15 results found
Rajendran A, Pannick S, Thomas-Gibson S, et al., 2020, Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy, COLORECTAL DISEASE, Vol: 22, Pages: 1085-1100, ISSN: 1462-8910
Pannick S, van Ree K, Cohen P, et al., 2019, Occult gastrointestinal bleeding: two eyes are better than one, GUT, Vol: 68, Pages: 1605-+, ISSN: 0017-5749
Pannick S, Archer S, Long S, et al., 2019, What matters to medical ward patients, and do we measure it? A qualitative comparison of patient priorities and current practice in quality measurement, on UK NHS medical wards, BMJ Open, Vol: 9, ISSN: 2044-6055
Objectives To compare the quality metrics selected for public display on medical wards to patients’ and carers’ expressed quality priorities.Methods Multimodal qualitative evaluation of general medical wards and semi-structured interviews.Setting UK tertiary National Health Service (public) hospital.Participants Fourteen patients and carers on acute medical wards and geriatric wards.Results Quality metrics on public display evaluated hand hygiene, hospital-acquired infections, nurse staffing, pressure ulcers, falls and patient feedback. The intended audience for these metrics was unclear, and the displays gave no indication as to whether performance was improving or worsening. Interviews identified three perceived key components of high-quality ward care: communication, staff attitudes and hygiene. These aligned poorly with the priorities on display. Suboptimal performance reporting had the potential to reduce patients’ trust in their medical teams. More philosophically, patients’ and carers’ ongoing experiences of care would override any other evaluation, and they felt little need for measures relating to previous performance. The display of performance reports only served to emphasise patients’ and carers’ lack of control in this inpatient setting.Conclusions There is a gap between general medical inpatients’ care priorities and the aspects of care that are publicly reported. Patients and carers do not act as ‘informed choosers’ of healthcare in the inpatient setting, and tokenistic quality measurement may have unintended consequences.
Pannick SAJ, Athanasiou T, Long SJ, et al., 2017, Translating staff experience into organisational improvement: the HEADS-UP stepped wedge, cluster controlled, non-randomised trial, BMJ Open, Vol: 7, ISSN: 2044-6055
Objectives:Frontline insights into care delivery correlate with patients’ clinical outcomes. These outcomes might be improved through near-real time identification and mitigation of staff concerns. We evaluated the effects of a prospective frontline surveillance system on patient and team outcomes.Design:Prospective, stepped wedge, non-randomised, cluster controlled trial; pre-specified per protocol analysis for high fidelity intervention delivery.Participants:Seven interdisciplinary medical ward teams, from two hospitals in the United Kingdom.Intervention:Prospective clinical team surveillance (PCTS): structured daily interdisciplinary briefings to capture staff concerns, with organisational facilitation and feedback.Main measures:The primary outcome was excess length of stay (eLOS): an admission more than 24 hours longer than the local average for comparable patients. Secondary outcomes included safety and teamwork climates, and incident reporting. Mixed-effects models adjusted for time effects, age, comorbidity, palliation status, and ward admissions. Safety and teamwork climates were measured with the Safety Attitudes Questionnaire. High fidelity PCTS delivery comprised high engagement and high briefing frequency.Results:Implementation fidelity was variable, both in briefing frequency (median 80% working days/month, interquartile range 65-90%), and engagement (median 70 issues/ward/month, interquartile range 34-113). 1714/6518 (26.3%) intervention admissions had eLOS vs 1279/4927 (26.0%) control admissions, an absolute risk increase of 0.3%. PCTS increased eLOS in the adjusted intention-to-treat model (OR 1.32, 95% CI 1.10-1.58, p=0.003). Conversely, high fidelity PCTS reduced eLOS (OR 0.79, 95% CI 0.67-0.94, p=0.006). High fidelity PCTS also increased total, high yield, and non-nurse incident reports (incidence rate ratios 1.28-1.79, all p<0.002). Sustained PCTS significantly improved safety and teamwork climates over time.Conclusions:This study highli
Pannick SAJ, Archer S, Johnston MJ, et al., 2017, Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards, BMJ Open, Vol: 7, ISSN: 2044-6055
ObjectivesTo understand how frontline reports of day-to-day care failings might be better translated into improvement.DesignQualitative evaluation of an interdisciplinary team intervention to capitalise on the frontline experience of care delivery. Prospective clinical team surveillance (PCTS) involved structured interdisciplinary briefings to capture challenges in care delivery, facilitated organisational escalation of the issues they identified, and feedback. Eighteen months of ethnography and two focus groups were conducted with staff taking part in a trial of PCTS.ResultsPCTS fostered psychological safety – a confidence that the team would not embarrass or punish those who speak up. This was complemented by a hard edge of accountability, whereby team members would regulate their own behaviour in anticipation of future briefings. Frontline concerns were triaged to managers, or resolved autonomously by ward teams, reversing what had been well-established normalisations of deviance. Junior clinicians found a degree of catharsis in airing their concerns, and their teams became more proactive in addressing improvement opportunities. PCTS generated tangible organisational changes, and enabled managers to make a convincing case for investment. However, briefings were constrained by the need to preserve professional credibility, and the relative comfort afforded by the avoidance of accountability. At higher organisational levels, frontline concerns were subject to competition with other priorities, and their resolution was limited by the scale of the challenges they described.ConclusionsProspective safety strategies relying on staff-volunteered data do approximate the realities of frontline care, but still produce acceptable, negotiated accounts, subject to the many interdisciplinary tensions that characterise ward work. Nonetheless, they give managers access to these accounts, and support frontline staff to make incremental changes in their daily work. These are
