Evaluating the impact of nurse practitioner involvement in a pleural procedures clinic

2020 ◽  
Vol 29 (14) ◽  
pp. 816-820
Author(s):  
Eleanor Peter
Keyword(s):  
Nurse Practitioner ◽  
Disease Incidence ◽  
Service Evaluation ◽  
Educational Opportunities ◽  
Structured Interviews ◽  
Number Of Patients ◽  
Key Staff ◽  
The Impact ◽  
Model Of Practice ◽  
Work Burden

Background: Pleural disease incidence is increasing and there has been a move towards outpatient management. Pleural clinics have been developed for patients to be assessed and have pleural procedures for diagnostic and symptomatic purposes. Aim: The study aimed to assess the impact of nurse practitioner (NP) involvement in a pleural procedures clinic on clinic capacity, and staff and patient experience. Methods: A mixed-methods service evaluation was completed in a medium-sized general hospital. The number of patients seen in clinic over a 6-month period at the beginning of NP involvement was compared with the number of patients seen 1 year later. Semi-structured interviews of key staff stakeholders were conducted. Findings: Clinic capacity increased from 4.57 to 5.86 patients per list. NP involvement increased access, improved patient care, reduced work burden for other staff and improved educational opportunities. Conclusion: The impact of NP involvement in the pleural clinic was seen as positive and increased clinic capacity. The same model of practice could be considered elsewhere.

scholarly journals Service evaluation for services for younger people with dementia in east locality of north Wales

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S20-S20
Author(s):  
Asha Dhandapani ◽  
Sathyan Soundararajan ◽  
Sharmi Bhattacharyya
Keyword(s):  
Time Frame ◽  
Service Evaluation ◽  
Young Onset ◽  
People With Dementia ◽  
North Wales ◽  
Number Of Patients ◽  
Time To Diagnosis ◽  
Working Age ◽  
The Impact ◽  
Timely Referral

AimsTo evaluate Young-onset dementia (YOD) services in terms of referral, its appropriateness, time to diagnosis and other criteria as per protocol that we have adapted.MethodCase notes of those under 65 referred to Memory service for cognitive assessment between July 2017 and June 2018 were retrospectively reviewed to look at the time to diagnosis, appropriate referrals, post-diagnostic support, etc.ResultCompared to the previous evaluation, the number of patients referred to had increased from 47–48/ year earlier to 63/year. Only 1/3 were appropriate referral over the 10-year period whereas between 2017 and 2018 more than half were appropriate referrals. More than half of them were seen within 12 weeks of referral (35/63 available). Only 132/252 were diagnosed as having some form of dementia in the previous evaluation which was about 13 cases of YOD a year. In contrast, in our new evaluation 19 patients were diagnosed with some form of dementia. Inappropriate referrals had reduced by more than 50%. Appropriateness and timely referral had improved in this time frame.ConclusionDementia is considered ‘young onset’ when it affects people under 65 years of age. It is also referred to as ‘early onset’ or ‘working age’ dementia. However, this is an arbitrary age distinction that is becoming less relevant as increasingly services are realigned to focus on the person and the impact of the condition, not the age. Teaching sessions to educate primary & secondary care clinicians on appropriateness and timely referrals have helped in improving the care for patients with YOD. Services need to be developed further to be able to diagnose & support those with YOD. Repeat evaluations every year would help to inform improvement in quality & appropriateness of referrals.

scholarly journals Mitigating the impact of SARS-CoV-2 on residential facilities for persons with intellectual disability and/or autism spectrum disorder: two experiences from the Italian red zone

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Jacopo Santambrogio ◽  
Michela Russo ◽  
Sergio Terrevazzi ◽  
Gianluca Peschi ◽  
Massimo Clerici ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Service Evaluation ◽  
Autism Spectrum ◽  
Residential Facilities ◽  
Structured Interviews ◽  
Content Type ◽  
The People ◽  
Specific Vulnerability ◽  
The Impact ◽  
High Support

