Learning from an intrepid pioneer: integrated care in North West

Gerald Wistow and Judith Smith report on their evaluation of the North West London Whole Systems Integrated Care (WSIC) programme.

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NEW WEBSITE PAVES THE WAY FOR ROTHERHAM’S NEW EMERGENCY CENTRE

A new website has been launched this week to support our patients to get the Right Care, First Time.

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The website, www.rotherhamemergencycentre.nhs.uk, will guide users through the right path to take if they are feeling unwell, are injured or if they are concerned about their health; this will help people have the right information about health services in Rotherham, ready for when our new Emergency Centre opens in 2017.

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The website includes information about the new Emergency Centre such as frequently asked questions, news about building works and links to local health services such as pharmacies.

How the new Rotherham Emergency Centre will look when it opens in 2017:

Rapid access A&E unit improved flow more than expansion

Improving patient flow processes may have better impacts than structural / physical reorganisation of the emergency department.

Many approaches to reduce emergency department crowding require extra space and staff. This study compared the impact of expanding the emergency department versus improving patient flow processes through a rapid assessment unit at hospital. The hospital first undertook physical expansion and then later reorganised patient flow. After emergency department expansion there were negative outcomes including increased length of stay and more patients leaving without being seen. After the rapid assessment unit was set up, patients saw professionals more quickly and had reduced length of stay (average 67 minutes).

Physical therapists provide efficient care in A&E

Physical therapists can work in emergency departments independently, providing fast and safe care. This may free clinicians’ capacity to focus on people needing more urgent help.

A hospital in Australia tested having physical therapists working in the emergency department. Data were collected over a six month period about service use. During this period 1,017 people were managed by physical therapists. Nine out of ten had conditions triaged as not serious. Forty-six percent of these people were managed by physical therapists independently, without support from medical colleagues. The most common diagnosis was fracture or dislocation and most people were referred to primary care or to hospital outpatient clinics. Physical therapists took less time than emergency department doctors to see similar groups of patients.
Full reference:
de Gruchy A, Granger C, Gorelik A. Physical therapists as primary practitioners in the emergency department: six-month prospective practice analysis. Physical Therapy. 2015. 95(9): 1207 – 1216

Automated drug dispensing systems in the intensive care unit: a financial analysis.

Introducing automated drug dispensing systems on ICUs may have a high return on investment for hospitals.

A hospital in France assessed the economic impact of automated-drug dispensing systems in three surgical intensive care units (ICUs). These systems were implemented in each unit to replace traditional floor stock approaches. Costs before and after implementation were assessed in terms of floor stock inventories, expired drugs and time spent by nurses and pharmacy technicians on medication-related work . After automated systems were introduced, nurses spent less time on medication-related activities, saving an average of 15 hours per 33 beds. However, pharmacy technicians spent more time on stocking activities, with an average of 3.5 extra hours per day across the three ICUs. The cost of drug storage reduced by 44,298 euro and the cost of expired drugs reduced by 14,772 euro per year across the three ICUs. The hospital continued to see savings over a five year period.
Full reference: Chapuis C. et al. Automated drug dispensing systems in the intensive care unit: a financial analysis. Critical Care. 2015. 19 318

The impact of a text messaging service on orthopaedic clinic Did Not Attend rates

Sending text message reminders about outpatient appointments can save the NHS money

A hospital outpatient clinic tested sending text message reminders to adult patients about their appointments. Data about did not attend rates were compared for 24 months before and 24 months after implementation. People were sent reminders one week prior to their scheduled appointment. The Did Not Attend rate reduced by 12%. Over a two year period, there was a cost saving of 19,853 pounds.

Full reference: Rohman L, Maruswezki D, Boyce Cam N. The impact of a text messaging service on orthopaedic clinic Did Not Attend rates. Journal of Telemedicine and Telecare. 2015. 21(7): 408 – 413

Short video increases patient involvement in decisions

Screening a short video in the waiting room before an appointment may help improve patient engagement in decision-making. This is a simple and feasible approach to helping service users become more involved in their care. 

In Australia, the AskShareKnow campaign encouraged service users to ask the questions: what are my options; what are the possible benefits and harms of those options; and how likely are each of those benefits and harms to happen to me?’

In total 121 people attending a clinic were invited to watch a four minute video about the campaign in the waiting room. They were surveyed before watching the video, immediately after their consultation and two weeks later. Seven out of ten people reported asking asked one or more of the questions during their consultation (69%) and one third said they asked all three (29%). Of those making a decision, 87% asked one or more questions and 43% asked all three. Two weeks later, half of the group could still remember the questions.

Full reference: Shepherd, H et al. Can consumers learn to ask three questions to improve shared decision making? A feasibility study of the ASK (AskShareKnow) patient-clinician communication model intervention in a primary health-care setting. Health Expectations. first published online: 14 Sept 2015