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NIHR Signal Reminders help GPs to find and manage inherited cholesterol disorders
GPs and practice nurses assess more adults with inherited raised cholesterol (familial hypercholesterolaemia) when prompted by reminders. More patients have repeat cholesterol tests and assessments for heart disease, in line with NICE guidelines. This NIHR-funded study used electronic health records from six GP practices to identify patients with total cholesterol greater than 7.5mmol/l. Reminder messages appeared when their records were opened during consultations and prompted GPs to carry out...
NIHR Signal UK-wide study reveals a pattern of delay in referrals to specialist end-of-life care
Referrals to hospice-based specialist palliative care occur closer to death in older than in younger people and in those without cancer. Existing evidence shows that some people near the end of life have a better quality of life and symptom control if they receive specialist palliative care. This research highlights the need to better understand the reasons for any delay. In this large NIHR-funded hospice study people aged under 50 years were referred to hospice specialist palliative care about...
NIHR Signal Outpatient video consultations are feasible but challenging for the NHS
Video consultations may be a useful substitute for face-to-face consultations for some hospital outpatient appointments. This NIHR funded study provided insights into the conditions which made them better. When these practical and clinical conditions are met, video consultations can be safe and effective and are liked by staff and patients. But there are challenges in embedding new technology in routine practice, and these challenges may have been under-estimated. This high-quality implementati...
NIHR Signal Structured training improves skills of wheelchair users
Structured wheelchair skills training increases wheelchair users’ skills when compared with no training, standard care or education controls. The training, as developed in Canada, is more effective for new wheelchair users than experienced users. It includes difficult everyday challenges from wheeling through gravel to negotiating high curbs. Links have been found previously between wheelchair skills capacity (reflecting what the user can do) and: independent mobility, reduced reliance on...
NIHR Signal Nurse staffing levels linked to reports of missed care in adult wards
Nurses are more likely to report omitting necessary care in acute inpatient wards when registered nurse staffing levels are low, even if there are additional healthcare assistants. Care categorised as planning and communication is reported as missed more often than clinical care. NHS hospitals are responsible for ensuring that the number and skills mix of nursing staff matches patient needs. Previous reviews have shown links between lower registered nurse staffing levels and poor patient outcom...
NIHR Signal Redesigning oral surgery with enhanced primary dental care, electronic referral and triage may save overall costs
An electronic referral system including consultant-led triage and an advanced oral surgery service in primary care results in fewer people requiring oral surgery in hospital. It comes at a lower overall cost than the previous arrangement. About two-thirds of patients could be treated safely in enhanced primary settings rather than hospital. This NIHR-funded study implemented several changes, an electronic referral system which standardised and improved the level of information provided in refer...
NIHR Highlight How commissioners use research evidence
Researchers want their work to be used and useful, but may not always understand the context in which decisions are made. Most health and care organisations aim to base decisions on the best available evidence, but accessing and interpreting the right evidence at the right time is hard. Researchers need to do what they can to make their research as useful as possible to those making decisions under pressure. The NIHR has funded six particular studies in the past five years on the use of eviden...
NIHR Signal Multi-morbidity predicted to increase in the UK over the next 20 years
Two-thirds of adults aged over 65 are expected to be living with multiple health conditions (multi-morbidity) by 2035. Seventeen percent would be living with four or more diseases, double the number in 2015. One-third of these people would have a mental illness like dementia or depression. Increased life expectancy by around three years for both men and women means people will spend longer living with multi-morbidity. This study, partly supported by NIHR, ran a computer model using data on ove...
NIHR Signal Introducing a primary care risk prediction tool did not reduce emergency admissions
Predicting emergency admissions paradoxically increased hospital admissions from primary care across all risk groups by about 3% overall. The Predictive Risk Stratification Model (PRISM) was evaluated in a trial in general practices in Wales, and there is little evidence it benefits patients by reducing deaths or improving quality of life either. The number of people living to older age with chronic health conditions is growing. Various risk stratification tools have been introduced across the...
NIHR Signal Quality improvement collaboratives can improve clinical processes and patient outcomes
Quality improvement collaboratives (QICs) were largely effective across a wide range of healthcare problems and settings. Of the 64 studies included in this systematic review, 53 showed improvement in some of the healthcare processes and patient outcomes that they investigated. A small number of studies also showed that collaboratives were cost-effective, and the improvements were sustainable for at least six months. Collaboratives originated in the US in the late 1980s. They provide opportunit...
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