Do patients use minor injury units appropriately?

Size: px
Start display at page:

Download "Do patients use minor injury units appropriately?"

Transcription

1 Journal of Public Health Medicine Vol. 18, No. 2, pp Printed in Great Britain Do patients use minor injury units appropriately? Jeremy Dale and Brian Dolan Abstract Background This study aimed to examine the extent to which patients make appropriate use of Accident and Emergency and Minor Injury Unit services. The outcomes used included the proportion of Minor Injury Unit patients referred to an Accident and Emergency department, comparison between the proportions admitted from patients attending Minor Injury Units and Accident and Emergency departments directly, and the diagnoses and lengths of stay of those requiring admissions from Minor Injury Units. Methods Patients were identified who were resident in the vicinity of Deal and Folkestone and in January 1994 attended local Minor Injury Units in these towns or nearby Accident and Emergency departments at times when the Minor Injury Units were open. The following details were documented from their hospital notes: presenting problem, time and date of attendance, mode of arrival at/referral to the facility, postcode of residence, age, sex, diagnosis and referral/discharge. A sub-sample of 448 patients were interviewed while waiting to be seen at the Minor Injury Units. Results The criteria for inclusion in the study were met by 1891 patients. Of these, 188 (99 per cent) were referred by a general practitioner (GP). A total of 1472 patients attended the Minor Injury Units without referral from a GP, of whom 28 [1-9 per cent; 95 per cent confidence interval (Cl) per cent] were referred for further assessment and care to a general hospital. Whereas 71 (29 5 per cent; 95 per cent Cl per cent) of the 241 who went directly to an Accident and Emergency department without GP referral required admission, this was true for only eight (0-5 per cent; 95 per cent Cl per cent) self-referred patients attending Minor Injury Units. Four of the latter admissions were for trauma-related problems and required stays of less than 24 hours. Of the patients attending the Deal and Folkestone Minor Injury Units who were interviewed, only 195 (470 per cent) said that they would have attended an Accident and Emergency department had the facility not been available; the remainder said that they would have either gone to their own G P or self treated. The latter were more likely to be female patients, to have problems of longer duration, and/or to have attended the facilities by public transport or taxi. Conclusion The results support the view that patients choose appropriately between attending a Minor Injury Unit or an Accident and Emergency department. However, there was evidence that the availability of an intermediate tier of health care for minor injuries appears likely to result in increased overall workload. This small-scale study leaves unanswered questions in terms of clinical outcomes and the quality of care provided by different facilities. Keywords: Minor Injury Units, A&E attenders, appropriateness of attendance Introduction Increasing numbers of Minor Injury Units are being established throughout the country. 1 These facilities provide an open access minor injury service for patients not requiring the specialist investigative and support services of an acute general hospital. They may be staffed by nurse practitioners 2 ' 3 and/or general practitioners (GPs), and provide a service that overlaps with the work of Accident and Emergency departments and GPs. 1 There is usually access to radiological investigations, in addition to emergency laboratory investigations at times when such services are available within the hospital. Emergency ambulances are not permitted to deliver patients to Minor Injury Units. There remains lack of agreement on what constitutes a Minor Injury Unit in terms of the basic range of services that should be provided. The Department of Health is currently reviewing the way it defines facilities providing emergency care (D. Gilbert, Special Clinical Services, DoH, personal communication, 1995). The trend towards rationalizing Accident and Emergency services onto fewer sites threatens the provision of locally available services. Minor Injury Units may fulfil a useful role in maintaining accessibility for local communities. They appear to be highly Department of General Practice and Primary Care, and Department of Accident and Emergency Medicine, King's College School of Medicine and Dentistry, London SE5 9PJ. JEREMY DALE, Senior Lecturer (Hon. Consultant) in Primary Care BRIAN DOLAN, Clinical Researcher Address correspondence to Dr J. Dale. Oxford University Press 1996