Pannick S, Sevdalis N, Athanasiou T, 2015, Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities, BMJ Quality & Safety, Vol: 25, Pages: 716-725, ISSN: 2044-5423
Despite taking advantage of established learning from other industries, quality improvementinitiatives in healthcare may struggle to outperform secular trends. The reasons for this arerarely explored in detail, and are often attributed merely to difficulties in engaging cliniciansin quality improvement work. In a narrative review of the literature, we argue that this focuson clinicians, at the relative expense of managerial staff, has proven counterproductive.Clinical engagement is not a universal challenge; moreover, there is evidence that managers– particularly middle managers – also have a role to play in quality improvement. Yetmanagerial participation in quality improvement interventions is often assumed, rather thanproven. We identify specific factors that influence the coordination of frontline staff andmanagers in quality improvement, and integrate these factors into a novel model: the modelof alignment. We use this model to explore the implementation of an interdisciplinaryintervention in a recent trial, describing different participation incentives and barriers fordifferent staff groups. The extent to which clinical and managerial interests align may be animportant determinant of the ultimate success of quality improvement interventions.
Pannick S, Beveridge I, Ashrafian H, et al., 2015, A stepped wedge, cluster controlled trial of an intervention to improve safety and quality on medical wards: the HEADS-UP study protocol, BMJ Open, Vol: 5, ISSN: 2044-6055
Introduction The majority of preventable deaths in healthcare are due to errors on general wards. Staff perceptions of safety correlate with patient survival, but effectively translating ward teams’ concerns into tangibly improved care remains problematic. The Hospital Event Analysis Describing Significant Unanticipated Problems (HEADS-UP) trial evaluates a structured, multidisciplinary team briefing, capturing safety threats and adverse events, with rapid feedback to clinicians and service managers. This is the first study to rigorously assess a simpler intervention for general medical units, alongside an implementation model applicable to routine clinical practice.Methods/analysis 7 wards from 2 hospitals will progressively incorporate the intervention into daily practice over 14 months. Wards will adopt HEADS-UP in a pragmatic sequence, guided by local clinical enthusiasm. Initial implementation will be facilitated by a research lead, but rapidly delegated to clinical teams. The primary outcome is excess length of stay (a surplus stay of 24 h or more, compared to peer institutions’ Healthcare Resource Groups-predicted length of stay). Secondary outcomes are 30-day readmission or excess length of stay; in-hospital death or death/readmission within 30 days; healthcare-acquired infections; processes of escalation of care; use of traditional incident-reporting systems; and patient safety and teamwork climates. HEADS-UP will be analysed as a stepped wedge cluster controlled trial. With 7840 patients, using best and worst case predictions, the study would achieve between 75% and 100% power to detect a 2–14% absolute risk reduction in excess length of stay (two-sided p<0.05). Regression analysis will use generalised linear mixed models or generalised estimating equations, and a time-to-event regression model. A qualitative analysis will evaluate facilitators and barriers to HEADS-UP implementation and impact.Ethics and dissemination Participating in
Pannick S, Davis R, ashrafian H, et al., 2015, Effects of interdisciplinary team care interventions on general medical wards. A systematic review., JAMA Internal Medicine, Vol: 175, Pages: 1288-1298, ISSN: 2168-6114
Importance Improving the quality of health care for general medical patients is a priority, but the organization of general medical ward care receives less scrutiny than the management of specific diseases. Optimizing teams’ performance improves patient outcomes in other settings, and interdisciplinary practice is a major target for improvement efforts. However, the effect of interdisciplinary team interventions on general medical ward care has not been systematically reviewed.Objectives To describe the range of objective patient outcomes used in studies of general medical ward interdisciplinary team care, and to evaluate the performance of interdisciplinary interventions against them.Evidence Review We searched EMBASE, MEDLINE, and PsycINFO from January 1, 1998, through December 31, 2013, for interdisciplinary team care interventions in adult general medical wards using an objective patient outcome measure. Reference lists of included articles were also searched. The last search was conducted on