It is unknown to what extent frequent callers impact upon EMS resources. Research should identify predictors and characteristics of frequent users of EMS, and a consistent definition of a frequent caller to or user of EMS would provide greater comparability. The lack of studies identified in this review suggests that further research is needed in order to inform policy and practice.

Highlights 472 COVID-19 cases and 70 deaths per 100,000 UK population as of 12th Aug 2020. Majority of deaths from COVID-19 were amongst people aged ≥60 years. COVID-19 mortality was higher in Black, Asian and Minority Ethnic (BAME) groups. Emergency department attendance and patient referrals have declined. Emergency ambulance and non-urgent (NHS111) calls have increased.

BackgroundHealthcare is a series of complex, interwoven systems in which any discontinuities of care may affect the safety of patients, who have been reported to perceive safety differently to clinicians. This study aimed to explore patient perceptions of safety and identify how they can be used to construct additional barriers to reduce safety incidents within organisational care transfers, which are known to be high in risk.DesignAppreciative Inquiry (AI) methodology was used to develop semi-structured interviews, using the Discover and Dream processes of AI. Fourteen patients (four men, 10 women; average age 76.2 years) were purposively recruited from NHS community care teams, social care homes and private nursing homes based on their experience of going through organisational care transfers. Thematic analysis was used to highlight key themes, which participants verified.FindingsCommunication, responsiveness and avoidance of traditional safety risks were identified as being important for patients to feel safe. Communication and responsiveness were mapped onto the Swiss-Cheese model of safety, presenting two new barriers to safety incidents. Traditional risks and the role of trust are discussed in relation to patients feeling safe.ConclusionPerceptions of safety such as communication and responsiveness were similar to those found in previous studies. Mapping these perceptions onto the Swiss-Cheese model of safety identifies how further defences, barriers and safeguards can be constructed to make people feel safer by reinforcing communication and responsiveness. Traditional risks are widely published, but the identification by patients reinforces the role they can play in identifying and reporting these risks.

ObjectiveThe importance of involving patients in reporting on safety is increasingly recognized. Whilst studies have identified barriers to clinician incident reporting, few have explored barriers and facilitators to patient reporting of safety experiences. This paper explores patient perspectives on providing feedback on safety experiences.Design/ParticipantsPatients (n=28) were invited to take part in semi‐structured interviews when given a survey about their experiences of safety following hospital discharge. Transcripts were thematically analysed using NVivo10.SettingPatients were recruited from four hospitals in the UK.ResultsThree themes were identified as barriers and facilitators to patient involvement in providing feedback on their safety experiences. The first, cognitive‐cultural, found that whilst safety was a priority for most, some felt the term was not relevant to them because safety was the “default” position, and/or because safety could not be disentangled from the overall experience of care. The structural‐procedural theme indicated that reporting was facilitated when patients saw the process as straightforward, but that disinclination or perceived inability to provide feedback was a barrier. Finally, learning and change illustrated that perception of the impact of feedback could facilitate or inhibit reporting.ConclusionsWhen collecting patient feedback on experiences of safety, it is important to consider what may help or hinder this process, beyond the process alone. We present a staged model of prerequisite barriers and facilitators and hypothesize that each stage needs to be achieved for patients to provide feedback on safety experiences. Implications for collecting meaningful data on patients' safety experiences are considered.

This study examines how patients conceptualize 'responsibility' for their healthcare and make sense of the complex boundaries between patient and professional roles. Focusing on the specific case of patient safety, narrative methods were used to analyze semi-structured interviews with 28 people recently discharged from hospital in England. We present a typology of attribution, which demonstrates that patients' attributions of responsibility to staff and/or to patients are informed by two dimensions of responsibility: basis and contingency.The basis of responsibility is the reason for holding an individual or group responsible. The contingency of responsibility is the extent to which that attribution is contextually situated.The paper contributes to knowledge about responsibility in complex organizational environments, and offers a set of conceptual tools for exploring patients' understanding of responsibility in such contexts. There are implications for addressing patient engagement in care, within and beyond the field of patient safety.

Frequent callers to YAS were a heterogeneous group that differed from the overall population served, resulting in numerous implications for the delivery of services for this group of patients. Further research is required to determine if and how frequent callers differ from frequent attenders at emergency departments.

BackgroundNational leaders recommend documenting social determinants of health and actions taken to address social determinants of health in electronic health records, and a growing body of evidence suggests the health benefits of doing so. However, little evidence exists to guide implementation of social determinants of health documentation/action.MethodsThis paper describes a 5-year, mixed-methods, stepped-wedge trial with realist evaluation, designed to test the impact of providing 30 community health centers with step-by-step guidance on implementing electronic health record-based social determinants of health documentation. This guidance will entail 6 months of tailored support from an interdisciplinary team, including training and technical assistance. We will report on tailored support provided at each of five implementation steps; impact of tailored implementation support; a method for tracking such tailoring; and context-specific pathways through which these tailored strategies effect change. We will track the competencies and resources needed to support the study clinics’ implementation efforts.DiscussionResults will inform how to tailor implementation strategies to meet local needs in real-world practice settings. Secondary analyses will assess impacts of social determinants of health documentation and referral-making on diabetes outcomes. By learning whether and how scalable, tailored implementation strategies help community health centers adopt social determinants of health documentation and action, this study will yield timely guidance to primary care providers. We are not aware of previous studies exploring implementation strategies that support adoption of social determinants of action using electronic health and interventions, despite the pressing need for such guidance.Trial registrationclinicaltrials.gov, NCT03607617, registration date: 7/31/2018—retrospectively registeredElectronic supplementary materialThe online version of this article (10.1186/s13012-019-0855-9) contains supplementary material, which is available to authorized users.

Habitat fragmentation is considered a contributing factor to declining populations of northern bobwhite (Colinus virginianus). Some population strongholds exist within large expanses of habitat; however, many regions of the species' range have become fragmented and populations therein have become nearly extirpated. Our objectives were to determine whether combined habitat management and bobwhite translocation could restore bobwhite populations in habitat patches within a fragmented landscape. We translocated 550 bobwhites to 2 sites (≥660 ha; Caldwell and Fayette counties) in the Post Oak Savannah ecoregion of Texas, USA, during 2004–2006. We compared survival, home‐range size, and reproduction between translocated bobwhites in a fragmented landscape and resident bobwhites in contiguous habitat (Brooks County). Pooled over the 3‐year study, translocated bobwhites had lower survival (6 Apr–15 Aug, 2004–2006; Ŝ = 0.35; n = 165 bobwhites) than did resident bobwhites (Ŝ = 0.56; n = 224 bobwhites; P < 0.001). Translocated bobwhites also had larger home ranges (${\bar {x}}$ = 398.1 ha; n = 55 bobwhites) than resident bobwhites (${\bar {x}}$ = 10.9 ha; n = 28 bobwhites; P = 0.003). Moreover, percent of hens nesting (95% CI = 36 ± 16.4%) and nesting rate (95% CI = 1.1 ± 0.2 nests/hen) were lower for translocated bobwhites than for resident bobwhites (79 ± 12.4% and 1.6 ± 0.3 nests/hen, respectively). Our restoration efforts were unsuccessful; relative abundance of bobwhites remained low (≤1.0 covey heard/point) on translocation sites despite intensive translocation efforts. Restoring bobwhite populations in areas with few remaining bobwhites may be beyond the realm of practical management in this fragmented ecoregion. © 2012 The Wildlife Society