Delivering outpatient antibiotic therapy (OPAT) in an Acute Medical Unit

Outpatient antibiotic therapy (OPAT) is being developed and practised in an increasing number of acute hospitals within the United Kingdom. This article is a review of the OPAT service delivered by a large inner city hospital over the last two years. The service demonstrates the key elements of OPAT demonstrating different delivery models, aspects of patient selection, spectrum of infections treated, choice and delivery of antimicrobials, efficacy, patient safety, outcomes, and the cost-effectiveness of this programme.

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Presentations to An Acute Medical Unit Due to Headache: A Review of 306 Consecutive Cases

Acute Medicine Journal ◽

10.52964/amja.0563 ◽

2012 ◽

Vol 11 (3) ◽

pp. 144-150

Author(s):

James Knox ◽

◽

Chandini Chuni ◽

Zehra Naqvi ◽

Pam Crawford ◽

...

Keyword(s):

National Health Service ◽

Health Service ◽

Ambulatory Care ◽

Significant Proportion ◽

Care Pathways ◽

Intracranial Tumour ◽

Medical Unit ◽

Acute Medical Unit ◽

The United Kingdom ◽

Acute Headache

The United Kingdom National Health Service has recently prioritised the need for ambulatory care pathways for acute headache. The present study sought to better characterise patients referred to an Acute Medical Unit so as to inform pathway development. In 2011, York Hospital received 306 referrals due to acute headache, representing 3% of acute medical admissions. Investigations included CT scan (38%), lumbar puncture (38%), and MRI (18%); there were no specialised investigations in 26%, and 18% of patients were discharged on the day of presentation. Subarachnoid haemorrhage occurred in only 4 patients (1%), meningitis in 10 (3%), and intracranial tumour in 5 (2%). The findings indicate that a significant proportion of patients with acute headache could be managed by ambulatory care.

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Sepsis- what is the role for acute medicine?

Acute Medicine Journal ◽

10.52964/amja.0583 ◽

2012 ◽

Vol 11 (4) ◽

pp. 235-237

Author(s):

Ron Daniels ◽

Keyword(s):

The United States ◽

The Body ◽

Acute Medicine ◽

Major Health ◽

Medical Unit ◽

Coronary Syndrome ◽

Acute Medical Unit ◽

Critical Care Admission ◽

Life Threatening ◽

The Cost

Sepsis- the life-threatening response of the body to an infection- is one of the more common reasons for presentation to an Acute Medical Unit, and a major health and economic burden to our healthcare system, with an estimated 37,000 deaths occurring annually in the U.K. In the United States, recent evidence suggests that the incidence of sepsis has been rising by between 8 and 13% per annum over the last decade, and that it is now higher than that of Acute Coronary Syndrome.1 Across Europe, the cost of a hospital admission for sepsis (due to the frequent need for prolonged Critical Care admission) has been estimated at between 25,000 and 55,000 Euros.2 For the NHS, this means an estimated expenditure of £2.5 billion per year.

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Geriatric Medicine

Oxford Assess and Progress: Clinical Medicine ◽

10.1093/oso/9780198812968.003.0023 ◽

2019 ◽

Author(s):

Dan Furmedge

Keyword(s):

Inner City ◽

Nursing Care ◽

Geriatric Medicine ◽

Medical Specialty ◽

Life Care ◽

Acute Medical Unit ◽

The United Kingdom ◽

Co Morbidity ◽

Hospital At Home ◽

Medical Wards

Geriatric medicine is the largest ‘medical’ specialty in the United Kingdom, with the number of geriatricians expanding at a huge rate with significant demand. Pragmatic specialists in frailty and complex co- morbidity, the work of geriatricians reaches across geriatric medicine wards, the acute medical unit, emergency departments and acute frailty units, surgical wards, and tertiary medical wards and in the community from inner city London to rural Scotland. They can be found in residential and nursing care homes, rehabilitation teams, and hospital at home teams. Frailty, falls, delirium, dementia, continence, immobility, rehabilitation, polypharmacy, nutrition, end- of- life care, advanced care planning, community medicine, and legal and ethical medicine are all core features of a geriatrician’s day. In this chapter, the questions give a taste of some of these concepts and will also demonstrate how geriatric medicine crosses almost every specialty.

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Care bundles for acute kidney injury: a balanced accounting of the impact of implementation in an acute medical unit

BMJ Open Quality ◽

10.1136/bmjoq-2018-000392 ◽

2018 ◽

Vol 7 (4) ◽

pp. e000392 ◽

Cited By ~ 5

Author(s):

Rachael Logan ◽

Peter Davey ◽

Alison Davie ◽

Suzanne Grant ◽

Vicki Tully ◽

...

Keyword(s):

