Friday 31 July 2015

Supporting people with a learning disability: DRAFT service model for commissioners

"This Service Model is intended for a particular juncture in the transformation of services for people with a learning disability and / or autism. It builds on existing NICE guidance (such as that on challenging behaviour) and will be superseded as good practice develops and in particular once NICE service model guidance is published in 2017."

Supporting people with a learning disability and / or autism who have a mental health condition or display behaviour that challenges: DRAFT service model for commissioners of health and social care services
NHS England, Local Government Association, Association of Directors of Adult Social Sevices 
July 2015

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New NICE Guideline: Melanoma: assessment and management

"This guideline covers the assessment and management of melanoma (a type of skin cancer) in children, young people and adults. It aims to reduce variation in practice and improve survival."

Melanoma: assessment and management - NICE guidelines [NG14] 
NICE
July 2015

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The Impact of Primary Care Quality on Inpatient Length of Stay for People with Dementia

"For those who are discharged home or to the community setting, the QOF review may have a small negative influence on length of stay. Such modest effects suggest that the QOF review does not have a major influence on LoS for dementia hospital admissions. However, this does not mean the review is unimportant for patient care: the increasing prevalence of dementia and the constraints on capacity in the acute hospital sector may mean even modest impacts are important financially. "

The Impact of Primary Care Quality on Inpatient Length of Stay for People with Dementia: An Analysis by Discharge Destination
P Kasteridis, M Goddard, R Jacobs, R Santos, A Mason
CHE Research Paper 113
Centre for Health Economics, University of York, UK
July 2015

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Wednesday 29 July 2015

Using Incentives To Improve Experience In Maternity, Children And Young People's Services

"The report will discuss three core recommendations, each with a number of sub-recommendations to support local, regional and national discussions on how CQUINs and other financial incentive schemes can be used to improve the quality and effectiveness of maternity, children and young people’s services." 

Using Incentives To Improve Experience In Maternity, Children And Young People's Services
P Kumalo, M Cunnington
NHS South East CSU
July 2015

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Breast Cancer Screening, Incidence, and Mortality Across US Counties

"Our analysis shows that, when directed toward the general US population, the most prominent effect of screening mammography is overdiagnosis. Nonetheless, we do not believe that the right rate of screening mammography is zero. As is the case with screening in general, the balance of benefits and harms is likely to be most favorable when screening is directed to those at high risk, provided neither too frequently nor too rarely, and sometimes followed by watchful waiting instead of immediate active treatment."

Breast Cancer Screening, Incidence, and Mortality Across US Counties
C Harding, F Pompei, D Burmistrov, HG Welch, R Abebe, R Wilson
JAMA Intern Med. Published online July 06, 2015. doi:10.1001/jamainternmed.2015.3043

Read more here.

Making change possible: A Transformation Fund for the NHS

"To ensure that the substantive changes required can be achieved, we argue that the NHS needs dedicated funding – a Transformation Fund – to deliver the change required, aligned with more effective practical support and the right policy context for change."

Making change possible: A Transformation Fund for the NHS
R Murray et al.
The Health Foundation, The King's Fund
July 2015

Read more here.

The NHS in 2030: a people-powered and knowledge-powered health system

"The NHS has the opportunity to take advantage of two powerful and under–exploited sources of innovation that have the potential to make care better and, under the right circumstances, cheaper. These are the rapidly accelerating pace of digital technology, and the power of social innovation."

The NHS in 2030: a people-powered and knowledge-powered health system
J Bland, H Khan, J  Loder, T Symons, S Westlake
NESTA
July 2015

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Using data and analytics to transform patient care

"Data-driven decision making has improved patient outcomes in Intermountain's cardiovascular medicine, endocrinology, surgery, obstetrics and care processes — while saving millions of dollars in procurement and in its the supply chain." 

How Intermountain Healthcare is using data and analytics to transform patient care
M Fitzgerald
MITSloan Management Review
June 2015

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Identifying alternatives to old age psychiatry inpatient admission

"The results suggest that if enhanced community services were available, a significant minority of inpatients could be more appropriately supported in their own homes at a cost considerably lower than that currently incurred."

