Track and trigger system for use in community hospitals

Wolfenden, Joanne; Dunn, Ailsa; Holmes, Alison; Davies, Cathy; Buchan, John

doi:10.7748/ns2010.07.24.45.35.c7905

Cited by 7 publications

(6 citation statements)

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“…This staff mix is described in studies of community hospitals in the UK [ 40 ], Norway [ 45 ], the Netherlands [ 49 ] and Australia [ 55 ]. In many hospitals GPs are in charge of hospital management [ 56 ], or have ultimate responsibility for patients and beds [ 49 57 ]. In NZ the community hospital workforce also includes the non-specialist Medical Officers of Special Scale (MOSSes) [ 35 58 ], a non-training position for a doctor who has not yet specialised [ 59 ].…”

Section: Resultsmentioning

confidence: 99%

“…In many community hospitals, medical doctors were reported to represent a small proportion of its staff, and were not available on site at all times. For example, a survey of NZ rural hospitals reported that 14% of hospitals had a GP on-site at all times and 41% had a facility for the GP to spend the night in the hospital [ 35 ], while a study of the ten community hospitals of the Powys region in Wales noted that none of these had resident medical doctors, including GPs [ 57 ]. Elsewhere, studies reported on-site availability of GPs only during weekdays, such as in a 12-bed intermediate care hospital in Norway [ 45 ], however, GPs are generally available to provide care at night and during week-ends, with on-call GPs committed to provide out-of-hours cover [ 23 57 60 61 ].…”

Section: Resultsmentioning

confidence: 99%

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Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models

Winpenny¹,

Corbett²,

Miani³

et al. 2016

International Journal of Integrated Care

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Background:There is no single definition of a community hospital in the UK, despite its long history. We sought to understand the nature and scope of service provision in community hospitals, within the UK and other high-income countries.Methods:We undertook a scoping review of literature on community hospitals published from 2005 to 2014. Data were extracted on features of the hospital model and the services provided, with results presented as a narrative synthesis.Results:75 studies were included from ten countries. Community hospitals provide a wide range of services, with wide diversity of provision appearing to reflect local needs. Community hospitals are staffed by a mixture of general practitioners (GPs), nurses, allied health professionals and healthcare assistants. We found many examples of collaborative working arrangements between community hospitals and other health care organisations, including colocation of services, shared workforce with primary care and close collaboration with acute specialists.Conclusions:Community hospitals are able to provide a diverse range of services, responding to geographical and health system contexts. Their collaborative nature may be particularly important in the design of future models of care delivery, where emphasis is placed on integration of care with a key focus on patient-centred care.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models

Winpenny¹,

Corbett²,

Miani³

et al. 2016

International Journal of Integrated Care

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“…To do that, different organizational models were implemented across the CHs of Emilia-Romagna: the heterogeneity of case mix served and skill mix required represents both a strength (i.e., capacity of adapting to the local context) and a weakness (i.e., difficulty of standardizing a model that can work everywhere) of these services. In Emilia-Romagna, we reported that clinical responsibilities in the CHs more frequently involved physicians from various disciplines, contrary to what happens in other countries where the involvement of doctors is less diverse [43 - 48]. In 8 out of 13 CHs, GPs had clinical responsibilities; specialists were available for clinical consultation in all the structures, and in 5 of them they also had clinical accountability and were present in the structure at all times.…”

Section: Discussionmentioning

confidence: 95%

The contribution of case mix, skill mix and care processes to the outcomes of community hospitals: a population-based observational study

Pianori

Adja

Lenzi

et al. 2020

Preprint

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Background: New organizational models to face the unmet needs of frail patients are needed. Community hospitals (CHs) could foster integration between acute and primary care. The aim of this study was to investigate which characteristics of the patients and which care processes affect clinical outcomes, in order to identify who could benefit the most from CH care. Methods: This study included all patients aged 65 and older and discharged in 2017 from the 16 CHs of Emilia-Romagna, Italy. Data sources were the regional CH informative system and hospital discharge records. CH skill mix and processes of care were collected with a survey. The study outcome was variation of the Barthel index (BI). We performed a 2-level random-intercept logistic regression analysis, and used the variance partition coefficient (VPC) to quantify the proportion of BI improvement that lay at CH level. Results: Of the 13 CHs, 8 had a general practitioner medical support model, and 6 had >12 nurses working hours/week/bed. Overall, 53% of the patients had a BI improvement of 10 or more. The patient case mix explained a portion of variability across CHs. Skill mix and processes of care were not associated with BI change. Conclusions: Patients characteristics explained part of between-CH variation in BI improvement. Professional skill mix and processes of care, albeit fundamental to achieve appropriate care and respond to the unmet needs of the frail elderly, did not account for differences in CH-specific outcomes.

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“…As evident from patient safety studies undertaken in NHS Wales, 210 the coherence and foundational competence of the 1000 Lives + programme is clearly linked to the underpinning MI-PDSA approach. 178,219 This method of service improvement has been advocated in health care for many years [420][421][422][423] and its widespread adoption in developed health-care systems promotes health-care actors' awareness of the MI-PDSA approach as accepted practice, 353 so aiding its embedding into day-to-day working.…”

Section: Coherencementioning

confidence: 99%

“…5 These include (i) the use of checklists; (ii) care bundles (checklists and associated directive guidelines) for high-risk drugs 197 and invasive practices; 192,198,199 (iii) multicomponent interventions, such as those advocated for the prevention and management of pressure ulcers, falls and hospital-acquired infections; [200][201][202][203] and (iv) various other forms of intervention, including staff training, 118,[204][205][206] adverse event simulation, 207,208 computer-assisted care management, 62,209 national and/or local alert systems and trigger tools. 28,53,210,211 Hospital patient safety: a realist analysis…”

Section: Design Implementation and Evaluationmentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Track and trigger system for use in community hospitals

Cited by 7 publications

References 0 publications

Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models

Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models

The contribution of case mix, skill mix and care processes to the outcomes of community hospitals: a population-based observational study

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

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