Delivering outpatient appointments through video consultations

NHS England | January 2022 | Delivering outpatient appointments through video consultations

In 2018/19, Ashford and St. Peter’s Hospitals (ASPH) hosted approximately 10,000 face-to-face outpatient appointments per week, with a 7 per cent increase in appointments expected each year.

As part of its strategy to help fulfill the NHS Long Term Plan commitment to reducing physical face-to-face appointments, ASPH adopted video to deliver some outpatient consultations. The aim was to:

• minimise physical attendances, protecting patients, staff and the community, particularly during the Coronavirus (COVID-19) pandemic
• reduce the cost of attending hospital appointments for patients and their carers/families, including the cost of travel, car parking, childcare and time off work
• improve patient satisfaction and convenience
• increase remote working for clinicians.
• reduce carbon emissions from travelling to appointments

ASPH were part of the NHS England and NHS Improvement national video consultation pilot. The platform was initially used with musculoskeletal (MSK) therapies in October 2019 with its use rapidly scaled up in March/April 2020 with the onset of the COVID-19 pandemic.

The adoption of video consultations allowed clinicians who needed to self-isolate or to shield as a result of COVID-19, to safely continue with their patients’ appointments, avoiding the need to cancel these appointments.

By the end April 2020, there were 38 different waiting/clinic areas on the video consultation platform, servicing 25 specialities and between mid-March and end of April 2020, the trust conducted 1145 video consultations with patients. These figures also continue to rise.

The initial MSK therapies pilot completed an evaluation of patient views relating to their video consultation.  Of the 82 patients seen during the pilot:

• 92 per cent did not require a face to face follow up or were discharged. This is above the comparison for First Contact Physiotherapy where the benchmark sits at 60 per cent.
• 81 per cent would have travelled to their face to face appointment by car; this saved 135kg of CO2 emissions – the equivalent of a single person flying from London to Barcelona.

66 per cent of staff reported enjoying working from home and 72 per cent of MSK therapists reported no increase in emotional intensity whilst conducting remote clinics

NHS England Delivering outpatient appointments through video consultations

Video consultation in North Tyneside Integrated Muscular Service

NHS England | January 2022 | Video consultation in North Tyneside Integrated Musculoskeletal Service

The outbreak of COVID-19  meant that our traditional methods of working were no longer a viable way of managing patient care needs, and with a backlog of patients from appointments that had to be cancelled as well as patients who were still coming into the service we had to consider new ways of working to meet these needs in a timely, safe and effective way.

The service found that a large proportion of telephone consultations were not an effective use of time as patients were not always available to answer our calls.

This case study outlines how video consultation has supported the service to all but clear our backlog of patients who had either had an appointment cancelled or who were waiting to be seen, and should allow us to start with an almost clear slate once we are beyond the current COVID-19 challenge (Source: NHS England).

NHS England Video consultations in North Tyneside Integrated Musculoskeletal Service (NTIMS)

£1 million to pioneering innovations to support the delivery of a net zero NHS

NHS England | January 2022 | SBRI Healthcare awards £1 million to pioneering innovations to support the delivery of a net zero NHS

SBRI Healthcare, in partnership with the Greener NHS Programme, has awarded £1 million to innovations from organisations, including small businesses, technology start-ups and NHS Trusts to support a net zero NHS. Those receiving awards entered the Competition 18 ‘Delivering a Net Zero NHS’. Specifically, innovations were called to address the following challenges (i) reducing emissions from care miles, (ii) reducing emissions from surgical pathways, (iii) reducing nitrous oxide emissions and (iv) tools to support low-carbon decision making. |

The competition, developed in partnership with the Greener NHS Programme, AHSN Network and Accelerated Access Collaborative, asked for innovations which could demonstrate their impact on carbon emissions whilst considering the systematic complexity, supply chain and product lifecycles involved in their implementation. These solutions also needed to demonstrate how they will maintain and improve the overall delivery of healthcare and health outcomes within the NHS.

