Patient Transport Audit 2012
Published by NHS Kidney Care March 2012
This publication draws together the key findings from a national audit of the experience of patient transport services. A survey of all people receiving haemodialysis was conducted in October 2012, asking about their experience of transport to and from haemodialysis, and comparing this with national standards. This audit is the third in a series of audits previously performed in 2008 and 2010. It was commissioned by NHS Kidney Care.
This document provides recommendations for bars for those aged 21 and up in different neighborhoods of San Francisco, including Geary, Polk Street, Mission, Marina, Lower Haight, and others. It summarizes 5 relatively low-key bars in these areas and provides details on their drink options and environments. The document also highlights specific bars like Lion Pub, Zeitgeist, Molotov's, Rye Bar, and Jones, with notes on their drink selections and prices.
A framework for social care at the end of life
15 July 2010 - National End of Life Care Programme
This framework, developed by the NEoLCP with the involvement of a group of senior professionals and other stakeholders in social care, sets out a direction of travel for social care at end of life.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
This guide is for members of the public and explains advance care planning. It outlines the different options available to people when planning for their end of life care.
This publication is a revised version of Planning for your future care (2009).
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
A Framework for Implementation
03 June 2009 - National End of Life Care Programme / NHS Kidney Care
A group of people with life-limiting conditions, and those who have experienced the death of a loved person, came together to discuss their involvement with people who had the task of supporting those approaching the end of life.
Through these discussions 'Finding the Words', the DVD and work book were developed to help staff in their conversations and care.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Pro/Desktop is a software product from PTC U.S.A. that provides desktop functionality. The document consists of repeating the phrase "Pro/Desktop" without providing any additional context about the software or what desktop functionality it offers.
Howcast is an online resource with thousands of how-to videos organized into 12 categories on topics ranging from style to parenting. Videos can be searched using keywords or browsed by category. If a specific topic cannot be found, changing the search terms or narrowing the search may help locate relevant videos. Howcast is freely available at howcast.com and provides engaging, useful information to empower people with knowledge.
What the health care law means for small businessesyhtham8
The Affordable Care Act provides benefits to small businesses and their employees. It offers tax credits to help small businesses afford health insurance coverage for their workers. Additionally, starting in 2014, small businesses will be able to purchase insurance plans through new competitive marketplaces called Health Insurance Marketplaces or Exchanges.
This document provides recommendations for bars for those aged 21 and up in different neighborhoods of San Francisco, including Geary, Polk Street, Mission, Marina, Lower Haight, and others. It summarizes 5 relatively low-key bars in these areas and provides details on their drink options and environments. The document also highlights specific bars like Lion Pub, Zeitgeist, Molotov's, Rye Bar, and Jones, with notes on their drink selections and prices.
A framework for social care at the end of life
15 July 2010 - National End of Life Care Programme
This framework, developed by the NEoLCP with the involvement of a group of senior professionals and other stakeholders in social care, sets out a direction of travel for social care at end of life.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
This guide is for members of the public and explains advance care planning. It outlines the different options available to people when planning for their end of life care.
This publication is a revised version of Planning for your future care (2009).
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
A Framework for Implementation
03 June 2009 - National End of Life Care Programme / NHS Kidney Care
A group of people with life-limiting conditions, and those who have experienced the death of a loved person, came together to discuss their involvement with people who had the task of supporting those approaching the end of life.
Through these discussions 'Finding the Words', the DVD and work book were developed to help staff in their conversations and care.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Pro/Desktop is a software product from PTC U.S.A. that provides desktop functionality. The document consists of repeating the phrase "Pro/Desktop" without providing any additional context about the software or what desktop functionality it offers.
Howcast is an online resource with thousands of how-to videos organized into 12 categories on topics ranging from style to parenting. Videos can be searched using keywords or browsed by category. If a specific topic cannot be found, changing the search terms or narrowing the search may help locate relevant videos. Howcast is freely available at howcast.com and provides engaging, useful information to empower people with knowledge.
What the health care law means for small businessesyhtham8
The Affordable Care Act provides benefits to small businesses and their employees. It offers tax credits to help small businesses afford health insurance coverage for their workers. Additionally, starting in 2014, small businesses will be able to purchase insurance plans through new competitive marketplaces called Health Insurance Marketplaces or Exchanges.
13 September 2012 - e-Learning for Healthcare / National End of Life Care Programme / The Association for Palliative Medicine of Great Britain and Ireland (APM)
This easy-to-follow starter pack is designed to help health and social care staff use the e-learning programme e-ELCA. It includes information on how to register and access the e-learning, as well as step-by-step quick guides, frequently asked questions and case studies.
Starter Pack Thumbnail
e-ELCA is free to access for health and social care staff delivering end of life care. Commissioned by the Department of Health, it is written and reviewed by clinicians and experts. There are over 150 e-learning sessions available across eight courses:
Assessment
Advance care planning
Communication skills
Symptom management
Integrating learning
Social care
Bereavement
Spirituality
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
This document introduces an End of Life Care Facilitator Competency Framework. The framework contains 4 core competency areas: communication, facilitation, audit, and learning and development. It is designed to help facilitators assess their own competencies, identify areas for improvement, and create learning plans. The framework provides indicators for each competency and tools for self-assessment and assessment by a mentor. It encourages facilitators to continually review and improve their practice through reflection, learning, and experience.
The route to success in end of life care - achieving quality in ambulance services
28 February 2012 - National End of Life Care Programme
This guide sets out the key role and contribution of ambulance services in achieving high quality care at each step along the end of life care pathway.
