scholarly journals P007 Service evaluation of the nurse-led telephone advice line in the wake of COVID-19: a report of audit and staff satisfaction

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Julia Day ◽  
Janet Ball ◽  
Jayne Down ◽  
Raj Sengupta
Keyword(s):  
Service Use ◽  
Single Point ◽  
Working Hours ◽  
Work Load ◽  
Service Evaluation ◽  
Service Improvement ◽  
Staff Satisfaction ◽  
Telephone Advice ◽  
Staff Workload

Abstract Background/Aims  The Rheumatology nurse advice line (NAL) at the Royal National Hospital for Rheumatic Diseases (RNHRD, Bath) provides a vital service for direct patient access to specialist advice via a designated voicemail system. Increasing numbers and difficulty connecting call returns have increased staff workload, reduced efficiency and impacted on staff satisfaction. An audit was therefore undertaken to evaluate service use and efficiency, paired with formal assessment of staff satisfaction in order to identify areas for improvement. Methods  The total number of monthly calls through the NAL during 2020 were counted. A subset of consecutive calls were audited in detail, documenting temporal parameters in relation to the call being logged, returned and concluded. The number of clinicians and attempts required to contact the patient was noted. An anonymised staff satisfaction questionnaire was completed by NAL nurses and administrators. Data was analysed using Excel. Results  An average 653 calls per month (range 340-894) came through the NAL between January and September 2020. 97 consecutive patient contacts were audited from August 2020. Multiple attempts were required to successfully return the call in 19.6% of cases (n = 19/97). Of those, 68.4% (n = 13/19) of calls needed ≥ 2 nurses to contact the patient. In general, the first attempt to return the call was prompt (average 7.6 hours, range 0.1-27.7). However, the time to conclude the call from the patient’s first call log ranged from 0.1 - 142.6 hours (average 12.7 hours) with increased time associated with difficulties contacting the patient or when further advice was required from a Rheumatology doctor (18.5%, n = 18/97). Staff surveys revealed 67% of staff felt that the NAL is a good service to offer patients. However, 67% of staff did not feel the NAL in its current format was easy to manage. Specific comments included that the lack of rota'd responsibility, unpredictable workload and time inefficiencies were barriers to managing the service. Conclusion  From this data, we conclude that patient calls are returned promptly, but utilising a system of voicemail and unscheduled call returns is inefficient and contributes to staff dissatisfaction. This data has driven change for service improvement. To improve efficiency, calls will be answered live by an administrator during working hours and patients given a call-back time. A doctor will be named as a single point of contact for the nurses to seek additional advice and a nurse rota will designate responsibility for NAL calls to reduce work-load uncertainty. Follow up service evaluation will include staff and patient satisfaction questionnaires, and repeat audit, with consideration of ways to support frequent service users. Disclosure  J. Day: None. J. Ball: None. J. Down: None. R. Sengupta: None. V. Flower: None.

scholarly journals Factors associated to managers’ belief whether their employees cannot and do not want to work until an older age, and measure activities increasing their employees’ possibilities of working in an extended working life.

2020 ◽  
Author(s):  
Kerstin Nilsson ◽  
Emma Nilsson
Keyword(s):  
Work Environment ◽  
Working Hours ◽  
Working Life ◽  
Work Load ◽  
Physical Work ◽  
Baseline Survey ◽  
Factors Associated ◽  
The Social ◽  
Physical Work Environment

Abstract Background: The demographic situation with an increasing number of elderly citizens will postpone the retirement age in most countries. However, retirement is a socially accepted way to withdraw from a demanding working life.Objectives: The aim of this study was to evaluate the main factors associated to managers’ beliefs their employees want to or can work until 65 years of age or beyond, and measures increasing participation in an extended working life.Methods: The baseline survey in a follow up study including 249 managers in the municipality sector in Sweden. By logistic regression we investigated the associations between two outcome measures: i) whether employees wanted to work, and ii) whether employees could work until 65 years of age or beyond, and statements within nine areas related to a sustainable working life as well as measure statements for an extend working life.Results : Of the mangers 79% stated their employees ‘can’ and 58% that their employees ‘want to’ work until 65 years of age or beyond. The employees’ health, physical work environment, skills and competence were statistically significant to the mangers’ belief that their employees could not work until 65 years of age or beyond. Lack of support in the social work environment and lack of possibilities to arrange relocations were the most important factors to managers’ beliefs whether employees would not want to work until age 65 or beyond.Conclusion: To offer the employee other tasks in the workplace if needed was a measure statistically significant associated to increase the managers’ belief whether their employees both could and wanted to go on and work until 65 years of age and beyond. Additionally, the managers’ belief measures to decreased physical and mental strains and rotation between different tasks to reduce work load and wear would increase whether their employees can work, and reduction of pace and working hours would increase whether employees want to work in an extended working life past 65 years of age. The managers’ perspective on how their employees ‘can’ and ‘want’ to work will hopefully contribute to the understanding of the extended working life process.

