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 ...
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...
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...
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...
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...
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...
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...
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...
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...
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...