Publications
255 results found
Bottle A, Goudie R, Cowie MR, et al., 2015, Relation between process measures and diagnosis-specific readmission rates in patients with heart failure, HEART, Vol: 101, Pages: 1704-1710, ISSN: 1355-6037
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- Citations: 12
Soong JTY, Poots AJ, Scott S, et al., 2015, Quantifying the prevalence of frailty in English hospitals, BMJ Open, Vol: 5, ISSN: 2044-6055
Objectives Population ageing has been associated with an increase in comorbid chronic disease, functional dependence, disability and associated higher health care costs. Frailty Syndromes have been proposed as a way to define this group within older persons. We explore whether frailty syndromes are a reliable methodology to quantify clinically significant frailty within hospital settings, and measure trends and geospatial variation using English secondary care data set Hospital Episode Statistics (HES).Setting National English Secondary Care Administrative Data HES.Participants All 50 540 141 patient spells for patients over 65 years admitted to acute provider hospitals in England (January 2005—March 2013) within HES.Primary and secondary outcome measures We explore the prevalence of Frailty Syndromes as coded by International Statistical Classification of Diseases, Injuries and Causes of Death (ICD-10) over time, and their geographic distribution across England. We examine national trends for admission spells, inpatient mortality and 30-day readmission.Results A rising trend of admission spells was noted from January 2005 to March 2013(daily average admissions for month rising from over 2000 to over 4000). The overall prevalence of coded frailty is increasing (64 559 spells in January 2005 to 150 085 spells by Jan 2013). The majority of patients had a single frailty syndrome coded (10.2% vs total burden of 13.9%). Cognitive impairment and falls (including significant fracture) are the most common frailty syndromes coded within HES. Geographic variation in frailty burden was in keeping with known distribution of prevalence of the English elderly population and location of National Health Service (NHS) acute provider sites. Overtime, in-hospital mortality has decreased (>65 years) whereas readmission rates have increased (esp.>85 years).Conclusions This study provides a novel methodology to reliably quantify clinically significant frailty. Applications in
Soong JTY, Poots AJ, Scott S, et al., 2015, Developing and validating a risk prediction model for acute care based on frailty syndromes, BMJ Open, Vol: 5, ISSN: 2044-6055
Objectives Population ageing may result in increased comorbidity, functional dependence and poor quality of life. Mechanisms and pathophysiology underlying frailty have not been fully elucidated, thus absolute consensus on an operational definition for frailty is lacking. Frailty scores in the acute medical care setting have poor predictive power for clinically relevant outcomes. We explore the utility of frailty syndromes (as recommended by national guidelines) as a risk prediction model for the elderly in the acute care setting.Setting English Secondary Care emergency admissions to National Health Service (NHS) acute providers.Participants There were N=2 099 252 patients over 65 years with emergency admission to NHS acute providers from 01/01/2012 to 31/12/2012 included in the analysis.Primary and secondary outcome measures Outcomes investigated include inpatient mortality, 30-day emergency readmission and institutionalisation. We used pseudorandom numbers to split patients into train (60%) and test (40%). Receiver operator characteristic (ROC) curves and ordering the patients by deciles of predicted risk was used to assess model performance. Using English Hospital Episode Statistics (HES) data, we built multivariable logistic regression models with independent variables based on frailty syndromes (10th revision International Statistical Classification of Diseases, Injuries and Causes of Death (ICD-10) coding), demographics and previous hospital utilisation. Patients included were those >65 years with emergency admission to acute provider in England (2012).Results Frailty syndrome models exhibited ROC scores of 0.624–0.659 for inpatient mortality, 0.63–0.654 for institutionalisation and 0.57–0.63 for 30-day emergency readmission.Conclusions Frailty syndromes are a valid predictor of outcomes relevant to acute care. The models predictive power is in keeping with other scores in the literature, but is a simple, clinically relevant and potentiall