Identifying alternatives to old age psychiatry inpatient admission: an application of the balance of care approach to health and social care planning

S Tucker, C Brand, M Wilberforce, M Abendstern, D Challis
BMC Health Services Research 2015, 15:267  doi:10.1186/s12913-015-0913-1

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The influence of context on the effectiveness of hospital quality improvement strategies

"Our findings suggest that some of the most relevant context factors are those close to the clinical microsystem in which the QI intervention is delivered. This provides cues for action for improvement practitioners who may include an assessment of such factors, and dedicated change processes, in their local plans for quality improvement."

The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews
DS Kringos et al.
BMC Health Services Research 2015, 15:277  doi:10.1186/s12913-015-0906-0

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Improving reporting of critical incidents through education and involvement

"This quality improvement project has resulted in increased reporting of critical incidents. This paves the way for future quality improvement projects to be performed targeting areas of concern which will help improve patient safety across various disciplines."

Improving reporting of critical incidents through education and involvement
P Donnelly
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u206996.w3776

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Tuesday 28 July 2015

Four Simple Ward Based Initiatives to Reduce Unnecessary In-Hospital Patient Stay

"A six cycle prospective audit was carried out to investigate if four simple ward based initiatives could optimise patient flow through a medical ward and reduce LoS [length of stay] of inpatients awaiting social packages and placement."

Four Simple Ward Based Initiatives to Reduce Unnecessary In-Hospital Patient Stay: A Quality Improvement Project
A Shabbir, G Wali, A Steuer
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208974.w3661

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Using league tables to reduce missed dose medication errors on mental healthcare of older people wards

"By greatly reducing the risk of patients experiencing adverse drug events as a result of missed doses, this project has given rise to a potential cost-saving of around £34,000 per year across the wards studied. "

Using league tables to reduce missed dose medication errors on mental healthcare of older people wards
A Cottney
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u204237.w3567

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Improving the safety of oxygen therapy

"Our quality improvement project aimed to increase the safety of oxygen therapy at University Hospitals Bristol NHS Foundation Trust. We aimed to increase the rate of oxygen prescribing and increase the percentage of nurses signing appropriately for oxygen titration and administration."

Changing an ingrained culture: Improving the safety of oxygen therapy at University Hospitals Bristol NHS Foundation Trust
M Gatter, G Dixon, J Wall, E Mew
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u203238.w1474

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Priorities for creating a learning healthcare system based on routinely collected data

"Ongoing feedback of insights from data to patients, clinicians, managers and policymakers can be a powerful motivator for change as well as provide an evidence base for action. Many studies and systems have demonstrated that routine data can be a powerful tool when used appropriately to improve the quality of care."

Making sense of the shadows: priorities for creating a learning healthcare system based on routinely collected data
SR Deeny, A Steventon
BMJ Quality and Safety 2015;24:505-515 doi:10.1136/bmjqs-2015-004278

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Characterising ‘near miss’ events in complex laparoscopic surgery through video analysis

"Error awareness is essential in daily surgical practice and surgical training. The current study highlights the benefits of detailed video analysis to create a database of common injury mechanisms and video clip repository that can be used in tailoring future training interventions."

Characterising ‘near miss’ events in complex laparoscopic surgery through video analysis
EM Bonrath, LE Gordon, TP Grantcharov
BMJ Quality and Safety 2015;24:516-521 doi:10.1136/bmjqs-2014-003816

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The Global Comparators project: international comparison of 30-day in-hospital mortality by day of the week

"We show that mortality outcomes for our sample vary within each country and per day of the week in agreement with previous studies of the ‘weekend effect’."

