scholarly journals Improving patient waiting times and quality of care by arranging access to notes from a neighbouring trust

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S175-S176
Author(s):  
Georgios Basdanis ◽  
Cormac Fenton
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Quality Of Care ◽  
Median Time ◽  
Discharge Planning ◽  
Waiting Times ◽  
Clinical Information ◽  
North West ◽  
Time Required

AimsWe aim to improve waiting times in the Emergency Department and improve the overall quality of care of out-of-area patients by arranging for the liaison team to have access to the electronic notes system of a neighbouring trust.MethodSt Thomas’ Hospital is located in south London, right opposite the City of Westminster. As a result, approximately 20% of patients we see in mental health liaison are from that locality. Given that they belong to a different trust, we do not have access to their notes, which leads to a delay in trying to establish whether they are known to local mental health services. Often, staff are reluctant to divulge information. When information is shared, it is often late and/or incomplete. We approached the Chief Clinical Information Officer and Head of Information Governance from Central and North West London (CNWL) NHS Foundation Trust. We held weekly meetings which included both IT departments. Our IT had to install the electronic notes application (SystmOne) on our computers and open relevant firewall ports. The information is access through an NHS Smartcard, therefore CNWL had to authorise read-only Smartcard profiles for every member of the liaison team. A quick reference guide was created for all staff that would be using the new application. The system went live on 21 January 2021.ResultWe audited patient outcomes in December 2020 and February 2021 for initial comparison. In December 2020, the median time from referral to discharge was 6 hours 35 minutes. 25% of patients were admitted and 17% discharged with HTT. In February 2021, the median time from referral to discharge was 3 hours 19 minutes. 16% of patients were admitted and 5% discharged with HTT.ConclusionIt is likely that by reducing the time required for collateral information, overall waiting times in the emergency department will be reduced. Clinicians are likely to feel more confident in their discharge planning if they have access to all clinical notes and previous risk assessments, which might in turn reduce referrals to HTT or admission. There should be further attempts by neighbouring NHS trusts, especially in London, to ensure access to their electronic notes system in order to reduce waiting times and improve the quality of patient care. We have already been approached for more information by a trust in North London who are interested in establishing access to a neighbouring trust's notes.

Provider interruptions and patient perceptions of care: an observational study in the emergency department

2018 ◽  
Vol 28 (4) ◽  
pp. 296-304
Author(s):  
Anna Schneider ◽  
Markus Wehler ◽  
Matthias Weigl
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Multiple Testing ◽  
Linear Models ◽  
Waiting Times ◽  
Patient Perceptions ◽  
Tertiary Referral Hospital ◽  
Positive Effects ◽  
Perceptions Of Care

BackgroundInterruptions are endemic in healthcare work environments. Yet, they can have positive effects in some instances and negative in others, with their net effect on quality of care still poorly understood. We aimed to distinguish beneficial and detrimental forms of interruptions of emergency department (ED) providers using patients’ perceptions of ED care as a quality measure.MethodsAn observational design was established. The study setting was an interdisciplinary ED of an academic tertiary referral hospital. Frequencies of interruption sources and contents were identified in systematic expert observations of ED physicians and nurses. Concurrently, patients rated overall quality of care, ED organisation, patient information and waiting times using a standardised survey. Associations were assessed with hierarchical linear models controlling for daily ED workload. Regression results were adjusted for multiple testing. Additionally, analyses were computed for ED physicians and nurses, separately.ResultsOn 40 days, 160 expert observation sessions were conducted. 1418 patients were surveyed. Frequent interruptions initiated by patients were associated with higher overall quality of care and ED organisation. Interruptions relating to coordination activities were associated with improved ratings of ED waiting times. However, interruptions containing information on previous cases were associated with inferior ratings of ED organisation. Specifically for nurses, overall interruptions were associated with superior patient reports of waiting time.ConclusionsProvider interruptions were differentially associated with patient perceptions of care. Whereas coordination-related and patient-initiated interruptions were beneficial to patient-perceived efficiency of ED operations, interruptions due to case-irrelevant communication were related to inferior patient ratings of ED organisation. The design of resilient healthcare systems requires a thorough consideration of beneficial and harmful effects of interruptions on providers’ workflows and patient safety.

scholarly journals Patient Satisfaction in a University Hospital Emergency Department in Turkey

