scholarly journals Stroke Care in the United Kingdom During the COVID-19 Pandemic

Stroke ◽  
2021 ◽  
Author(s):  
Abdel Douiri ◽  
Walter Muruet ◽  
Ajay Bhalla ◽  
Martin James ◽  
Lizz Paley ◽  
...  
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Acute Stroke ◽  
Case Fatality ◽  
Stroke Care ◽  
Care Quality ◽  
Study Cohort ◽  
True Incidence ◽  
The United Kingdom ◽  
The Impact

Background and Purpose: The coronavirus disease 2019 (COVID-19) pandemic has potentially caused indirect harm to patients with other conditions via reduced access to health care services. We aimed to describe the impact of the initial wave of the pandemic on admissions, care quality, and outcomes in patients with acute stroke in the United Kingdom. Methods: Registry-based cohort study of patients with acute stroke admitted to hospital in England, Wales, and Northern Ireland between October 1, 2019, and April 30, 2020, and equivalent periods in the 3 prior years. Results: One hundred fourteen hospitals provided data for a study cohort of 184 017 patients. During the lockdown period (March 23 to April 30), there was a 12% reduction (6923 versus 7902) in the number of admissions compared with the same period in the 3 previous years. Admissions fell more for ischemic than hemorrhagic stroke, for older patients, and for patients with less severe strokes. Quality of care was preserved for all measures and in some domains improved during lockdown (direct access to stroke unit care, 1-hour brain imaging, and swallow screening). Although there was no change in the proportion of patients discharged with good outcome (modified Rankin Scale score, ≤2; 48% versus 48%), 7-day inpatient case fatality increased from 6.9% to 9.4% ( P <0.001) and was 22.0% in patients with confirmed or suspected COVID-19 (adjusted rate ratio, 1.41 [1.11–1.80]). Conclusions: Assuming that the true incidence of acute stroke did not change markedly during the pandemic, hospital avoidance may have created a cohort of untreated stroke patients at risk of poorer outcomes or recurrent events. Unanticipated improvements in stroke care quality should be used as an opportunity for quality improvement and to learn about how to develop resilient health care systems.

scholarly journals Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia

2021 ◽  
pp. 1-9
Author(s):  
Anna Ramos-Pachón ◽  
Álvaro García-Tornel ◽  
Mònica Millán ◽  
Marc Ribó ◽  
Sergi Amaro ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Stroke Care ◽  
Care Quality ◽  
Point Of View ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Vessel Occlusion ◽  
Prehospital Delays ◽  
The Impact

<b><i>Introduction:</i></b> The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system’s bottlenecks from a territorial point of view. <b><i>Methods:</i></b> Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15–May 2, 2020) and an immediate prepandemic period (January 26–March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. <b><i>Results:</i></b> Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = −0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05–2.4], <i>p</i> 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4–0.9], <i>p</i> 0.015) during the pandemic period. <b><i>Conclusion:</i></b> During the COVID-19 pandemic, Catalonia’s stroke system’s weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system’s analysis is crucial to allocate resources appropriately.

Competition and Containment in Health Care

2000 ◽  
Vol 30 (2) ◽  
pp. 257-284 ◽  
Author(s):  
Ben Griffith
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Cost Effectiveness ◽  
Transaction Costs ◽  
Health Care Services ◽  
Internal Markets ◽  
Care Services ◽  
The United Kingdom ◽  
Additional Funding ◽  
The Impact

In the United Kingdom and elsewhere, the preconditions for well-functioning internal markets (in relation to market structure, transaction costs, and information) may not exist in health care. Similar doubts exist about the impact of internal markets on cost-effectiveness. While the quantity of health care has increased, the effects on quality are ambiguous and costs have not been successfully restrained. With respect to equity of health care, fears have been raised that sections of the population may be discriminated against. In the United Kingdom, resources have been shifted away from deprived areas and toward the more affluent. Health care services are once again being reformed, by New Labour in the United Kingdom and similar administrations elsewhere. The rhetoric of competition has given way to talk of partnership. The imposition of new forms of rationing has been reshaped, not abandoned. Additional funding is required, along with an effective commitment to the pursuit of equity and quality in health care.