2 valued by their local populations. 4 ' 5 However, concern has been voiced, particularly by some members of the Accident and Emergency profession, that patients may misjudge their needs and so inadvertently delay receiving care requiring specialist skills and resources. 6 " 8 The current study was undertaken as part of a larger appraisal of minor injury services commissioned by Kent Family Health Services Authority (FHSA). 4 ' 9 The aim of the study was to examine the extent to which patients make appropriate use of Accident and Emergency and Minor Injury Unit services. Two Minor Injury Units and three neighbouring Accident and Emergency departments were studied. The hours of opening of the Minor Injury Units were 9 a.m.- 6 p.m. and 8 a.m. 6 p.m. (weekdays and weekends) for the Folkestone and Deal services, respectively. The staffing of both units included local GPs working as clinical assistants who treated all patients attending with new problems. Data were collected on all patients attending the Minor Injury Units, on those referred from the Minor Injury Units to Accident and Emergency departments, and on patients directly attending the Accident and Emergency departments from the districts served by the Minor Injury Units. The outcomes used to determine appropriateness included the proportion of Minor Injury Unit patients subsequently referred to an Accident and Emergency department, comparison between the proportion admitted from those directly attending an Accident and Emergency department with those who first attended a Minor Injury Unit, and the diagnoses and lengths of stay of patients requiring admission who had first attended a Minor Injury Unit. In addition, as part of a study of users' perceptions of the service a sub-sample of patients attending the two facilities during the study period were asked about USE OF MINOR INJURY UNITS 153 where they would have sought health care had the Minor Injury service not been available. Method Data were collected in two ways. First, from hospital attendance registers patients were identified who were resident in the vicinity of Deal and Folkestone (CT14, CT19 and CT20 postal districts) and in January 1994 had attended Minor Injury Units in these towns or nearby Accident and Emergency departments at Ashford (Kent), Canterbury or Dover at times when the Minor Injury Units were open. Those attending with new problems had their records retrieved. The following details were documented from case notes: presenting problem, time and date of attendance, mode of arrival, postcode of residence, age, sex, diagnosis and referral/discharge. Second, during the study period 448 patients at the Minor Injury Units were interviewed while waiting to see the doctor. Full details of the method of sampling and the interview schedule have been described elsewhere. 9 Results The outcome of hospital attendance During January 1994, 1891 patients resident in the CT14, CT19 and CT20 postal districts presented a new problem at one of the Minor Injury Units or Accident and Emergency departments included in the study. Of these, 188 (9-9 per cent) were referred by a GP. Of the 856 patients attending Folkestone Minor Injury Unit without referral from a GP, 17 (20 per cent) were referred for further assessment and care to one of the three neighbouring Accident and Emergency departments. For those attending the Deal Minor TABLE 1 Total numbers (with percentages given in parentheses) of patients (excluding referrals from GPs) attending Minor Injury Units and Accident and Emergency departments, with postal codes of residence in Folkestone and Deal, at times when the Minor Injury Units were open Attendances in January 1994 Attenders requiring admission Minor Injury Units Folkestone Deal Total Accident and Emergency departments Ashford (Kent) Canterbury Dover Total (0-7) 2 (0-3) 8 (0-5) 50 (340) 2 (6-3) 19(30-6) 71 (29-5)

3 154 JOURNAL OF PUBLIC HEALTH MEDICINE TABLE 2 Patients requiring acute hospital admission who were referred from a Minor Injury Unit to an Accident and Emergency department Age (years) Sex Admitting specialty Diagnosis Admission duration <1 Paediatrics Medical Surgical Medical Orthopaedics Surgical Orthopaedics Paediatrics Head injury/concussion Chest pain Acute pancreatitis Pneumothorax Fractured wrist, manipulation required Facial/chest injury/assault?rib fracture Compound fracture of finger Irritable?diagnosis Injury Unit, this occurred for 11 (1-8 per cent) of the 616 non-gp referred patients. A further 330 patients with Deal or Folkestone postal codes attended one of the three Accident and Emergency departments at times when the Minor Injury Units in Deal and Folkestone were open. Of these patients, 89 (270 per cent) were referred by a GP. Of the remainder, 67 (27-8 per cent) attended by emergency '999' ambulance and 174 (72-2 per cent) by private or public transport. Many of the latter, it appeared, had been working, shopping or travelling in the vicinity of Ashford, Canterbury or Dover at the time when they decided to attend the Accident and Emergency department. Of the 1713 patients attending a Minor Injury Unit or an Accident and Emergency department without referral by a GP, 79 (4-6 per cent) required admission at one of the three district hospitals (Table 1). Of these patients, 71 (89-9 per cent) had referred themselves directly to an Accident and Emergency department; 31 (39-2 per cent) arriving by emergency ambulance and 40 (50-6 per cent) by private or public transport. Eight (10-1 per cent) patients had been referred from a Minor Injury Unit (Table 2). Minor Injury Unit patients' perceptions of the need for hospital care Of the 415 patients attending the Deal and Folkestone units who answered the question 'If there was no Minor Injury Unit available, what would you have done?' only 195 (470 per cent) said that they would have attended an Accident and Emergency department; the remainder said that they would have either gone to their own GP or self treated. Those who stated that they would have attended an Accident and Emergency department were more likely to be male, to have problems of shorter duration, and to have attended the Minor Injury Unit by private car (Table 3). TABLE 3 Numbers (with percentages given in parentheses) of patients at the Minor Injury Units who would have attended an Accident and Emergency department if the local facility was not available, by sex, duration of problem and mode of transportation to the unit Gone to A&E Not gone to A&E (n = 220) df Sex 116 (60-4) 76 (39-6) 96 (44-4) 120(55-6) Duration of problem < 6 hours 6-24 hours 1-7 days > 1 week 80(410) 50 (25-6) 41 (21 0) 24(12-3) 57 (260) 64 (29-2) 63 (28-8) 35(16-0) Mode of transport to Minor Injury Unit Private car 149 (76-4) 137(62-2)

