Publications
255 results found
Sharma U, Reed J, Doyle C, et al., 2012, Challenges in evaluating telehealth through RCT-the problem of randomization, QUALITY OF LIFE THROUGH QUALITY OF INFORMATION, Vol: 180, Pages: 323-327, ISSN: 0926-9630
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- Citations: 6
Austen C, Patterson C, Poots A, et al., 2012, Using a Local Early Warning Scoring System as a Model for the Introduction of a National System, Acute Medicine, Vol: 11, Pages: 66-73
BackgroundChelsea and Westminster Hospital introduced the Chelsea Early Warning Score (CEWS) in 2007 to aid the recognition of acutely unwell patients. The Royal College of Physicians subsequently recommended a National Early Warning Score (NEWS) for implementation across the NHS. The aim of this study was to evaluate local adherence to CEWS to identify potential obstacles to the consistent implementation of NEWS.MethodEmergency Department (ED) and Acute Assessment Unit (AAU) notes were retrospectively reviewed for a convenience sample of 102 patients admitted to the AAU. Outcome measures were completeness of documentation of CEWS parameters, documentation and accuracy of aggregate CEWS scores. Aggregate NEWS scores were calculated from the documented observations and the calculated CEWS and NEWS scores were compared.ResultsPhysiological observations were documented for all patients attending the ED and AAU. Heart rate, blood pressure, respiratory rate, oxygen saturation and conscious level were documented in over 95% of ED and AAU patients. Urine output was recorded for only 48% of ED and 69% of AAU patients. Aggregate CEWS scores were documented for 66% of ED and 84% of AAU patients. These were calculated accurately in 73% of ED and 79% of AAU patients. Calculation errors were eleven times more likely to result in under-scoring than over-scoring. NEWS scores were significantly higher than CEWS for the same observations and would have resulted in a 71% increase in patients requiring escalation of care in the ED and a 116% increase in AAU.ConclusionConcerns highlighted with CEWS were the incomplete and inaccurate recording of aggregate scores, with underscoring resulting in the potential failure to recognise deteriorating patients. It is anticipated that NEWS will be accompanied by standardised documentation and training across the NHS which will support more complete and accurate recording of physiological data. Furthermore, NEWS appears from this study to be more
Thomson AD, Guerrini I, Bell D, et al., 2012, Alcohol-related brain damage: report from a Medical Council on Alcohol Symposium, June 2010., Alcohol Alcohol, Vol: 47, Pages: 84-91
Nicol E, Bryan L, Woodcock T, et al., 2012, RE: Letter to the Editor regarding 'The effect of applying NICE guidelines for the investigation of stable chest pain on out-patient cardiac services in the UK', QJM
Hopkinson NS, Englebretsen C, Cooley N, et al., 2011, Designing and implementing a COPD discharge care bundle, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ Publishing Group, Pages: A108-A108, ISSN: 0040-6376
Soljak M, Calderon-Larranaga A, Sharma P, et al., 2011, Does higher quality primary health care reduce stroke admissions? a national cross-sectional study, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 61, ISSN: 0960-1643
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- Citations: 34
Patterson C, Maclean F, Bell C, et al., 2011, Early warning systems in the UK: variation in content and implementation strategy has implications for a NHS early warning system, CLINICAL MEDICINE, Vol: 11, Pages: 424-427, ISSN: 1470-2118
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- Citations: 28
Smith SM, Bell D, Hopkinson NS, et al., 2011, A review of discharge planning for people with chronic obstructive pulmonary disease at high risk for readmission, CLINICAL MEDICINE, Vol: 11, Pages: 510-511, ISSN: 1470-2118
Subbe CP, Bottle RA, Bell D, 2011, Acute Medicine: Triage, timing and teaching in the context of medical emergency admissions, EUROPEAN JOURNAL OF INTERNAL MEDICINE, Vol: 22, Pages: 339-343, ISSN: 0953-6205
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- Citations: 7
Vaughan L, McAlister G, Bell D, 2011, 'August is always a nightmare': results of the Royal College of Physicians of Edinburgh and Society of Acute Medicine August transition survey, CLINICAL MEDICINE, Vol: 11, Pages: 322-326, ISSN: 1470-2118
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- Citations: 29
Reed JE, Marshall M, Bell D, 2011, Centres for Healthcare Improvement: solution to the quality problem, Journal of the Royal Society of Medicine, Vol: 104, Pages: 276-277, ISSN: 1758-1095
Nicol E, Bryan L, Woodcock T, et al., 2011, The effect of applying NICE guidelines for the investigation of stable chest pain on out-patient cardiac services in the UK, QJM
