We found not only a lack of OH policy guidance but apparent inertia in dealing with obesity. The action plan demonstrated how OH clinical practice can draw upon CG43 to combat obesity in an NHS workforce.
SUMMARYVirus-specific antibody responses were studied in 12 children with cancer in whom rubella was diagnosed by seroconversion or a rising titre (>s fourfold) of haemagglutination inhibiting (HI) antibody. Our results confirmed the difficulties of making a diagnosis of rubella infection in immunocompromised children using criteria for interpreting antibody assays established in immunocompetent patients. Specific IgM antibody persisted for more than 2 months in 7 of 10 children with probable primary rubella, 3 of whom had high concentrations of such antibody 6, 7 and 11 months after the rash. Radial haemolysis and specific IgG, and IgG3 antibody responses were low in 4, 2, and 4 patients, respectively.
Three coloured hearts were used to identify different distances for patients to walk to. These were strategically placed within the ward environment, and changed daily as the patients exercise tolerance improved. This improvement has been trialled with a single cardiac surgeon. The Physiotherapist assessed the patient's ability, showed the patient the heart and explained to the patient the distance and number of times they were required to walk the heart each day. Mobilisation goals were agreed and a different coloured heart put on the wall at the appropriate distance. Nursing staff on the ward supported and assisted the patients throughout the day to achieve their mobilisation goals.
Background
A hospital's trolley count is often highlighted as a measure of its performance. However there is a more complex reality for each organisation in accessing suitable resources for often frail older patients to improve care and capacity. Coupled with this is the need for pathways that identify these patients early in their admission and access the appropriate specialist care. In 2018, 65% of this hospital's bed days were occupied by those whose hospital stay was greater than 14 days. Nationally this was 57%. We undertook to review processes locally around the care of older acute patients.
Methods
On the 20th November 2018 we conducted a chart audit of 85 in-patients who had been in the acute setting for more than 14 days. A proforma was completed for each patient by a doctor and multi-disciplinary team member.
Results
The length of stay ranged from 15 – 527 days with the median being 41 days. The average age was 76 years. A history of falls/dementia/“acopia” was recorded on admission in 57%. The mean time for referral to MDT was 5 days. Social history was only documented in 47% of cases. Ward transfers was a significant issue with 69% moving wards at least once and 9% moving three times or more. A care planning meeting had not been held in 49% of cases. Over 17% of charts audited were awaiting home care package hours whilst 20% were awaiting long term care. In 62% of cases there was no ongoing medical reason keeping them in hospital and 56% of this cohort could have been cared for elsewhere.
Conclusion
Deficits in clear communication and appropriate timely planning for patients resulted in significant delays in discharge. The findings of our research informed a decision to conduct a root and branch analysis of discharge planning utilising the Lean Six Sigma model.
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