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NIHR Signal ICU admission decision support tool showed promise but was rarely used
A decision support tool developed to help doctors determine whether patients should be admitted to intensive care showed promise in facilitating patient-clinician communication, but was not often used by doctors, with fewer than 30% using the forms. Intensive care can deliver lifesaving treatment. It can be invasive and distressing with no guarantee of success. At present, there is little to guide doctors in the decision-making process, and this NIHR-funded study sought to help doctors by devel...
NIHR Signal Online patient feedback is mostly positive — but is not being used effectively
People are increasingly reading online feedback from other patients to gauge service qualitybut fewer people go online to write feedback themselves. Health organisations and professionals are not currently effective at using this feedback to improve services. These findings come from an NIHR-funded study which used five research streams to provide an overview of online patient feedback in the NHS. Healthcare professionals rarely encourage online patient feedback and may be sceptical about it. ...
NIHR Signal Holistic services in advanced lung disease can help people cope better with breathlessness
Services providing holistic health care can improve the psychological well-being of people who are living with breathlessness associated with chronic or advanced lung disease, such as lung cancer or chronic obstructive pulmonary disease. Breathlessness is a distressing symptom in which feelings of fear and helplessness, social isolation, high levels of anxiety and significant carer burden are common experiences. Drugs can have limited effectiveness in advanced disease and do not address the und...
NIHR Signal A nurse-led intervention did not reduce post-traumatic stress disorder symptoms in critical care patients
For adults in critical care, a complex psychological intervention delivered by nurses did not reduce the severity of post-traumatic stress disorder (PTSD) symptoms at six months, compared with usual care. The intervention included creating a therapeutic environment, three stress support sessions, and a relaxation/recovery programme. A cost-effectiveness evaluation showed great uncertainty over whether the programme was value for money. The intervention was developed using the limited evidence t...
NIHR Signal Closer links between police and health services can improve experiences for people in mental health crisis
Tighter working partnerships between health professionals and police services are likely to improve the care of people who come into contact with police during mental health crises. People experiencing severe mental health episodes can present with extreme and unpredictable behaviour posing a danger to themselves and members of the public. Police are often the first to respond in these challenging situations. New models are emerging of mental health staff working with police. This NIHR-funded ...
NIHR Signal Packages of care interventions ‘not effective’ to reduce repeat admissions for COPD
Care bundles for COPD are difficult to implement, and their introduction in NHS hospitals does not reduce repeat admissions, deaths or use of resources when used on or after admission. Care bundles are packages of interventions which, in other situations, can improve care. COPD care bundles include: checking inhaler technique and medication use providing a written plan for COPD management and supply of emergency medicines assessing willingness to stop smoking assessing suitability for pul...
NIHR Signal Physician associates appear to make a positive contribution to inpatient care
Physician associates improve continuity of care and patient experience within the hospital setting. This first evaluation of the new role in the NHS suggests they could provide safe and equivalent care on defined tasks, freeing up time for doctors, and help with patient flow. However, some say that the actual and perceived potential is being held back by a lack of professional statutory regulation and the ability to prescribe. The number of physician associates trained in some of the tasks done...
NIHR Signal Steps to better understanding resistant behaviours and the culture of bedside dementia care in hospitals
High levels of resistance to care by people with dementia can be exacerbated by responses by staff on the wards. This study sought to understand the interactions and culture underlying care by closely observing and documenting what was actually happening on ten wards in five UK hospitals, and through interviews with carers and families. This in-depth study confirmed that people living with dementia are often resistant to care in acute hospital settings. Behaviour included wandering in wards, pu...
NIHR Signal Centralising stroke services can save lives
Changing access to more specialised stroke centre care in one city (London) was estimated to save an additional 96 lives per year (1%) compared to the reductions occurring in the rest of England. These improvements were sustained over time. Other cities did well on quality of care indicators, including time to admission in a stroke unit and length of stay. Patients and carers reported good experiences despite slightly increased travel times to the central stroke units. A stroke can have devasta...
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...
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