Purpose Persons with intellectual disability and/or low-functioning autism spectrum didorder are with high support need (ID/ASD-HSN) are among the people who are most vulnerable to the COVID-19 pandemic. The specific vulnerability and the protective factors for persons with ID/LF-ASD attending residential and rehabilitative facilities have however received little attention. This paper aims to describe how two facilities located in the Italian COVID-19 red zone faced the risks associated with the spread of the pandemic and the results they have achieved so far. Design/methodology/approach Interventions to contrast the spread of the pandemic and preserve clients’ health conditions have been systematically monitored and recorded since the very beginning of the pandemic. Findings 26/138 clients had to undergo clinical screening and laboratory tests for COVID-like symptomatology, but only one resulted affected by COVID-19 and survived. Considering that Lombardy had 89,595 cases and 16,262 deaths (January–May 2020), one COVID-19 case/138 clients is a good result. Temporarily limiting physical contacts with friends/family in favor of reducing the burden of risk and adopting a system of prevention/safety strategies directed for persons with ID/LF-ASD attending and their caregivers have been useful measures. Research limitations/implications Structured or semi-structured interviews (using professional caregivers as informant) to confirm behavioral and emotional changes in the clients could not be carried out because of lack of time and resources (which were captured by the management of the pandemic) and could be the next goal for our residential facilities to implement the management of epidemic acute phases in a research-oriented view. Originality/value This study is a service evaluation report about facing COVID-19 pandemic. Only few such studies are present in medical literature about ID/ASD.

scholarly journals Increased number of deaths within 24 h of admission during a period of social restriction related to the COVID-19 pandemic: A retrospective service evaluation in a metropolitan palliative care unit

2021 ◽  
pp. 026921632110265
Author(s):  
Rachel Everitt ◽  
Neil Robinson ◽  
David Marco ◽  
Jennifer Weil ◽  
Tamsin Bryan
Keyword(s):  
Palliative Care ◽  
Tertiary Hospital ◽  
Service Evaluation ◽  
Health Care Utilisation ◽  
Palliative Care Unit ◽  
Published Data ◽  
Hospital Inpatient ◽  
Number Of Patients ◽  
Social Restriction ◽  
The Impact

Background: COVID-19 has led to implementation of wide-ranging social restriction measures with consequent impact on health care utilisation in many domains. There is little published data on the experience of palliative care services catering to a population with low case numbers of COVID-19. Aim: This study aimed to consider the impact of COVID-19 on utilisation of inpatient palliative care in the context of low community transmission, and low numbers of cases in hospital. Design: A retrospective service evaluation examining differences in number of admissions, diagnoses, number of deaths and time from admission to death, across three discrete 8-week time periods spanning the early COVID-19 pandemic. Setting/participants: All admissions ( n = 194) to a metropolitan tertiary hospital inpatient palliative care unit in Melbourne during the study period. Results: An initial 16.9% fall in admissions was followed by a return to baseline admission numbers, with a 46.7% increase in number of deaths compared to baseline. The number of deaths within 24 h rose from 10.8% to 37.3% ( p < 0.01). The number of patients with non-malignant diagnoses increased from 32.4% to 52%, and those with non-malignant diagnoses were more likely to die rapidly ( p < 0.01). There were no patients with COVID-19 infection. Conclusion: Increased numbers of deaths within 24 h of admission occurred on the palliative care unit despite low COVID-19 case numbers in the wider community, and in the setting of widespread social restriction measures. More research is needed examining the health-related consequences of such restrictions for individuals not infected with COVID-19.

Impact of a Multidisciplinary Craniofacial Clinic for Patients With Craniofacial Syndromes on Patient Satisfaction and Outcome

2020 ◽  
Vol 57 (12) ◽  
pp. 1357-1361
Author(s):  
Caitlin Hoffman ◽  
Melissa Yuan ◽  
Andre Boyke ◽  
Imali Perera ◽  
Corinne Rabbin-Birnbaum ◽  
...  
Keyword(s):  
Nurse Practitioner ◽  
Treatment Plan ◽  
Tertiary Care ◽  
Surgical Care ◽  
Parent Satisfaction ◽  
Plastic Surgeon ◽  
Time To Surgery ◽  
Number Of Patients ◽  
The Impact ◽  
Craniofacial Syndromes