Papoutsi C, Reed JE, Marston C, et al., 2015, Patient and public views about the security and privacy of Electronic HealthRecords (EHRs) in the UK: results from a mixed methods study, BMC Medical Informatics and Decision Making, Vol: 15, ISSN: 1472-6947
BackgroundAlthough policy discourses frame integrated Electronic Health Records (EHRs) as essential for contemporary healthcare systems, increased information sharing often raises concerns among patients and the public. This paper examines patient and public views about the security and privacy of EHRs used for health provision, research and policy in the UK.MethodsSequential mixed methods study with a cross-sectional survey (in 2011) followed by focus group discussions (in 2012-2013). Survey participants (N = 5331) were recruited from primary and secondary care settings in West London (UK). Complete data for 2761 (51.8 %) participants were included in the final analysis for this paper. The survey results were discussed in 13 focus groups with people living with a range of different health conditions, and in 4 mixed focus groups with patients, health professionals and researchers (total N = 120). Qualitative data were analysed thematically.ResultsIn the survey, 79 % of participants reported that they would worry about the security of their record if this was part of a national EHR system and 71 % thought the National Health Service (NHS) was unable to guarantee EHR safety at the time this work was carried out. Almost half (47 %) responded that EHRs would be less secure compared with the way their health record was held at the time of the survey. Of those who reported being worried about EHR security, many would nevertheless support their development (55 %), while 12 % would not support national EHRs and a sizeable proportion (33 %) were undecided. There were also variations by age, ethnicity and education. In focus group discussions participants weighed up perceived benefits against potential security and privacy threats from wider sharing of information, as well as discussing other perceived risks: commercial exploitation, lack of accountability, data inaccuracies, prejudice and inequalities in health provision.ConclusionsPatient and pub
Pizzo E, Laverty AA, Phekoo KJ, et al., 2015, A retrospective analysis of the cost of hospitalizations for sickle cell disease with crisis in England, 2010/11, JOURNAL OF PUBLIC HEALTH, Vol: 37, Pages: 529-539, ISSN: 1741-3842
Angus DC, Barnato AE, Bell D, et al., 2015, A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators, Intensive Care Medicine, Vol: 41, Pages: 1549-1560, ISSN: 0342-4642
PurposeTo determine whether early goal-directed therapy (EGDT) reduces mortality compared with other resuscitation strategies for patients presenting to the emergency department (ED) with septic shock.MethodsUsing a search strategy of PubMed, EmBase and CENTRAL, we selected all relevant randomised clinical trials published from January 2000 to January 2015. We translated non-English papers and contacted authors as necessary. Our primary analysis generated a pooled odds ratio (OR) from a fixed-effect model. Sensitivity analyses explored the effect of including non-ED studies, adjusting for study quality, and conducting a random-effects model. Secondary outcomes included organ support and hospital and ICU length of stay.ResultsFrom 2395 initially eligible abstracts, five randomised clinical trials (n = 4735 patients) met all criteria and generally scored high for quality except for lack of blinding. There was no effect on the primary mortality outcome (EGDT: 23.2 % [495/2134] versus control: 22.4 % [582/2601]; pooled OR 1.01 [95 % CI 0.88–1.16], P = 0.9, with heterogeneity [I 2 = 57 %; P = 0.055]). The pooled estimate of 90-day mortality from the three recent multicentre studies (n = 4063) also showed no difference [pooled OR 0.99 (95 % CI 0.86–1.15), P = 0.93] with no heterogeneity (I 2 = 0.0 %; P = 0.97). EGDT increased vasopressor use (OR 1.25 [95 % CI 1.10–1.41]; P < 0.001) and ICU admission [OR 2.19 (95 % CI 1.82–2.65); P < 0.001]. Including six non-ED randomised trials increased heterogeneity (I 2 = 71 %; P < 0.001) but did not change overall results [pooled OR 0.94 (95 % CI 0.82 to 1.07); P = 0.33].ConclusionEGDT is not superior to usual care for ED patients with septic shock but is associated with increased utilisation of ICU resources.