Whilst highlighting the crucial role of ambulance services, the guide also acknowledges the unique set of challenges and barriers that need to be addressed and overcome.
Good practice examples and top tips are provided throughout to make this guide a key tool not only for ambulance services, but also for other health and social care providers, professionals, managers and commissioners.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
(last offices) 05 April 2011 - National End of Life Care Programme
Developed by the National End of Life Care Programme and National Nurse Consultant Group (Palliative Care), this guidance sets out key principles is intended as a guide for training, as well as for informing the development of organisational protocols for this area of care aims to provide a consistent view that accommodates England's diverse religious and multi-cultural beliefs.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Death from liver disease : Implications for end of life care in England
22 March 2012
This report presents the latest data on place of death for those with liver disease and shows how this varies with sex, age, region, socioeconomic deprivation and place. It is aimed at commissioners and providers of end of life care, clinicians caring for patients with liver disease, and others concerned with providing quality end of life care for this patient group, including patients themselves and their carers.
Some key findings:
Liver disease causes approximately 2% of all deaths
The number of people who die from liver disease in England is rising (from 9,231 in 2001 to 11,575 in 2009)
More men than women die from liver disease (60% are men, 40% women)
Alcoholic liver disease accounts for well over a third (37%) of liver disease deaths.
If you are involved in treating patients, managing and/or improving health services or
managing or training those that do, you will understand the importance of providing the
best care possible for all our patients.
Great progress has been made in improving service standards and access and in reducing
waiting times, but there is still some way to go to ensure consistently high standards of
patient care across the NHS.
It is clear that we need to ensure we are getting it right first time, which means better care
and better value through the reduction of waste and errors and the prioritisation of effective
treatments. Quality, innovation, productivity and prevention (QIPP) is the mechanism through
which we can achieve this.
QIPP is about creating an environment in which change and improvement can flourish; it
is about leading differently and in a way that fosters a culture of innovation; and it is
about providing staff with the tools, techniques and support that will enable them to take
ownership of improving quality of care.
The Handbook of Quality and Service Improvement Tools from the NHS Institute brings
together a collection of proven tools, theories and techniques to help NHS staff design and
implement quality improvement projects that do not compromise on the quality and safety of
patient care but rather enhance the patient experience.
Getting it right: end of life care in advanced kidney disease
Published by NHS Kidney Care
This document brings together the experiences and learning from three project groups that have been working over the last two years to implement the framework for end of life care in advanced kidney disease. It also addresses the data items that are associated with managing end of life care.
No place like home: Increasing access to home dialysis
Published by NHS Kidney Care March 2013
This document outlines the key learning and outcomes from locally-led and centrally
co-ordinated projects to improve access to home therapies.
Ceri Jones has extensive education and experience in public health, clinical perfusion, and cardiovascular research. She holds several degrees including an MPH from the University of Manchester and an MSc from Imperial College London. Currently, she works as a clinical perfusion scientist at University Hospitals Bristol NHS Foundation Trust and is a research fellow at the University of Bristol. Additionally, she founded and directs Connect 2 Health, a community interest company focused on digital health technologies. Jones has consulted on various public health projects in the UK, Kenya, Ghana, and Liverpool. She is involved in establishing new primary healthcare services, developing community-based health insurance, and creating tools to evaluate local government approaches to obesity.
Aine Carroll, National Director of Clinical Strategy & Programmes, HSEInvestnet
The document discusses the challenges of clinical leadership in Ireland and reforming the health system. It outlines why reform is needed, including improving service delivery through integrated models of care. It summarizes some of the achievements of Ireland's National Clinical Programmes in reducing wait times and lengths of stay for various conditions. It also discusses some of the problems within the current system like lack of integration and the need for reform of the clinical strategy and programmes division.
This study surveyed 285 patients across five outpatient clinics to understand their experiences and level of satisfaction. Key findings include:
- Patients reported high satisfaction with the quality of consultations and attitude of medical staff.
- The main areas identified for improvement were waiting times from referral to first appointment and delays during clinic visits.
- Despite these issues, patients expressed understanding of pressures on outpatient staff.
#31 Why do patients call acute oncology services?RecoveryPackage
The Mid Yorkshire Hospitals NHS Trust serves over 550,000 people and delivers almost 15,000 cycles of cancer therapy per year. The trust operates an acute oncology (AO) service during weekday working hours and a 24-hour AO helpline. A recent audit of the AO service found that telephone triage is a main component and that the majority of patients can be managed over the phone without needing to come to the hospital. Appropriate training for staff on triage strategies could help the AO service optimize patient management and prevent unnecessary admissions.
1) Comprehensive care centres that adhere to standards of care for inherited bleeding disorders like hemophilia have been shown to significantly improve health outcomes and reduce costs.
2) A 1970s study in Montreal found that home treatment of bleeding episodes supported by a comprehensive care centre reduced hospitalizations by 85% and costs by 85% for children with hemophilia.
3) Later studies also showed patients who received care at comprehensive care centres had lower risks of hospitalization and morbidity.
Welcome and the National Patient Safety Plan - Dr Mike Durkin (Chair), Director for Patient Safety, NHS England
Presentation from the Patient Safety Collaborative launch event held in London on 14 October 2014
More information at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/patient-safety-collaboratives.aspx
Nicholas Black: Linking disease registry information Nuffield Trust
This document discusses linking disease registry information and predictive modeling. It describes the characteristics of national clinical databases in England, including three main types: routine administrative databases, clinical registries, and national clinical audits. Over 60 national clinical audits exist, covering a wide range of clinical areas. The document advocates expanding the use of national clinical databases to support decision-making and predictive modeling.