Objective: Multidisciplinary clinics are becoming widely utilized. Given the number of patients with craniofacial syndromes evaluated at our institution, and the burden of assessment by multiple subspecialists, we created an American Cleft Palate-Craniofacial Association–certified Craniofacial Multidisciplinary Clinic (CMC) composed of a nurse practitioner, neurosurgeon, plastic surgeon, otolaryngologist, oromaxillofacial surgeon, geneticist, pulmonologist, occupational therapist, dentist, and child life specialist to improve patient experience, lessen the burden of assessment, decrease time to surgery, and improve patients’ understanding of the diagnosis and treatment plan specifically for patients with complex craniofacial syndromes. We reviewed the impact of this clinic after 1 year of implementation. Design: Retrospective review was performed to identify patients with craniofacial syndromic diagnoses seen by the neurosurgery department before and after implementation of the CMC from February 2017 to present. Setting: The CMC is an outpatient clinic based in a tertiary care academic institution. Patients: Chart review was performed to identify demographic, diagnostic, clinical, and treatment data. We assessed clinic experience, and the impact on quality of clinical and surgical care was assessed via survey. We compared this cohort to patients with similar craniofacial syndromes treated prior to the CMC. Thirty patients seen at the CMC were identified, and data from a comparable cohort of 30 patients seen prior to the clinic’s inception was reviewed. Results: Our CMC survey response rate was 67% (n = 20/30) for the CMC patients. Second opinions sought by parents prior to CMC was higher (mean = 0.85, range: 0-3) than for patients seen at the CMC (mean = 0.16, range: 0-1). Mean time to surgery before the CMC was 10.1 months (range: 1-15) compared to 4 months (range: 3-5) after implementation. Parents agreed that they felt well-informed about their diagnosis (n = 18/20, 90%), and that the presence of a plastic surgeon (19/20, 95%) and a nurse practitioner (17/20, 85%) were valuable in coordination of their care. Following surgery, 76% (n = 13/17) of patients who received surgery were happy with the outcome, 76% (n = 13/17) were happy with the appearance of the scar, and 95% (n = 19/20) would recommend the CMC to others. Conclusion: Multidisciplinary evaluation of patients with complex craniofacial conditions provides comprehensive, efficient, and effective care, as well as improved parent satisfaction and knowledge base.

scholarly journals Does total triage and remote-by-default consulting impact vulnerable groups: A pilot study

2020 ◽  
Author(s):  
Aaminah Verity ◽  
Dharmendra Naidu ◽  
Victoria Tzortziou-Brown
Keyword(s):  
General Practice ◽  
Pilot Study ◽  
Service Evaluation ◽  
Mitigation Strategies ◽  
Vulnerable Groups ◽  
Structured Interviews ◽  
New Ways Of Working ◽  
Vulnerable Patients ◽  
The Impact ◽  
Gp Model

AbstractBackgroundCOVID-19 mandated a rapid and dramatic transformation of general practice. ‘Total Triage’ (TT), where all consultations should be triaged first, and ‘Remote-by-Default’ (RbD) consulting, where a clinician should consult remotely unless there is a “clinical exception”, were advised. It is unclear how these new ways of working were implemented in practice, and how they impacted vulnerable patients.AimTo assess the impact of TT and RbD on vulnerable patients and identify mitigation strategies.Design and SettingA mixed methods service evaluation in Lewisham, London, an area of high deprivation.MethodThree parallel datasets were collected and analysed: Semi-structured interviews with stakeholders working with vulnerable groups and qualitative data from forums with black and ethnic minority patients, a survey of General Practitioners exploring implementation of TT and RbD, and a mystery shopper exercise reviewing access and messaging of ten practices.ResultsBarriers to access for vulnerable patients included challenges navigating the new model, difficulty engaging with remote consultations and digital exclusion. There was wide variation in messaging regarding changes to services and the practical application of TT and RbD. Potential solutions included clearer practice guidance and patient messaging, more consistent implementation, and identification and recording of patient access needs to enable better tailoring of care provision.ConclusionThis pilot study identified perceived and actual barriers to accessing general practice for vulnerable patients following the rapid introduction of TT and RbD consulting. It proposes immediate steps to mitigate some of these impacts and highlights the need for further research in this area.How This Fits InThe rapid and widespread adoption, recommended by NHS England, of total triage and remote-by-default consulting in general practice has yet to be evaluated. We provide a first look at how these changes are impacting those with historic difficulties in accessing primary care under the traditional GP model. We also provide some local recommendations that can be implemented easily at practice level and beyond, to mitigate the impact of these changes whilst making recommendations for further research to corroborate these findings widely.

The impact of GP referrals on overcrowding in emergency departments and acute medicine

2021 ◽  
Vol 27 (2) ◽  
pp. 1-6
Author(s):  
Ayaz A Abbasi ◽  
Shams Khan ◽  
Victor Ameh ◽  
Ilyas Muhammad
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Patient Flow ◽  
General Medicine ◽  
Service Evaluation ◽  
Urgent Care ◽  
Ambulatory Assessment ◽  
Acute Medicine ◽  
Number Of Patients ◽  
The Impact

