Seven day consultant present care
Professor Norman Williams
Chair, Academy Steering Group
President, Royal College of Surgeons of England
Presentation from the 'NHS services open seven days a week: every day counts' event on Saturday 16 November at The Metropole Hotel, Birmingham.
This event was hosted by NHS Improving Quality and NHS England to share the views and ideas of public, patients, carers, NHS England and health and social care staff on how to improve access to services for patients across the seven day week.
More information at http://www.nhsiq.nhs.uk/improvement-programmes/acute-care/seven-day-services.aspx or #7DayServices
Sussex Partnership NHS Foundation Trust - one of the partners working with NHS Improving Quality on the Winterbourne Medicines Programme
Presentation from the Winterbourne Medicines Programme Launch held in London on 10 September 2014
Ensuring safe, appropriate and optimised use of medication for people with learning disabilities who demonstrate behaviour that can challenge
Sussex Partnership NHS Foundation Trust - one of the partners working with NHS Improving Quality on the Winterbourne Medicines Programme
Presentation from the Winterbourne Medicines Programme Launch held in London on 10 September 2014
Ensuring safe, appropriate and optimised use of medication for people with learning disabilities who demonstrate behaviour that can challenge
The patient experience describes an individual's experience of illness/injury and how healthcare treats them. Good patient experience is very helpful for healthcare industry. Many hospitals and clinics use patient experience surveys to identify where they stand in the term of Patient Experience.
Patient & Family Advisory Councils: the Business Case for Starting a PFAC & P...EngagingPatients
This webinar was presented on March 12, 2015 by Barbara Lewis. It looks at the prevalence and roles that Patient & Family Advisory Councils (PFACs) are playing in U.S. hospitals today, and builds a business case for their implementation:
This resource summarizes the eight recommendations outlined in the Institute of Medicine's a new consensus study entitled, Improving Diagnosis in Health Care. The recommendations are aimed at making diagnoses more accurate, reliable, efficient, and safe. This work is a continuation of the IOM’s Quality Chasm series.
Dr Avi Ratnanesan is the Chief Executive Officer of Energesse, a leading firm that specialises in improving patient experience and customer experience in healthcare. Energesse provides thought leadership in patient-centred innovation and technology solutions including MES Experience for real-time patient feedback and PanSensic for free-text analytics of patient stories.
Patient Experience Measures: Past and FutureBivarus
What is the value of measuring the patient experience? Kevin Schulman, MD shares data on why measuring the patient experience is important in today's changing healthcare environment.
Quality management in nursing professionSANJAY SIR
Quality improvement requires in any field to provide best services to the community in the health care system. it is uploaded to aware the the paramedics & nursing personnel to improve the quality care & helps educators to teach their students.
Same-Visit Contraception: Implementation Strategies from the FieldJSI
According to the CDC and OPA, clients should have access to their contraceptive method of choice without unnecessary delays. Same-visit provision of contraception means providing immediate access to contraceptive methods using Quick Start. As long as a clinician can be reasonably certain a client is not pregnant, there is not medical reason to require clients to return for a follow-up visit or to initiate methods during menses. Clients face many barriers (work, child care, secure transportation) when asked to return for a second visit in order to initiate contraception and up to 50% of clients will not return for a follow up appointment.
Title X grantees and service sites across the country to identify successful strategies for implementing same-visit contraception including: 1. Stock devices and make supplies readily available, 2. Adjust systems for efficient and sustainable service delivery, 3. Engage, train, and support all staff.
To support implementation to Title X service sites, the FPNTC provides a Same-Visit Contraception Guide which includes: video case studies, slides and a discussion guide, interactive tools including checklists, calculators and printable sheets that can be posted at the office.
Professional coach Sandra Schiff served as a member of the advisory council of The Senior Alliance in Wayne, Michigan, from 2011 to 2013. The president of Health Mate, Inc., Sandra Schiff continues to provide care transition coaching as a member of the Care Transitions Program®.