The newly funded projects aim to bring benefits to patients and care service users, whilst reducing carbon emissions. Innovations include tools to engage with patients and clinicians, supporting clinical decision making; managing the delivery or capture of anaesthetic gases in clinical environments; providing digital solutions and telehealth, supporting patients at home and improving clinical pathways; considering the circular economy for surgical textiles, among others (Source: NHS England)

NHS England SBRI Healthcare awards £1 million to pioneering innovations to support the delivery of a net zero NHS

HEE: New AHPs’ Research and Innovation Strategy

Health Education England | 26 January 2022 | Allied Health Professions’ Research and Innovation Strategy for England

Health Education England (HEE) has this morning launched a new strategy to support allied health professionals undertaking research (AHPs).

The Allied Health Professions’ Research and Innovation Strategy for England outlines a  bold vision to support and accelerate the existing research and innovation strategies; but will specifically will provide a framework to drive and accelerate the pace of transformational impact for AHPs’ research and innovation, specifically for enhanced visibility, reputation, influence and impact on services.

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Image shows the 14 different allied health associations on the front cover of the strategy

The scope of the Strategy addresses four domains.

• Capacity and engagement of the AHP workforce community, to implement research and
  innovation in practice;
• Capability for individuals to undertake and achieve excellence in research and
  innovation activities, roles, careers and leadership;
• Context for AHPs to have equitable access to sustainable support, infrastructures and
  investment for research and innovation;
• Culture for AHP perceptions and expectations of professional identities and roles that “research is everybody’s business”.

(Source: HEE)

There are a number of case studies available from HEE

HEE Allied Health Professions’ Research and Innovation Strategy for England [press release]

See also: CSP New AHP Research and Innovation Strategy

Accelerating patient’s access to their record

NHS Digital | December 20221| Accelerating patient access to their record

This guidance for GP practices outlines how enabling patients to view their medical record through the NHS App and other online service will accelerate patient access to their health record.

From April 2022, patients with online accounts such as through the NHS App will be able to read new entries in their health record. This applies to patients whose practices use the TPP and EMIS systems. Arrangements with practices which use Vision as the clinical system are under discussion.

This is an NHS England programme supported by NHSX and NHS Digital.

The change supports NHS Long Term Plan commitments to provide patients with digital access to their health records. It means GPs will need to consider the impact of each entry, including documents and test results, as they add them to a patient’s record. Patients will not see personal information – such as positive test results – until they have been checked and filed, giving GPs the chance to contact and speak to patients first.

We also aim to enable patients to request their historic coded records in 2022 through the NHS App.

Research shows that increasing numbers of patients want easy access to health information about them, including 80% of the 20 million NHS App users. Better access supports patients as partners in managing their health, and can help reduce queries to general practice such as on negative test results and referral letters.

Full details are available from NHS Digital

Impact of the COVID-19 pandemic on the incidence and mortality of hospital-onset bloodstream infection

Valik, J.K. et al. (2022). Impact of the COVID-19 pandemic on the incidence and mortality of hospital-onset bloodstream infection: a cohort study. BMJ Quality & Safety.  Published Online First: 18 January 2022. doi: 10.1136/bmjqs-2021-014243

The COVID-19 pandemic has put stress on the healthcare system and healthcare workers, but the consequences for quality of care outcomes in entire hospital populations are not well studied.1 One such outcome measure is hospital-onset bloodstream infection (HOB), which is closely related to central line-associated bloodstream infections, but also reflects bacteraemia secondary to other healthcare-associated infections.2 3 HOB rate is an objective measure and has been suggested as an indicator of changes in healthcare delivery.4–7 The authors of this cohort study aimed to compare the incidence and mortality of HOB before and after the emergence of COVID-19.

