J. Leferink ◽  
M. J. Kooij ◽  
F. Karapinar-Çarkit ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Descriptive Analysis ◽  
Clinical Information ◽  
National Guidelines ◽  
Stroke Patients ◽  
Discharge Letter

Abstract Introduction Approximately two-thirds of the patients admitted to the hospital with an ischemic stroke are discharged directly home. Discontinuity of care may result in avoidable patient harm, re-admissions and even death. We hypothesized that the transfer of information is most essential in this patient group since any future care for these patients relies solely on the information that is available to the care provider responsible at that time. Aim The objective of this study was to evaluate the continuity of transmural care in ischemic stroke patients by assessing 1) the transfer of clinical information through discharge letters to general practitioners (GPs), 2) subsequent documentation of this information and early follow-up by GPs and 3) the documentation of medication-related information in discharge letters, at GPs and community pharmacies (CPs). Methods This prospective cohort study was conducted from September 2019 through March 2020 in OLVG, Amsterdam, the Netherlands, in patients with a first stroke discharged directly home. Outcome measures were derived from national guidelines and regional agreements. Results were analyzed using descriptive analysis. Results A total of 33 patients were included. Discharge letters (n = 33) and outpatient clinic letters (n = 24) to GPs contained most of the essential items, but 16% (n = 9) of the letters were sent in time. GPs (n = 31) infrequently adhered to guidelines since 10% (n = 3) of the diagnoses were registered using the correct code and 55% (n = 17) of the patients received follow-up shortly after discharge. Medication overviews were inaccurately communicated to GPs since 62% (n = 150) of all prescriptions (n = 243) were correctly noted in the discharge letter. Further loss of information was seen as only 39% (n = 95) of all prescriptions were documented correctly in GP overviews. We found that 59% (n = 144) of the prescriptions were documented correctly in CP overviews. Conclusion In this study, we found that discontinuity of care occurred to a varying extent throughout transmural care in patients with a first stroke who were discharged home.

Frequency and predictors of adverse events

1998 ◽  
Vol 173 (5) ◽  
pp. 376-384 ◽  
Author(s):  
Sonia Johnson ◽  
Morven Leese ◽  
Liz Brooks ◽  
Paul Clarkson ◽  
Hilary Guite ◽  
...  
Keyword(s):  
Mental Health ◽  
Adverse Events ◽  
Research Evidence ◽  
Community Based ◽  
Public Records ◽  
Care Services ◽  
Primary Care Services ◽  
Community Based Services ◽  
Major Adverse Events

BackgroundCommunity care has been criticised as a hazardous policy associated with high rates of adverse events. There is little research evidence as to the truth of this claim.MethodBest available evidence from public records, interviews, case notes, key workers and general practitioners was assembled to establish: (a) which of the 514 subjects initially identified as having psychotic illnesses had died during an average follow-up of 4.9 years; (b) care currently received by all 286 subjects originally selected for interview; and (c) rates of major adverse events and of admission for these 286 individuals.ResultsTwenty-eight natural and 11 unnatural deaths had occurred. Among subjects still living at the end of the follow-up, 84% were in contact with specialist mental health services and 11% only with primary care services. Rates of serious violence, imprisonment and homelessness were relatively low. Forty-one per cent had been admitted at least once during a mean follow-up of 3.2 years and 20% at least once under the Mental Health Act. After adjustment, there were no significant differences between standard and intensive care sectors.ConclusionsRates of adverse events and slipping through the net’ are relatively low among individuals receiving community-based services, whether intensive or standard care.

scholarly journals Examining GP online consultation in a primary care setting in east midlands, UK

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dewy Nijhof ◽  
Andy Ingram ◽  
Rebecca Ochieng ◽  
Emma-Jane Roberts ◽  
Barnaby Poulton ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Condition ◽  
Care Services ◽  
Online Consultation ◽  
Primary Care Services ◽  
East Midlands ◽  
Consultation System ◽  
Exploratory Data ◽  
Age Range

Abstract Background Increasing pressure threatens to overwhelm primary care services, affecting the quality of care and their role as gatekeepers to specialised care services. This study investigated healthcare users’ acceptability of – and the effectiveness of – an e-consultation system in primary care services. Methods Seven GP practices in East-Midlands, all of whom use online consultation system participated in the study, with a retrospective review being undertaken of 189 electronic patients’ records (age range of 18–76 years) over 5 months. The focus was on the electronic records of patients who accessed the service for five different conditions identified as presenting common conditions seen by the GPs practices. Statistical analysis was done using SPSS to perform an exploratory data analysis and descriptive statistics. Results The results showed a positive reception of the online consultation platform, with an average satisfaction score of 4.15 (most likely to recommend score = 5). Given the nature of the conditions, 47.6% of patients had experienced a previous episode of the health condition they were seeking consultation for, and a total of 72% had existing comorbidities. Follow-up activity occurred for 87.3% of patients, 66.1% of which included at least one follow-up visit for the same condition as the initial online consultation. Conclusion The results suggest that online consultation is convenient for patients, and it also has the potential to relieve pressure placed on primary care services. Although a number of challenges were identified, such as patient verification, this study gives insight into – and enhances our understanding of – the use of online GP consultations.

