Browse through all publications from the Institute of Global Health Innovation, which our Patient Safety Research Collaboration is part of. This feed includes reports and research papers from our Centre. 

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  • Journal article
    Judah G, Darzi A, Vlaev I, Gunn L, King D, King D, Valabhji J, Bicknell Cet al., 2018,

    Financial disincentives? A three-armed randomised controlled trial of the effect of financial Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial

    , British Journal of Ophthalmology, Vol: 102, Pages: 1014-1020, ISSN: 0007-1161

    OBJECTIVE: Conflicting evidence exists regarding the impact of financial incentives on encouraging attendance at medical screening appointments. The primary aim was to determine whether financial incentives increase attendance at diabetic eye screening in persistent non-attenders. METHODS AND ANALYSIS: A three-armed randomised controlled trial was conducted in London in 2015. 1051 participants aged over 16 years, who had not attended eye screening appointments for 2 years or more, were randomised (1.4:1:1 randomisation ratio) to receive the usual invitation letter (control), an offer of £10 cash for attending screening (fixed incentive) or a 1 in 100 chance of winning £1000 (lottery incentive) if they attend. The primary outcome was the proportion of invitees attending screening, and a comparative analysis was performed to assess group differences. Pairwise comparisons of attendance rates were performed, using a conservative Bonferroni correction for independent comparisons. RESULTS: 34/435 (7.8%) of control, 17/312 (5.5%) of fixed incentive and 10/304 (3.3%) of lottery incentive groups attended. Participants who received any incentive were significantly less likely to attend their appointment compared with controls (risk ratio (RR)=0.56; 95% CI 0.34 to 0.92). Those in the probabilistic incentive group (RR=0.42; 95% CI 0.18 to 0.98), but not the fixed incentive group (RR=1.66; 95% CI 0.65 to 4.21), were significantly less likely to attend than those in the control group. CONCLUSION: Financial incentives, particularly lottery-based incentives, attract fewer patients to diabetic eye screening than standard invites in this population. Financial incentives should not be used to promote screening unless tested in context, as they may negatively affect attendance rates.

  • Journal article
    Flott K, Darzi A, Mayer E, 2018,

    Care pathway and organisational features driving patient experience: Statistical analysis of large NHS datasets

    , BMJ Open, Vol: 8, ISSN: 2044-6055

    Objective: The aim of this study was to identify the care pathway and organisational factors that predict patient experience Design: Statistical analysis of large NHS datasets Setting & participants: England; Acute NHS organisational-level dataPrimary and secondary outcome measures: The relationship of care pathway and organisational variables to organisation-level patient experience Results: A framework of 18 care pathway and organisational variables were created based on the existing literature. Eleven of these correlated to patient experience in univariate analyses. Multi-collinearity tests resulted in one of the 11 variables holding a correlation to another variable larger than r=0.70. A significant multi-linear regression equation including the final ten variables was found (F(10,108) = 6.214, p < 0.00), with an R^2 of 0.365. Two variables were significant in predicting better in patient experience: Amount of support to clinical staff (Beta = 0.2, p = 0.02) and the proportion of staff who would recommend the trust as a place to work or receive treatment (Beta = 0.26, p = 0.01). Two variables were significant in predicting a negative impact on the patient’s rating of their experience: Number of patients spending over 4 hours from decision to admit to admission (Beta =-1.99 p = 0.03) and the percentage of estates and hotel services contracted out (Beta = -0.23, p = 0.01). Conclusions: These results indicate that augmenting clinical support and investing in the mechanisms that facilitate positive staff experience is essential to delivering appropriate, informative and patient-centric care. Reducing wait times and the extent of external contracting within hospitals is also likely to improve patient ratings of experience. Understanding the relationship between patient experience and objective, measurable organisational features promotes a more patient-centric interpretation of quality and compels a better use of patient experience feedback to drive im

  • Journal article
    Rao A, Bicknell C, Bottle R, Darzi A, Aylin PPet al., 2018,

    Common sequences of emergency readmissions among high-impact users following AAA repair

    , Surgery Research and Practice, Vol: 2018, ISSN: 2356-7759

    IntroductionThe aim of the study was to examine common sequences of causes of readmissions among those patients with multiple hospital admissions, high-impact users, after abdominal aortic aneurysm (AAA) repair and to focus on strategies to reduce long-term readmission rate. MethodsThe patient cohort (2006-2009) included patients from Hospital Episodes Statistics, the national administrative data of all NHS English hospitals, and followed up for 5 years. Group-based trajectory modelling and sequence analysis were performed on the data. ResultsFrom a total of 16,973 elective AAA repair patients, 18% (n=3055) were high-impact users. The high-impact users among rAAA repair constituted 17.3% of the patient population (n=4144). There were 2 subtypes of high-impact users, short-term (7.2%) with initial high readmission rate following by rapid decline and chronic high-impact (10.1%) with persistently high readmission rate. Common causes of readmissions following elective AAA repair were respiratory tract infection (7.3%), aortic graft complications (6.0%), unspecified chest pain (5.8%), and gastro-intestinal haemorrhage (4.8%). However, high-impact users included significantly increased number of patients with multiple readmissions and distinct sequences of readmissions mainly consisting of COPD (4.7%), respiratory tract infection (4.7%) and ischaemic heart disease (3.3%).ConclusionA significant number of patients were high-impact users after AAA repair. They had a common and distinct sequence of causes of readmissions following AAA repair, mainly consisting of cardiopulmonary conditions and aortic graft complications. The common causes of long-term mortality were not related to AAA repair. The quality of care can be improved by identifying these patients early and focusing on prevention of cardiopulmonary diseases in the community.