A Systematic Review of the Impact of Healthcare Reforms on Access to Emergency Department and Elective Surgery Services

2017 ◽  
Vol 48 (1) ◽  
pp. 81-105 ◽  
Author(s):  
Sandeep Reddy ◽  
Peter Jones ◽  
Harsha Shanthanna ◽  
Raechel Damarell ◽  
John Wakerman
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Emergency Department ◽  
United Kingdom ◽  
Elective Surgery ◽  
Grey Literature ◽  
Unintended Consequences ◽  
Health Care Reforms ◽  
The United Kingdom ◽  
The Impact

This systematic review sought to identify whether health care reforms led to improvement in the emergency department (ED) length of stay (LOS) and elective surgery (ES) access in Australia, Canada, New Zealand, and the United Kingdom. The review was registered in the PROSPERO database (CRD42015016343), and nine databases were searched for peer-reviewed, English-language reports published between 1994 and 2014. We also searched relevant “grey” literature and websites. Included studies were checked for cited and citing papers. Primary studies corresponding to national and provincial ED and ES reforms in the four countries were considered. Only studies from Australia and the United Kingdom were eventually included, as no studies from the other two countries met the inclusion criteria. The reviewers involved in the study extracted the data independently using standardized forms. Studies were assessed for quality, and a narrative synthesis approach was taken to analyze the extracted data. The introduction of health care reforms in the form of time-based ED and ES targets led to improvement in ED LOS and ES access. However, the introduction of targets resulted in unintended consequences, such as increased pressure on clinicians and, in certain instances, manipulation of performance data.

Medical Technology in the United Kingdom

1988 ◽  
Vol 4 (2) ◽  
pp. 171-183 ◽  
Author(s):  
Barbara Stocking
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Medical Technology ◽  
New Technology ◽  
Financing System ◽  
Significant Control ◽  
Diffusion Of Technology ◽  
Medical Technologies ◽  
The United Kingdom ◽  
The Impact

This article describes and explains the impact of the National Health Service bureaucracy on the diffusion of medical technology in the United Kingdom. Through case studies of six medical technologies, the author demonstrates how health care authorities may exercise significant control by using the central financing system to dampen the general diffusion of technology. However, the United Kingdom has less control in specific cases due to the absence of a bureaucratic body to coordinate the evaluation and introduction of new technology.

scholarly journals Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care

The Lancet ◽  
2016 ◽  
Vol 388 (10040) ◽  
pp. 170-177 ◽  
Author(s):  
Benjamin D Bray ◽  
Geoffrey C Cloud ◽  
Martin A James ◽  
Harry Hemingway ◽  
Lizz Paley ◽  
...  
Keyword(s):  
Health Care ◽  
Cohort Study ◽  
Acute Stroke ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Health Care Quality ◽  
Stroke Care ◽  
Care Quality ◽  
Acute Stroke Care ◽  
Time Of Admission

The network of Shanghai Stroke Service System (4S): A public health-care web-based database using automatic extraction of electronic medical records

2018 ◽  
Vol 13 (5) ◽  
pp. 539-544 ◽  
Author(s):  
Yi Dong ◽  
Kun Fang ◽  
Xin Wang ◽  
Shengdi Chen ◽  
Xueyuan Liu ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Acute Stroke ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Service System ◽  
Stroke Care ◽  
Care Quality ◽  
Web Based ◽  
Baseline Characteristics

Background Several stroke outcome and quality control projects have demonstrated the success in stroke care quality improvement through structured process. However, Chinese health-care systems are challenged with its overwhelming numbers of patients, limited resources, and large regional disparities. Aim To improve quality of stroke care to address regional disparities through process improvement. Method and design The Shanghai Stroke Service System (4S) is established as a regional network for stroke care quality improvement in the Shanghai metropolitan area. The 4S registry uses a web-based database that automatically extracts data from structured electronic medical records. Site-specific education and training program will be designed and administrated according to their baseline characteristics. Both acute reperfusion therapies including thrombectomy and thrombolysis in the acute phase and subsequent care were measured and monitored with feedback. Primary outcome is to evaluate the differences in quality metrics between baseline characteristics (including rate of thrombolysis in acute stroke and key performance indicators in secondary prevention) and post-intervention. Conclusions The 4S system is a regional stroke network that monitors the ongoing stroke care quality in Shanghai. This project will provide the opportunity to evaluate the spectrum of acute stroke care and design quality improvement processes for better stroke care. A regional stroke network model for quality improvement will be explored and might be expanded to other large cities in China. Clinical Trial Registration-URL http://www.clinicaltrials.gov . Unique identifier: NCT02735226.