Patterson C, Nicol E, Bryan L, et al., 2011, 126 The impact of nice guidelines for the investigation of chest pain on outpatient cardiology services in the UK, Publisher: heart.bmj.com
Calderón-Larrañaga A, Carney L, Soljak M, et al., 2011, Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross-sectional study, Vol: 66, Pages: 191-196
Background Hospital admission rates for chronic obstructive pulmonary disease (COPD) are known to be strongly associated with population factors. Primary care services may also affect admission rates, but there is little direct supporting evidence.Objectives To determine associations between population characteristics, diagnosed and undiagnosed COPD prevalence, primary healthcare factors, and COPD admission rates primary care trust (PCT) and general practice levels in England.Design, setting, and participants National cross-sectional study (53,676,051 patients in 8,064 practices in 152 English PCTs), combining data on hospital admissions, populations, primary healthcare staffing, clinical practice quality and access, and prevalence.Main outcome measures Directly and indirectly standardised hospital admission rates for COPD, for PCT and practice populations.Results Mean annual COPD admission rates per 100 000 population varied from 124.7 to 646.5 for PCTs and 0.0 to 2175.2 for practices. Admissions were strongly associated with population deprivation at both levels. In a practice-level multivariate Poisson regression, registered and undiagnosed COPD prevalence, smoking prevalence and deprivation were risk factors for admission (p<0.001), while healthcare factors- influenza immunisation, patient-reported access to consultations within two days, and primary care staffing, were protective (p<0.05).Conclusion Associations of COPD admission rates with deprivation, primary healthcare access and supply highlight the need for adequate services in deprived areas. An association between admission rates and undiagnosed COPD prevalence suggests that case-finding strategies should be evaluated. Of the COPD clinical quality indicators, only influenza immunisation was associated with reduced admission rates. Patients' experience of access to primary care may also be clinically important.
Bell D, Poots AJ, Woodcock T, 2011, Commenting on Of Targets, Policy and Planning
Short analysis of 4 hour A&E waiting times
Bell D, 2010, The 4 hour emergency access target- a patient journey, Acute Medicine, Vol: 9, Pages: 137-138, ISSN: 1747-4884
McCallum L, Bell D, Sturgess I, et al., 2010, National ambulatory emergency care survey: current level of adoption and considerations for the future, CLINICAL MEDICINE, Vol: 10, Pages: 555-559, ISSN: 1470-2118
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- Citations: 6
Doyle C, Reed J, Woodcock T, et al., 2010, Understanding what matters to patients – identifying key patients' perceptions of quality, JRSM open, Vol: 1, ISSN: 2054-2704
Objectives To demonstrate a statistical method to enable the identification of key drivers of quality from a patient perspective that can be used by service providers to help drive improvement. Design Cross-tabulation, Chi-square analysis and Cramer's V calculation using SPSS software of NHS Inpatient Surveys 2006 and 2007. Setting The NHS Inpatient Survey is a standardized survey designed by the Picker Institute conducted on a sample of patients across all acute care hospital trusts in England. Participants The surveys (available from the UK Data Archive) provide anonymized patient data for over 77,000 patients in 2006 and 72,000 patients in 2007. Main outcome measures Cramer's V score testing associations between patient ratings on multiple components of care and ratings on the overall quality of care. Results Of the 58 questions analysed, some questions correlate more strongly with overall satisfaction of care than others and there is strong agreement of results over the two years. Of the top 20 rated components, communication (both between professionals and between professionals and patients) and trust engendered by that communication is a recurring theme. Conclusions Hospital trusts are required to develop quality indicators and collate detailed feedback from patients in addition to the annual inpatient survey to measure these. To make best use of resources, additional data collection should focus on those aspects of care of most importance to patients locally. This analysis demonstrates a statistical technique that can help to identify such priority areas by showing those aspects of care most strongly associated with the overall rating of care. The analysis uses national level data to demonstrate how this can be achieved. This shows the importance to patients of being treated with dignity and respect, and good communication between staff and between staff and patients.