The patient experience describes an individual's experience of illness/injury and how healthcare treats them. Good patient experience is very helpful for healthcare industry. Many hospitals and clinics use patient experience surveys to identify where they stand in the term of Patient Experience.
Patient & Family Advisory Councils: the Business Case for Starting a PFAC & P...EngagingPatients
This webinar was presented on March 12, 2015 by Barbara Lewis. It looks at the prevalence and roles that Patient & Family Advisory Councils (PFACs) are playing in U.S. hospitals today, and builds a business case for their implementation:
This resource summarizes the eight recommendations outlined in the Institute of Medicine's a new consensus study entitled, Improving Diagnosis in Health Care. The recommendations are aimed at making diagnoses more accurate, reliable, efficient, and safe. This work is a continuation of the IOM’s Quality Chasm series.
Dr Avi Ratnanesan is the Chief Executive Officer of Energesse, a leading firm that specialises in improving patient experience and customer experience in healthcare. Energesse provides thought leadership in patient-centred innovation and technology solutions including MES Experience for real-time patient feedback and PanSensic for free-text analytics of patient stories.
Patient Experience Measures: Past and FutureBivarus
What is the value of measuring the patient experience? Kevin Schulman, MD shares data on why measuring the patient experience is important in today's changing healthcare environment.
Quality management in nursing professionSANJAY SIR
Quality improvement requires in any field to provide best services to the community in the health care system. it is uploaded to aware the the paramedics & nursing personnel to improve the quality care & helps educators to teach their students.
Same-Visit Contraception: Implementation Strategies from the FieldJSI
According to the CDC and OPA, clients should have access to their contraceptive method of choice without unnecessary delays. Same-visit provision of contraception means providing immediate access to contraceptive methods using Quick Start. As long as a clinician can be reasonably certain a client is not pregnant, there is not medical reason to require clients to return for a follow-up visit or to initiate methods during menses. Clients face many barriers (work, child care, secure transportation) when asked to return for a second visit in order to initiate contraception and up to 50% of clients will not return for a follow up appointment.
Title X grantees and service sites across the country to identify successful strategies for implementing same-visit contraception including: 1. Stock devices and make supplies readily available, 2. Adjust systems for efficient and sustainable service delivery, 3. Engage, train, and support all staff.
To support implementation to Title X service sites, the FPNTC provides a Same-Visit Contraception Guide which includes: video case studies, slides and a discussion guide, interactive tools including checklists, calculators and printable sheets that can be posted at the office.
Professional coach Sandra Schiff served as a member of the advisory council of The Senior Alliance in Wayne, Michigan, from 2011 to 2013. The president of Health Mate, Inc., Sandra Schiff continues to provide care transition coaching as a member of the Care Transitions Program®.
Capstone Report - Industrial Attachment Program (IAP) Evaluation PortalAkshit Arora
Capstone Project Report on IAP Evaluation Portal submitted in partial fulfillment of the requirements for the award of the degree of Bachelor of Engineering in Computer Science and Engineering Department by:
Abhinav Garg (101303004), Arush Nagpal (101303034), Akshit Arora (101303012) and Chahak Gupta (101303041)
Under the supervision of:
Dr. Prashant Singh Rana, Assistant Professor, CSED (http://psrana.com) and Dr. Ajay Batish, Professor, MED (www.thapar.edu/index.php/mechanical-engineering-department/faculty?pid=153&sid=387:dr-ajay-batish)
Thapar University,
Patiala, Punjab, India - 147004.
December 2016
A Student Management System Project abstract that contains the basics needs in a student management system. It can also be used as a base to implementing your new creative ideas.