SP3.1.14 NELA; what happens after discharge?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sarah A Mohamed ◽  
L Silva ◽  
P Strong ◽  
A Dietrich ◽  
J Cornish
Keyword(s):  
Service Use ◽  
Abdominal Sepsis ◽  
Service Evaluation ◽  
Emergency Laparotomy ◽  
Surgical Department ◽  
Unscheduled Care ◽  
Discharge Outcomes ◽  
Common Causes ◽  
Scheduled Care

Abstract Aims NELA has been instrumental at improving perioperative care and 30–day mortality following emergency laparotomy (EmLap); long-term outcomes and follow-up are less well reported. This study aims to establish the unscheduled and scheduled service use of EmLap patients after discharge. Methods This is a single-centre service evaluation. Patients were included if they had an EmLap recorded from 2016-2019 at our local institute and were alive on discharge. Outcomes were 30-day readmission rate and outpatient follow-up. Results 944 patients were included. 11.9% re-presented to the surgical department within 30-days; 58.0% of these needed readmissions. The most common causes for re-presentation (n = 112) were management of a wound issue (15.2%), ongoing pain without evidence of complication (10.7%) and ongoing intra-abdominal sepsis (9.8%). 1-year survival was 81.4%. Of these (n = 856); 74.3% were invited to outpatients; DNA rate was 8.8%, with only 67.8% of patients having a follow-up review. Median time to follow up was 9 weeks. Patients were more likely to be invited for outpatient review if they had a new stoma (OR 2.56, 95% CI 1.81 – 3.56), and less likely if adhesiolysis was the primary procedure (OR 0.55, 95% 0.39-0.76). Patients who failed to attend an appointment were significantly younger (median age 53 vs. 60 years, p = 0.0033) and from more deprived areas (average WIMD 673.6 vs 977.3, p = 0.002). Conclusion This study demonstrates higher levels of unscheduled care and lower levels of scheduled care than expected. Care standards should be extended beyond the 30-day milestone to fully appreciate the morbidity associated from EmLap.

scholarly journals Satisfaction with healthcare services among refugees in Zaatari camp in Jordan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nesreen A. Salim ◽  
Shroq Hafedh Meyad ◽  
Faleh A. Sawair ◽  
Julian D. Satterthwaite ◽  
Samiha Sartawi
Keyword(s):  
Health Resources ◽  
Working Hours ◽  
Healthcare Services ◽  
Service Improvement ◽  
Dental Services ◽  
Key Indicators ◽  
Satisfaction Rates ◽  
Self Administered Questionnaire ◽  
Satisfaction With Healthcare Services

Abstract Background Feedback on satisfaction regarding healthcare services is vital for continuous improvement of the service delivery process and outcome. Aims and methods The objective of this study was to assess the satisfaction of refugees with the medical and dental services in Zaatari camp, under 3 domains with 20 key indicators (human and physical health resources, interaction and reactivity, and administration) using a self-administered questionnaire. Results Of the 500 participants, the satisfaction rate was 72.5%. Young participants and participants with a shorter stay in the camp showed higher overall satisfaction rates (P ≤ 0.01). Within the domains, ‘interaction and reactivity’ achieved the highest satisfaction score, whereas ‘administration efficiency’ was ranked the lowest. As for elements within the domains, the most acceptable were the sufficient number of staff and the working hours, availability of radiological services and proper care for children, reasonable waiting time and asking for medical history in every visit. Whereas difficulty to access healthcare services, difficulty to be referred to hospitals, lack of follow up and lack of dental services were the least acceptable. Conclusion In conclusion, whereas refugees were generally satisfied with the provided services, this study indicates that there are areas for further service improvement. This study highlights a significant gaps in healthcare services which if not addressed have the potential to amplify oral/medical health problems.

SP1.1.4The Walking Thread – What happens to fistula-in-ano patients who are lost to follow up? A Service Improvement Study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ellen Murgitroyd ◽  
Blair Wilson ◽  
Darja Kremel ◽  
David Anderson
Keyword(s):  
Current Practice ◽  
Single Point ◽  
Perianal Abscess ◽  
Service Improvement ◽  
Fistula In Ano ◽  
Best Management ◽  
Retrospective Audit ◽  
Lost To Follow Up