Providing access to interventional
radiology services, seven days a week
Interventional radiology procedures are low volume and have a number of complex challenges. The service configuration at each Trust differs and is dependent on the number and the skill mix of interventional radiology consultants in the Trust. It is a service that supports a wide range of clinical pathways.
Based on the work of the NHS England Seven Day Services Forum and NHS Improving Quality’s Seven Day Services Improvement Programme (SDSIP), the focus for the 2013/14 interventional radiology programme has been to develop networks to deliver seven day access for nephrostomy, embolisation for haemorrhage and embolisation for post-partum haemorrhage.
Nephrostomy is a core interventional radiology service required for patients with a potential to deteriorate and require urgent intervention. Embolisation for haemorrhage usually, but not exclusively, is performed as an emergency/urgent intervention.Embolisation for post-partum haemorrhage may involve predelivery planning and be performed as an emergency/urgent intervention.
This document summarizes a study investigating patient experience and flow following contact with NHS 111 for four common pediatric conditions. It describes three parts:
1) A data linkage study found it feasible to link NHS 111, primary care, and hospital data to analyze patient pathways. The study identified over 4,000 children under 5 years old with fever who contacted NHS 111.
2) A patient-reported experience measure (PREM) for NHS 111 was developed and implemented, receiving over 1,000 responses. Overall experience ratings were positive while wait times and call outcomes needed improvement.
3) An online survey for healthcare professionals is under development to understand referral management of pediatric patients from NHS 111.
This document provides guidelines for pressure ulcer risk assessment and prevention. It was developed by the Royal College of Nursing to help reduce pressure ulcer occurrence. The guidelines are intended for use by all healthcare staff, and provide evidence-based recommendations on identifying individuals at risk, using risk assessment scales, recognizing risk factors, skin inspection, pressure redistribution devices, positioning, seating, education and training. They also cover essential care aspects like nutrition, continence and hygiene that can impact pressure ulcer development.
This document summarizes a workshop in the United Kingdom focused on improving clinical trial capacity for Duchenne muscular dystrophy (DMD). Representatives from patient organizations, clinical sites, industry, and government research agencies attended to assess the current situation and develop strategies. DMD is a fatal genetic disorder in need of more treatment options. While larger centers are reaching capacity in multiple DMD studies, smaller centers require support to participate in trials. The group aimed to better utilize resources and expand trial access across the UK.
This study examined the core predictors of "hassles" experienced by patients with multiple chronic conditions (multimorbidity) in primary care. The researchers surveyed 486 patients with multimorbidity across four general practices in the UK. They found that the most commonly reported hassles related to lack of information about conditions/treatments, poor communication among providers, and poor access to specialists. Having more conditions, symptoms of anxiety/depression, younger age, employment, and no recent discussion with their GP predicted greater hassles. The study highlights key hassles that should be addressed and patient groups most at risk to help design improved models of care for multimorbidity.
This document provides an updated summary of guidelines for blood conservation in cardiac surgery from The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists. Major revisions include new recommendations regarding dual anti-platelet therapy management before surgery, drugs that augment red blood cell volume or limit blood loss, blood derivatives, blood salvage management, minimally invasive procedures, extracorporeal membrane oxygenation, hemostatic agents, and insights into team-based interventions. The guidelines were updated based on a literature review using standardized search terms to ensure the recommendations reflect the most current evidence available.
This document provides guidance for implementing a single unit transfusion guideline based on Patient Blood Management Guidelines. It recommends transfusing one unit of red blood cells and reassessing the patient before additional units to reduce risks. Implementing the guideline requires identifying responsible staff, education, empowering staff to question multiple unit requests, collecting transfusion data, and providing feedback to promote safer, evidence-based transfusion practices.
13 September 2012 - e-Learning for Healthcare / National End of Life Care Programme / The Association for Palliative Medicine of Great Britain and Ireland (APM)
This easy-to-follow starter pack is designed to help health and social care staff use the e-learning programme e-ELCA. It includes information on how to register and access the e-learning, as well as step-by-step quick guides, frequently asked questions and case studies.
Starter Pack Thumbnail
e-ELCA is free to access for health and social care staff delivering end of life care. Commissioned by the Department of Health, it is written and reviewed by clinicians and experts. There are over 150 e-learning sessions available across eight courses:
Assessment
Advance care planning
Communication skills
Symptom management
Integrating learning
Social care
Bereavement
Spirituality
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
This document introduces an End of Life Care Facilitator Competency Framework. The framework contains 4 core competency areas: communication, facilitation, audit, and learning and development. It is designed to help facilitators assess their own competencies, identify areas for improvement, and create learning plans. The framework provides indicators for each competency and tools for self-assessment and assessment by a mentor. It encourages facilitators to continually review and improve their practice through reflection, learning, and experience.
The route to success in end of life care - achieving quality in ambulance services
28 February 2012 - National End of Life Care Programme
This guide sets out the key role and contribution of ambulance services in achieving high quality care at each step along the end of life care pathway.
Whilst highlighting the crucial role of ambulance services, the guide also acknowledges the unique set of challenges and barriers that need to be addressed and overcome.
Good practice examples and top tips are provided throughout to make this guide a key tool not only for ambulance services, but also for other health and social care providers, professionals, managers and commissioners.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
(last offices) 05 April 2011 - National End of Life Care Programme
Developed by the National End of Life Care Programme and National Nurse Consultant Group (Palliative Care), this guidance sets out key principles is intended as a guide for training, as well as for informing the development of organisational protocols for this area of care aims to provide a consistent view that accommodates England's diverse religious and multi-cultural beliefs.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Death from liver disease : Implications for end of life care in England
22 March 2012
This report presents the latest data on place of death for those with liver disease and shows how this varies with sex, age, region, socioeconomic deprivation and place. It is aimed at commissioners and providers of end of life care, clinicians caring for patients with liver disease, and others concerned with providing quality end of life care for this patient group, including patients themselves and their carers.