Software Engineering Project On School Management System. its Presentation .Data flow diagram , use case diagram of SMS , class diagram of school management system , functional and non-functional requirements
Download completer BS Computer Science Degree Study Data
http://studyofcs.blogspot.com/p/bs.html
This report paper contains online banking system in j2ee component of java.also include system requirements,design modules,data flow diagrams, sequence diagrams and the architecture of online banking.
content:Introduction
Project requirements
System modules
User interface specification
Use case and data flow diagram’s
Presentation made by Celia Ingham Clark National Director for Reducing Premature Mortality, at Improving access to seven day services. Southampton 25 March 2015
7 day services practical tips for achieving consultant review of patients wit...NHS England
Sue Cottle, Programme Lead, 7 Day Services, Sustainable Improvement, NHS England South
Celia Ingham Clark, MBE, Medical Director for Clinical Effectiveness, NHS England
Claire Gorzanski, Head of Clinical Effectiveness, Salisbury NHS Foundation Trust
Sam Burrows, Director of Strategy, NHS Wokingham CCG
This webinar aims to provide you with:
An overview of the updated guidance for the priority clinical standards and timing of the forthcoming self-assessment survey
Practical examples of how commissioners and acute providers are working together to support delivery of timely Consultant assessment (clinical standard 2) – their successes, challenges and opportunities
An opportunity to ask questions of your colleagues and identify key areas of support required
Two of the New York metro area’s largest provider organizations will share their experiences leveraging HIE as one of many tools to decrease fragmentation of care and improve patients’ experiences across acute and post-acute care settings for patients undergoing elective surgeries. Representatives from NYULMC and VNSNY will summarize their efforts to redesign more personalized specific care pathways and the central role played by the implementation of real-time data exchange to provide a seamless transfer of clinical data between providers caring for the patient at the time of discharge and throughout the post-acute period.
• Kathleen Mullaly - Senior Director for Clinical Operations, Department of Network Integration, NYU Langone Medical Center
• Amy Weiss - Director for Strategic Account Development, Integrated Delivery Systems, Visiting Nurse Service of New York (VNSNY)
New York eHealth Collaborative Digital Health Conference
November 18, 2014
Making Seven Day Services a reality, pop up uni, 2 pm, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Involving patients in outcomes based commissioning in community services, pop...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Developing and implementing clinical standards for seven day servicesNHS Improving Quality
Celia Ingham Clark National Director: Reducing Premature Mortality. Slides from Celia's presentation from the 7 Day Services events West Midlands 11th June and East Midlands 12th June 2014
7 day working: implications for emergency servicescroseveare
Practical issues around the implementation of the Academy of Medical Royal Colleges' standards for 7 day consultant-present care, along with the potential impact on training
Presentation given by Dr Rab McEwan Interim Chief Operating Officer Dorset County Hospital NHS Foundation Trust. At the Improving access to seven day services event, Southampton 25 March 2015
3.4 - Workforce and developing multi-disciplinary teams in primary careNHS England
The importance of the workforce needs in Beds, Luton and Milton Keynes, what does it mean to the people on the ground and how are they going to be affected. How will it improve their working lives?
7DS Board Assurance Framework: Planning or June 2019 submissionNHS England
This webinar will provide:
• Key lessons learned from review of 7DS Board Assurance Framework (BAF) return in February
• Information on how to prepare for the next submission by 28th June 2019
• An opportunity to raise questions
Weitzman 2013 Relative patient benefits of a hospital-PCMH collaboration with...CHC Connecticut
Anuj K Dalal presents information on a PCORI research grant: Relative patient benefits of a hospital-PCMH collaboration within an ACO to improve care transitions.
NHSE South 7DS Webinar - How 7 day therapy services can become business as us...NHS England
This webinar gives an example of how the role of Allied Health Professionals is improving care and flow across seven days a week.
Caroline Poole from NHS Improvement gives a brief update on the AHP ‘Flow Collaborative’ and Vicki Sheen from Torbay and South Devon NHS Foundation Trust describes the impact of therapy teams providing a seven day service and how this has become business as usual.
Tips to engage stakeholders in 7 day servicesNHS England
NHS England’s Sustainable Improvement team are hosting a series of free sharing and learning webinars to support organisations implement seven day services (7DS).
The next in the series focuses on stakeholder engagement, as feedback from the service has indicated that good stakeholder engagement is a key factor in successfully implementing 7DS.
This webinar will showcase practical tried and tested approaches supported by Trust examples. There will be opportunities for peer to peer connections, learning and for participants to share their own practice.
