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NIHR Signal Are track and trigger systems linked to rates of in-hospital cardiac arrest?
Use of the National Early Warning Score (NEWS) to monitor adults in hospital is associated with reduced risk of having a cardiac arrest while in hospital. Using an electronic rather than paper-based system is also linked to reduced risk. Many patients who die from a cardiac arrest while in hospital show signs of deterioration beforehand that aren’t identified or acted upon. Several interventions aimed at reducing these avoidable deaths have been introduced in the NHS. These includeNEWS, a...
NIHR Signal Having more registered nurses on general wards is linked to lower mortality
Higher registered nurse staffing levels are associated with lower mortality, and the fact that fewer vital sign observations are missed is the most likely explanation for this. Increasing registered nursing staff by an hour for each patient per day could reduce the risk of death by 3%. If the ratio of healthcare assistants to nurses gets too high, the data also suggest that rates of missed vital sign observations and mortality increase in line with the extra registered nurse time spent supervis...
NIHR Signal New strategies for maintaining blood supplies from donations may be cost-effective
Opening blood donation centres on weekday evenings and at weekends is a cost-effective way of increasing the blood supply used by hospitals in the UK. Allowing donors to give blood more often could increase supplies in the short term, but it isn’t clear if it would be cost-effective in the long-term. This NIHR-funded modelling study used data from a recent large randomised trial in the UK that investigated the safety of donating blood more frequently than current guidance allows. This was...
NIHR Signal Reconfiguring neonatal services balances survival chances against increased travel for families
Centralising services so that all babies are delivered in high-volume neonatal units could more than halvethe number of units from 161 to 72, meaning that more parents would need to travel above 30 minutes. However, ensuring that all very preterm and low birthweight babies are cared for in high-volume neonatal intensive care units would reduce mortality. NHS reconfiguration plans for neonatal services include closing smaller neonatal units to concentrate care where there are resources and speci...
NIHR Signal NHS managers need support to use tools to ensure safe nurse staffing levels
Workforce planning technologies can help NHS managers plan for safe nurse staffing levels, but only with proper support and tools that are designed with good understanding of local needs. Tools also need to give easy access to standardised information such as staff availability and costs. NHS Trusts need to be open to information sharing and system integration. Adequate nurse staffing is linked with improved patient outcomes and quality of care, making this an NHS priority. Technologies are ava...
NIHR Signal A reflective group activity supports healthcare staff in England
Regular participation in structured organisation-wide forums, known as Schwartz Center Rounds®, helps support healthcare staff. The forums are linked with increased empathy and compassion for colleagues and patients, and they facilitate practice change. Levels of poor psychological well-being decrease in forum attendees compared with non-attendees. Originating in the US, these forums provide the opportunity for clinical and non-clinical staff, from Chief Executives to porters, to deliver en...
NIHR Signal Ways of integrating care that better coordinate services may benefit patients
New integrated care models can increase patient satisfaction, perceived quality of care and improve access to services. It is less clear whether there may be effects on hospital admissions, appointments or healthcare costs. Strong leadership and patient engagement are among factors influencing successful implementation. The NHS is undergoing reconfiguration to better coordinate services around patients. This NIHR-funded review looked at the international literature to understand how new care mo...
NIHR Signal Closing five emergency departments not linked with increased hospital admissions, though ambulance call-outs increased
Closure of five small emergency departments in England was not associated with change in the number of hospital admissions, urgent care attendances or deaths among the local populations. However, ambulance call-outs increased by 14% relative to comparison areas, with a four-minute increase in the time to reach a hospital with an emergency department. Emergency departments continue to be under high pressure, while staff shortages increase patient safety concerns. One option is to close smaller s...
NIHR Signal The proportion of patients not transported to emergency departments after an ambulance is called varies across the country
Nationally, around half of people making urgent calls for ambulance services are not then taken to hospital. This is called the non-conveyancing rate. But this rate varies two-fold from region to region. There are differences too in what happens to patients not going to hospital. Some places discharge more patients at the scene, offer telephone advice or send to other non-emergency health services like walk-in centres. This NIHR mixed methods study used observation and analysis of routine ambul...
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...
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