Abstract

The COVID-19 pandemic burdens hospitals, but consequences for quality of care outcomes such as healthcare-associated infections are largely unknown. This cohort included all adult hospital episodes (n equal to 186 945) at an academic centre between January 2018 and January 2021. Data were collected from the hospitals’ electronic health record data repository. Hospital-onset bloodstream infection (HOB) was defined as any positive blood culture obtained more than or equal to 48 hours after admission classified based on microbiological and hospital administrative data. Subgroup analyses were performed with exclusion of potential contaminant bacteria. The cohort was divided into three groups: controls (prepandemic period), non-COVID-19 (pandemic period) and COVID-19 (pandemic period) based on either PCR-confirmed SARS-CoV-2 infections from respiratory samples or International Classification of Diseases 10th Revision diagnoses U071 and U72 at discharge. Adjusted incidence rate ratios (aIRR) and risk of death in patients with HOB were compared between the prepandemic and pandemic periods using Poisson and logistic regression. The incidence of HOB was increased for the COVID-19 group compared with the prepandemic period (aIRR 3.34, 95 per cent CI 2.97 to 3.75). In the non-COVID-19 group, the incidence was slightly increased compared with prepandemic levels (aIRR 1.20, 95 per cent CI 1.08 to 1.32), but the difference decreased when excluding potential contaminant bacteria (aIRR 1.15, 95 per cent CI 1.00 to 1.31, p equal to 0.04). The risk of dying increased for both the COVID-19 group (adjusted odds ratio (aOR) 2.44, 95 per cent CI 1.75 to 3.38) and the non-COVID-19 group (aOR 1.63, 95% CI 1.22 to 2.16) compared with the prepandemic controls. These findings were consistent also when excluding potential contaminants. In summary, we observed a higher incidence of HOB during the COVID-19 pandemic, and the mortality risk associated with HOB was greater, compared with the prepandemic period. Results call for specific attention to quality of care during the pandemic.

Impact of the COVID-19 pandemic on the incidence and mortality of hospital-onset bloodstream infection: a cohort study [report]

Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings

Bourne, R.S. et al (2022). Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta-analysis. BMJ Quality & Safety.  Published Online First: 18 January 2022. doi: 10.1136/bmjqs-2021-013760

This systematic review and meta-analysis aimed to (i) examine the impact of medication-related interventions on medication and patient outcomes on transition from adult ICU settings and (ii) identify barriers and facilitators during intervention implementation

Abstract

Background 

Patients recovering from an episode in an intensive care unit (ICU) frequently experience medication errors on transition to the hospital ward. Structured handover recommendations often underestimate the challenges and complexity of ICU patient transitions. For adult ICU patients transitioning to a hospital ward, it is currently unclear what interventions reduce the risks of medication errors.

The aims were to examine the impact of medication-related interventions on medication and patient outcomes on transition from adult ICU settings and identify barriers and facilitators to implementation.

Methods 

The systematic review protocol was preregistered on PROSPERO. Six electronic databases were searched until October 2020 for controlled and uncontrolled study designs that reported medication-related (ie, de-prescribing; medication errors) or patient-related outcomes (ie, mortality; length of stay). Risk of bias (RoB) assessment used V.2.0 and ROBINS-I Cochrane tools. Where feasible, random-effects meta-analysis was used for pooling the OR across studies. The quality of evidence was assessed by Grading of Recommendations, Assessment, Development and Evaluations.

Results 

Seventeen studies were eligible, 15 (88 per cent) were uncontrolled before-after studies. The intervention components included education of staff (n equal to 8 studies), medication review (n equal to 7), guidelines (n equal to 6), electronic transfer/handover tool or letter (n equal to 4) and medicines reconciliation (n equal to 4). Overall, pooled analysis of all interventions reduced risk of inappropriate medication continuation at ICU discharge (OR equal to 0.45 (95 per cent CI 0.31 to 0.63), I² equal to 55 per cent, n equal to 9) and hospital discharge (OR equal to 0.39 (95 per cent CI 0.2 to 0.76), I² equal to 75 per cent, n equal to9). Multicomponent interventions, based on education of staff and guidelines, demonstrated no significant difference in inappropriate medication continuation at the ICU discharge point (OR 0.5 (95 per cent CI 0.22 to 1.11), I² equal to 62 per cent, n equal to 4), but were very effective in increasing de-prescribing outcomes on hospital discharge (OR 0.26 (95 per cent CI 0.13 to 0.55), I² equal to 67 per cent, n equal to 6)). Facilitators to intervention delivery included ICU clinical pharmacist availability and participation in multiprofessional ward rounds, while barriers included increased workload associated with the discharge intervention process.