Abstract Aims Management of perianal abscess and resultant fistula-in-ano remains controversial. Studies suggest that 1/3 of idiopathic cryptoglandular abscesses can result in fistula-in-ano. Our current practice is to incise and drain primary abscesses and for patients to return as necessary. Known fistula patients will be appointed for Examination Under Anaesthetic (EUA) at 6-12 weeks. Does this result in best management or do they become “elective emergencies”? Methods A retrospective audit of management of fistula-in-ano over 4 years was conducted, utilising precollected data of Cryptoglandular abscesses, excluding inflammatory, radiation or malignant causes. Patients lost to follow up were analysed including presentation, fistula diagnosed at first or subsequent attendance, number of operations, number of attendances and seton placement. Results 512 patients underwent operations for cryptoglandular abscess causing fistula-in-ano between 2013 and 2017. 10% (N = 50) were lost to follow up despite documented follow up plans for 32. Of these, 18 were elective attendances, 14 emergency. 24 of the 32 had a Seton sited prior to being lost to follow up. Conclusions The various presentations (emergency, elective, clinic) and waiting lists mean these patients are presenting as emergencies whilst awaiting follow-up. Many are simply lost to follow up, with Setons in-situ.   We propose a fortnightly hot-clinic system, run by second on-call registrars to assess and manage these patients. This would provide an elective clinic to allow single point of access to fistula-in-ano patients ensuring prompt follow-up and reduction in unnecessary EUA, as well as improving senior colorectal trainees exposure to perianal disease and its management.

scholarly journals 1703 The Walking Thread – What Happens to Fistula-In-Ano Patients Who Are Lost to Follow Up? A Service Improvement Study

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Ellen ◽  
B Wilson ◽  
D Anderson
Keyword(s):  
Single Point ◽  
Safety Net ◽  
Day Surgery ◽  
Service Improvement ◽  
Data Set ◽  
Fistula In Ano ◽  
Best Management ◽  
Retrospective Audit ◽  
Lost To Follow Up

Abstract Aim 1/3 of idiopathic cryptoglandular abscesses can result in fistula-in-ano. Current practice is to incise and drain primary abscesses and safety net for patients to return as necessary. Known fistula patients will be appointed for Examination Under Anaesthetic at 6-12 weeks.Is this best management or do they become “elective emergencies”? Method We performed a retrospective audit of management of fistula-in-ano over 4 years. We used a precollected data set of Cryptoglandular abscesses, excluding inflammatory, radiation or malignant causes and collected data for patients lost to follow up, including presentation, fistula diagnosed at first or subsequent attendance, number of operations, number of attendances and seton placement. Results 512 patients were operated on for cryptoglandular abscess causing fistula-in-ano between 2013 and 2017. 10% (N = 50) were lost to follow up. 32 had documented follow up plans, that were not fulfilled (eg elective theatre not booked). Of these, 18 were elective attendances, 14 emergency. 24 of the 32 had a Seton sited prior to being lost to follow up Conclusions The various presentations (emergency, elective, clinic or day surgery) and long waiting lists mean many of these patients are presenting as emergencies still awaiting follow up. Many are lost to follow-up, with Setons in situ. We propose a fortnightly hot-clinic system, registrar led to assess and manage these patients. This would provide an elective clinic to allow single point of access to fistula-in-ano patients ensuring prompt follow up and reduction in unnecessary EUA, as well as improving senior colorectal trainees exposure to perianal disease and its management.

81 Integrating A Front Door Frailty Service in the Emergency Department: Results of A Pilot Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
L Dunnell ◽  
A Shrestha ◽  
E Li ◽  
Z Khan ◽  
N Hashemi
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Community Services ◽  
Service Improvement ◽  
Specialist Nurse ◽  
Front Door ◽  
Medication Changes ◽  
Health Service Improvement

Abstract Introduction Increasing old age and frailty is putting pressure on health services with 5–10% of patients attending the emergency department (ED) and 30% of patients in acute medical units classified as older and frail. National Health Service improvement mandates that by 2020 hospital trusts with type one EDs provide at least 70 hours of acute frailty service each week. Methodology A two-week pilot (Monday–Friday 8 am-5 pm) was undertaken, with a “Front Door Frailty Team” comprising a consultant, junior doctor, specialist nurse and pharmacist, with therapy input from the existing ED team. They were based in the ED seeing patients on arrival, referrals from the ED team and patients in the ED observation ward—opposed to the usual pathway of referral from the ED team to medical team. Data was captured using “Cerner” electronic healthcare records. A plan, do, study, act methodology was used throughout with daily debrief and huddle sessions. Results 95 patients were seen over two weeks. In the over 65 s, average time to be seen was 50 minutes quicker than the ED team over the same period, with reduced admission rate (25.7% vs 46.5%). The wait between decision to admit and departure was shortened by 119 minutes. Overall, this led to patients spending on average 133 minutes less in the ED. 64 patients were discharged, of which 44 had community follow-up (including 37.5% of 64 referred to acute elderly clinic and 25% to rapid response). 47 medications were stopped across 25 patients. Conclusion The pilot shows that introduction of an early comprehensive geriatric assessment in the ED can lead to patients being seen sooner, with more timely decisions over their care and reduction in hospital admissions. It allowed for greater provision of acute clinics and community services as well as prompt medication review and real time medication changes.