Some key findings:
Liver disease causes approximately 2% of all deaths
The number of people who die from liver disease in England is rising (from 9,231 in 2001 to 11,575 in 2009)
More men than women die from liver disease (60% are men, 40% women)
Alcoholic liver disease accounts for well over a third (37%) of liver disease deaths.
If you are involved in treating patients, managing and/or improving health services or
managing or training those that do, you will understand the importance of providing the
best care possible for all our patients.
Great progress has been made in improving service standards and access and in reducing
waiting times, but there is still some way to go to ensure consistently high standards of
patient care across the NHS.
It is clear that we need to ensure we are getting it right first time, which means better care
and better value through the reduction of waste and errors and the prioritisation of effective
treatments. Quality, innovation, productivity and prevention (QIPP) is the mechanism through
which we can achieve this.
QIPP is about creating an environment in which change and improvement can flourish; it
is about leading differently and in a way that fosters a culture of innovation; and it is
about providing staff with the tools, techniques and support that will enable them to take
ownership of improving quality of care.
The Handbook of Quality and Service Improvement Tools from the NHS Institute brings
together a collection of proven tools, theories and techniques to help NHS staff design and
implement quality improvement projects that do not compromise on the quality and safety of
patient care but rather enhance the patient experience.
Getting it right: end of life care in advanced kidney disease
Published by NHS Kidney Care
This document brings together the experiences and learning from three project groups that have been working over the last two years to implement the framework for end of life care in advanced kidney disease. It also addresses the data items that are associated with managing end of life care.
No place like home: Increasing access to home dialysis
Published by NHS Kidney Care March 2013
This document outlines the key learning and outcomes from locally-led and centrally
co-ordinated projects to improve access to home therapies.
Ceri Jones has extensive education and experience in public health, clinical perfusion, and cardiovascular research. She holds several degrees including an MPH from the University of Manchester and an MSc from Imperial College London. Currently, she works as a clinical perfusion scientist at University Hospitals Bristol NHS Foundation Trust and is a research fellow at the University of Bristol. Additionally, she founded and directs Connect 2 Health, a community interest company focused on digital health technologies. Jones has consulted on various public health projects in the UK, Kenya, Ghana, and Liverpool. She is involved in establishing new primary healthcare services, developing community-based health insurance, and creating tools to evaluate local government approaches to obesity.
Aine Carroll, National Director of Clinical Strategy & Programmes, HSEInvestnet
The document discusses the challenges of clinical leadership in Ireland and reforming the health system. It outlines why reform is needed, including improving service delivery through integrated models of care. It summarizes some of the achievements of Ireland's National Clinical Programmes in reducing wait times and lengths of stay for various conditions. It also discusses some of the problems within the current system like lack of integration and the need for reform of the clinical strategy and programmes division.
This study surveyed 285 patients across five outpatient clinics to understand their experiences and level of satisfaction. Key findings include:
- Patients reported high satisfaction with the quality of consultations and attitude of medical staff.
- The main areas identified for improvement were waiting times from referral to first appointment and delays during clinic visits.
- Despite these issues, patients expressed understanding of pressures on outpatient staff.
#31 Why do patients call acute oncology services?RecoveryPackage
The Mid Yorkshire Hospitals NHS Trust serves over 550,000 people and delivers almost 15,000 cycles of cancer therapy per year. The trust operates an acute oncology (AO) service during weekday working hours and a 24-hour AO helpline. A recent audit of the AO service found that telephone triage is a main component and that the majority of patients can be managed over the phone without needing to come to the hospital. Appropriate training for staff on triage strategies could help the AO service optimize patient management and prevent unnecessary admissions.
1) Comprehensive care centres that adhere to standards of care for inherited bleeding disorders like hemophilia have been shown to significantly improve health outcomes and reduce costs.
2) A 1970s study in Montreal found that home treatment of bleeding episodes supported by a comprehensive care centre reduced hospitalizations by 85% and costs by 85% for children with hemophilia.
3) Later studies also showed patients who received care at comprehensive care centres had lower risks of hospitalization and morbidity.
Welcome and the National Patient Safety Plan - Dr Mike Durkin (Chair), Director for Patient Safety, NHS England
Presentation from the Patient Safety Collaborative launch event held in London on 14 October 2014
More information at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/patient-safety-collaboratives.aspx
Nicholas Black: Linking disease registry information Nuffield Trust
This document discusses linking disease registry information and predictive modeling. It describes the characteristics of national clinical databases in England, including three main types: routine administrative databases, clinical registries, and national clinical audits. Over 60 national clinical audits exist, covering a wide range of clinical areas. The document advocates expanding the use of national clinical databases to support decision-making and predictive modeling.
Providing access to interventional
radiology services, seven days a week
Interventional radiology procedures are low volume and have a number of complex challenges. The service configuration at each Trust differs and is dependent on the number and the skill mix of interventional radiology consultants in the Trust. It is a service that supports a wide range of clinical pathways.
Based on the work of the NHS England Seven Day Services Forum and NHS Improving Quality’s Seven Day Services Improvement Programme (SDSIP), the focus for the 2013/14 interventional radiology programme has been to develop networks to deliver seven day access for nephrostomy, embolisation for haemorrhage and embolisation for post-partum haemorrhage.