scholarly journals Experiencia en tiempos de pandemia

2020 ◽  
Vol 1 (2) ◽  
pp. 21-31
Author(s):  
Santos Ibáñez Barceló ◽  
Luis Alcaraz Clemente ◽  
Francisca Del Valle Cebrián
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Workers ◽  
Psychological Needs ◽  
Contact Tracing ◽  
Care Providers ◽  
Care Services ◽  
Phone Calls ◽  
Primary Care Services

En los últimos meses, el virus SARS-CoV-2 ha generado una crisis global que atañe a todos los ámbitos de la vida. La enorme velocidad de propagación y el elevado número de contagios entre los profesionales de la salud han requerido aumentar la disponibilidad de personal sanitario. En respuesta, numerosos países han propuesto la posibilidad de que estudiantes de medicina y recién graduados sean contratados para realizar diversos trabajos que alivien estas carencias. En España, la declaración del Estado de Alarma inició la regulación legal para que esta posibilidad fuese llevada a cabo, lo que ha permitido contratar a estudiantes y médicos pre-MIR en diversos territorios. Dentro de este marco, se describe la experiencia llevada a cabo en la Gerencia de Atención Integrada de Almansa (Albacete), con la creación de un equipo integrado por dos graduados en medicina a la espera de escoger plaza MIR y una especialista de oftalmología. En el período comprendido entre el 27 de marzo y el 21 de abril de 2020, se ha realizado seguimiento clínico vía telefónica de 274 pacientes dados de alta con diagnóstico o sospecha de COVID-19, 790 llamadas y 26 derivaciones al servicio de Urgencias. El seguimiento telefónico supone una tarea que, aunque cuenta con limitaciones, puede ser desempeñada por médicos con menor experiencia laboral. Su papel ha sido clave en estos momentos, pues disminuye la congestión de los servicios hospitalarios y permite el adecuado control epidemiológico de los casos y sus contactos. Esta experiencia ha puesto de manifiesto otros puntos que atañen a la incertidumbre en tiempos cambiantes, las necesidades psicológicas de acompañamiento o el refuerzo de valores. Elementos como la telemedicina, el valor de la atención primaria, o la consideración de los estudiantes en la asistencia sanitaria deberán tenerse en cuenta por los planes de estudio de ahora en adelante. In recent months SARS-CoV-2 has generated a global crisis, which has had an impact on all aspects of life. The quick spread of the virus amongst medical professionals has meant that more and more health workers are needed. To address this demand, many countries have approached Medicine graduates to assist health care providers. The state of emergency in Spain started the legal process so this initiative could materialise and, ultimately, Medicine students and pre-resident medical interns could be hired across different territories. This account describes the experience of two pre-specialty graduates and a consultant ophthalmologist within this context. This team conducted clinical follow-up phone calls on 274 patients discharged from hospital with confirmed or suspected COVID-19, 790 calls and 26 referrals to A&E. Although with limitations, clinical follow- up conversations can be carried out by less experienced doctors. Their role has been key as they ease up congestion in hospital services as well as contributing towards the provision of epidemiological control and contact tracing. This experience has brought to light other issues related to the uncertainty in these fast-moving times, the psychological needs of social interaction and the strengthening of human values. Therefore, aspects such as telemedicine, the importance of primary care services and the role of students in health care will have to be taken into account in university programmes of study in the future.

Managing patients in care homes

2020 ◽  
Vol 13 (2) ◽  
pp. 102-108
Author(s):  
Michael Gill
Keyword(s):  
Nursing Homes ◽  
Care Homes ◽  
Residential Home ◽  
Care Needs ◽  
Long Term Conditions ◽  
Nursing Support ◽  
Care Services ◽  
Primary Care Services ◽  
Health And Social Care ◽  
Socially Isolated

Older people in care homes deserve the best health and social care we can offer. Their care needs are usually high and they are vulnerable either physically, cognitively or both. They are likely to have several long-term conditions and be in the last year or so of life. Although some may have families and friends supporting them with regular visits and advocacy, others may be more alone and socially isolated. Care homes are traditionally classed as either residential homes or nursing homes, with some being dual registered. The main difference is the presence of 24-hour on-site qualified nursing support in nursing homes. This means that, in general, the residents of nursing homes are more dependent and complex. This article will first describe how to approach the planning and delivery of primary care services to nursing homes, and then consider some of the most common problems and conditions. Much of this also applies to residential home residents.

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