4 Discussion The results from this study lend support to the view that patients choose appropriately between attending a Minor Injury Unit or an Accident and Emergency department. Altogether, 1-9 per cent [95 per cent confidence interval (CI) per cent] of the patients attending the Minor Injury Units required referral to an Accident and Emergency department. Whereas 29-5 per cent (95 per cent CI per cent) of those who went directly to an Accident and Emergency department required admission, this was only true for 8 (0-5 per cent; 95 per cent CI per cent) patients attending a Minor Injury Unit. As shown in Table 2, only 4 (0-3 per cent) of the 1472 patients who selfreferred to a Minor Injury Unit were admitted to hospital for longer than 24 hours duration. In considering the applicability of these results to other settings, it is important to note that both Minor Injury Units employed local GPs as clinical assistants. There is some evidence to suggest that nurse practitioner run facilities refer a larger proportion of patients for Accident and Emergency department assessment than was identified in this study. For example, at St Charles' Hospital in West London the nurse run Minor Injury Unit refers about 10 per cent of attenders to an Accident and Emergency department. 3 This study only looked at attendances during January However, the workload at the Minor Injury Units studied varies throughout the year, reflecting seasonal variation in the populations served (both units receive large numbers of tourists and foreign language students during the summer months) as well as variations in the patterns of injury that occur. At the Folkestone Minor Injury Unit, for example, the monthly attendance rates in 1993 varied from 825 new attenders in December to 1216 patients in July. 9 It is possible that the proportion of patients referred on to Accident and Emergency departments might also show seasonal variation. The impact that attending a Minor Injury Unit has on clinical outcome needs further study. Although there is clearly a possibility that attending a Minor Injury Unit may have a detrimental effect on the patient's clinical outcome through delaying access to specialist care, conversely the initial assessment and care patients receive at an accessible, local facility might often be a beneficial factor. It is also possible that some of the patients who were discharged home from the Minor Injury Unit should have been referred to an Accident and Emergency department for further care, and experienced negative outcomes as a result. It was beyond the scope of the current study to determine the extent to which attending a Minor USE OF MINOR INJURY UNITS 155 Injury Unit adversely or favourably influences health status. Using admissions as an outcome measure of appropriateness clearly has its limitations, as the decision to admit a patient is known to reflect aspects of both the patient's presentation and the doctor's experience and approach. There is evidence that junior medical staff working in Accident and Emergency departments have a lower threshold than GPs for referring patients for investigations and to specialist teams; this may lead to some unnecessary admissions. 10 Psychosocial factors often accompany, or may lead to, patients' attendance at an Accident and Emergency department, 11 ' 12 and failing to recognize and respond to these concerns, expectations and beliefs may lead to inappropriate interventions or ineffective care. A larger-scale study would be required to identify the extent to which patients attending the Accident and Emergency departments without GP referral could appropriately be managed in either a Minor Injury Unit or general practice. Attendance at Accident and Emergency departments is recognized as strongly correlating with the patients' geographical distance from the department. l3 ~ 15 In this study, attendance at an Accident and Emergency department was confounded by processes involved in decision-making related to contacting the emergency services for help. Emergency ambulances do not transport patients to the Minor Injury Units studied and so the determinants of whether patients attended an Accident and Emergency department or a Minor Injury Unit included whether or not the emergency services had been contacted. Not all the self-referred patients who attended the Minor Injury Units would have used an Accident and Emergency department had the Minor Injury Unit service not been available. Approximately half would have either gone to their own GP or self treated; these were more likely to be patients who were female, had attended the facility by public transport or taxi, and/or had problems of longer duration. This suggests that the availability of an intermediate tier of health care in these environments may be contributing to an increased overall workload for the health service, but this needs to be balanced against potential unmet need that might result were these facilities not present. The overall impact of altering local access to minor injury care needs further study. In conclusion, although these findings support the view that patients use Minor Injury Units appropriately, the limitations of the measures of appropriateness used in this study need to be acknowledged. They leave unanswered questions in terms of clinical outcomes and the quality of care provided by such