  • Journal article
    Murray AC, Markar S, Mackenzie H, Baser O, Wiggins T, Askari A, Hanna G, Faiz O, Mayer E, Bicknell C, Darzi A, Kiran RPet al., 2018,

    An observational study of the timing of surgery, use of laparoscopy and outcomes for acute cholecystitis in the USA and UK

    , Surgical Endoscopy, Vol: 32, Pages: 3055-3063, ISSN: 0930-2794

    BACKGROUND: Evidence supports early laparoscopic cholecystectomy for acute cholecystitis. Differences in treatment patterns between the USA and UK, associated outcomes and resource utilization are not well understood. METHODS: In this retrospective, observational study using national administrative data, emergency patients admitted with acute cholecystitis were identified in England (Hospital Episode Statistics 1998-2012) and USA (National Inpatient Sample 1998-2011). Proportions of patients who underwent emergency cholecystectomy, utilization of laparoscopy and associated outcomes including length of stay (LOS) and complications were compared. The effect of delayed treatment on subsequent readmissions was evaluated for England. RESULTS: Patients with a diagnosis of acute cholecystitis totaled 1,191,331 in the USA vs. 288 907 in England. Emergency cholecystectomy was performed in 628,395 (52.7% USA) and 45,299 (15.7% England) over the time period. Laparoscopy was more common in the USA (82.8 vs. 37.9%; p < 0.001). Pre-treatment (1 vs. 2 days; p < 0.001) and total ( 4 vs. 7 days; p < 0.001) LOS was lower in the USA. Overall incidence of bile duct injury was higher in England than the USA (0.83 vs. 0.43%; p < 0.001), but was no different following laparoscopic surgery (0.1%). In England, 40.5% of patients without an immediate cholecystectomy were subsequently readmitted with cholecystitis. An additional 14.5% were admitted for other biliary complications, amounting to 2.7 readmissions per patient in the year following primary admission. CONCLUSION: This study highlights management practices for acute cholecystitis in the USA and England. Despite best evidence, index admission laparoscopic cholecystectomy is performed less in England, which significantly impacts subsequent healthcare utilization.

  • Journal article
    Puaar SJ, Franklin BD, 2018,

    Impact of an inpatient electronic prescribing system on prescribing error causation: a qualitative evaluation in an English hospital

    , BMJ QUALITY & SAFETY, Vol: 27, Pages: 529-538, ISSN: 2044-5415
  • Journal article
    Al-Fageh B, Aljadhey H, Mahmoud MA, Al-Fadel N, Hassali MA, Franklin BDet al., 2018,

    Perceived causes of prescribing errors by physicians: A qualitative study

    , TROPICAL JOURNAL OF PHARMACEUTICAL RESEARCH, Vol: 17, Pages: 1415-1422, ISSN: 1596-5996
  • Conference paper
    Deligianni F, Singh H, Modi H, Darzi A, Leff D, Yang GUANGet al., 2018,

    Expertise Related Disparity in Prefrontal-Motor Brain Connectivity

    , Hamlyn Symposium on Medical Robotics
  • Journal article
    Martin G, Ghafur S, Kinross J, Hankin C, Darzi Aet al., 2018,

    WannaCry-a year on

    , BMJ: British Medical Journal, Vol: 361, ISSN: 0959-8138
  • Journal article
    Hassen Y, Singh P, Pucher PH, Johnston MJ, Darzi Aet al., 2018,

    Identifying quality markers of a safe surgical ward: an interview study of patients, clinical staff, and administrators

    , Surgery, Vol: 163, Pages: 1226-1233, ISSN: 0039-6060

    BACKGROUND: Postoperative care quality is variable. Risk-adjusted mortality rates differ between institutions despite comparable complication rates. This indicates that there are underlying factors rooted in how care is delivered that determines patient safety. This study aims to evaluate systematically the surgical ward environment with respect to process-driven and structural factors to identify quality markers for safe care, from which new safety metrics may be derived. METHODS: Semistructured interviews of clinicians, nurses, patients and administrators were undertaken for the study. RESULTS: In the study, 97% of staff members recognized the existence of variation in patient safety between surgical wards. Four main error-prone processes were identified: ward rounds (57%), medication prescribing and administration (49%), the presence of outliers (43%), and deficiencies in communication between clinical staff (43%). Structural factors were categorized as organizational or environmental; organizational included shortage in staffing (39%) and use of temporary staff (27%). Environmental factors considered layout and patient visibility to nurses (49%) as well as cleanliness (29%). Safety indicators identified included staff experience level (31%), overall layout of the ward, cleanliness and leadership (all 27% each). The majority of patients (87%) identified staff attentiveness as a safety indicator. CONCLUSION: This study demonstrates that there are a number of factors that may contribute to safety on the surgical ward spanning multiple processes, organizational, and environmental factors. Safety indicators identified across all these categories presents an opportunity to develop broader and more effectual safety improvement measures focusing on multiple areas simultaneously.

  • Journal article
    Garfield S, Furniss D, Husson F, Turley M, Franklin BDet al., 2018,

    Use of patient-held information about medication (PHIMed) to support medicines optimisation: protocol for a mixed-methods descriptive study

    , BMJ OPEN, Vol: 8, ISSN: 2044-6055

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