Bauld RA, Patterson C, Naylor J, et al., 2015, Deep vein thrombosis and pulmonary embolism in the military patient, JOURNAL OF THE ROYAL ARMY MEDICAL CORPS, Vol: 161, Pages: 288-295, ISSN: 0035-8665
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- Citations: 3
Jubraj B, Marvin V, Poots A, et al., 2015, A pilot survey of junior doctors’ attitudes and awareness around medication review: Time to change our educational approach?, European Journal of Hospital Pharmacy: Science and Practice, Vol: 22, Pages: 243-248, ISSN: 2047-9964
Objectives Our aim was to explore junior doctors’ attitudes and awareness around concepts related to medication review, in order to find ways to change the culture for reviewing, altering and stopping inappropriate or unnecessary medicines. Having already demonstrated the value of team working with senior doctors and pharmacists and the use of a medication review tool, we are now looking to engage first year clinicians and undergraduates in the process.Method An online survey about medication review was distributed among all 42 foundation year one (FY1) doctors at the Chelsea and Westminster Hospital NHS Foundation Trust in November 2014. Descriptive statistics were used for analysis.Results Twenty doctors completed the survey (48%). Of those, 17 believed that it was the pharmacist's duty to review medicines; and 15 of 20 stated the general practitioner (GP). Sixteen of 20 stated that they would consult a senior doctor first before stopping medication. Eighteen of 20 considered the GP and consultant to be responsible for alterations, rather than themselves. Sixteen of 20 respondents were not aware of the availability of a medication review tool. Seventeen of 20 felt that more support from senior staff would help them become involved with medication review.Conclusions Junior doctors report feeling uncomfortable altering mediations without consulting a senior first. They appear to be building confidence with prescribing in their first year but not about the medication review process or questioning the drugs already prescribed. Consideration should be given to what we have termed a ‘bottom-up’ educational approach to provide early experience of and change the culture around medication review, to include the education of undergraduate and foundation doctors and pharmacists.
Green SA, Honeybourne E, Chalkley S, et al., 2015, A retrospective observational analysis to identify patient and treatment-related predictors of outcomes in a community mental health programme, BMJ Open, ISSN: 2044-6055
Mouncey PR, Osborn TM, Power GS, et al., 2015, Trial of early, goal-directed resuscitation for septic shock, New England Journal of Medicine, Vol: 372, Pages: 1301-1311, ISSN: 0028-4793
BACKGROUNDEarly, goal-directed therapy (EGDT) is recommended in international guidelines for the resuscitation of patients presenting with early septic shock. However, adoption has been limited, and uncertainty about its effectiveness remains.METHODSWe conducted a pragmatic randomized trial with an integrated cost-effectiveness analysis in 56 hospitals in England. Patients were randomly assigned to receive either EGDT (a 6-hour resuscitation protocol) or usual care. The primary clinical outcome was all-cause mortality at 90 days.RESULTSWe enrolled 1260 patients, with 630 assigned to EGDT and 630 to usual care. By 90 days, 184 of 623 patients (29.5%) in the EGDT group and 181 of 620 patients (29.2%) in the usual-care group had died (relative risk in the EGDT group, 1.01; 95% confidence interval [CI], 0.85 to 1.20; P=0.90), for an absolute risk reduction in the EGDT group of −0.3 percentage points (95% CI, −5.4 to 4.7). Increased treatment intensity in the EGDT group was indicated by increased use of intravenous fluids, vasoactive drugs, and red-cell transfusions and reflected by significantly worse organ-failure scores, more days receiving advanced cardiovascular support, and longer stays in the intensive care unit. There were no significant differences in any other secondary outcomes, including health-related quality of life, or in rates of serious adverse events. On average, EGDT increased costs, and the probability that it was cost-effective was below 20%.CONCLUSIONSIn patients with septic shock who were identified early and received intravenous antibiotics and adequate fluid resuscitation, hemodynamic management according to a strict EGDT protocol did not lead to an improvement in outcome. (Funded by the United Kingdom National Institute for Health Research Health Technology Assessment Programme; ProMISe Current Controlled Trials number, ISRCTN36307479. opens in new tab.)