January 29, 2014, and the narrative and statistical analysis was conducted through December 1, 2014. Study quality was assessed using the Cochrane Effective Practice and Organization of Care group’s tool.Findings Thirty of 6934 articles met the selection criteria. The studies included 66 548 patients, with a mean age of 63 years. Nineteen of 30 (63%) studies reported length of stay, readmission, or mortality rate as their primary outcome, or did not specify the primacy of their outcomes. The most commonly reported objective patient outcomes were length of stay (23 of 30 [77%]), complications of care (10 of 30 [33%]), in-hospital mortality rate (8 of 30 [27%]), and 30-day readmission rate (8 of 30 [27%]). Of 23 interventions, 16 (70%) had no effect on length of stay, 12 of 15 (80%) did not reduce readmissions, and 14 of 15 (93%) did not affect mortality. Five of 10 (50%) interventions reduced complications of care. In an exploratory quantitative analysis, the
Pannick S, Beveridge I, Sevdalis N, 2015, HEADS-UP: a novel intervention to improve clinical outcomes with daily, team-based risk recognition., Medicine 2015: Royal College of Physicians Annual Conference 2015, ISSN: 1470-2118
Pannick S, Beveridge I, Wachter RM, et al., 2014, Improving the quality and safety of care on the medical ward: A review and synthesis of the evidence base, European Journal of Internal Medicine, ISSN: 0953-6205
Abstract Despite its place at the heart of inpatient medicine, the evidence base underpinning the effective delivery of medical ward care is highly fragmented. Clinicians familiar with the selection of evidence-supported treatments for specific diseases may be less aware of the evolving literature surrounding the organisation of care on the medical ward. This review is the first synthesis of that disparate literature. An iterative search identified relevant publications, using terms pertaining to medical ward environments, and objective and subjective patient outcomes. Articles (including reviews) were selected on the basis of their focus on medical wards, and their relevance to the quality and safety of ward-based care. Responses to medical ward failings are grouped into five common themes: staffing levels and team composition; interdisciplinary communication and collaboration; standardisation of care; early recognition and treatment of the deteriorating patient; and local safety climate. Interventions in these categories are likely to improve the quality and safety of care in medical wards, although the evidence supporting them is constrained by methodological limitations and inadequate investment in multicentre trials. Nonetheless, with infrequent opportunities to redefine their services, institutions are increasingly adopting multifaceted strategies that encompass groups of these themes. As the literature on the quality of inpatient care moves beyond its initial focus on the intensive care unit and operating theatre, physicians should be mindful of opportunities to incorporate evidence-based practice at a ward level.
Adelson M, Pannick S, East J, et al., 2014, UK colorectal cancer patients are inadequately assessed for Lynch syndrome, Frontline Gastroenterology, Vol: 5, Pages: 31-35
Objective To establish whether colorectal cancer patients in two centres in the UK are screened appropriately for Lynch syndrome, in accordance with current international guidance.Design Patients newly diagnosed with colorectal cancer over an 18-month period were identified from the UK National Bowel Cancer Audit Programme. Their records and management were reviewed retrospectively.Setting Two university teaching hospitals, Imperial College Healthcare and Oxford Radcliffe Hospitals NHS Trusts.Outcomes These measured whether patients were screened for Lynch syndrome—and the outcome of that evaluation, if it took place—were assessed. The age, tumour location and family history of screened patients were compared to those of unscreened patients.Results Five hundred and fifty three patients with newly diagnosed colorectal cancer were identified. Of these, 97 (17.5%) satisfied the revised Bethesda criteria, and should have undergone further assessment. There was no evidence that those guidelines had been contemporaneously applied to any patient. In practice, only 22 of the 97 (22.7%) eligible patients underwent evaluation. The results for 14 of those 22 (63.6%) supported a diagnosis of Lynch syndrome, but only nine of the 14 (64.3%) were referred for formal mismatch repair gene testing. No factors reliably predicted whether or not a patient would undergo Lynch syndrome screening.Conclusions Colorectal teams in the UK do not follow international guidance identifying the patients who should be screened for Lynch syndrome. Patients and their families are consequently excluded from programmes reducing colorectal cancer incidence and mortality. Multidisciplinary teams should work with their local genetics services to develop reliable algorithms for patient screening and referral.
Pannick S, Chaggar S, Dehn Lunn A, et al., 2013, Microscopic colitis is expensive to diagnose: an analysis of the utility of random colonic biopsies, British Society of Gastroenterology annual meeting 2013
Pannick S, Chaggar S, Lunn AD, et al., 2013, MICROSCOPIC COLITIS IS EXPENSIVE TO DIAGNOSE: AN ANALYSIS OF THE UTILITY OF RANDOM COLONIC BIOPSIES, GUT, Vol: 62, Pages: A232-A232, ISSN: 0017-5749
Pannick SAJ, Clark CLI, 2009, Waiting time to lymph node biopsy is dependent on referral method: don't write, phone!, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 91, Pages: 673-676, ISSN: 0035-8843
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