Background/Aims A long-standing issue common to most emergency departments worldwide is overcrowding, and the UK is no exception. Overcrowding can have many adverse consequences, such as increased medical errors, decreased quality of care and poor patient outcomes. This service evaluation aimed to review the number of patients referred to acute specialties by their GPs and to evaluate the impact of these referrals on the flow of patients in and out of the emergency department and acute medicine. Methods GP referral letters were collected at an emergency department in Greater Manchester, England, between 15 May 2019 and 28 May 2019. A proforma was used by a consultant in acute medicine and a consultant in emergency medicine to evaluate each letter. Result A total of 139 GP referrals were received by the emergency department, of which 43 were to general medicine and 96 to other specialties. Of the latter, 54 cases were directed to the emergency department, 20 were directed to a different specialty and 23 did not have a specialty clearly specified. The majority of referrals were for gastrointestinal conditions or abdominal pain, with the next largest category being chest infections. Most of these patients were eventually seen in the trust's ambulatory assessment area to relieve pressure on the emergency department. Conclusions Planned and specific use of urgent care centres and ambulatory assessment areas can help to relieve pressure on emergency departments, but appropriate intervention at the primary care level is also necessary to improve patient flow.

scholarly journals Impact of total triage and remote-by-default consulting on vulnerable groups: A pilot study

2021 ◽  
Author(s):  
Aaminah Verity ◽  
Dharmendra Naidu ◽  
Victoria Tzortziou Brown
Keyword(s):  
General Practice ◽  
Local Level ◽  
Service Evaluation ◽  
Mitigation Strategies ◽  
Vulnerable Groups ◽  
Structured Interviews ◽  
New Ways Of Working ◽  
Vulnerable Patients ◽  
The Impact ◽  
Gp Model

Rationale, Aims & Objectives COVID-19 mandated a rapid and dramatic transformation of general practice. ‘Total Triage’ (TT), where all consultations should be triaged first, and ‘Remote-by-Default’ (RbD) consulting, where a clinician should consult remotely unless there is a “clinical exception”, were advised. It is unclear how these new ways of working were implemented in practice, and how they impacted vulnerable patients. We provide a first look at how these changes are impacting those with historic difficulties in accessing primary care under the traditional GP model. This service evaluation aimed to assess the impact of TT and RbD on vulnerable patients and identify mitigation strategies using a mixed methods service evaluation in Lewisham, London, an area of high deprivation. Method Three parallel datasets were collected and analysed: Semi-structured interviews with stakeholders working with vulnerable groups and qualitative data from forums with black and ethnic minority patients, a survey of General Practitioners exploring implementation of TT and RbD, and a mystery shopper exercise reviewing access and messaging of ten practices. Results Barriers to access for vulnerable patients included challenges navigating the new model, difficulty engaging with remote consultations and digital exclusion. There was wide variation in messaging regarding changes to services and the practical application of TT and RbD. Potential solutions included clearer practice guidance and patient messaging, more consistent implementation, and identification and recording of patient access needs, to enable better tailoring of care provision. Conclusion We identified perceived and actual barriers to accessing general practice for vulnerable patients following the rapid introduction of TT and RbD consulting in Lewisham. We recommend immediate steps that can be implemented at a local level to mitigate some of these impacts, and propose further work to gain better insights into the issues identified.

Offender Personality Disorder Pathway: Evaluation of Team Consultation

2014 ◽  
Vol 19 (3) ◽  
pp. 185-195 ◽  
Author(s):  
Elaine McMullan ◽  
Jo Ramsden ◽  
Mark Lowton
Keyword(s):  
Criminal Justice ◽  
Personality Disorder ◽  
Workforce Development ◽  
Service Evaluation ◽  
Structured Interviews ◽  
Content Type ◽  
Personality Disordered ◽  
The Impact ◽  
Practical Implications

Purpose – The purpose of this paper is to highlight the findings of a service evaluation project assessing the impact of team consultation to criminal justice staff working with personality disordered offenders. Design/methodology/approach – A qualitative design using content analysis of focus groups and individual semi-structured interviews. Findings – Criminal justice staff report increased awareness and understanding, use of a person-centred approach, development of formulation skills and defensible practice following team consultation. Practical implications – This paper will be of interest to practitioners who offer and/or receive consultation for work with offenders with personality disorder. Suggested changes to team consultation formats may be of interest to services involved with the Offender Personality Disorder Pathway. Originality/value – This paper contributes towards the emerging literature on the role of consultation and formulation on workforce development for individuals with personality disorder. It also contributes to the evaluation of the services offered by this specialist team as they support probation Trusts across Yorkshire/Humber to support the community specification of the national Offender Personality Disorder Pathway.

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