Bell D, Jarvie A, 2015, Preventing 'where next?' Patients, professionals and learning from serious failings in care., J R Coll Physicians Edinb, Vol: 45, Pages: 4-8
Laverty AA, Elkin SL, Watt HC, et al., 2015, Impact of a COPD Discharge Care Bundle on Readmissions following Admission with Acute Exacerbation: Interrupted Time Series Analysis, PLOS ONE, Vol: 10, ISSN: 1932-6203
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- Citations: 28
Riordan F, Papoutsi C, Reed JE, et al., 2015, Patient and public attitudes towards informed consent models and levels of awareness of Electronic Health Records in the UK, International Journal of Medical Informatics, Vol: 84, Pages: 237-247, ISSN: 1386-5056
BackgroundThe development of Electronic Health Records (EHRs) forms an integral part of the information strategy for the National Health Service (NHS) in the UK, with the aim of facilitating health information exchange for patient care and secondary use, including research and healthcare planning. Implementing EHR systems requires an understanding of patient expectations for consent mechanisms and consideration of public awareness towards information sharing as might be made possible through integrated EHRs across primary and secondary health providers.ObjectivesTo explore levels of public awareness about EHRs and to examine attitudes towards different consent models with respect to sharing identifiable and de-identified records for healthcare provision, research and planning.MethodsA cross-sectional questionnaire survey was administered to adult patients and members of the public in primary and secondary care clinics in West London, UK in 2011. In total, 5331 individuals participated in the survey, and 3157 were included in the final analysis.ResultsThe majority (91%) of respondents expected to be explicitly asked for consent for their identifiable records to be accessed for health provision, research or planning. Half the respondents (49%) did not expect to be asked for consent before their de-identified records were accessed. Compared with White British respondents, those from all other ethnic groups were more likely to anticipate their permission would be obtained before their de-identified records were used. Of the study population, 59% reported already being aware of EHRs before the survey. Older respondents and individuals with complex patterns of interaction with healthcare services were more likely to report prior awareness of EHRs. Individuals self-identifying as belonging to ethnic groups other than White British, and those with lower educational qualifications were less likely to report being aware of EHRs than White British respondents and respondents w
Patterson CM, Nair A, Ahmed N, et al., 2015, Clinical outcomes when applying NICE guidance for the investigation of recent-onset chest pain to a rapid-access chest pain clinic population, HEART, Vol: 101, Pages: 113-118, ISSN: 1355-6037
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- Citations: 11
Cowling TE, Soljak MA, Bell D, et al., 2014, Emergency Hospital Admissions via Accident and Emergency Departments in England: Time Trend, Conceptual Framework and Policy Implications, Journal of the Royal Society of Medicine, Vol: 107, Pages: 432-438, ISSN: 1758-1095
Issen LA, Reed JE, McNicholas C, et al., 2014, Designing quality improvement initiatives: the action effect method, a structured approach to identifying and articulating programme theory, BMJ Quality & Safety, ISSN: 2044-5423
Background The identification and articulation of programme theory can support effective design, execution and evaluation of quality improvement (QI) initiatives. Programme theory includes an agreed aim, potential interventions to achieve this aim, anticipated cause/effect relationships between the interventions and the aim and measures to monitor improvement. This paper outlines the approach used in a research and improvement programme to support QI initiatives in identifying and articulating programme theory: the action effect method.Background to method development Building on a previously used QI method, the driver diagram, the action effect method was developed using co-design and iteration over four annual rounds of improvement initiatives. This resulted in a specification of the elements required to fully articulate the programme theory of a QI initiative.The action effect method The action effect method is a systematic and structured process to identify and articulate a QI initiative's programme theory. The method connects potential interventions and implementation activities with an overall improvement aim through a diagrammatic representation of hypothesised and evidenced cause/effect relationships. Measure concepts, in terms of service delivery and patient and system outcomes, are identified to support evaluation.Discussion and conclusions The action effect method provides a framework to guide the execution and evaluation of a QI initiative, a focal point for other QI methods and a communication tool to engage stakeholders. A clear definition of what constitutes a well-articulated programme theory is provided to guide the use of the method and assessment of the fidelity of its application.
Barber S, Thakkar K, Marvin V, et al., 2014, Evaluation of my medication passport: a patient-completed aide-memoire designed by patients, for patients, to help towards medicines optimisation, BMJ Open, Vol: 4, ISSN: 2044-6055
Objectives A passport-sized booklet, designed by patients for patients to record details about their medicines, has been developed as part of a wider project focusing on improving prescribing in the elderly (‘ImPE’). We undertook an evaluation of ‘My Medication Passport’ to gain an understanding of its value to patients and how it may be used in communications about medicines.Setting The Passport was launched in secondary care with the initial users being older people discharged home after an admission to one of the four North West London participating Trusts. The uptake subsequently spread to other (community) locations and other age groups.Participants We recruited more than 200 patients from a cohort who had been given a passport as part of the improvement projects at one of four sites. Of them, 63% (133) completed the structured telephone questionnaire including 27% for whom English was not their first language. Approximately half of the respondents were male and 40% were over 70 years of age.Results More than half of the respondents had found their medication passport useful or helpful in some way; 42% through sharing details from it with others (most frequently family, carer or doctor) or using it as a platform for conversations with healthcare professionals. One-third of those questioned carried the passport with them at all times.Conclusions My Medication Passport has been positively evaluated; we have a better understanding of how it is used by patients, what they are recording and how it can be an aid to dialogue about medicines with family, carers and healthcare professionals. Further development and spread is underway including an App for smartphones that will be subject to wider evaluation to include feedback from clinicians.
