scholarly journals 112 Sweet talk-out of hours diabetes related phone advice service for children and young persons-an educational and a service improvement initiative

2021 ◽  
Author(s):  
Claire Alcorn ◽  
Emily Hagan ◽  
Steven Montgomery ◽  
Sarinda Milllar ◽  
Shilpa Shah
Keyword(s):  
Service Improvement ◽  
Out Of Hours ◽  
Advice Service

scholarly journals Into the Night: Factors affecting response to abnormal Early Warning Scores out-of-hours and implications for service improvement

2014 ◽  
Vol 13 (2) ◽  
pp. 56-60
Author(s):  
C J Yiu ◽  
◽  
S U Khan ◽  
Christian P Subbe ◽  
K Tofeec ◽  
...  
Keyword(s):  
Nursing Staff ◽  
Early Warning ◽  
Service Evaluation ◽  
Early Warning Score ◽  
Service Improvement ◽  
Out Of Hours ◽  
Factors Affecting ◽  
Alarm Fatigue ◽  
Early Warning Scores ◽  
Medical Wards

Background: Early Warning Scores alert staff to preventable deterioration. Raised scores should lead to escalation of care. Aims: To establish response of staff to patients scoring National Early Warning Score (NEWS) of six or above and to identify patient and environmental factors affecting escalation by nursing staff. Methods: Service evaluation with prospective review of patient records of 118 beds on four medical wards during 20 night-shifts. Results: During 2360 observed bed days 109 patients triggered NEWS >=6 at least once during the observation period. Nursing staff escalated only 18 (17%) of these patients; nearly all of them had predefined chronic health conditions, the majority fulfilled criteria for frailty. Despite their higher 30-day mortality patients with COPD had lower escalation rates. Additionally wards that had more patients with a NEWS >=6 had lower escalation rates. Conclusion: Alarm fatigue and clinical judgement of staff might result in deviation from escalation protocols.

scholarly journals Point-of-care blood tests during home visits by out-of-hours primary care clinicians; a mixed methods evaluation of a service improvement

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033428
Author(s):  
Gail Hayward ◽  
Sharon Dixon ◽  
Sophie Garland ◽  
Margaret Glogowska ◽  
Helen Hunt ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Point Of Care ◽  
Home Visits ◽  
Total Carbon ◽  
Secondary Outcome ◽  
Service Improvement ◽  
Team Approach ◽  
Out Of Hours ◽  
Blood Tests

ObjectivesWe aimed to evaluate test usage and patient and clinician experience following the introduction of point-of-care (POC) blood tests into a primary care out-of-hours service.DesignA mixed methods service evaluation comprising quantitative records of the clinical contexts of tests taken and qualitative interviews with clinicians. Research permissions and governance were obtained for patient interviews.SettingOut-of-hours primary care.ParticipantsAll patients requiring home visits from the service during the implementation period.InterventionsThe i-STAT POC blood test platform was introduced to two bases providing home visits for a period of 8 months. Venous blood samples were used and two cartridges were available. The CHEM8 cartridge measures sodium, potassium, chloride, total carbon dioxide (TCO2), anion gap, ionised calcium, glucose, urea, creatinine, haematocrit and haemoglobin. The CG4 cartridge measures lactate, pH, PaO2 and PCO2, TCO2, bicarbonate, base excess and oxygen saturation.Primary and secondary outcome measuresThe proportion of home visits where tests were taken, the clinical contexts of those tests, the extent to which clinicians felt the tests had influenced their decisions, time taken to perform the test and problems encountered. Clinician and patient experiences of using POC tests.Resultsi-STAT POC tests were infrequently used, with successful tests taken at just 47 contacts over 8 months of implementation. The patients interviewed felt that testing had been beneficial for their care. Clinician interviews suggested barriers to POC tests, including practical challenges, concerns about time, doubt over whether they would improve clinical decision making and concern about increased medicolegal risk. Suggestions for improving adoption included sharing learning, adopting a whole team approach and developing protocols for usage.ConclusionsPOC tests were not successfully adopted by an out-of-hours home visiting service in Oxfordshire. While some clinicians felt they could not add value, in other cases they resulted in improved patient experience. Adoption could be promoted by improving technical, team and education factors.

