A Pragmatic Randomized Evaluation of a Nurse-Initiated Protocol to Improve Timeliness of Care in an Urban Emergency Department

Douma, M.J. et al. Annals of Emergency Medicine. Published online: July 29, 2016

Study objective: Emergency department (ED) crowding is a common and complicated problem challenging EDs worldwide. Nurse-initiated protocols, diagnostics, or treatments implemented by nurses before patients are treated by a physician or nurse practitioner have been suggested as a potential strategy to improve patient flow.

Methods: This is a computer-randomized, pragmatic, controlled evaluation of 6 nurse-initiated protocols in a busy, crowded, inner-city ED. The primary outcomes included time to diagnostic test, time to treatment, time to consultation, or ED length of stay.

Results: Protocols decreased the median time to acetaminophen for patients presenting with pain or fever by 186 minutes (95% confidence interval [CI] 76 to 296 minutes) and the median time to troponin for patients presenting with suspected ischemic chest pain by 79 minutes (95% CI 21 to 179 minutes). Median ED length of stay was reduced by 224 minutes (95% CI –19 to 467 minutes) by implementing a suspected fractured hip protocol. A vaginal bleeding during pregnancy protocol reduced median ED length of stay by 232 minutes (95% CI 26 to 438 minutes).

Conclusion: Targeting specific patient groups with carefully written protocols can result in improved time to test or medication and, in some cases, reduce ED length of stay. A cooperative and collaborative interdisciplinary group is essential to success.

Read the full article here
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Improving maternity services

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image source: Erin Warren – Flickr // CC BY-ND 2.0

NHS England has laid out new plans to improve maternity services and is calling on local areas to road test new ways of working.

The Maternity Transformation Programme has now identified nine working areas to take forward implementation of the recommendations set out in the report of the national maternity review, Better Births.

These include supporting local transformation, promoting good practice for safer care and improving access to perinatal mental health services to make care safer and more personalised. NHS England is calling on local areas to act as early adopters to test a combination of all areas outlined in the programme.

Health technology

The Widening Digital Participation Programme run by NHS England and the Tinder Foundation have published Health and Digital: reducing inequalities, improving society: an evaluation of the widening digital participation programme.

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image source: nhs.tinderfoundation.org/

The idea was to see how improved digital health literacy could improve the health outcomes for groups most likely to experience health inequalities.

As a result of the programme 59% of learners report feeling more confident to use online tools to manage their health, 65% feel more informed and 52% say they feel less lonely with 62% saying they feel happier as a result of social contact, an important indicator for overall wellbeing.

Mental health services transformation

Thousands to benefit from kick-start of mental health services transformation

NHS England has published Implementing the five year forward view for mental health.  This report details how new funding, pledged in response to the Five Year Forward View for Mental Health, rising to £1bn a year by 2020/21 in addition to the cumulative £1.4bn already committed for children, young people and perinatal care, will be made available for CCGs year on year.

It also shows how the workforce requirements will be delivered in each priority area and outlines how data, payment and other system levers will support transparency.

Additional link: RCGP press release

Working collaboratively in General Practice

The Nuffield Trust has published Is bigger better? Lessons for large-scale general practice. Published following 15-month study of large-scale general practice organisations in England this report examined the factors affecting their evolution and their impact on quality, staff and patient experience, the wider health economy and the quality of care. The study combined national surveys with an in-depth mixed-methods evaluation of contrasting, large-scale general practice organisations.

The full report includes detailed insights about governance, leadership, management or change, staff perceptions and quality improvement methods used in each of the case study sites.

Additional link: RCGP press release