5 156 JOURNAL OF PUBLIC HEALTH MEDICINE facilities. Given that Minor Injury Units vary greatly in staffing, activity and populations served, a multi-centre study is needed to address these issues definitively. This would allow comparative assessment of different models of care, including their cost effectiveness. Acknowledgements We thank Linda Tyson, Caroline Grenfell and the staff at all five hospitals who assisted with data collection. References NHSME. A study of minor injury services. Leeds: Department of Health, Jones G. Minor injury in the community. Nursing Standard 1993; 7(22): Baker B. Model methods. Nursing Times 1993, 89(47): Dale J, Dolan B. Cut and thrust. Health Serv J 1994; 104(5406): Garnett SM, Elton PJ. A treatment service for minor injuries: maintaining equity of access. Public Hlth Med 1991; 13: British Association for Accident and Emergency Medicine. Response to 'Review of Minor Injury Services, NHSME' (letter). London: BAEM, Porter J (A&E Clinical Director, Southend Health Care Trust), quoted in Health Serv J. Minor Injuries Units are 'a dangerous con'. 1 December 1994; 4. 8 Miles S (Hon. Secretary, British Association for Accident and Emergency Medicine), quoted in Doctor. Fear of sanction threat to A&E. 20 July 1995; 3. 9 Dale J, Dolan B, Lang H. Healthcare in Folkestone and Deal: new directions for the Minor Injury Units. London: King's Accident and Emergency Primary Care Service and Kent FHSA, Dale J, Green J, Reid F, Glucksman E, Higgs R. Primary care in the Accident and Emergency department: II. Comparison of general practitioners and hospital doctors. Br Med J 1995; 311: " Salkovskis PM, Storer D, Atha C, Warwick HMC. Psychiatric morbidity in an accident and emergency department: characteristics of patients at presentation and one month follow-up. Br J Psychiat 1990; 156: Olsson M, Edhag O Rosenqvist U. Emergency care: identification of psychosocial problems. Scand J Social Med 1986; 14: McKee C, Gleadhill D, Watson J. Accident and emergency attendance rates: variation among patients from different general practices. Br J Gen Pract 1990; 40: Ingram DR, Clarke D, Murdie RA. Distance and decision to visit an emergency department. Social Sci Med 1978; 12: Magnusson G The role of proximity in the use of hospital emergency departments. Sociol Hlth Illness 1980; 2: Accepted on 31 October 1995

Patient survey report Survey of adult inpatients in the NHS 2009 Airedale NHS Trust

Patient survey report Survey of adult inpatients in the NHS 2009 Airedale NHS Trust Patient survey report 2009 Survey of adult inpatients in the NHS 2009 The national survey of adult inpatients in the NHS 2009 was designed, developed and co-ordinated by the Acute Surveys Co-ordination

More information

Patient survey report Survey of adult inpatients in the NHS 2010 Yeovil District Hospital NHS Foundation Trust

Patient survey report Survey of adult inpatients in the NHS 2010 Yeovil District Hospital NHS Foundation Trust Patient survey report 2010 Survey of adult inpatients in the NHS 2010 The national survey of adult inpatients in the NHS 2010 was designed, developed and co-ordinated by the Co-ordination Centre for the

More information

Patient survey report Inpatient survey 2008 Royal Devon and Exeter NHS Foundation Trust

