BackgroundInconsistent and poorly coordinated systems of tracheostomy care commonly result in frustrations, delays, and harm. Quality improvement strategies described by exemplar hospitals of the Global Tracheostomy Collaborative have potential to mitigate such problems. This three-year guided implementation program investigated interventions designed to improve quality and safety of tracheostomy care. MethodsThe program management team guided implementation of 18 interventions over three phases (baseline/implementation/evaluation). Mixed methods interviews, focus groups, and Hospital Anxiety and Depression questionnaires defined outcome measures, with patient-level databases tracking and benchmarking process metrics. Appreciative Inquiry, interviews and Normalisation Measure Development questionnaires explored change barriers and enablers. ResultsAll sites implemented at least 16/18 interventions, with the magnitude of some improvements linked to staff engagement (1536 questionnaires from 1019 staff). 2405 admissions (1868 ICU/HDU, 7.3% children) were prospectively captured. Median stay was 50 hospital days, 23 ICU days, and 28 tracheostomy days. Incident severity score reduced significantly (n=606, p<0.01). There were significant reductions in ICU (-0.25 days.month -1 ), ventilator (-0.11 days.month -1 ), tracheostomy (-0.35 days.month -1 ) and hospital (-0.78 days.month -1 ) days (all p<0.01). Time to first vocalisation and first oral intake both decreased by 7 days (n=733, p<0.01). Anxiety decreased by 44% (from 35.9% to 20.0%), and depression decreased by 55% (from 38.7% to 18.3%) (n=385, both p<0.01). Independent economic analysis demonstrated £33 251 savings per patient, with projected annual UK National Health Service savings of £275 million. ConclusionsThis guided improvement program for tracheostomy patients significantly improved the quality and safety of care, contributing rich qualitative improvement data. Patient-centred outcomes were improved along with significant efficiency and cost savings across diverse UK hospitals.

Aims and MethodTo examine the effectiveness of integrating evidence-based supported employment into an early intervention service for young people with first-episode psychosis. Demographic, clinical and vocational data were collected over a 12-month period to evaluate the effect on vocational outcomes at 6 months and 12 months of the employment of a vocational specialist, and to assess model fidelity.ResultsFollowing vocational profiling and input from the vocational specialist and the team, there were significant increases in the proportion of clients engaged in work or educational activity over the first 6 months of the intervention, and in a subsample over a second 6-month period. The evidence-based Supported Employment Fidelity Scale was used to measure the degree of implementation, which scored 71, signifying ‘good implementation’.Clinical ImplicationsThe results suggest that implementing evidence-based supported employment within an early intervention service increases employment and education opportunities for patients within the service.

BackgroundOffering financial incentives to achieve medication adherence in patients with severe mental illness is controversial.AimsTo explore the views of different stakeholders on the ethical acceptability of the practice.MethodFocus group study consisting of 25 groups with different stakeholders.ResultsEleven themes dominated the discussions and fell into four categories: (1) ‘wider concerns’, including the value of medication, source of funding, how patients would use the money, and a presumed government agenda behind the idea; (2) ‘problems requiring clear policies’, comprising of practicalities and assurance that incentives are only one part of a tool kit; (3) ‘challenges for research and experience’, including effectiveness, the possibility of perverse incentives, and impact on the therapeutic relationship; (4) ‘inherent dilemmas’ around fairness and potential coercion.ConclusionsThe use of financial incentives is likely to raise similar concerns in most stakeholders, only some of which can be addressed by empirical research and clear policies.

Enhancing multi-disciplinary CMHTs with FACT provides a clinically effective alternative to AO teams. FACT offers a cost-effective model compared to AO.

Summary Traditional methods used to disseminate educational resources to front‐line healthcare staff have several limitations. Social media may increase the visibility of these resources among targeted groups and communities. Our project aimed to disseminate key clinical messages from the National Tracheostomy Safety Project to those caring for patients with tracheostomies or laryngectomies. We commissioned an external media company to design educational material and devise a marketing strategy. We developed videos to communicate recommendations from the safety project and used Facebook, Twitter, YouTube and LinkedIn to deliver these to our target users. We recorded 629,270 impressions over a paid 12‐week campaign. Our YouTube channel registered more than a five‐fold increase in views and watch time during the campaign as compared with the previous year. Around two‐thirds of views across all platforms were from peer‐to‐peer sharing. We spent £4140 on social media advertising, with each view and click costing £0.02 and £0.67, respectively. This intelligence‐led approach using social media is an effective and efficient method to disseminate knowledge on the principles of safe tracheostomy care to front‐line clinical staff. Similar strategies may be effective for other patient safety topics, especially when targeting groups that do not use medical journals or other traditional means of dissemination.

Background: Various interventions have been tested to achieve adherence to anti-psychotic maintenance medication in non-adherent patients with psychotic disorders, and there is no consistent evidence for the effectiveness of any established intervention. The effectiveness of financial incentives in improving adherence to a range of treatments has been demonstrated; no randomised controlled trial however has tested the use of financial incentives to achieve medication adherence for patients with psychotic disorders living in the community.

AO patients are remarkably resilient to substantial reductions in the intensity of care. Reinforcing multi-disciplinary community mental health teams (CMHTs) with FACT appears to provide an integrated service that is clinically effective and an affordable alternative to orthodox AO teams.

Results are consistent with earlier studies. Reinforcing community mental health teams can provide an integrated service model that is clinically effective and equally acceptable to patients, making this a viable and affordable alternative to orthodox AO teams.