Knowledge @lert for Friday 19th June

June 19, 2015 Daily News

Merseyside trusts paid £135k to cover Capita redundancy costs – Health Service Journal
Merseyside trusts made payments totalling at least £135,000 to help cover redundancy costs when they terminated their HR contracts with Capita, HSJ can reveal.

Teamwork, communication and safety climate: a systematic review of interventions to improve surgical culture. BMJ Qual Saf 2015;24: Sacks, G. D., Shannon, E. M., Dawes, A. J., Rollo, J. C., Nguyen, D. K., Russell, M. M., Ko, C. Y., Maggard-Gibbons, M. A.
The literature provides promising evidence for various strategies to improve surgical culture, although these approaches differ in terms of the interventions employed as well as the techniques used to measure culture. Nevertheless, culture improvement appears to be associated with other positive effects, including better patient outcomes and enhanced healthcare efficiency.

Role of cognition in generating and mitigating clinical errors. BMJ Qual Saf 2015;24. Patel, V. L., Kannampallil, T. G., Shortliffe, E. H.
Given the complexities of current clinical practice environments, strategies to reduce clinical error must appreciate that error detection and recovery are integral to the function of complex cognitive systems. In this review, while acknowledging that error elimination is an attractive notion, we use evidence to show that enhancing error detection and improving error recovery are also important goals. We further show how departures from clinical protocols or guidelines can yield innovative and appropriate solutions to unusual problems. This review addresses cognitive approaches to the study of human error and its recovery process, highlighting their implications in promoting patient safety and quality. In addition, we discuss methods for enhancing error recognition, and promoting suitable responses, through external cognitive support and virtual reality simulations for the training of clinicians.

Back to basics: checklists in aviation and healthcare BMJ Qual Saf 2015;24. Clay-Williams, R., Colligan, L.
The checklist approach has the same potential to save lives and prevent morbidity in medicine that it did in aviation over 70 years ago by ensuring that simple standards are applied for every patient, every time. Healthcare safety activists have looked to checklists to solve a myriad of problems, particularly with the current iteration of checklists that have been imported from aviation. Large-scale implementations with conflicting outcomes suggest that these tools are not as simple or effective as hoped. Scholars debating the efficacy of checklist implementation in healthcare have identified important reasons for varying results: that success requires complex, cultural and organisational change efforts, not just the checklist itself; that results may be confounded by a mix of the technical and socioadaptive elements, and that local contexts may either augment or undermine the implementation’s outcomes.

The impact of minor injury unit closures on travel time and attendances – British Journal of Health Care Management 
Geographic modelling techniques provide a means of optimising the location of services, or understanding the potential impact of geographic service reconfigurations. In response to commissioner queries, we assessed the potential impact on patient travel time and attendances of the closure of four minor injury units (MIUs) in a locality of South West England. We used the MPMileCharter add-in for Microsoft MapPoint and the attendance records of 90252 minor injury unit patients to calculate car travel time data to the units in the locality. We then built a geographic model of the existing configuration of MIUs in Microsoft Excel, and used ‘what if’ analysis to determine the potential impact of the proposed closures. The model predicted that if the four MIUs were closed, there would be only a trivial increase in average travel time across all patients, but a significant increase of around 20 minutes per patient for those whose nearest unit was closed. The model also predicted that the closure of one of the MIUs could lead to significant increased demand at the walk-in centre located at the acute hospital. Using these results, the local commissioners decided to close only three of the four units.

“It’s easier to stick a tube in”: a qualitative study to understand clinicians’ individual decisions to place urinary catheters in acute medical care. BMJ Qual Saf 2015;24. Murphy, C., Prieto, J., Fader, M.
These findings help to explain why clinicians sometimes deviate from IUC best practice guidance and resist interventions to modify practice. In order to engage nurses and physicians in change, interventions to reduce IUC use should acknowledge and respond to the complexity and lack of clarity often faced by clinicians making the decision to place an IUC. However, it is equally important that inconsistencies in IUC-related beliefs are recognised, investigated and, where appropriate, challenged.

Giving whistleblowers greater protection: Improving quality of care – British Journal of Health Care Management
This year, an independent review of whisleblowing in the NHS made recommendations as to how whistleblowers could be given greater protection. The review, chaired by Sir Robert Francis, intended to improve the quality of patient care and safety in the health service. But with many practitioners remaining unregulated, there are unanswered questions as to how reports of mistakes can be properly investigated and the necessary action taken against incompetent or negligent practitioners. Amanda Casey, Chair of the Registration Council for Clinical Physiologists, makes the case for regulation of professionals whose work poses potential risks to patients and can place healthcare managers in an invidious position.

Unlocking patient activation in chronic disease care – British Journal of Healthcare Management 
Chronic diseases bear increasingly important costs on healthcare budgets. This article reviews examples from the field of e-health, looking at how gamification can help foster behavioural change, which can in turn improve patients’ health. Ultimately, it can alleviate the cost incurred by treating the disease. Drawing from emerging best practices, the authors discuss how coupling gamification with e-health represents a significant advance in the management of chronic disease.

Local estates strategies: a framework for commissioners – Department of Health 
This framework explains how clinical commissioning groups and their partners can create strategic estate plans. Commissioners can also get advice from local strategic estates advisers. Contact details for advisers are included.

MCP vanguard leaders: We will find the solutions – Health Service Journal 
In the second of a series on vanguards, HSJ talks to leaders of three vanguard areas on their progress testing out the multispecialty community provider care model.In January NHS England announced it was looking for vanguard sites to test out the new models of care proposed by Simon Stevens’ NHS Five Year Forward View. More than 260 organisations applied. In March a lucky few were chosen, including 14 multispecialty community provider (MCP) vanguards.

Greater Manchester to reduce ‘specialist’ surgery sites – Health Service Journal
Emergency and high risk surgery in Greater Manchester will be concentrated on four sites, rather than five, commissioners have announced. The decision, made yesterday as part of the Healthier Together programme, effectively leaves four foundation trusts vying for one remaining “specialist” slot.

What’s your excuse for Foley use? BMJ Quality & Safety current issue. Krein, S. L., Saint, S. 
Efforts to prevent catheter-associated urinary tract infection (CAUTI) are underway worldwide. Reducing indwelling urinary catheter (or ‘Foley’) use is a key component of most prevention initiatives, which makes sense given the evidence showing its effectiveness in reducing CAUTI rates. Such an approach, however, requires a specific focus on promoting the use of appropriate indications for a Foley at the time of insertion and throughout the duration of catheterisation. Unfortunately, data show substantial variability in both interpreting and applying such indications. The article by Murphy and colleagues uses robust qualitative methods to provide insights into decision-making about Foley insertion, including indications for use and the clinical context. This focus corresponds with what we and others have characterised as the socio-adaptive…

What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis, Health Services and Delivery Research, Vol:3, Iss:24. Authors: Blank L, Baxter S, Woods HB, Goyder E, Lee A, Payne N, Rimmer M.
Demand management describes any method used to monitor, direct or regulate patient
referrals. Several strategies have been developed to manage the referral of patients to secondary care, with interventions targeting primary care, specialist services, or infrastructure.

 

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