Publications
255 results found
Jen MH, Bottle A, Majeed A, et al., 2009, Early in-hospital mortality following trainee doctors' first day at work, PLOS One, Vol: 4, ISSN: 1932-6203
BackgroundThere is a commonly held assumption that early August is an unsafe period to be admitted to hospital in England, as newly qualified doctors start work in NHS hospitals on the first Wednesday of August. We investigate whether in-hospital mortality is higher in the week following the first Wednesday in August than in the previous week.MethodologyA retrospective study in England using administrative hospital admissions data. Two retrospective cohorts of all emergency patients admitted on the last Wednesday in July and the first Wednesday in August for 2000 to 2008, each followed up for one week.Principal FindingsThe odds of death for patients admitted on the first Wednesday in August was 6% higher (OR 1.06, 95% CI 1.00 to 1.15, p = 0.05) after controlling for year, gender, age, socio-economic deprivation and co-morbidity. When subdivided into medical, surgical and neoplasm admissions, medical admissions admitted on the first Wednesday in August had an 8% (OR 1.08, 95% CI 1.01 to 1.16, p = 0.03) higher odds of death. In 2007 and 2008, when the system for junior doctors' job applications changed, patients admitted on Wednesday August 1st had 8% higher adjusted odds of death than those admitted the previous Wednesday, but this was not statistically significant (OR 1.08, 95% CI 0.95 to 1.23, p = 0.24).ConclusionsWe found evidence that patients admitted on the first Wednesday in August have a higher early death rate in English hospitals compared with patients admitted on the previous Wednesday. This was higher for patients admitted with a medical primary diagnosis.
Beckett DJ, Gordon CF, Paterson R, et al., 2009, Improvement in out-of-hours outcomes following the implementation of Hospital at Night, QJM-AN INTERNATIONAL JOURNAL OF MEDICINE, Vol: 102, Pages: 539-546, ISSN: 1460-2725
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- Citations: 13
Molokhia M, Tanna S, Bell D, 2009, Improving reporting of adverse drug reactions: systematic review, Clinical Epidemiology, Vol: 1, Pages: 75-92, ISSN: 1179-1349
BACKGROUND: Adverse drug reactions (ADRs) are a significant cause of morbidity and mortality, with many being identified post-marketing. Improvement in current ADR reporting, including utility of underused or innovative methods, is crucial to improve patient safety and public health. OBJECTIVES: To evaluate methods to improve ADR reporting via a systematic literature review. METHODS: Data sources were Medline, Embase, Cochrane Library and National Library for health searches on ADR reporting (January 1997 to August 2007) including cross-referenced articles. Twenty-four out of 260 eligible studies were identified and critically assessed. Studies were grouped as follows: i) spontaneous reporting (11); ii) medical chart/note review (2); iii) patient interviews/questionnaires (3); and iv) combination methods including computer-assisted methods (8). RESULTS: Using computerized monitoring systems (CMS) to generate signals associated with changes in laboratory results with other methods can improve ADR reporting. Educational interventions combined with reminders and/or prescription card reports can improve hospital-based ADR reporting, and showed short to medium term improvement. CONCLUSIONS: The use of electronic health data combined with other methods for ADR reporting can improve efficiency and accuracy for detecting ADRs and can be extended to other health care settings. Although methods with educational intervention appear to be effective, few studies have reviewed long-term effects to assess if the improvements can be sustained.
Gordon C, Backett D, Jones M, 2009, ACUMEN: The Acute Medicine Network, BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 70, Pages: 301-301, ISSN: 1750-8460
Bell D, 2009, Acute Medical Care - back to basics, The Journal of the Royal College of Physicians of Edinburgh, Vol: 39, Pages: 2-3
Bell D, Douglas ML, 2009, What are the appropriate standards for acute medicine?, British Journal of Hospital Medicine, Vol: 70, ISSN: 1750-8460
Jones MC, Bell D, 2009, What is acute medicine and do we need it?, British Journal of Hospital Medicine, Vol: 70, ISSN: 1750-8460
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- Citations: 2
Jones MC, Bell D, 2009, What is acute medicine and do we need it?, Br J Hosp Med (Lond), Vol: 70, Pages: S8-10, ISSN: 1750-8460
Bell D, Douglas L, 2009, What are the appropriate standards for acute medicine?, Br J Hosp Med (Lond), Vol: 70, Pages: S26-S30, ISSN: 1750-8460
Bell D, Jones M, 2009, Acute Medicine - setting new standards of care, NHS Healthcare The Way Forward, Editors: THE, Publisher: THE NHS TRUST ASSOCIATION’S, Pages: 21-24
Beckett DJ, Gordon CF, Chalkley S, et al., 2009, Assessment of clinical risk in the out of hours hospital prior to the introduction of Hospital at Night, Acute Medicine, Vol: 8, Pages: 33-40
Crosswaite A, Dougall H, Duguid I, et al., 2009, Providing Better Care for Patients with Complex Needs in Acute Medicine, Acute Medicine, Vol: 8, Pages: 79-83, ISSN: 1747-4884
Crosswaite AG, Dougall H, Duguid I, et al., 2009, Providing better care for patients with complex needs in acute medicine., Acute Med, Vol: 8, Pages: 80-84, ISSN: 1747-4884
Patients with complex needs are commonly admitted on the acute medical take and comprise a significant proportion of the workload for an acute physician. An innovative multi-professional approach to the assessment of this group of patients has been developed in Edinburgh; this paper summarises the results of a 4 week review of data collected on patients assessed by the multiprofessional team on the Medical Assessment Unit at Edinburgh Royal Infirmary.
