Entitlement to hospital treatment in the UK: qualifiers, challenges and comment

Background: Acute stroke patients are usually transported to the nearest hospital regardless of their required level of care. This can lead to increased pressure on emergency departments and treatment delay. Objective: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions. Methods: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service area in Southend-on-Sea was conducted. Emergency patients categorized as code stroke and headache were included from June 5, 2018, to December 18, 2018. Rate of avoided admission to the accident and emergency (A&E) department, rate of admission directly to target ward, and stroke management metrics were assessed. Results: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to 8 of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, 1 patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 min (interquartile range, 40–60). Conclusion: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&E departments.

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Mobile stroke unit in the UK healthcare system: avoidance of unnecessary accident and emergency admissions

British Paramedic Journal ◽

10.29045/14784726.2021.3.5.4.64 ◽

2021 ◽

Vol 5 (4) ◽

pp. 64-64

Author(s):

Daniel Phillips ◽

Iris Q. Grunwald ◽

Silke Walter ◽

Klaus Faßbender

Keyword(s):

Hospital Admission ◽

Stroke Unit ◽

Hospital Admissions ◽

Hospital Treatment ◽

Transient Ischaemic Attacks ◽

Accident And Emergency ◽

Mobile Stroke Unit ◽

Catheter Laboratory ◽

Uk National Health Service ◽

The Uk

<sec id="s1"> Aims: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions. </sec> <sec id="s2"> Methods: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service was conducted. Emergency patients categorised as code stroke and headache were included from 5 June to 18 December 2018. Rate of avoided admission to the accident and emergency (A&E) department, rate of admission directly to target ward and stroke management metrics were assessed. </sec> <sec id="s3"> Results: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to eight of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, one patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 mins (interquartile range, 40‐60). </sec> <sec id="s4"> Conclusion: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&E departments. </sec>

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Adrenal crisis in treated Addison's disease: a predictable but under-managed event

Acta Endocrinologica ◽

10.1530/eje-09-0559 ◽

2010 ◽

Vol 162 (1) ◽

pp. 115-120 ◽

Cited By ~ 82

Author(s):

Katherine White ◽

Wiebke Arlt

Keyword(s):

Demographic Data ◽

Vital Role ◽

Postal Survey ◽

Hospital Treatment ◽

Adrenal Crisis ◽

Practical Training ◽

Patient Reports ◽

Life Saving ◽

Injection Materials ◽

The Uk

ContextAdrenal crisis is a life-threatening event that occurs regularly in Addison's patients receiving standard replacement therapy. Patient reports suggest that it is an underestimated and under-managed event.ObjectiveTo assess the frequency of adrenal crisis in diagnosed patients and to understand the factors contributing to the risks of adrenal crisis.DesignWe conducted a postal survey of Addison's patients in four countries, UK (n=485), Canada (n=148), Australia (n=123) and New Zealand (n=85) in 2003, asking about patients' experiences of adrenal crisis and their demographic characteristics. In 2006, a shorter follow-up survey was conducted in the UK (n=261).MethodThe frequency and causes of adrenal crisis were compared across both surveys. Demographic data from the 2003 survey were analysed to establish the main variables associated with an elevated risk of crisis.ResultsAround 8% of diagnosed cases can be expected to need hospital treatment for adrenal crisis annually. Exposure to gastric infection is the single most important factor predicting the likelihood of adrenal crisis. Concomitant diabetes and/or asthma increase the frequency of adrenal crises reported by patients.ConclusionThe endocrinologist has a responsibility to ensure that Addison's patients have adequate access to life-saving emergency injection materials and repeated, practical training sessions in how to use them, while the general practitioner plays a vital role as in arranging prompt emergency admissions.