scholarly journals The emergence and utilisation of frailty in the United Kingdom: a contemporary biopolitical practice

2018 ◽  
Vol 40 (4) ◽  
pp. 695-712 ◽  
Author(s):  
Louise Tomkow
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Older People ◽  
Health Care Professionals ◽  
Geriatric Medicine ◽  
Adverse Outcomes ◽  
Ageing Population ◽  
Political Climate ◽  
The United Kingdom ◽  
The Impact

AbstractFrailty has recently emerged as a dominant concept against a backdrop of media and governmental narratives that frame the growing ageing population as an economic threat to the current configuration of health care in the United Kingdom (UK). Despite frailty's popularity amongst geriatricians and policy makers, the concept faces resistance from other health-care professionals and older people themselves. This paper draws on the Foucauldian idea of biopower; by suggesting that the contemporary emergence and utilisation of frailty represents a biopolitical practice a number or critical observations are made. First, despite biomedical experts acknowledging ambiguities in the definition of frailty, the concept is presented as a truth discourse. This is driven by the ability of frailty measurements to predict risk of costly adverse outcomes; the capability of frailty scores to enumerate complex needs; and the scientific legitimacy frailty affords to geriatric medicine. Consequently, frailty has become pervasive, knowable and measurable. Second, the routine delineation between frail and robust objectifies older people, and can be said to benefit those making the diagnosis over those being labelled frail, with the latter becoming disempowered. Last, studies show that frailty is associated with increasing wealth inequalities in the UK; however, experts’ suggested management of frailty shifts the focus of responsibility away from ideologically driven structural inequalities towards the frail older person, attempting to encourage individuals to modify lifestyle choices. This neglects the association between lifestyle opportunities and socio-economic deprivation, and the impact of long-term poverty on health. These observations, set against the contemporary political climate of economic austerity, cuts to public services and rationalisation of health resources, bring the urgency of a critical consideration of frailty to the fore.

scholarly journals The impact of coronavirus disease 2019 pandemic on working dynamics of junior and middle grade doctors in the United Kingdom: Learning from their experience requires immediate improvement in health care planning and management—An outcome analysis of a nationwide survey

2021 ◽  
Vol 9 ◽  
pp. 205031212110390
Author(s):  
Madiha Abbas ◽  
Abbas Ghazanfar
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Intensive Therapy ◽  
Mass Movement ◽  
Well Being ◽  
Minority Ethnic Group ◽  
Middle Grade ◽  
Clinical Practices ◽  
The United Kingdom ◽  
The Impact

Objectives: Severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) pandemic had an unprecedented impact on health services across the world resulting in increased demand of intensive care capacity, opening Nightingale hospitals, and mass movement of doctors across various specialities. This unplanned redeployment raised concerns among various health care workers. The objective of the current study is to explore working dynamics and experience of junior and middle grade doctors during current pandemic. Methods: We organised a nationwide cross-sectional survey of junior and middle grade doctors working in the United Kingdom. The survey was aimed to study their level of participation during coronavirus disease 2019 pandemic and its impact on their clinical practices and well-being. Results: In total, 1564 completed questionnaires with representations from all regions of the United Kingdom were included. The mean age of respondents was 30.64 years (95% confidence interval +1.025; standard deviation = 9.9057). There were 51.5% females with significantly more participants from Black, Asian, and minority ethnic group ( n = 835, p = 0.0073); 963 (61.6%, p ⩽ 0.0001) doctors were redeployed outside their primary speciality. The major redeployments were from other specialities to Intensive Therapy Units (41.8%, p ⩽ 0.001); 63.3% of respondents spend more than 8 weeks in redeployed speciality ( p ⩽ 0.0001). There was a significant impact of coronavirus disease 2019 on personal, mental, and physical well-being of doctors. The major areas requiring immediate attention include proper leadership and clinical support (64.1%), pre-redeployment planning and induction (48.5%), redeployment according to the skills and/or in familiar specialities (44.6%), and regular mental and physical well-being checks (37%). Conclusion: The outcome of the survey concluded with four major recommendations, including the need to have a named supervisor for these doctors, structured induction program, regular well-being checks, and involving them in crisis planning. These recommendations will help to shape future health care policies and management particularly when it is related to redeployment of doctors during any crisis or pandemic.