Nephrostomy is a core interventional radiology service required for patients with a potential to deteriorate and require urgent intervention. Embolisation for haemorrhage usually, but not exclusively, is performed as an emergency/urgent intervention.Embolisation for post-partum haemorrhage may involve predelivery planning and be performed as an emergency/urgent intervention.
This document summarizes a study investigating patient experience and flow following contact with NHS 111 for four common pediatric conditions. It describes three parts:
1) A data linkage study found it feasible to link NHS 111, primary care, and hospital data to analyze patient pathways. The study identified over 4,000 children under 5 years old with fever who contacted NHS 111.
2) A patient-reported experience measure (PREM) for NHS 111 was developed and implemented, receiving over 1,000 responses. Overall experience ratings were positive while wait times and call outcomes needed improvement.
3) An online survey for healthcare professionals is under development to understand referral management of pediatric patients from NHS 111.
This document provides guidelines for pressure ulcer risk assessment and prevention. It was developed by the Royal College of Nursing to help reduce pressure ulcer occurrence. The guidelines are intended for use by all healthcare staff, and provide evidence-based recommendations on identifying individuals at risk, using risk assessment scales, recognizing risk factors, skin inspection, pressure redistribution devices, positioning, seating, education and training. They also cover essential care aspects like nutrition, continence and hygiene that can impact pressure ulcer development.
This document summarizes a workshop in the United Kingdom focused on improving clinical trial capacity for Duchenne muscular dystrophy (DMD). Representatives from patient organizations, clinical sites, industry, and government research agencies attended to assess the current situation and develop strategies. DMD is a fatal genetic disorder in need of more treatment options. While larger centers are reaching capacity in multiple DMD studies, smaller centers require support to participate in trials. The group aimed to better utilize resources and expand trial access across the UK.
This study examined the core predictors of "hassles" experienced by patients with multiple chronic conditions (multimorbidity) in primary care. The researchers surveyed 486 patients with multimorbidity across four general practices in the UK. They found that the most commonly reported hassles related to lack of information about conditions/treatments, poor communication among providers, and poor access to specialists. Having more conditions, symptoms of anxiety/depression, younger age, employment, and no recent discussion with their GP predicted greater hassles. The study highlights key hassles that should be addressed and patient groups most at risk to help design improved models of care for multimorbidity.
This document provides an updated summary of guidelines for blood conservation in cardiac surgery from The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists. Major revisions include new recommendations regarding dual anti-platelet therapy management before surgery, drugs that augment red blood cell volume or limit blood loss, blood derivatives, blood salvage management, minimally invasive procedures, extracorporeal membrane oxygenation, hemostatic agents, and insights into team-based interventions. The guidelines were updated based on a literature review using standardized search terms to ensure the recommendations reflect the most current evidence available.
This document provides guidance for implementing a single unit transfusion guideline based on Patient Blood Management Guidelines. It recommends transfusing one unit of red blood cells and reassessing the patient before additional units to reduce risks. Implementing the guideline requires identifying responsible staff, education, empowering staff to question multiple unit requests, collecting transfusion data, and providing feedback to promote safer, evidence-based transfusion practices.
The vision, priorities & approach for ucl partners AHSNPM Society
UCL Partners AHSN aims to improve health outcomes for 6 million people through collaboration across healthcare organizations, universities, and local authorities. It will achieve this through 5 integrated programs in areas like cancer, cardiovascular disease, and mental health. The programs will focus on initiatives to improve treatment, increase clinical research participation, and better manage conditions. UCL Partners will work across boundaries and with industry partners to spread innovations and solutions at scale. Success requires strong partnerships, local leadership, and a focus on operational delivery rather than single control.
Optimising venous leg ulcer services in a changing NHS: A UK consensus.GNEAUPP.
This document provides guidelines for optimizing venous leg ulcer services in a changing NHS. It recommends that venous leg ulcer services should:
- Provide rapid assessment and diagnosis to determine appropriate treatment and referrals.
- Aim to prevent new ulcers, heal existing ulcers quickly, and prevent recurrences through a multidisciplinary team approach and integrated care pathways.
- Plan services considering prevalence, integration with other services, roles and training, accessibility, equipment needs, and costs to deliver high-quality and efficient care.
Management of Diabetic Ketoacidosis DKA 2013 Guidelines.pdfDr Musadiq
This document provides guidelines for the management of diabetic ketoacidosis (DKA) in adults. It recommends managing DKA based on bedside monitoring of blood glucose and ketone levels using portable meters. The key steps in treatment include administering a fixed rate intravenous insulin infusion to suppress ketones and reverse acidosis, closely monitoring electrolytes, and involving the diabetes specialist team as soon as possible. Measurement of blood ketones rather than just glucose is important for assessing resolution of DKA. The guidelines emphasize point-of-care monitoring and emphasize the role of the diabetes specialist team in management and discharge planning.
C12 british diabetes societies management of dka 2013Diabetes for all
This document provides guidelines for the management of diabetic ketoacidosis (DKA) in adults. It recommends monitoring blood ketone levels using bedside meters as the primary indicator for assessing treatment response, rather than solely relying on blood glucose levels. The guidelines emphasize early involvement of diabetes specialist teams and note that mortality from DKA has declined significantly with improved care practices. The guidelines were updated in 2013 to reflect developments in near-patient testing technology and changes in how DKA often presents.
Similar to Kidney patient transport audit 2012 (20)
This Guide for Executives is aimed at senior healthcare leaders. It provides 31 practical tips for leaders
who want to contribute positively to the culture for innovation in their organisations and systems.