Patient survey report Inpatient survey 2008 Royal Devon and Exeter NHS Foundation Trust Patient survey report 2008 Inpatient survey 2008 Royal Devon and Exeter NHS Foundation Trust The national Inpatient survey 2008 was designed, developed and co-ordinated by the Acute Surveys Co-ordination

More information

Evaluation of an independent, radiographer-led community diagnostic ultrasound service provided to general practitioners

Evaluation of an independent, radiographer-led community diagnostic ultrasound service provided to general practitioners Journal of Public Health VoI. 27, No. 2, pp. 176 181 doi:10.1093/pubmed/fdi006 Advance Access Publication 7 March 2005 Evaluation of an independent, radiographer-led community diagnostic ultrasound provided

More information

Paediatric accident & emergency short-stay ward: a 1-year audit

Paediatric accident & emergency short-stay ward: a 1-year audit Archives of Emergency Medicine, 1993, 10, 181-186 Paediatric accident & emergency short-stay ward: a 1-year audit T. F. BEATTIE & P. A, MOIR Accident and Emergency Department, Royal Aberdeen Children's

More information

7 NON-ELECTIVE SURGERY IN THE NHS

7 NON-ELECTIVE SURGERY IN THE NHS Recommendations Debate whether, in the light of changes to the pattern of junior doctors working, non-essential surgery can take place during extended hours. 7 NON-ELECTIVE SURGERY IN THE NHS Ensure that

More information

A retrospective study of patients discharged within 24 hours after emergency admission in a public general hospital

A retrospective study of patients discharged within 24 hours after emergency admission in a public general hospital Hong Kong Journal of Emergency Medicine A retrospective study of patients discharged within 24 hours after emergency admission in a public general hospital SST Cheng and CH Chung Objectives: To identify

More information

Telephone triage systems in UK general practice:

Telephone triage systems in UK general practice: Research Tim A Holt, Emily Fletcher, Fiona Warren, Suzanne Richards, Chris Salisbury, Raff Calitri, Colin Green, Rod Taylor, David A Richards, Anna Varley and John Campbell Telephone triage systems in

More information

Who cares for the patient with head injury now?

Who cares for the patient with head injury now? 352 Glasgow Royal Infirmary, Glasgow G4 OSF, Scotland IJSwann Greater Glasgow Health Board, Glasgow A Walker Correspondence to: Mr Swann (ian.swann@ northglasgow.nhs.scot.uk) Accepted for publication 12

More information

Introducing a 7-day service: the benefits of increased consultant presence

Introducing a 7-day service: the benefits of increased consultant presence Introducing a 7-day service: the benefits of increased consultant presence This Future Hospital Programme case study comes from Wrightington, Wigan & Leigh NHS Foundation Trust (WWL). Here, Dr Stephen

More information

Patient survey report Survey of adult inpatients 2012 Sheffield Teaching Hospitals NHS Foundation Trust

Patient survey report Survey of adult inpatients 2012 Sheffield Teaching Hospitals NHS Foundation Trust Patient survey report 2012 Survey of adult inpatients 2012 The national survey of adult inpatients in the NHS 2012 was designed, developed and co-ordinated by the Co-ordination Centre for the NHS Patient

More information

T he National Health Service (NHS) introduced the first

T he National Health Service (NHS) introduced the first 265 ORIGINAL ARTICLE The impact of co-located NHS walk-in centres on emergency departments Chris Salisbury, Sandra Hollinghurst, Alan Montgomery, Matthew Cooke, James Munro, Deborah Sharp, Melanie Chalder...

More information

Patient survey report Survey of adult inpatients 2016 Chesterfield Royal Hospital NHS Foundation Trust

Patient survey report Survey of adult inpatients 2016 Chesterfield Royal Hospital NHS Foundation Trust Patient survey report 2016 Survey of adult inpatients 2016 NHS patient survey programme Survey of adult inpatients 2016 The Care Quality Commission The Care Quality Commission is the independent regulator

More information

Do GPs sick-list patients to a lesser extent than other physician categories? A population-based study

Do GPs sick-list patients to a lesser extent than other physician categories? A population-based study Family Practice Vol. 18, No. 4 Oxford University Press 2001 Printed in Great Britain Do GPs sick-list patients to a lesser extent than other physician categories? A population-based study Britt Arrelöv,