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Measurement of breathing in patients with post-COVID-19 using structured light plethysmography (SLP)

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2021-001070 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001070

Author(s):

Eyas Alhuthail ◽

James Stockley ◽

Andrew Coney ◽

Brendan Cooper

Keyword(s):

Respiratory Symptoms ◽

Structured Light ◽

Intensive Therapy ◽

Management Strategies ◽

Respiratory Physiology ◽

Hospital Treatment ◽

Tidal Breathing ◽

Promising Tool ◽

Hospitalised Patients ◽

The Uk

IntroductionCOVID-19 pandemic has had a huge impact on global health to date, with 5.6 million cases in the UK since its emergence. The respiratory symptoms largely mimic those of pneumonia’ with symptoms ranging from mild to severe. The effects on respiratory physiology are not yet fully understood, but evidence is emerging that there is much dysfunctional breathing reported but little information on tidal ventilation from the acute phase of the infection. Structured light plethysmography (SLP) is a contactless technique of respiratory function testing that measures tidal breathing parameters by assessing thoracoabdominal displacement.MethodsIn a postdischarge clinic, SLP was performed routinely on 110 hospitalised patients recovering from COVID-19 who had been screened for respiratory symptoms to confirm any respiratory changes occurring after the disease. Patients were categorised based on their hospital treatment in (1) the intensive therapy unit (ITU) (requiring intubation) (n=65) or (2) respiratory wards only (n=45). Data from these two patient cohorts were compared with preacquired data from healthy controls (n=30).ResultsWe have found a significantly increased respiratory rate (p=0.006) in ITU patients compared with the healthy cohort and also a significant decrease in the inspiratory time (p=0.01), expiratory time (p=0.005) and the total breathing cycle (p=0.008). There were no significant differences between ITU and ward patients and no significant differences in healthy compared with ward patients. We examined the variability of breathing (‘entropy’) both in terms of the breath-to-breath interval and the volume-to-volume change. The breath-to-breath interval alone was significantly lower in ITU patients compared with healthy cohorts (p=0.02).ConclusionOur findings suggest that abnormalities in tidal breathing can be detected in COVID-19 recovery patients, and SLP may be a promising tool in assessing the aftermath of diseases such as COVID-19, particularly if more intensive management strategies such as mechanical ventilation are required.

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Healthwise, Part 5. Prevention and treatment of type 2 diabetes

British Journal of Healthcare Assistants ◽

10.12968/bjha.2022.16.1.18 ◽

2022 ◽

Vol 16 (1) ◽

pp. 18-25

Author(s):

Linda Nazarko

Keyword(s):

Public Health ◽

Risk Factors ◽

Type 2 Diabetes ◽

Hospital Treatment ◽

Death Rates ◽

Prevention And Treatment ◽

Poor Outcomes ◽

The Uk

The coronavirus (COVID-19) pandemic has highlighted the importance of public health in the UK and globally. The UK's death rates and obesity rates are related and many people in the UK experience poor health because they are overweight or obese ( Lobstein, 2021 ; Mohammad et al, 2021 ). Obesity increases the risks of developing type 2 diabetes. People with both type 1 and type 2 diabetes are at greater risk of developing severe COVID symptoms, of requiring hospital treatment and of poor outcomes and death ( Barron et al, 2020 ). This article, the fifth in a series, examines risk factors for type 2 diabetes and explains how readers can reduce their risk of developing type 2 diabetes.

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Hospital treatment and management in relapse of schizophrenia in the UK: associated costs

The Psychiatrist ◽

10.1192/pb.bp.109.027714 ◽

2011 ◽

Vol 35 (3) ◽

pp. 95-100 ◽

Cited By ~ 12

Author(s):

Janet Munro ◽

Sarah Osborne ◽

Lindsay Dearden ◽

Katie Pascoe ◽

Aline Gauthier ◽

...