Acute Kidney Injury ◽

Patient Safety ◽

Good Practice ◽

Kidney Injury ◽

Care Bundle ◽

Simple Task ◽

Care Bundles ◽

Medical Unit ◽

Acute Medical Unit ◽

The Impact

In 2009, a National Confidential Enquiry into Patient Outcome and Death report detailed significant shortcomings in recognition and management of patients with acute kidney injury (AKI). As part of a national collaborative to reduce harm from AKI, the Scottish Patient Safety Programme developed two care bundles to improve response (‘SHOUT’) and review (‘BUMP’) of AKI.Baseline data from eight patients with AKI on the acute medical unit (AMU) in Ninewells Hospital showed 62% compliance with SHOUT. However, most patients were transferred from AMU within 24 hours so BUMP could not be assessed. Our aim was to achieve >95% compliance with SHOUT on AMU within 2 months. The content of the SHOUT bundle was condensed onto a sticker for the case notes, which was implemented using Plan-Do-Study-Act cycles. Compliance was assessed weekly and feedback obtained from stakeholders concerning their opinion of the sticker, SHOUT bundle and care bundles in general.Use of the sticker was 27% in week 1 but fell to 5% by week 4. Compliance with the bundle varied from 45% to 60% and was only slightly improved by use of the sticker (OR 1.58, 95% CI 0.39 to 6.42). Staff found the sticker burdensome and did not agree that all elements of SHOUT were equally important. This opinion was supported by finding that their compliance with sepsis and hypovolaemia recommendations was 91%–100% throughout, whereas urinalysis was documented in only 55%–63% of patients. Several staff mentioned ‘bundle fatigue’ and on one day we identified 22 other care bundles or structured improvement forms in AMU.We concluded that the AMU staff had legitimate concerns about the SHOUT care bundle and that our intervention was demotivating. Overcoming bundle fatigue will not be a simple task. We plan to work with staff on integrating AKI into patient safety huddles and on using modelling and recognition of good practice to improve motivation.

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Faculty Opinions recommendation of Modelling the cost-effectiveness of human milk and breastfeeding in preterm infants in the United Kingdom.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727352908.793534182 ◽

2017 ◽

Author(s):

Jean-Ralph Zahar

Keyword(s):

United Kingdom ◽

Cost Effectiveness ◽

Human Milk ◽

Preterm Infants ◽

The United Kingdom ◽

The Cost

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Denitrification of Sewage Effluents in Deep Bed Sand Filters

Water Science & Technology ◽

10.2166/wst.1993.0516 ◽

1993 ◽

Vol 27 (5-6) ◽

pp. 381-390 ◽

Cited By ~ 4

Author(s):

John Upton

Keyword(s):

Waste Water ◽

Pilot Study ◽

Water Industry ◽

Trickling Filter ◽

Sand Filters ◽

The United Kingdom ◽

The Usa ◽

Water Plants ◽

The Cost ◽

Pilot Plant Study

The European waste water industry will need to develop denitrification processes to remove nitrogen as pressures increase to reduce nutrient levels discharged in effluents. In the USA deep bed filter technology has been used extensively to provide denitrification to levels less than 5 mg/l TN. This paper describes this technology and the full scale performance at some waste water plants in Florida, USA. This paper also describes a pilot study in the United Kingdom at Severn Trent Water. The results of the pilot plant study indicate that denitrification in deep bed sand filters is a sound robust technology using methanol addition. Nitrogen removals greater than the 70% required in the EC Directive 1991 are possible at winter sewage temperatures. The process is most suitable for achieving nitrogen removal at trickling filter plants. The cost of methanol addition is calculated to be ₤10/1000m3.

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Analisis Faktor Yang Berhubungan Dengan Penerapan Surgical Safety Checklist Di Kamar Operasi Rumah Sakit Kota Batam

Jurnal Endurance ◽

10.22216/jen.v4i3.4501 ◽

2019 ◽

Vol 4 (3) ◽

pp. 456

Author(s):

Endang Yuliati ◽

Hema Malini ◽

Sri Muharni

Keyword(s):

Patient Safety ◽

Operating Room ◽

Work Experience ◽

Improve Patient Safety ◽

Standard Procedure ◽

City Hospital ◽

Chi Square ◽

Cross Sectional ◽

Surgical Safety Checklist ◽

Surgical Safety

The use of the Surgical Safety Checklist (SSC) is associated with improving patient care according to nursing process standards includes the quality of work of the operating room nurse team. The form of professionalism in the operating room is how the application of a surgical safety checklist as the standard procedure for patient safety in the operating room. This study aims to determine the relationship of characteristics, knowledge, and motivation of nurses in the application of the surgical safety checklist in the operating room of a Batam city hospital. This research is quantitative using an observational analytic research design. This study was conducted on 67 nurses who were taken by total sampling. This research was conducted in three Batam City Hospitals, with hospital accreditation at the same level. Data were analysed by univariate and bivariate using the chi-square test. The results of the study found that most nurses had education at diploma level, with a working period experiences of > 6 months (82%); good knowledge (53.7%) with low motivation (57.7%). There is a relationship between education (p = 0.042); length of work experience (p = 0.010); knowledge (p = 0.002); and motivation (p = 0.05) with the application of SSC. It is expected that health services carry out SSC following the applicable SOPs in the Hospital so that it can reduce work accident rates and improve patient safety. Penerapan Surgical Safety Checklist (SSC) berhubungan langsung dengan kualitas asuhan keperawatan yang termasuk adalah bagaimana perawat menerapkan fungsi sebagai bagian dari kamar operasi. Bentuk profesionalisme ini menjadi standar bagaimana kemampuan perawat menerapakan SSC. Tujuan penelitian adalah mengetahui hubungan karakteristik perawat, pengetahuan dan motivasi dengan penerapan SSC di kamar operasi. Penelitian ini menggunakan desain kuantitatif Cross Sectional dengan jumlah sampel 67 orang perawat kamar operasi. Data dianalisa dengan distribusi frekuensi dan uji hubungan bivariat. Didapatkan penerapan SSC perawat kota Batam masih kurang baik, dengan faktor yang mempunyai hubungan adalah Pendidikan, pelatihan dan pengetahuan. Diharapkan perawat mampu menerapkan SSC sesuai dengan Standar pelaksanaan fungsi perawat dikamar operasi.

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