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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...
NIHR Signal Study raises questions about NHS “weekend effect”
The increased mortality observed if patients are taken to hospitals at weekends also affects night admissions and can be explained in part by the severity of illness. Five linked NIHR-funded studies reviewed mortality and time and day of admission to hospital, largely using routine England-wide data. Fewer people are admitted from A&E at the weekend. Admission is more likely if they have arrived by ambulance or been referred directly for admission from community services. Though death rate...
NIHR Signal A primary care intervention helps older people with depression
Enhanced case management (also called collaborative care) added to primary care reduced symptoms in people with clinical depression, compared with usual primary care. The benefit was similar to other depression treatments. However, the small benefit over usual care was not sustained to 12 months. This NIHR-funded UK trial was carried out among nearly 500 adults aged at least 65 years. Primary care mental health practitioners delivered six sessions to encourage activity and social contact (five ...
NIHR Signal Starting antiretroviral therapy immediately after HIV diagnosis reduces transmission of the virus
Giving antiretroviral therapy to people newly diagnosed with HIV may be an effective and cost-effective way of reducing new infections. Increased HIV testing in at-risk populations may identify more people for treatment and also reduce infection rates. Using data from a number of sources including NIHR funded projects, researchers developed a computer simulation model. The model looked at the relationship between HIV infections, sexual risk behaviours and antiretroviral therapy over a 30 year p...
NIHR Signal What works to support residents’ health in care homes and why
Long-term relationships and joint working between community health practitioners and care homes are the keys to improving appropriate hospital admissions and access to medications. Additional payments for GPs, jointly agreed protocols, clear role specifications and structured systems have impact only if they trigger and sustain collaborative working. This realist evaluation in 12 English care homes for older people explored contexts for ‘relational working’ in three service delivery...
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