The Global Comparators project: international comparison of 30-day in-hospital mortality by day of the week
M Ruiz, A Bottle, PP Aylin
BMJ Quality and Safety 2015;24:492-504 doi:10.1136/bmjqs-2014-003467

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Insights on earlier adoption of medical innovations

"The aims of this piece of work are:

• To identify the key features of systems in which drugs, devices and diagnostics are assessed from trials to patients quickly, by considering a number of global ‘front-runners’;
• To understand how these systems work in practice;
• To reflect on the challenges and opportunities to effectively translate into the UK’s health system"

Insights on earlier adoption of medical innovations: An international review of emerging and effective practice in improving access to medicines and medical technology
S Wooding, G Cochrane, J Taylor, A Kamenetzky, S Sousa, S Parks
Rand Europe
July 2015

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Home administration of intravenous diuretics to heart failure patients

"Originally a 2-year pilot programme to assess safe and effective ways for specialist nursing teams to administer intravenous (IV) diuretics to people at home or in a day-care setting, preventing hospital admissions and improving patient experience. Without this service patients would be admitted to hospital to receive IV diuretics."

Home administration of intravenous diuretics to heart failure patients: Increasing productivity and improving quality of care
Quality and Productivity case study
British Heart Foundation
June 2015

Read more here.

Template reports for radiology cancer staging: improving information

"This initiative uses templates to record tumour staging information from magnetic resonance (MR) investigations. The information provided by radiologists to clinicians is improved and standardised, allowing management decisions to be better informed and reducing the need for additional clarification. This initiative is primarily about improving quality, although there are some small productivity savings"

Template reports for radiology cancer staging: improving information to guide treatment decisions
Quality and Productivity case study
Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust
July 2015

Read more here.

Podiatry education to empower patients to self-care

"This project was designed to identify and train patients suitable for self-care, so they can be discharged from the service. This helped to ensure that podiatry care is targeted at those with the greatest need. "

Podiatry education to empower patients to self-care
Quality and productivity collection example
Community and Primary Services, Sheffield Teaching Hospitals NHS Foundation Trust
July 2015

Read more here.


How is the NHS performing? Quarterly Monitoring Report

"three-quarters of trust finance directors intend to recruit more permanent nurses in the next six months, suggesting that the NHS is continuing to prioritise quality of patient care despite rising financial pressures."

How is the NHS performing? Quarterly Monitoring Report
J Appleby, J Thompson, J Jabbal
The King's Fund
July 2015


Read more here.

Using a simple handover to improve the timing of gentamicin levels

"Prior to our intervention, the timing of gentamicin levels was poorly performed, with 42.2% of levels taken late and two episodes of missed doses were reported."

Using a simple handover to improve the timing of gentamicin levels
A Williamson, A Bradley, K Khan
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u207727.w3081

Read more here.

Improving the quality of handover

"This project demonstrates that replacing an ad-hoc system of handover with a multi-disciplinary, team based approach to handover improves handover quality. In addition it provides a useful guide to introducing a new handover meeting to a department and contains useful lessons on how to combat cultural barriers to change within a department."

Improving the quality of handover by addressing handover culture and introducing a new, multi-disciplinary, team-based handover meeting
H Walton, W Munro
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u206069.w2989

Read more here.

Tuesday 14 July 2015

Services for people with neurological conditions: progress review

"Part One of this report sets out a range of data on the quality of neurological services since we reported in 2011, including waiting times and emergency admissions."

Services for people with neurological conditions: progress review
Department of Health and NHS England
National Audit Office
July 2015

Read more here.

Enhanced recovery programme in gynaecology

"We describe the successful implementation of an ERP in Southend Hospital resulting with no difference in measurable morbidity and mortality, a shorter length of stay, and a high patient satisfaction scores and outcomes."

Enhanced recovery programme in gynaecology: outcomes of a hysterectomy care pathway
D Mukhopadhyay
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u206142.w2524

Read more here.

Mental Health Staffing Framework

"Mental Health Staffing: A Practical Guide has been developed as part of the ‘Compassion in Practice programme’ led by NHS England. It is based around standards set by the National Quality Board and is expected to inform national Mental Health programmes of work "

Mental Health Staffing Framework
Health Education West Midlands
NHS England
June 2015

Read more here.