A more in-depth practitioners guide, Creating the Culture for Innovation, provides much more
detailed advice and guidance, a host of additional examples, and information about an online staff
survey that can be used to assess, benchmark and understand the culture for innovation.
The Sustainability Model is a diagnostic tool that will identify strengths and
weaknesses in your implementation plan and predict the likelihood of sustainability
for your improvement initiative.
The Sustainability Guide provides practical advice on how you might increase the
likelihood of sustainability for your improvement initiative.
The document provides information and guidance for patients on how to take an active role in their recovery process before and after a hospital operation or procedure. It emphasizes the importance of staying physically and mentally active before surgery, eating healthy foods, and making plans for support and transportation at home after being discharged from the hospital. Taking small, achievable steps each day toward recovery goals like walking, showering, and eating can help patients leave the hospital sooner and feel better faster.
This document discusses bringing social movement thinking to healthcare improvement by incorporating principles from successful social movements. It outlines five key principles for creating social movement dynamics within healthcare organizations: see change as a personal mission; frame issues to connect with core values; energize and mobilize individuals; organize for impact; and maintain forward momentum. The document argues that while traditional improvement approaches have had some success, social movement thinking can help deliver deeper, more sustainable changes to better serve patients. It provides several case studies of teams that have applied social movement ideas to spur healthcare improvements.
The 15 Steps Challenge provides a toolkit to help healthcare teams evaluate the quality of patient care from the patient's perspective. A 15 Steps Challenge team conducts ward walkarounds using the toolkit to assess four areas: Welcoming, Safe, Caring and Involving, and Well Organised and Calm. The team then provides feedback to the ward and trust sponsor to identify good practices and areas for improvement. Repeating the Challenge ensures continuous quality improvement by regularly incorporating the patient voice.
This document provides an overview of a toolkit aimed at helping NHS trusts reduce their Caesarean section rates. The toolkit was developed by the NHS Institute for Innovation and Improvement based on visits to maternity services with low C-section rates. It includes self-assessment tools covering key areas like first pregnancies, VBAC, and organizational characteristics. The goal is to help services evaluate their practices and develop action plans to promote normal birth and reduce C-section rates in a safe and sustainable way.
This document provides an introduction to thinking differently and why it is important, especially within the healthcare system. It discusses how thinking differently has led to innovations that have transformed various industries. Within healthcare, thinking differently created the NHS and has led to improvements like keyhole surgery. The document encourages readers to challenge traditional ways of doing things and consider new possibilities, like using interactive TV to book appointments. It argues that thinking differently is needed to achieve reforms and make significant gains in effectiveness and efficiency. Examples are given of projects that emerged from rethinking traditional models of service delivery.
The ebd approach (experience based design) is a method of designing better experiences for patients, carers and staff. The approach captures the experiences of those involved in healthcare services. It involves looking at the care journey
and in addition the emotional journey people
experience when they come into contact with a particular pathway or part of the service. Staff work together with patients and carers to firstly understand these experiences and then to improve them.
This guide is an introduction to the ebd approach (experience based design).
This guide and toolkit has been produced as
a result of work that the NHS Institute for
Innovation and Improvement has undertaken in collaboration with NHS organisations and external agencies, using the experience of patients, carers and staff to design better
healthcare services.
- Slit lamp examination (including fundus)
- Perform biometry and focimetry
- Decide appropriateness for surgery
- Perform auto-refraction
- Discuss desired post-operative refractive status
with the patient (including current type of
spectacle correction) to enable the choice of lens
implant
- Perform ECG and blood tests
- Identify 2nd eye surgery where appropriate
Benefits
- reduces duplication of tasks
- reduces waiting time for patients
- frees up nursing time for other duties
- ensures all key tasks are completed in one visit
- improves patient experience
- reduces overall time in clinic
09
The Preferred Priorities for Care (PPC) is a tool that:
1. Facilitates discussions about end of life care wishes and preferences which can then be recorded.
2. Enables communication across care providers for care planning and decisions.
3. Acts as an advance statement if the person loses capacity, allowing their previously expressed wishes to inform best interest decisions about their care.
The PPC records an individual's end of life care preferences but these may change, so current views should take precedence. It is a voluntary and non-binding document but informs best interest decisions if capacity is lost.
The document discusses key principles for designing end-of-life care environments. It notes that the physical environment can directly impact patient experience and the memories of family and caregivers. Design should facilitate privacy, dignity, and respect. Key principles include being fit for purpose, providing comfort and connection to nature, use of natural light and materials, clarity of wayfinding, and enabling patient control and privacy. Improving environmental design can enhance patient and family experience through intuitive wayfinding, access to nature, consideration of heightened senses, provision of informal spaces, and co-located bereavement services. An environmental improvement project requires forming a multidisciplinary team to review needs, develop a plan and budget, and implement high quality design standards.
The Fast Track Tool is used to gain immediate access to funding for individuals who need urgent care packages due to rapidly deteriorating health conditions that may be terminal. It can be completed by nurses or doctors familiar with the patient's needs. The tool must be used when urgent continuing healthcare is required and replaces the regular assessment process. Patient consent is required unless they lack capacity, in which case clinicians make a best interests decision. Evidence of a completed Fast Track Tool is sufficient for eligibility and PCTs must accept and immediately action properly completed tools.
Support Sheet 13: Decisions made in a person's 'Best Interests'
This support sheet outlines the process for making decisions on behalf of someone who lacks capacity.