scholarly journals Analysis of Covid-19 Data for Eight European Countries and the United Kingdom Using a Simplified SIR Model

2020 ◽  
Author(s):  
Gyan Bhanot ◽  
Charles DeLisi
Keyword(s):  
United Kingdom ◽  
Time Lag ◽  
Case Fatality ◽  
Sir Model ◽  
Control Measures ◽  
European Countries ◽  
Daily Number ◽  
The United Kingdom ◽  
The Impact ◽  
Infective Period

Abstract Background: As the SARS-Cov-2/Covid-19 pandemic continues to ravage the world, it is important to understanding the characteristics of its spread and possible correlates for control to develop strategies of response. Methods: Here we show how a simple Susceptible-Infective-Recovered (SIR) model applied to data for eight European countries and the United Kingdom (UK) can be used to forecast the descending limb (post-peak) of confirmed cases and deaths as a function of time, and predict the duration of the pandemic once it has peaked, by estimating and fixing parameters using only characteristics of the ascending limb and the magnitude of the first peak. Results: The predicted and actual case fatality ratio, or number of deaths per million population from the start of the pandemic to when daily deaths number less than five for the first time, was lowest in Norway (predicted: 44 5 deaths/million; actual: 36 deaths/million) and highest for the United Kingdom (predicted: 578 +/- 65 deaths/million; actual 621 deaths/million). The inferred pandemic characteristics separated into two distinct groups: those that are largely invariant across countries, and those that are highly variable. Among the former is the infective period, TL = 16.3 2.7 days, the average time between contacts, TR = 3.8+/- 0.5 days and the average number of contacts while infective R = 4.4 +/- 0.5. In contrast, there is a highly variable time lag TD between the peak in the daily number of confirmed cases and the peak in the daily number of deaths, ranging from lows of TD = 2,4 days for Denmark and Italy respectively, to highs of TD = 12, 15 for Germany and Norway respectively. The mortality fraction, or ratio of deaths to confirmed cases, was also highly variable, ranging from low values 3%, 5% and 5% for Norway, Denmark and Germany respectively, to high values of 18%, 20% and 21% for Sweden, France, and the UK respectively. The probability of mortality rather than recovery was a significant correlate of the duration of the pandemic, defined as the time from 12/31/2019 to when the number of daily deaths fell below 5. Finally, we observed a small but detectable effect of average temperature on the probability of infection per contact, with higher temperatures associated with lower infectivity. Conclusions: Our simple model captures the dynamics of the initial stages of the pandemic, from its exponential beginning to the first peak and beyond, with remarkable precision. As with all epidemiological analyses, unanticipated behavioral changes will result in deviations between projection and observation. This is abundantly clear for the current pandemic. Nonetheless, accurate short-term projections are possible, and the methodology we present is a useful addition to the epidemiologist's armamentarium. Our predictions assume that control measures such as lockdown, social distancing, use of masks etc. remain the same post-peak as before peak. Consequently, deviations from our predictions are a measure of the extent to which loosening of control measures have impacted case-loads and deaths since the first peak and initial decline in daily cases and deaths. Our findings suggest that the two key parameters to control and reduce the impact of a developing pandemic are the infective period and the mortality fraction, which are achievable by early case identification, contact tracing and quarantine (which would reduce the former) and improving quality of care for identified cases (which would reduce the latter).

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