During this session you will hear about examples from:
University Hospital Southampton NHS Foundation Trust: Whole System: Engaging commissioners, clinicians and Patients for 7DS with Dr Juliane Kause, Care Group Lead Emergency Care, Lead Consultant Out of Hours Care and Seven Day Services.
Oxford University Hospitals NHS Foundation Trust: Spreading the word and resources to help clinicians: Portal for Oxford 7DS Guide with Belinda Boulton, Director of Transformation and Ruth McNamara, Integrated Care Projects Lead.
Maidstone and Tunbridge Wells NHS Trust: Getting it right from the start: engaging internal stakeholders for 7DS clinical leadership and planning with Lynne Sheridan, Head of Delivery Development
Cheryl Davenport, Director of Health and Care Integration at Leicestershire County Council, talks about how simulation is helping to evaluate how emergency hospital admissions can be reduced.
Stopping over-medication of People with Learning Disabilities
(STOMPLD) 2016.
Reducing Inappropriate Psychotropic Drugs in People with a Learning Disability in General Practice and Hospitals in 2016.
Presentation slides Frailty: building understanding, empathy and the skills t...NHS Improving Quality
Frailty: building understanding, empathy and the skills to support self-care
Guest speaker:Dr Dawn Moody, Director - Fusion48
An opportunity to learn about some innovative approaches to making the health and care workforce 'Fit for Frailty'* (*British Geriatrics Society 2015).
Learning outcomes:
To explore the Frailty Fulcrum as a tool for holistic assessment and management of frailty
To hear how Virtual Reality is being used to build empathy for older people living with frailty
To learn about the impact of a county-wide, multi-agency, multi-professional training an toolkit for care professionals working with older people
Resources:www.fusion48.net
Self-management in the community and on the Internet - Presentation 22nd Marc...NHS Improving Quality
LTC Lunch & Learn webinar:- 22nd March 2016
Presenter:- Pete Moore, Educator, Author & Pain Toolkit Trainer
As pain is the most daily health problem reported to a GP-
Developing a national pain strategy- reviews from around the world
Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient C...NHS Improving Quality
Speaker slides from the national conference, 'Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life', 17 March 2016
Fire service as an asset: providing telecare support in the community Webinar...NHS Improving Quality
Guest speaker: Steve Vincent - West Midlands Fire Service & Simon Brake from Coventry Council
Hosted by: Bev Matthews, Long Term Conditions Programme Lead, NHS England
Learning Outcomes:-
To better understand the role that the Fire and Rescue service can provide as a community asset to support health needs Enhancing the quality of life for people by supporting them to stay in their own home, even in a crisis
An overview of the work carried out by NHS England and NHS Improving Quality's Long Term Conditions Sustainable Improvement Team. It puts the case for why person-centred care has to be at the heart of healthcare.
Commissioning Integrated models of care
Kent LTC Year of Care Commissioning Early Implementer Site
Alison Davis, Integration Programme Health and Social Care, Working on behalf of Kent County Council and South Kent Coast and Thanet CCG's
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Seven day consultant present care
1. Seven Day
Consultant Present Care
Professor Norman Williams
Chair, Academy Steering Group
President, Royal College of Surgeons of England
2. The Benefits of Consultant-Delivered Care
‘the benefits of consultant-delivered care should be available to
all patients throughout the week …. work should be undertaken
by clinicians and employers to map out the staffing
requirements and service implications of implementing a
consultant-delivered service throughout the week’
3. The weekend challenge…
• Higher case-mix adjusted mortality - new admissions and
in-patients
• Greater illness severity amongst weekend admissions
• Fewer consultants in hospital
7. Standard 1
Hospital inpatients should be reviewed by an on-site consultant
at least once every 24 hours, seven days a week, unless it has
been determined that this would not affect the patient’s care
pathway.
8. Standard 2
Consultant-supervised interventions and investigations along
with reports should be provided seven days a week if the results
will change the outcome or status of the patient’s care pathway
before the next ‘normal’ working day.