Bottle A, Aylin P, Bell D, 2014, Effect of the readmission primary diagnosis and time interval in heart failure patients: analysis of English administrative data, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 16, Pages: 846-853, ISSN: 1388-9842
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- Citations: 25
Doyle C, Jones M, Bell D, 2014, Monitoring patient flow in emergency departments: the use of scatterplots versus time-based measures to assess patient flow in A&E, EUROPEAN JOURNAL OF EMERGENCY MEDICINE, Vol: 21, Pages: 291-295, ISSN: 0969-9546
Lovett DA, Poots AJ, Clements JTC, et al., 2014, Using geographical information systems and cartograms as a health service quality improvement tool, Spatial and Spatio-temporal Epidemiology, Vol: 10, Pages: 67-74, ISSN: 1877-5845
Introduction: Disease prevalence can be spatially analysed to provide support for service implementation and health care planning, these analyses often display geographic variation. A key challenge is to communicate these results to decision makers, with variable levels of Geographic Information Systems (GIS) knowledge, in a way that represents the data and allows for comprehension. The present research describes the combination of established GIS methods and software tools to produce a novel technique of visualising disease admissions and to help prevent misinterpretation of data and less optimal decision making. The aim of this paper is to provide a tool that supports the ability of decision makers and service teams within health care settings to develop services more efficiently and better cater to the population; this tool has the advantage of information on the position of populations, the size of populations and the severity of disease. Methods: A standard choropleth of the study region, London, is used to visualise total emergency admission values for Chronic Obstructive Pulmonary Disease and bronchiectasis using ESRI's ArcGIS software. Population estimates of the Lower Super Output Areas (LSOAs) are then used with the ScapeToad cartogram software tool, with the aim of visualising geography at uniform population density. An interpolation surface, in this case ArcGIS' spline tool, allows the creation of a smooth surface over the LSOA centroids for admission values on both standard and cartogram geographies. The final product of this research is the novel Cartogram Interpolation Surface (CartIS). Results: The method provides a series of outputs culminating in the CartIS, applying an interpolation surface to a uniform population density. The cartogram effectively equalises the population density to remove visual bias from areas with a smaller population, while maintaining contiguous borders. CartIS decreases the number of extreme positive values not present in t
Soljak M, Calderon-Larranaga A, Bell D, et al., 2014, Authors' response to: primary healthcare factors and hospital admission rates for COPD: no association, THORAX, Vol: 69, Pages: 590-U127, ISSN: 0040-6376
Calderon-Larranaga A, Soljak M, Cecil E, et al., 2014, Does higher quality of primary healthcare reduce hospital admissions for diabetes complications? A national observational study, DIABETIC MEDICINE, Vol: 31, Pages: 657-665, ISSN: 0742-3071
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- Citations: 18
Curcin V, Woodcock T, Poots A, et al., 2014, Model-driven approach to data collection and reporting for quality improvement, Journal of Biomedical Informatics, Vol: 52, Pages: 151-162, ISSN: 1532-0480
Continuous data collection and analysis have been shown essential to achieving improvement in healthcare. However, the data required for local improvement initiatives are often not readily available from hospital Electronic Health Record (EHR) systems or not routinely collected. Furthermore, improvement teams are often restricted in time and funding thus requiring inexpensive and rapid tools to support their work. Hence, the informatics challenge in healthcare local improvement initiatives consists of providing a mechanism for rapid modelling of the local domain by non-informatics experts, including performance metric definitions, and grounded in established improvement techniques. We investigate the feasibility of a model-driven software approach to address this challenge, whereby an improvement data model designed by a team is used to automatically generate required electronic data collection instruments and reporting tools. To that goal, we have designed a generic Improvement Data Model (IDM) to capture the data items and quality measures relevant to the project, and constructed Web Improvement Support in Healthcare (WISH), a prototype tool that takes user-generated IDM models and creates a data schema, data collection web interfaces, and a set of live reports, based on Statistical Process Control (SPC) for use by improvement teams. The software has been successfully used in over 50 improvement projects, with more than 700 users. We present in detail the experiences of one of those initiatives, Chronic Obstructive Pulmonary Disease project in Northwest London hospitals. The specific challenges of improvement in healthcare are analysed and the benefits and limitations of the approach are discussed.