Children and young people's survey 2014

"This is the first national children’s survey conducted by CQC. It represents the experiences of nearly 19,000 children and young people who received inpatient or day case care in 137 acute NHS trusts in 2014."

Children and young people's survey 2014
Care Quality Commission
July 2015

Read more here.

Wednesday 8 July 2015

Unbundling recovery: Recovery, rehabilitation and reablement

"This report describes how an audit methodology used previously for surgical conditions can be used to assess whether the rehabilitation aspects of a patient's acute hospital stay could be better provided.

It shows how, with some further evidence, a locally derived tariff for recovery, rehabilitation and reablement could be developed to support service improvements."

Unbundling recovery: Recovery, rehabilitation and reablement national audit report
NHS Improving Quality
June 2015

Read more here.

Impact of Inpatient Harms on Hospital Finances and Patient Clinical Outcomes

"This all-cause harm safety study indicates that inpatient harm has negative financial outcomes for hospitals and negative clinical outcomes for patients."

Impact of Inpatient Harms on Hospital Finances and Patient Clinical Outcomes
L Adler et al.
2015, Journal of Patient Safety, doi: 10.1097/PTS.0000000000000171

Read more here.

Better value in the NHS

"In a time of severe financial constraint, the NHS is being asked to make productivity savings of £22 billion by 2020/21. However, this report argues that, rather than looking at efficiency and costs, the NHS should be focusing on getting better value from its budget."

Better value in the NHS: The role of changes in clinical practice
H Alderwick, R Robertson, J Appleby, P Dunn, D Maguire
The King's Fund
July 2015

Read more here.

Tuesday 7 July 2015

Good practice in ambulance commissioning

"The National Ambulance Commissioners Network (NACN), which is part of NHS Clinical Commissioners, brings together individuals from across the country with an interest in ambulance commissioning to share learning, provoke discussion and work together to find solutions. As part of that we have collected and brought together a number of good practice examples to contribute to the ongoing debate on finding new approaches to the provision of emergency services, and the role that clinical commissioners can play in driving those new approaches forward."

Good practice in ambulance commissioning
The National Ambulance Commissioners Network
NHS Clinical Commissioners
June 2015

Read more here.

“Conversation Ready”: A Framework for Improving End-of-Life Care

"This white paper describes the Conversation Ready framework, the changes associated with the framework’s five principles that can be implemented to improve end-of-life care, examples of changes tested by organizations, and suggested measures to guide improvement."

“Conversation Ready”: A Framework for Improving End-of-Life Care (IHI White Paper)
K McCutcheon Adams, A Kabcenell, K Little, L Sokol-Hessner
Institute for Healthcare Improvement
June 2015

Read more here.

Monday 6 July 2015

Focus on: International comparisons of healthcare quality

"This report uses the data to understand what international comparisons tell us about changes in quality of healthcare in the UK between 2000 and 2013, and provides a baseline for future comparisons."

Focus on: International comparisons of healthcare quality: What can the UK learn?
L Kossarova, I Blunt, M Bardsley
QualityWatch
July 2015

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Examining the implementation of NICE guidance

"In the UK, NHS hospitals receive large amounts of evidence-based recommendations for care delivery from the National Institute for Health and Care Excellence (NICE) and other organisations. Little is known about how NHS organisations implement such guidance and best practice for doing so." 

Examining the implementation of NICE guidance: cross-sectional survey of the use of NICE interventional procedures guidance by NHS Trusts
K Lowson, M Jenks, A Filby, L Carr, B Campbell, J Powell
Implementation Science 2015, 10:93  doi:10.1186/s13012-015-0283-4

Read more here.

The Budget: health and social care funding

"There are still significant opportunities to improve productivity, and the NHS must redouble its efforts to deliver better outcomes at lower cost by changing the way clinical care is delivered."

The Budget: health and social care funding
The King's Fund
July 2015

Read more here.