9. Standard 3
Support services both in hospitals and in the primary care
setting in the community should be available seven days a week
to ensure that the next steps in the patient’s care pathway, as
determined by the daily consultant review, can be taken.
10. Seven Day Consultant Present Care – Follow
up
Purpose: to develop a more detailed understanding of the
implications of each of the standards for each specialty in order
to encourage and assist implementation.
11. Approach
•Questionnaire (10 questions) sent to specialty organisations
with inpatients
•Responses from 36 different specialties
•Followed up results with an additional 14 organisations
•Final report reviewed by Academy Council on 13 November
2013
•Issue has high profile:
• NHS Services Seven Days a Week Forum
• HSJ gathering readers opinion
• Sunday Times campaign
12. The Key Findings
•Report framed as a catalyst for local conversations.
•Factors such as the specific specialty and whether the patient
is known to the consultant impact the duration of a consultant
led review.
•Assuming the patient is known and looking at the most
common durations given by specialties: for 30 inpatients,
around six hours of consultant time is needed each day at the
weekend to undertake consultant led inpatient reviews.
13. The Key Findings (cont’d)
•Effective multi-disciplinary team working is essential.
•Opportunity for coaching and supervision of doctors in
training.
•Some investigations, interventions, hospital based and
community based services are more critical to effective
weekend care than others. For example:
– laboratory services, radiology, ultrasound and cross
sectional imaging
– emergency surgery, interventional radiology and
therapeutic upper gastrointestinal endoscopy
– physiotherapy, occupational therapy, pharmacy
– patient transport, access to social care
14. The Key Findings (cont’d)
•Planning in advance for transfer of care.
•Delivering consultant present care at weekends is likely to
require additional consultant appointments as well as
reorganisation of the existing consultant workforce and
increased resourcing for community based services; careful job
planning is essential to minimise the impact on patient care
during weekdays.
15. The Key Findings (cont’d)
•How Trusts might meet this demand will depend on a number
of factors, including:
– case mix and complexity of patients within a Trust, some of
whom may require a high level of specialty expertise
– whether consultants are already covering weekends
– level of ‘generalist’ skills
– the flexibility of workplans.
•Possible resourcing approaches:
– Invest to save – reductions in morbidity / improved
outcomes
– Reshaping of services
– Greater levels of networked / federated arrangements
– Need detailed financial modelling
In January 2012, Academy of Medical Royal Colleges published its report – the Benefits of Consultant Delivered Care. This report set out a summary of written and oral evidence regarding the benefits and difficulties with a system of consultant delivered care plus an externally commissioned independent review of the literature and commentary on the findings.
Examples of the benefits identified:
Rapid and appropriate decision making
Improved safety, fewer errors
Improved outcomes
More efficient use of resources
The report also noted that, having identified benefits associated with consultant delivered care, that these benefits should be availability irrespective of the day of the week.
There is growing evidence relating to the comparison of outcomes from weekday versus weekend care. Currently there are fewer consultants at weekends. No robust evidence (yet) to relate the two, but instinct would indicate there is a link. On that note, the Academy is supporting the NIHR funded research project being led by Julian Bion, Professor of Intensive Care Medicine at the University of Birmingham, which is planning to start in February 2014. This research will evaluate the impact of consultant present care over a period of approximately three years.
Illustration of the consultant presence difference – the staff car park on a weekday….
And the staff car park on a weekend (Southampton General Hospital)
Following on from the Benefits of Consultant Delivered Care (published Jan 2012) and the issues around weekend-related outcomes for patients – in April 2012, the Academy established a project to look at seven day consultant present care – chaired by Professor Norman Williams on behalf of the Academy.
Driven by patient safety – not a ‘patient choice’ or convenience agenda.
The project looked at seven day standards already published by individual Royal Colleges, reviewed the available evidence for differences in patient outcomes, and developed three patient-centred standards for all hospital in-patients.
Consultants are currently available 24/7 – on-call. Key change encapsulated in this standard: to opt out of a daily review for patients at a weekend – rather than current mainstream practice of identifying any patients that need a bedside consultant review at the weekend.