scholarly journals Clinician perspectives on having point of care tests made available to them during out of hours home visiting

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
S. Dixon ◽  
M. Glogowska ◽  
S. Garland ◽  
H. Hunt ◽  
D. Lasserson ◽  
...  
Keyword(s):  
Decision Making ◽  
Nurse Practitioners ◽  
Home Visiting ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Home Visits ◽  
Service Improvement ◽  
Improvement Project ◽  
Out Of Hours ◽  
Clinical Scenarios

Abstract Background Little is known about clinicians’ perspectives on the use of point of care (POC) tests in assessment of acute illness during primary care out of hours (OOH) care. During a service improvement project, POC tests (including creatinine, electrolytes, haemoglobin and lactate) were made available to clinicians undertaking OOH home visits, with the clinicians allowed absolute discretion about when and whether they used them. Method To explore clinicians’ perspectives on having POC tests available during OOH home visits, we undertook a qualitative study with clinicians working in Oxfordshire OOH home visiting teams. We conducted 19 Semi-structured interviews with clinicians working in OOH, including those who had and had not used the POC tests available to them. To explore evolving perspectives over time, including experience and exposure to POC tests, we offered clinicians the opportunity to be interviewed twice throughout the study period. Our sample included 7 GPs (4 interviewed once, 3 interviewed twice - earlier and later during the study), 6 emergency practitioners (EPs) including advanced nurse practitioners and paramedics, 1 Healthcare Assistant, and 2 ambulatory care physicians. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Results The clinicians reflected on their decision-making to use (or not use) POC tests, including considering which clinical scenarios were “appropriate” and balancing the resources and time taken to do POC tests against what were perceived as likely benefits. The challenges of using the equipment in patients’ homes was a potential barrier, though could become easier with familiarity and experience. Clinicians who had used POC tests described benefits, including planning onward care trajectories, and facilitating communication, both between professionals and with patients and their families. Conclusion Clinicians described a discriminatory approach to using POC tests, considering carefully in which situations they were likely to add value to clinical decision-making.

Developing a Hyperacute Stroke-Ready Nursing Workforce: a Service Improvement Initiative

2020 ◽  
Vol 16 (Sup5) ◽  
pp. S10-S16
Author(s):  
Nicola Turner ◽  
Pedro Duarte ◽  
Anthony Jones ◽  
Ian Dovaston ◽  
David Pitchforth
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Stroke Care ◽  
Nursing Workforce ◽  
Service Improvement ◽  
Acute Stroke Care ◽  
Out Of Hours ◽  
Hyperacute Stroke ◽  
Stroke Thrombolysis

Background Thrombolysis treatment varies considerably between in- and out-of-hours services. Aims This improvement initiative aimed to upskill acute stroke unit nurses as stroke thrombolysis response nurses, testing a new model of nursing in readiness for hyperacute stroke unit developments. Methods Three registered nurses were trained to a specialist competency framework. The role was tested over 28 weeks, and times to treatment milestones were measured. Thrombolysed patients from the test period were statistically compared with a matched group using a two-sample t-test in Excel. Qualitative feedback was sought from the stroke team, medical and emergency department colleagues. Findings Median out-of-hours door-to-needle time reduced from 85 to 61.5 minutes. Statistically significant differences were seen in the time to stroke unit admission (p=0.012) and swallow screen (p=0.038). Stroke and emergency department colleagues considered the role essential to out-of-hours thrombolysis treatment. Conclusions The stroke thrombolysis response nurse role reduced variation in treatment and improved timely acute stroke care. This work may inform the development of stroke nursing workforce models.

National Symptom Surveillance Using Calls to a Telephone Health Advice Service - United Kingdom, December 2001-February 2003

2004 ◽  
Author(s):  
Duncan L. Cooper ◽  
G. Smith ◽  
M. Baker ◽  
F. Chinemana ◽  
N. Verlander ◽  
...  
Keyword(s):  
United Kingdom ◽  
Health Advice ◽  
Advice Service
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