scholarly journals Single-lead ECGs (AliveCor) are a feasible, cost-effective and safer alternative to 12-lead ECGs in community diagnosis and monitoring of atrial fibrillation

2021 ◽  
Vol 10 (1) ◽  
pp. e001270
Author(s):  
Jonathan James Hyett Bray ◽  
Elin Fflur Lloyd ◽  
Firdaus Adenwalla ◽  
Sarah Kelly ◽  
Kathie Wareham ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Community Setting ◽  
Cost Effective ◽  
Ventricular Rate ◽  
Service Improvement ◽  
Community Monitoring ◽  
Ventricular Response ◽  
Community Diagnosis ◽  
New Onset

BackgroundCommunity management of atrial fibrillation (AF) often requires the use of electrocardiographic (ECG) investigation. Patients discharged following treatment of AF with fast ventricular response (fast AF) can require numerous ECGs to monitor rate and/or rhythm control. Single-lead ECGs have been proposed as a more convenient and relatively accurate alternative to 12-lead ECGs for rate/rhythm management and also diagnosis of AF. We aimed to examine the feasibility of using the AliveCor single-lead ECG monitor for diagnosis and monitoring of AF in the community setting.MethodsDuring the course of 6 months, this evaluation of a clinical service improvement pathway used the AliveCor in management of patients requiring (1) follow-up ECGs for AF with previously documented rapid ventricular rate or (2) ECG confirmation of rhythm where AF was suspected. Twelve AliveCor devices provided to the acute community medical team were used to produce 30 s ECG rhythm strips (iECG) that were electronically sent to an overreading physician.ResultsSeventy-four patients (mean age 82 years) were managed on this pathway. (1) The AliveCor was successfully used to monitor the follow-up of 37 patients with fast AF, acquiring a combined total of 113 iECGs (median 1.5 ±3.75 per patient). None of these patients required a subsequent 12-lead ECG and this approach saved an estimate of up to £134.49 per patient. (2) Of 53 patients with abnormal pulses, the system helped identify 8 cases of new onset AF and 19 cases of previously known AF that had reverted from sinus back into AF.ConclusionsWe have demonstrated that the AliveCor system is a feasible, cost-effective, time-efficient and potentially safer alternative to serial 12-lead ECGs for community monitoring and diagnosis of AF.

scholarly journals Cognitive decline and alcohol consumption adjusting for functional status over a 3-year period in French speaking community living older adults

2018 ◽  
Vol 41 (2) ◽  
pp. e177-e184 ◽  
Author(s):  
Helen-Maria Vasiliadis ◽  
Marie-Christine Payette ◽  
Djamal Berbiche ◽  
Sébastien Grenier ◽  
Carol Hudon
Keyword(s):  
Older Adults ◽  
Alcohol Consumption ◽  
Cognitive Decline ◽  
Functional Status ◽  
Repeated Measures ◽  
Service Use ◽  
High Functioning ◽  
French Speaking ◽  
Changing Patterns

AbstractBackgroundThe effect of alcohol consumption on cognitive decline is not clear. We aimed to study the association between alcohol consumption and cognitive functioning controlling for functional heath status.MethodsA total of 1610 older adults with a score ≥26 on the Mini-Mental State Examination (MMSE) were followed to assess the change in scores at the 3-year follow-up. Information on alcohol consumption as well as socio-demographic, lifestyle, psychosocial and clinical factors, as well as health service use were assessed at baseline and 3-year follow-up interviews. Linear mixed models with repeated measures were used stratifying by functional status.ResultsClose to 73% reported consuming alcohol in the past 6 months, of which 11% were heavy drinkers (≥11 and ≥16 drinks for women and men). A significant decrease in MMSE scores was observed in low functioning non-drinkers (−1.48; 95% CI: −2.06, −0.89) and light to moderate drinkers (−0.99; 95% CI: −1.54, −0.44) and high functioning non-drinkers (−0.51; 95% CI: −0.91, −0.10).ConclusionsAlcohol consumption did not contribute to cognitive decline. Cognitive decline was greater in individuals reporting low functional status. Research should focus on the interaction between changing patterns of alcohol consumption and social participation in individuals with low and high functioning status.

scholarly journals ePRO-based individual follow-up care for women treated for early breast cancer: impact on service use and workflows

2021 ◽  
Author(s):  
Cathrine Lundgaard Riis ◽  
Mette Stie ◽  
Troels Bechmann ◽  
Pernille Tine Jensen ◽  
Angela Coulter ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Service Use ◽  
Follow Up Care
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