This standard does not make any artificial divide between elective / non-elective patients – the deciding factor is whether the individual’s care pathway can be progressed if they see a consultant. If it can – they should see one.
And following on from Standard 1 – there is no point in having a consultant review if the decisions taken cannot then be acted upon.
This includes the need to be able to act on a decision to discharge a patient.
The Academy’s Seven Day Consultant Present Care report recognised that to deliver the three standards there would be significant resource and working practice implications. So a follow up project was established to look at the implications of the standards in more detail and provide implementation guidance.
This has been led on behalf of the Academy by Professor Norman Williams, with Dr Chris Roseveare as the Clinical Project Lead and Professor Julian Bion chairing the project assurance group.
In April a structured questionnaire was developed for each speciality organisation to respond to.
Early findings were reviewed in June and the report has been built around the survey responses. Over 50 specialty organisations have been involved.
The report is due to be published on 18 November and will make a further contribution to the growing guidance and debate on how to achieve parity of care across all seven days of the week.
For change to actually happen, things need to change locally in Trusts – there is no ‘one size fits all’. This report will provide good ‘conversation starters’ for local clinical and managerial leaders and commissioners to look at their own practices and priorities in making changes to meet the Academy standards.
There is no absolute answer to how long a consultant review of an inpatient takes – there are many variables – but as a ROUGH guide, the survey returns have indicated around 10-15 mins for a patient known to the consultant. The review will take less time if a patient is already known to the consultant - so rota patterns which optimise continuity of care should be designed to ensure best use of consultant time.
Optimal value from consultant weekend presence will be achieved if the consultant is leading a multi-disciplinary team of health care professionals and the required specialist supporting services are available. It takes more than the consultant alone to deliver the care a patient needs and move them along their care pathway.
Consultant presence at weekends will enable greater coaching and supervision of doctors in training, and time should be allowed for consultants to deliver training as well as service at weekends. However this must not discourage the development of decision making skills in junior doctors.
There is no point in having a daily consultant-led review if cannot then act on the consequences of the review and take the next steps on the patient’s care pathway. So having availability of the key investigations, interventions, hospital based and community based services is essential. The survey results have given a ‘popularity’ order to interventions, investigations and other services. For example, all specialties require pharmacy and physiotherapy services at weekends and the majority of specialties said emergency surgery is an intervention likely to be needed as a result of a consultant daily review. This sort of information – which will be explained in more detail in the report – will be useful to Trusts looking at which services to address first when looking at seven day provision.
Another key finding is the importance of having greater levels of early, weekday engagement and advance discharge planning between patients and their carers, hospital and community-based staff and equipment providers. Doing this will increase the ability to make a safe transfer care from the hospital at the weekend.
If existing consultant numbers are ‘spread’ over seven days, this will have an impact on the elective care that can be provided. To maintain service levels during the week AND increase weekend presence will need more consultants.
In fact, the Academy believes that meeting the three seven day consultant present care recommendations will require additional resourcing across the whole healthcare system – hospital, primary and community care.
How a Trust meets this resourcing demand will depend on a number of factors (e.g whether consultants are already covering weekends, the flexibility of workplans etc). Moving toward having more consultants with the skills to manage patients across different specialty areas (‘generalists’) will increase the flexibility of the consultant workforce delivering daily inpatient reviews at weekends. This is not about providing cross-cover for full service delivery, where specialty knowledge is critical to patient outcomes, but about optimising the generic ability of consultants to recognise the deteriorating patient during a daily review and instigate appropriate action.
In terms of resourcing, the Academy’s report identifies factors that will affect the scale of demand and solution approach relevant for each individual Trust. The Academy believes additional investment by Trusts will be needed, but this should deliver longer-term benefits and more efficient practice.
However, as well as consideration of the situation within Trusts, the Academy, as stated earlier, believes the changes needed are whole system ones. For example, reconfiguration and networks.
But the whole economic question requires detailed financial modelling so that informed and sustainable choices can be made.
So – I hope that describes the Academy’s work in this area and gives you a feel for the Academy report due to be published on Monday.