Wu T-Y, Jen M-H, Bottle A, et al., 2010, Ten-year trends in hospital admissions for adverse drug reactions in England 1999-2009, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 103, Pages: 239-250, ISSN: 0141-0768
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- Citations: 110
Aylin P, Yunus A, Bottle A, et al., 2010, Weekend mortality for emergency admissions. A large, multicentre study, QUALITY & SAFETY IN HEALTH CARE, Vol: 19, Pages: 213-217, ISSN: 1475-3898
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- Citations: 191
Doyle C, Reed J, Bell D, 2010, Response to 'Transforming healthcare ... ', QUALITY & SAFETY IN HEALTH CARE, Vol: 19, Pages: 159-159, ISSN: 1475-3898
Salisbury C, Bell D, 2010, Access to urgent health care, EMERGENCY MEDICINE JOURNAL, Vol: 27, Pages: 186-188, ISSN: 1472-0205
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- Citations: 4
Bell D, Mason S, 2010, Secondary care and changing the face of emergency care, EMERGENCY MEDICINE JOURNAL, Vol: 27, Pages: 189-190, ISSN: 1472-0205
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- Citations: 1
Reade MC, Huang DT, Bell D, et al., 2010, Variability in management of early severe sepsis, EMERGENCY MEDICINE JOURNAL, Vol: 27, Pages: 110-115, ISSN: 1472-0205
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- Citations: 59
Mason AM, Dingle NJ, Knottenbelt WJ, et al., 2010, Modelling infection spread using location tracking, International Journal of Healthcare Technology and Management, Vol: 11, Pages: 442-461, ISSN: 1368-2156
The precision of location tracking technology has improved greatly over the last few decades. We aim to show that by tracking the locations of individuals in a closed environment, it is now possible to record the nature and frequency of interactions between them. Further, that it is possible to use such data to predict the way in which an infection will spread throughout such a population, given parameters such as transmission and recovery rates. We accordingly present a software package that is capable of recording and then replaying location data provided by a high-precision location tracking system. The software then employs a combination of SIR modelling and the epidemiological technique of contact tracing in order to predict the spread of an infection. We use this software to conduct a number of experiments using a sample data set, and compare the SIR graphs generated from these to similar graphs generated using the traditional SIR differential equations. Copyright © 2010 Inderscience Enterprises Ltd.
Bryan L, Nicol E, Duncan M, et al., 2010, The consequences of applying NICE chest pain guidelines to an acute medical population: a role for cardiac computed tomography, QJM
Ward D, Potter J, Ingham J, et al., 2009, Acute medical care. The right person, in the right setting - first time: how does practice match the report recommendations?, CLINICAL MEDICINE, Vol: 9, Pages: 553-556, ISSN: 1470-2118
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- Citations: 16
Scott I, Vaughan L, Bell D, 2009, Effectiveness of acute medical units in hospitals: a systematic review, INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, Vol: 21, Pages: 397-407, ISSN: 1353-4505
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- Citations: 134
Ward D, Murch N, Agarwal G, et al., 2009, A multi-centre survey of inpatient pharmacological management strategies for alcohol withdrawal, QJM-AN INTERNATIONAL JOURNAL OF MEDICINE, Vol: 102, Pages: 773-780, ISSN: 1460-2725
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- Citations: 21
Baker EH, Bell D, 2009, Blood glucose: of emerging importance in COPD exacerbations, THORAX, Vol: 64, Pages: 830-832, ISSN: 0040-6376
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- Citations: 17
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