Elevated mortality among weekend hospital admissions is not associated with adoption of seven day clinical standards

Meacock R, Sutton M. Elevated mortality among weekend hospital admissions is not associated with adoption of seven day clinical standards
Emerg Med J Published Online First: 08 November 2017. doi: 10.1136/emermed-2017-206740

Introduction Patients admitted to hospital in an emergency at weekends have been found to experience higher mortality rates than those admitted during the week. The National Health Service (NHS) in England has introduced four priority clinical standards for emergency hospital care with the objective of reducing deaths associated with this ‘weekend effect’. This study aimed to determine whether adoption of these clinical standards is associated with the extent to which weekend mortality is elevated.

Methods We used publicly available data on performance against the four priority clinical standards in 2015 and estimates of Trusts’ weekend effects between 2013/2014 and 2015/2016 for 123 NHS Trusts in England. We examined whether adoption of the priority clinical standards was associated with the extent to which weekend mortality was elevated, and changes over a 3 year period in the extent to which mortality was elevated.

Results Levels of achievement of two of the four clinical standards (ongoing review and access to diagnostic services) had small positive associations with the magnitude of the weekend effect in 2015/2016. Levels of achievement of the remaining two standards (time to first consultant review and access to consultant directed interventions) had small negative associations with the magnitude of the weekend effect in 2015/2016. No association was statistically significant. The same pattern was observed in the associations between achievement of the standards and changes in the magnitudes of the weekend effect between 2013/2014 and 2015/2016.

Discussion
We found no association between Trusts’ performance against any of the four standards and the current magnitude of their weekend effects, or the change in their weekend effects over the past 3 years. These findings cast doubt on whether adoption of seven day clinical standards in the delivery of emergency hospital services will be successful in reducing the weekend effect.

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Making a reality of the Accelerated Access Review: Improving patient access to breakthrough technologies and treatments

Department of Health

The government has announced a new fast-track route into the NHS for “breakthrough” medicines and technologies. This will speed up the time it takes for patients to benefit from ground-breaking products for conditions such as cancer, dementia and diabetes.

From April 2018, the new ‘accelerated access pathway’ will mean products with the greatest potential to change lives could be available up to 4 years earlier. It will be done by reducing the time it takes to negotiate evaluation and financial approvals before the NHS can purchase the products.

Under the scheme, a number of products each year will receive ‘breakthrough’ designation. This will unlock a package of support allowing firms to accelerate clinical development and gain a fast-track route through the NHS’s approval processes.

Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey

Journal of the Royal Society of Medicine, Article first published online: November 2, 2017

Objective: 
To examine associations between the contract and ownership type of general practices and patient experience in England.
Design
Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey).
Setting
All general practices in England in 2013–2014 (n = 8017).
Participants
903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent).
Main outcome measures
Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice.
Results
Most practices had a centrally negotiated contract with the UK government (‘General Medical Services’ 54.6%; 4337/7949). Few practices were limited companies with locally negotiated ‘Alternative Provider Medical Services’ contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference −3.04, 95% CI −4.15 to −1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (−12.78, 95% CI −15.17 to −10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949).
Conclusions
Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013–2014.

Staff ‘be the change’ for quality improvement

NHS Employers

Case study looking at Ashford and St Peter’s Hospitals NHS Foundation Trust’s approach to quality improvement.

Part of our series focusing on staff involvement for quality improvement, the case study looks at how Ashford and St Peter’s has used innovative staff involvement techniques to help all staff improve quality of patient care. Beginning as an initiative solely for medical staff engagement, it has now been adopted across the organisation.

Health and wellbeing as part of the reward offer

NHS Employers
Northumbria Healthcare NHS Foundation Trust has taken positive action to support the health and wellbeing of its staff through its reward offer.

This case study looks at the importance of communicating the entire reward offer to potential and existing staff, how the approach had been embedded in HR processes and the targeted approach to health and wellbeing.

As a result, there has been a positive impact in what staff think about the trust and there has been a reduction in short-term absence

 

Using mobile app technology to reduce agency spend

NHS Employers
This case study describes how Chelsea and Westminster Hospital NHS Foundation Trust has significantly reduced their agency spend by developing an app which allows locums to easily self-roster.
iphone-410311__340LocumTap has increased bank use from 30 to 70 per cent, is saving the trust approximately £40,000 a month for junior doctor shifts alone and is improving morale, recruitment and retention.

Use of an electronic consultation system in primary care: a qualitative interview study

Jon Banks, Michelle Farr, Chris Salisbury, Elly Bernard, Kate Northstone, Hannah Edwards and Jeremy Horwood, Br J Gen Pract 6 November 2017

Background The level of demand on primary care continues to increase. Electronic or e-consultations enable patients to consult their GP online and have been promoted as having potential to improve access and efficiency.

Aim To evaluate whether an e-consultation system improves the ability of practice staff to manage workload and access.

Design and setting A qualitative interview study in general practices in the West of England that piloted an e-consultation system for 15 months during 2015 and 2016.

Method Practices were purposefully sampled by location and level of e-consultation use. Clinical, administrative, and management staff were recruited at each practice. Interviews were transcribed and analysed thematically.

Results Twenty-three interviews were carried out across six general practices. Routine e-consultations offered benefits for the practice because they could be completed without direct contact between GP and patient. However, most e-consultations resulted in GPs needing to follow up with a telephone or face-to-face appointment because the e-consultation did not contain sufficient information to inform clinical decision making. This was perceived as adding to the workload and providing some patients with an alternative route into the appointment system. Although this was seen as offering some patient benefit, there appeared to be fewer benefits for the practices.

Conclusion The experiences of the practices in this study demonstrate that the technology, in its current form, fell short of providing an effective platform for clinicians to consult with patients and did not justify their financial investment in the system. The study also highlights the challenges of remote consultations, which lack the facility for real time interactions.