2005 ◽  
Vol 48 (1) ◽  
pp. 59-62 ◽  
Author(s):  
Cuma Yildirim ◽  
Hasan Koçoğlu ◽  
Sıtkı Göksu ◽  
Nurullah Gunay ◽  
Haluk Savas
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Quality Care ◽  
Waiting Times ◽  
Adult Patients ◽  
University Hospital ◽  
Patient Dissatisfaction ◽  
Insurance Carrier

Objective: Patient satisfaction, an indicator of the quality of care provided by emergency department (ED) personnel, is a significant issue for EDs. The purpose of this study was to identify factors associated with patient satisfaction and dissatisfaction, and to describe demographic characteristics of those surveyed in a university hospital ED. Methods: All adult patients who consecutively presented to the ED between 8:00 a.m. and 5:00 p.m. on weekdays were included in the study. Patients were asked to complete a questionnaire prior to discharge. The questionnaire asked about the attitude, politeness, and efficiency of the medical and ancillary staff, the reason for preferring our centre and reasons for dissatisfaction. Results: Two-hundred and forty-five adult patients presenting to our ED were included in this study. Forty-five percent of patients preferred our ED because of the previous perception of higher quality of care, informed by other people previously treated in this ED unit, and 35% because of restrictions by their health insurance carrier. The main causes of patient dissatisfaction were lengthy waiting times (27%). Conclusion: As a result, lengthy waiting time was the major reason for patient dissatisfaction, and high quality care together with insurance restrictions were the main reasons for preference of this university hospital ED.

Quality of care in longer term mental health institutions in Portugal

2011 ◽  
Vol 38 (S 01) ◽  
Author(s):  
G Cardoso ◽  
C Pacheco ◽  
J Caldas-de-Almeida
Keyword(s):  
Mental Health ◽  
Quality Of Care ◽  
Health Institutions ◽  
Mental Health Institutions

scholarly journals A Risk Exchange: Health and Mobility in the Context of Climate and Environmental Change in Bangladesh—A Qualitative Study

2021 ◽  
Vol 18 (5) ◽  
pp. 2629
Author(s):  
Patricia Nayna Schwerdtle ◽  
Kate Baernighausen ◽  
Sayeda Karim ◽  
Tauheed Syed Raihan ◽  
Samiya Selim ◽  
...  
Keyword(s):  
Climate Change ◽  
Mental Health ◽  
Quality Of Care ◽  
Health Risks ◽  
Thematic Analysis ◽  
Health Determinants ◽  
Physical And Mental Health ◽  
Health And Wellbeing ◽  
Healthcare Environment

Background: Climate change influences patterns of human mobility and health outcomes. While much of the climate change and migration discourse is invested in quantitative predictions and debates about whether migration is adaptive or maladaptive, less attention has been paid to the voices of the people moving in the context of climate change with a focus on their health and wellbeing. This qualitative research aims to amplify the voices of migrants themselves to add nuance to dominant migration narratives and to shed light on the real-life challenges migrants face in meeting their health needs in the context of climate change. Methods: We conducted 58 semi-structured in-depth interviews with migrants purposefully selected for having moved from rural Bhola, southern Bangladesh to an urban slum in Dhaka, Bangladesh. Transcripts were analysed using thematic analysis under the philosophical underpinnings of phenomenology. Coding was conducted using NVivo Pro 12. Findings: We identified two overarching themes in the thematic analysis: Firstly, we identified the theme “A risk exchange: Exchanging climate change and health risks at origin and destination”. Rather than describing a “net positive” or “net negative” outcome in terms of migration in the context of climate change, migrants described an exchange of hazards, exposures, and vulnerabilities at origin with those at destination, which challenged their capacity to adapt. This theme included several sub-themes—income and employment factors, changing food environment, shelter and water sanitation and hygiene (WaSH) conditions, and social capital. The second overarching theme was “A changing health and healthcare environment”. This theme also included several sub-themes—changing physical and mental health status and a changing healthcare environment encompassing quality of care and barriers to accessing healthcare. Migrants described physical and mental health concerns and connected these experiences with their new environment. These two overarching themes were prevalent across the dataset, although each participant experienced and expressed them uniquely. Conclusion: Migrants who move in the context of climate change face a range of diverse health risks at the origin, en route, and at the destination. Migrating individuals, households, and communities undertake a risk exchange when they decide to move, which has diverse positive and negative consequences for their health and wellbeing. Along with changing health determinants is a changing healthcare environment where migrants face different choices, barriers, and quality of care. A more migrant-centric perspective as described in this paper could strengthen migration, climate, and health governance. Policymakers, urban planners, city corporations, and health practitioners should integrate the risk exchange into practice and policies.

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