Conclusions 

Multicomponent interventions based on education of staff and guidelines were effective at achieving almost four times more de-prescribing of inappropriate medication by the time of patient hospital discharge. Based on the findings, practice and policy recommendations are made and guidance is provided on the need for, and design of theory informed interventions in this area, including the requirement for process and economic evaluations.

Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta-analysis [paper]

Has the provision of mental health services for children and young people improved?

House of Commons Library | December 2021 | Has the provision of mental health services for children and young people improved?

Four years after the Government’s publication of its green paper on transforming children and young people’s mental health provision in 2017. MPs on the Health and Social Care Committee wanted to review progress and find out how much the Government has achieved on mental health services for children and young people. The Committee have received over 100 written submissions, and have now heard from ministers, experts, service providers, clinicians, practitioners and young people with experience of using mental heath services.

This publication reviews:

• The scale of the problem
• Access to mental health services
• Where is mental health support available

Inpatient care

Full details are available from the House of Commons Committees

Has the provision of mental health services for children and young people improved?

Children and young people’s mental health [report]

Conceptualising interventions to enhance spread in complex systems

Lennox, L. et al. (2022) Conceptualising interventions to enhance spread in complex systems: a multisite comprehensive medication review case study. BMJ Quality & Safety . 31. P. 31-44.

This review aimed to co-produce a detailed description of an evidence-based intervention and capture how it was spread. The co-production of knowledge was achieved through a partnership: improvement team members brought expert clinical, practice and quality improvement (QI) knowledge needed to understand and intervene in their local system; researchers brought expertise in observing, capturing and making sense of what happens, and finding patterns in the busy world of front line practice.

1. To describe the work required to operationalise evidence-based practice from the perspective of improvement team members.
2. To identify what stayed the same and what changed between the different sites and why.
3. To critically appraise the ‘HC’ and ‘SP’ construct as a way of conceptualising interventions in complex systems.

This study provides rich insight into the work conducted from the perspective of improvement teams to appraise and advance the description and conceptualisation of interventions in complex systems.

Abstract

Background Advancing the description and conceptualisation of interventions in complex systems is necessary to support spread, evaluation, attribution and reproducibility. Improvement teams can provide unique insight into how interventions are operationalised in practice. Capturing this ‘insider knowledge’ has the potential to enhance intervention descriptions.

Objectives This exploratory study investigated the spread of a comprehensive medication review (CMR) intervention to (1) describe the work required from the improvement team perspective, (2) identify what stays the same and what changes between the different sites and why, and (3) critically appraise the ‘hard core’ and ‘soft periphery’ (HC/SP) construct as a way of conceptualising interventions.

Design A prospective case study of a CMR initiative across five sites. Data collection included: observations, document analysis and semistructured interviews. A facilitated workshop triangulated findings and measured perceived effort invested in activities. A qualitative database was developed to conduct thematic analysis.

Results Sites identified 16 intervention components. All were considered essential due to their interdependency. The function of components remained the same, but adaptations were made between and within sites. Components were categorised under four ‘spheres of operation’: Accessibility of evidence base; Process of enactment; Dependent processes and Dependent sociocultural issues. Participants reported most effort was invested on ‘dependent sociocultural issues’. None of the existing HC/SP definitions fit well with the empirical data, with inconsistent classifications of components as HC or SP.

Conclusions This study advances the conceptualisation of interventions by explicitly considering how evidence-based practices are operationalised in complex systems. We propose a new conceptualisation of ‘interventions-in-systems’ which describes intervention components in relation to their: proximity to the evidence base; component interdependence; component function; component adaptation and effort.

Conceptualising interventions to enhance spread in complex systems: a multisite comprehensive medication review case study [paper]