Keyword(s):

Hospital Costs ◽

Length Of Hospital Stay ◽

Hospital Treatment ◽

Clinical Implications ◽

Treatment Length ◽

Patient Costs ◽

Unit Costs ◽

National Health Service Trust ◽

Heavy Burden ◽

The Uk

Aims and methodRelapse in schizophrenia carries a heavy burden. This study aimed to describe the characteristics of patients admitted to hospital for relapse and to explore the treatment, length of stay and associated in-patient costs. The sample comprised individuals discharged from a London National Health Service trust following a relapse of schizophrenia. The costs of hospital treatment were obtained by applying referenced unit costs.ResultsThe cohort comprised 71 patients. Treatment non-adherence was implicated in 76% of relapses. Mean length of hospital stay was 138.9 days (range 1 week-1.8 years). Mean admission cost was £25 852 (range £1270-120 000). Over 97% of costs were hospital costs and less than 3% drug costs.Clinical implicationsHospital treatment for relapse of schizophrenia carries a considerable economic burden, as shown in this study. Treatment non-adherence is a significant factor contributing to relapse.

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A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK

BMC Psychiatry ◽

10.1186/1471-244x-13-287 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 54

Author(s):

Elizabeth Goddard ◽

Rebecca Hibbs ◽

Simone Raenker ◽

Laura Salerno ◽

Jon Arcelus ◽

...

Keyword(s):

Anorexia Nervosa ◽

Cohort Study ◽

Hospital Treatment ◽

Short Term ◽

The Uk

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Dextropropoxyphene Deaths: Coroner's Report

Human Toxicology ◽

10.1177/096032718400300116 ◽

1984 ◽

Vol 3 (1_suppl) ◽

pp. 175s-185S ◽

Cited By ~ 17

Author(s):

R.M. Whittington

Keyword(s):

Respiratory Failure ◽

Drug Overdose ◽

The Elderly ◽

Hospital Treatment ◽

Accidental Death ◽

The West ◽

Common Cause ◽

West Midlands ◽

Drug Fatalities ◽

The Uk

1 Dextropropoxyphene has been increasingly prescribed as an analgesic in the UK, chiefly in the form of Distalgesic (dextropropoxyphene hydrochloride 32.5 mg and paracetamol 325 mg per tablet). After reports of sudden deaths from the misuse of this combination, prescribing is declining. 2 Distalgesic remains the most common cause of fatal drug overdose in the West Midlands, UK. The 1983 Birmingham inquests are compared with those from the year 1976 to 1979. 3 In comparison with other drug fatalities, death characteristically occurs rapidly, as little as 1 h after ingestion and usually before hospital treatment can be initiated. 4 Toxicity is increased by alcohol which is also extensively abused. 5 The fatal dose may be as small as 15 tablets or possibly less. 6 Many victims are young and some never intended to take their life. 7 Convulsions and respiratory failure precede death. The elderly and respiratory cripples may be more vulnerable to accidental death. 8 Evidence suggests a liability to dependence or even addiction with dextropropoxyphene.

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Eating disorders

Oxford Textbook of Inpatient Psychiatry ◽

10.1093/med/9780198794257.003.0036 ◽

2019 ◽

pp. 313-322

Author(s):

Agnes Ayton

Keyword(s):

Eating Disorders ◽

Real Life ◽

Evidence Base ◽

Point Of View ◽

Hospital Treatment ◽

Increasing Demand ◽

The Uk ◽

Body Mass Indexes ◽

Physical Morbidity

There is increasing demand for inpatient treatment of severe eating disorders, both in the UK and internationally. However, hospital treatment of severe eating disorders remains controversial, mainly because of poor long-term outcomes. This chapter provides a highly relevant and clinically focused review of the complex issues involved in inpatient care of people with severe eating disorders. The main guidelines and evidence base are critically reviewed from the point of view of a real-life clinical practice dealing with people with very low body mass indexes. Evidence, or lack of it, for a range of interventions is outlined, including artificial feeding and compulsory treatment. Practical issues regarding management of weight, physical morbidity, and psychological interventions are discussed.

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