Support Sheet 12: Mental Capacity Act (2005)
This support sheet outlines the main provisions of the Mental Capacity Act the four tests essential for assessing capacity
Support Sheet 11: Quality Markers for Acute Hospitals
This support sheet outlines the quality markers by which acute hospitals can measure the standard of end of life care they provide.
Support Sheet 7: Models/Tools of Delivery
This support sheet outlines the key elements of
Advance Care Planning (ACP)
Gold Standards Framework (GSF)
Liverpool Care Pathway (LCP)
Dignity should be accorded to all people receiving end-of-life care, especially dying patients and their families. The Department of Health established ten principles for dignified care, including treating each person with respect, enabling independence and choice, listening to needs and wishes, and ensuring privacy. These principles involve holistic needs assessments, advance care planning, and engaging family members to plan care that maintains confidence and alleviates loneliness for those nearing the end of life.
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
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10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
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Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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7. 3. Summary of discussion points
6.1 Response rate
The findings of the audit are based on 11,190 patient responses from 246 of the 256
units known to provide haemodialysis in England, Wales and Northern Ireland. With
such high participation rates the audit is likely to reflect the national picture with respect
to haemodialysis patient transport.
Variation in the number of responses, and response rate, should be considered when
interpreting unit level results.
An overrepresentation of patients using hospital arranged transport compared to
patients using their own car or using public transport is suspected, but this does not
affect the major findings and conclusions of the audit.
6.2 Age of patients
People aged 24 or younger accounted for less than two per cent of respondents, whilst
older people aged 65 or more accounted for over half, a similar age profile to previous
surveys.
6.3 Mode of transport
Two thirds of patients who travel regularly for haemodialysis treatment do so using
hospital arranged transport. Older patients are more likely to rely on hospital arranged
transport, and there has been no change in the proportion using hospital arranged
transport between 2010 and 2012.
By unit, there is over three‐fold variation in the proportion of patients using hospital
arranged transport. This requires careful interpretation in the light of local knowledge
regarding application of eligibility criteria.
The most common reasons for being unable to use private or public transport were
related to ill health or immobility, or lack of access to a car. However, local units should
investigate whether those reasons amenable to change (including lack of parking) can be
addressed.
6.4 Payment for transport
Units may find it more cost effective to reimburse patients using other modes of
transport if this leads to a reduction in reliance on hospital arranged transport.
Overall 22 per cent of patients pay for their transport to and from dialysis; most
commonly people using public or private transport.
Only six per cent of patients said they had been given the chance to review whether or
not they have to pay for dialysis transport within the last six months.
7 | P a g e
8. 6.5 Journey distance
Patients usually wish to minimise the distance they travel to get to their dialysis unit.
These data continue to provide reassurance that for the majority of patients the
distance travelled to get to their dialysis unit is less than 10 miles.
Just over six per cent of survey respondents said they were not having dialysis in their
unit of choice, and about two thirds of these said they would prefer to have dialysis in a
unit closer to where they live. This indicates that this is a relatively small – although
potentially very important – issue.
6.6 Travelling time for patients
Travelling time is important for patients and, except due to local geographical
circumstances, it is recommended that travel time to a haemodialysis unit should be less
than 30 minutes.
In 2012, 67 per cent of patients had a travel time of less than 30 minutes. Overall, there
has been no substantial change compared to previous surveys.
The aggregate numbers drawn from so many dialysis units could mask real and
important changes in individual centres, both improvements and deterioration, and the
local reports will illustrate this important detailed information.
Patients using public transport have much longer travel times than those using private or
hospital arranged transport. One in five patients using public transport travel for more
than one hour to reach their dialysis unit.
There is wide variation in travel time by unit and this emphasises the importance of
taking local knowledge into account when setting and measuring targets. However,
while a journey time of less than 30 minutes may be difficult to achieve in congested or
sparsely populated areas it is an aspiration worth pursuing as it makes a difference to
the quality of life for patients.
Patient comments illustrate the frustration of making multiple detours in what would
otherwise be a quick and straightforward journey to and from home. A straightforward
way of reducing transit time for hospital arranged transport patients is to minimise
diversions to collect or drop off other patients where possible, ensuring journeys are
more direct.
6.7 Waiting time for pickup for journey to dialysis
It is recommended that patients using hospital arranged transport are collected within
30 minutes of their scheduled pick up time.
Overall in 2012, over 81 per cent of patients using hospital arranged transport were
collected within 30 minutes – an improvement since 2010.
About one third of patients stated that they had an appointment window rather than a
specific pick up time and for about one in eight of these patients the pick up window
was two hours or more, which could cause significant inconvenience to the patient.
8 | P a g e
9. The aggregate numbers drawn from so many dialysis units could mask real and
important changes in individual centres, so units should look their own local reports for
this and other waiting time indicators included in the survey.
6.8 Waiting time at unit for dialysis to start
It is recommended that patients using hospital arranged transport commence dialysis
within 30 minutes of arrival at the unit.
Overall in 2012, over 77 per cent of patients using hospital arranged transport
commenced dialysis within 30 minutes of arrival on the unit; an improvement since
2010.
6.9 Waiting time for pick up for journey after dialysis
It is recommended that patients using hospital arranged transport should be collected to
return home within 30 minutes of finishing dialysis.
In 2012 almost 65 per cent of patients using hospital arranged transport commenced
their journey home within 30 minutes of being ready, similar to the proportions in 2010
and 2008. However, 12 per cent waited for more than one hour to leave.
Around 16 per cent of patients using hospital arranged transport say that transport
arrangements have affected the length of their dialysis session, but this happens
relatively infrequently.