More information

Patient survey report Survey of adult inpatients 2013 North Bristol NHS Trust

Patient survey report Survey of adult inpatients 2013 North Bristol NHS Trust Patient survey report 2013 Survey of adult inpatients 2013 National NHS patient survey programme Survey of adult inpatients 2013 The Care Quality Commission The Care Quality Commission (CQC) is the independent

More information

National findings from the 2013 Inpatients survey

National findings from the 2013 Inpatients survey National findings from the 2013 Inpatients survey Introduction This report details the key findings from the 2013 survey of adult inpatient services. This is the eleventh survey and involved 156 acute

More information

Foundation Programme Individual Placement Descriptor* Trust

Foundation Programme Individual Placement Descriptor* Trust Foundation Programme Individual Placement Descriptor* Site Intrepid Post Code (or local post number if Intrepid N/A) Placement details (i.e. the specialty and sub-specialty) Department Type of work to

More information

Delivering surgical services: options for maximising resources

Delivering surgical services: options for maximising resources Delivering surgical services: options for maximising resources THE ROYAL COLLEGE OF SURGEONS OF ENGLAND March 2007 2 OPTIONS FOR MAXIMISING RESOURCES The Royal College of Surgeons of England Introduction

More information

POLICY FOR X RAY REFERRAL BY QUALIFIED NURSE PRACTITIONERS WORKING IN GENERAL PRACTICE

POLICY FOR X RAY REFERRAL BY QUALIFIED NURSE PRACTITIONERS WORKING IN GENERAL PRACTICE POLICY FOR X RAY REFERRAL BY QUALIFIED NURSE PRACTITIONERS WORKING IN GENERAL PRACTICE APPROVED BY: Chief Nurse May 2016 EFFECTIVE FROM: May 2016 REVIEW DATE: May 2018 Version Control Policy Category:

More information

General practitioner workload with 2,000

General practitioner workload with 2,000 The Ulster Medical Journal, Volume 55, No. 1, pp. 33-40, April 1986. General practitioner workload with 2,000 patients K A Mills, P M Reilly Accepted 11 February 1986. SUMMARY This study was designed to

More information

The new chronic psychiatric population

The new chronic psychiatric population Brit. J. prev. soc. Med. (1974), 28, 180.186 The new chronic psychiatric population ANTHEA M. HAILEY MRC Social Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, London SE5 SUMMARY Data from

More information

Unscheduled care Urgent and Emergency Care

Unscheduled care Urgent and Emergency Care Unscheduled care Urgent and Emergency Care Professor Derek Bell Acute Medicine Director NIHR CLAHRC for NW London Imperial College London Chelsea and Westminster Hospital Value as the overarching, unifying

More information

Patient survey report Accident and emergency department survey 2012 North Cumbria University Hospitals NHS Trust

Patient survey report Accident and emergency department survey 2012 North Cumbria University Hospitals NHS Trust Patient survey report 2012 Accident and emergency department survey 2012 The Accident and emergency department survey 2012 was designed, developed and co-ordinated by the Co-ordination Centre for the NHS

More information

Impact of private funding on access to elective hospital treatment in the regions of England and Wales

Impact of private funding on access to elective hospital treatment in the regions of England and Wales EUROPEAN JOURNAL OF PUBLIC HEALTH 2001; 11: 402-406 Impact of private funding on access to elective hospital treatment in the regions of England and Wales National records survey BRIAN WILLIAMS, PAMELA

More information

Patient survey report Outpatient Department Survey 2009 Airedale NHS Trust

Patient survey report Outpatient Department Survey 2009 Airedale NHS Trust Patient survey report 2009 Outpatient Department Survey 2009 The national Outpatient Department Survey 2009 was designed, developed and co-ordinated by the Acute Surveys Co-ordination Centre for the NHS

More information

Patient survey report Survey of adult inpatients 2011 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

Patient survey report Survey of adult inpatients 2011 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Patient survey report 2011 Survey of adult inpatients 2011 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust The national survey of adult inpatients in the NHS 2011 was designed, developed

More information

Survey of adult inpatients in the NHS, Care Quality Commission comparing results between national surveys from 2009 to 2010

Survey of adult inpatients in the NHS, Care Quality Commission comparing results between national surveys from 2009 to 2010 Royal United Hospital, Bath, NHS Trust Survey of adult inpatients in the NHS, Care Quality Commission comparing results between national surveys from 2009 to 2010 Please find below charts comparing the