Subedi D, Bell D, Lewinski MJB, et al., 2009, Use of SimpliRED D-Dimer assay and computerised tomography in the diagnosis of acute pulmonary embolism, Acute Medicine, Vol: 8, Pages: 84-86, ISSN: 1747-4884
Car J, Koshy E, Bell D, et al., 2008, Telephone triage in out of hours call centres, BRITISH MEDICAL JOURNAL, Vol: 337, ISSN: 0959-535X
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- Citations: 11
Sharma A, Teh B, Morgan DJR, et al., 2008, When ascites is not ascites, POSTGRADUATE MEDICAL JOURNAL, Vol: 84, Pages: 502-503, ISSN: 0032-5473
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- Citations: 10
Aylin P, Bottle A, Kirkwood G, et al., 2008, Trends in hospital admissions for pulmonary embolism in England: 1996/7 to 2005/6, CLINICAL MEDICINE, Vol: 8, Pages: 388-392, ISSN: 1470-2118
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- Citations: 25
Bell D, Skene H, Jones M, et al., 2008, A guide to the acute medical unit, British Journal of Hospital Medicine, Vol: 69, Pages: M107-M109, ISSN: 1750-8460
St Noble VJ, Davies G, Bell D, 2008, Improving continuity of care in an acute medical unit: initial outcomes, QJM-AN INTERNATIONAL JOURNAL OF MEDICINE, Vol: 101, Pages: 529-533, ISSN: 1460-2725
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- Citations: 29
Proudfoot A, Yarranton H, Gibbs S, et al., 2008, Initial Treatment of Pulmonary embolism, Acute Medicine, Vol: 6, Pages: 95-102
Bell D, Jones M, 2007, Emergency admissions - a time for action and improving patient outcomes, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 100, Pages: 487-488, ISSN: 0141-0768
Williams B, Bell D, Almond S, et al., 2007, Acute Medical Care The right person in the right setting- first time, Acute Medical Care, London, Publisher: Royal College of Physicians, London
Patel H, Bell D, Molokhia M, et al., 2007, Trends in hospital admissions for adverse drug reactions in England: analysis of national hospital episode statistics 1998-2005, BMC Clinical Pharmacology, Vol: 7, Pages: 9-9, ISSN: 1472-6904
BACKGROUND: Adverse drug reactions (ADRs) are a frequent cause of mortality and morbidity to patients worldwide, with great associated costs to the healthcare providers including the NHS in England. We examined trends in hospital admissions associated with adverse drug reaction in English hospitals and the accuracy of national reporting. METHODS: Data from the Hospital Episode Statistics database (collected by the Department of Health) was obtained and analysed for all English hospital episodes (1998-2005) using ICD-10 codes with a primary (codes including the words ('drug-induced' or 'due to') or secondary diagnosis of ADR (Y40-59). More detailed analysis was performed for the year 2004-2005 RESULTS: Between 1998 and 2005 there were 447 071 ADRs representing 0.50% of total hospital episodes and over this period the number of ADRs increased by 45%. All ADRs with an external code increased over this period. In 2005 the total number of episodes (all age groups) was 13,706,765 of which 76,692 (0.56%) were drug related. Systemic agents, which include anti-neoplastic drugs, were the most implicated class (15.7%), followed by analgesics (11.7%) and cardiovascular drugs (10.1%). There has been a 6 fold increase in nephropathy secondary to drugs and a 65% decline in drug induced extra-pyramidal side effects. 59% of cases involving adverse drug reactions involved patients above 60 years of age. CONCLUSION: ADRs have major public health and economic implications. Our data suggest that national Hospital Episode Statistics in England have recognised limitations and that consequently, admissions associated with adverse drug reactions continue to be under-recorded. External causes of ADR have increased at a greater rate than the increase in total hospital admissions. Improved and more detailed reporting combined with educational interventions to improve the recording of ADRs are needed to accurately monitor the morbidity caused by ADRs and to meaningfully evaluate national initia
Proudfoot A, Bell D, 2007, The Diagnostic Assessment of Suspected Pulmonary Embolism on the Acute Medical Take: An evidence based guide, Acute Medicine, Vol: 6, Pages: 20-26
Proudfoot A, Cocburn E, Bell D, 2007, Pulmonary Embolism in the Critically Ill, Care of the Critically Ill, Vol: 23.3, Pages: 79-86
Bell D, McNaney N, Jones M, 2006, Improving health care through redesign - It's time to shift from small projects to whole systems, BMJ-BRITISH MEDICAL JOURNAL, Vol: 332, Pages: 1286-1287, ISSN: 1756-1833
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- Citations: 16
Paterson R, MacLeod DC, Thetford D, et al., 2006, Prediction of in-hospital mortality and length of stay using an early warning scoring system: clinical audit, CLINICAL MEDICINE, Vol: 6, Pages: 281-284, ISSN: 1470-2118
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- Citations: 150
Bell D, Jones M, Jenkins P, 2006, Acute Medicine and Academic Medicine - a unique opportunity to improve health care., Acute Med, Vol: 5, Pages: 72-73, ISSN: 1747-4884
Acute medicine was recognised as a subspeciality of General (Internal) Medicine by the Specialist Training Authority in July 2003. In practice it had been growing as a clinical entity for over a decade and several reports have been published.1, 2, 3 The most recent Royal College of Physicians report on Acute medicine: making it work for patients4 states "Acute medicine in the UK requires the development of an academic and research base in order to support teaching and training at medical undergraduate and postgraduate level, to support basic and clinical research, to develop clinical standards, and to provide audit tools for the assessment of clinical performance."
Bell D, Darling K, 2005, Understanding waiting times in accident and emergency and potential impact on patients and beds, BMJ
Schmulewitz L, Proudfoot A, Bell D, 2005, The impact of weekends on outcome for emergency patients, CLINICAL MEDICINE, Vol: 5, Pages: 621-625, ISSN: 1470-2118
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- Citations: 76
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