McNicholas C, Bell D, Reed J, 2014, Opening the "Black Box" of Plan-Do-Study-Act Cycles: Achieving a Scientific Yet Pragmatic Approach to Improving Patient Care, Publisher: BMJ PUBLISHING GROUP, Pages: 352-352, ISSN: 2044-5415
Taylor MJ, McNicholas C, Nicolay C, et al., 2014, Systematic review of the application of the plan-do-study-act method to improve quality in healthcare, BMJ QUALITY & SAFETY, Vol: 23, Pages: 290-298, ISSN: 2044-5415
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- Citations: 805
Poots A, Green SA, Honeybourne E, et al., 2014, Improving mental health outcomes: achieving equity through quality improvement, International Journal for Quality in Health Care, Vol: 46
Objective To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative.Design Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control.Setting A psychological therapy service in Westminster, London, UK.Participants People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012.Intervention(s) Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks.Main Outcome Measure(s) (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator.Results Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), compared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low, medium and high deprivation areas attained similar changes in depression score (ΔPHQ9: M = −6.60, SD = 6.41). Similar proportions of patients achieved the key performance indicator across initiative phase and deprivation categories.Conclusions QI methods improved access to mental health services; this paper finds no evidence for differences in clinical outcomes in patients, regardless of level of deprivation, interpreted as no evidence of inequity in the service with respect to this outcome.
Jones SE, Green SA, Clark AL, et al., 2014, Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence, THORAX, Vol: 69, Pages: 181-182, ISSN: 0040-6376
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- Citations: 123
Howe C, Bell D, 2014, Improving engagement in a quality collaborative, British Journal of Health Care Management, Vol: 20, Pages: 528-535, ISSN: 1358-0574
The increasing financial constraints facing the NHS require that services be efficient and effective. Attempts to improve quality of care and services must also be efficient and effective. Quality improvement collaboratives (QICs) improve evidence-based practice within limited timescales by bringing teams together and providing 'change agent' support to follow a defined approach. The efficacy of QICs has yet to be demonstrated and little has been reported on how best to manage them efficiently. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Northwest London (CLAHRC NWL) QIC works with NHS-based teams on a range of clinical topics. An assessment framework was developed that allowed programme managers to review teams' use of the QIC's approach and identify and address engagement problems. This study describes the application of this assessment framework to 49 CLAHRC NWL projects between 2009 and 2013. Changes made to address engagement problems included changes to collaborative learning approaches and changes to specific collaborative tools and method such as redesign or simplification of the tool or approach. The results show increasing engagement scores over successive rounds of projects. By reviewing and acting on issues regarding teams' engagement, managers can make changes to improve implementation fidelity, increasing the potential value of the programme and the robustness of any evaluation.
Bell D, 2014, From the President., J R Coll Physicians Edinb, Vol: 44, Pages: 266-267
Lennox L, Green S, Howe C, et al., 2014, Identifying the challenges and facilitators of implementing a COPD care bundle., BMJ Open Respir Res, Vol: 1, ISSN: 2052-4439
BACKGROUND: Care bundles have been shown to improve outcomes, reduce hospital readmissions and reduce length of hospital stay; therefore increasing the speed of uptake and delivery of care bundles should be a priority in order to deliver more timely improvements and consistent high-quality care. Previous studies have detailed the difficulties of obtaining full compliance to bundle elements but few have described the underlying reasons for this. In order to improve future implementation this paper investigates the challenges encountered by clinical teams implementing a chronic obstructive pulmonary disease (COPD) care bundle and describes actions taken to overcome these challenges. METHODS: An initial retrospective documentary analysis of data from seven clinical implementation teams was undertaken to review the challenges faced by the clinical teams. Three focus groups with healthcare professionals and managers explored solutions to these challenges developed during the project. RESULTS: Documentary analysis identified 28 challenges which directly impacted implementation of the COPD care bundle within five themes; staffing, infrastructure, process, use of improvement methodology and patient and public involvement. Focus groups revealed that the five most significant challenges for all groups were: staff too busy, staff shortages, lack of staff engagement, added workload of the bundle and patient coding issues. The participants shared facilitating factors used to overcome issues including: shifting perceptions to improve engagement, further education sessions to increase staff participation and gaining buy-in from managers through payment frameworks. CONCLUSIONS: Maximising the impact of a care bundle relies on its successful and timely implementation. Teams implementing the COPD care bundle encountered challenges that were common to all teams and sites. Understanding and learning from the challenges faced by previous endeavours and identifying the facilitators to ov
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