6.10 Patient satisfaction
Just under 90 per cent of respondents said that their current transport arrangements
met their needs either all or most of the time. There have been small improvements in
overall satisfaction levels with each consecutive survey.
Patients travelling by public transport express much lower levels of satisfaction
compared to patients travelling by hospital arranged or private transport.
Users of hospital arranged transport were particularly happy with friendliness of staff
and staff understanding of their needs, though far less so with punctuality and with the
number of additional patients collected or dropped off by their vehicle.
As with other aspects of this audit, the real value will be on reflection and interpretation
of findings, both positive and those which show room for improvement, by local centres.
The detailed unit level reports, published separately, will allow such consideration.
7. Results – Unit Manager Questionnaire
For many of the questions in the survey a large proportion of respondents indicated that
they did not know the answer. In some cases this may be because the questionnaire
was completed by people with insufficient knowledge of the transport service.
However, on the whole the questionnaire was completed by the unit manager and it is
an important observation that some are unaware of how transport services are
commissioned, monitored and managed.
9 | P a g e
10. In over a third of units there was no regular process to review patient eligibility for free
transport or reimbursement for transport services.
There are high proportions of unit managers who were unaware of the charging
arrangements for hospital arranged transport.
Over half of unit managers reported that funding for renal transport is clearly identified,
with roughly the same proportion indicating that there is a separate contract in place for
renal transport, and detailed specifications for renal transport service levels are included
in the contract.
About two thirds of the unit managers indicated there were no limitations on
appointment times for patients due to transport provision.
Regular contract monitoring with the transport providers was in place in over two thirds
of cases. A similar proportion of units indicated that that patient views were captured in
the monitoring process.
Transport issues affect dialysis unit staff, either through having to change working
patterns to cover late arrivals or spend time resolving problems. Staff also observe the
physical and psychological impact on patients.
10 | P a g e
32. Discussion points
Travelling time is important for patients and, except due to local geographical
circumstances, it is recommended that travel time to a haemodialysis unit
should be less than 30 minutes.
In 2012, 67 per cent of patients had a travel time of less than 30 minutes.
Overall, there has been no substantial change compared to previous surveys.
The aggregate numbers drawn from so many dialysis units could mask real and
important changes in individual centres, both improvements and deterioration,
and the local reports will illustrate this important detailed information.
Patients using public transport have longer travel times compared to patients
using private or hospital arranged transport. One in five patients using public
transport travel for more than one hour to reach their dialysis unit.
There is wide variation in travel time by unit and this emphasises the
importance of taking local knowledge into account when setting and measuring
targets. However, while a journey time of less than 30 minutes may be difficult
to achieve in congested or sparsely populated areas, it is an aspiration worth
pursuing as it makes a difference to the quality of life for patients.
Patient comments illustrate the frustration of making multiple detours in what
would otherwise be a quick and straightforward journey to and from home. A
straightforward way of reducing transit time for hospital arranged transport
patients is to minimise diversions to collect or drop off other patients where
possible, ensuring journeys are more direct.
32 | P a g e
41. Discussion points
It is recommended that patients using hospital arranged transport should be
collected to return home within 30 minutes of finishing dialysis.
In 2012 almost 65 per cent of patients using hospital arranged transport
commenced their journey home within 30 minutes of being ready, similar to the
proportions in 2010 and 2008. However, 12 per cent waited for more than one
hour to leave.
Around 16 per cent of patients using hospital arranged transport say that transport
arrangements have affected the length of their dialysis session, but this happens
relatively infrequently.
6.10 Patient satisfaction
Patients said
“Our taxi drivers are kind, considerate and helpful and having a regular driver is nice – you
build up a relationship with them and fellow travellers and give each other mutual support
and friendship at a difficult time in your life.”
“The transport services are excellent, the drivers are professional, competent and very
friendly and they really understand the problems and needs of the patients.”
“Hospital transport is a great help ensuring attendance to the hospital regularly. Without
it, life may have lost its meaning. This singular service has I believe saved lives for many ….
it’s most helpful to lonely patients or those who live alone in their respective apartments a
long way away from the various hospitals.”
Background
Questions regarding satisfaction with transport arrangements were included in the 2008
and 2010 surveys, and high levels of satisfaction with many aspects were found. Comments
made by patients suggest that the attitude and care shown by drivers and other staff are at
41 | P a g e
47. Table 2 Review of patient transport arrangements
Regular review of each patient’s
transport service needs
Each patient’s eligibility for free
transport reviewed regularly
Each patient’s eligibility for reimbursed
transport reviewed regularly
Yes
Yes
Yes
approx approx approx
every every every
3 m
6 m
12 m
48%
14%
7%
No
Don't
know
23%
8%
27%
10%
10%
39%
14%
14%
6%
9%
42%
29%
7.3 Charging for hospital arranged transport
Around a quarter of units have a policy on charging, and roughly the same proportion report
that the Healthcare Travel Costs Scheme (HTCS)
(www.nhs.uk/nhsengland/Healthcosts/pages/Travelcosts.aspx) is widely publicised to
patients. A lower proportion state that the HTCS covers arrangements for reimbursement.
For these questions, in addition to those who answered ‘don’t know’, almost three quarters
of respondents left the question blank. This suggests that awareness of charging
arrangements is generally poor, even in staff involved in this area.
Table 3 Charging for hospital arranged transport
Yes
No
Don't
know
Clear policy on charging
22%
37%
41%
Healthcare Travel Costs Scheme is widely publicised to
patients
Charging arrangements cover patients entitled to
reimbursement through the Healthcare Travel Costs
Scheme
23%
42%
35%
17%
17%
65%
47 | P a g e