More information

Informal care and psychiatric morbidity

Informal care and psychiatric morbidity Journal of Public Health Medicine Vol. 20, No. 2, pp. 180-185 Printed in Great Britain Informal care and psychiatric morbidity Stephen Horsley, Steve Barrow, Nick Gent and John Astbury Abstract Background

More information

Telephone consultations to manage requests for same-day appointments: a randomised controlled trial in two practices

Telephone consultations to manage requests for same-day appointments: a randomised controlled trial in two practices Telephone consultations to manage requests for same-day appointments: a randomised controlled trial in two practices Brian McKinstry, Jeremy Walker, Clare Campbell, David Heaney and Sally Wyke SUMMARY

More information

Patient survey report 2004

Patient survey report 2004 Inspecting Informing Improving Patient survey report 2004 - young patients The survey of young patient service users was designed, developed and coordinated by the NHS survey advice centre at Picker Institute

More information

SAFE STAFFING GUIDELINE

SAFE STAFFING GUIDELINE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline title SAFE STAFFING GUIDELINE SCOPE 1. Safe staffing for nursing in accident and emergency departments Background 2. The National Institute for

More information

Who calls 999 and why? A survey of the emergency workload of the London Ambulance

Who calls 999 and why? A survey of the emergency workload of the London Ambulance 174 Department of Public Health Sciences, St George's Hospital Medical School C R Victor J L Peacock C Chazot London Ambulance Service S Walsh D Holmes Correspondence to: Dr Christina R Victor, Reader

More information

Recommendations for safe trainee changeover

Recommendations for safe trainee changeover Recommendations for safe trainee changeover Introduction Doctors in training in the UK have historically started new six-monthly rotations in February and August, with the majority of junior doctors rotating

More information

NHS occupational health services in England and Wales a changing picture

NHS occupational health services in England and Wales a changing picture Occupational Medicine 2003;53:47 51 DOI: 10.1093/occmed/kqg008 NHS occupational health services in England and Wales a changing picture A. Hughes, R. Philipp and C. Harling Introduction Aims Method Results

More information

The Royal College of Surgeons of England

The Royal College of Surgeons of England The Royal College of Surgeons of England Provision of Trauma Care Policy Briefing This policy briefing outlines the view of the Royal College of Surgeons of England in relation to the planning and provision

More information

Management of minor head injuries in the accident and emergency department: the effect of an observation

Management of minor head injuries in the accident and emergency department: the effect of an observation Journal of Accident and Emergency Medicine 1994 11, 144-148 Correspondence: C. Raine, Senior House Officer, University Department of Surgery, Royal Infirmary of Edinburgh, 1 Lauriston Place, Edinburgh

More information

Frequently Asked Questions (FAQ) Updated September 2007

Frequently Asked Questions (FAQ) Updated September 2007 Frequently Asked Questions (FAQ) Updated September 2007 This document answers the most frequently asked questions posed by participating organizations since the first HSMR reports were sent. The questions

More information

Patient survey report Outpatient Department Survey 2011 County Durham and Darlington NHS Foundation Trust

Patient survey report Outpatient Department Survey 2011 County Durham and Darlington NHS Foundation Trust Patient survey report 2011 Outpatient Department Survey 2011 County Durham and Darlington NHS Foundation Trust The national survey of outpatients in the NHS 2011 was designed, developed and co-ordinated

More information

Physiotherapy outpatient services survey 2012

Physiotherapy outpatient services survey 2012 14 Bedford Row, London WC1R 4ED Tel +44 (0)20 7306 6666 Web www.csp.org.uk Physiotherapy outpatient services survey 2012 reference PD103 issuing function Practice and Development date of issue March 2013

More information

reported, as well as a series of verification and validation checks on the results.

reported, as well as a series of verification and validation checks on the results. DEVELOPING SIMULATION MODELS OF POSSIBLE FUTURE SCENARIOS FOR THE DELIVERY OF ACUTE CARE IN NHS AYRSHIRE AND ARRAN TO INFORM THE DECISION MAKING PROCESS Consuelo Lara Modelling Analyst Kirstin Dickson

More information

National Inpatient Survey. Director of Nursing and Quality

National Inpatient Survey. Director of Nursing and Quality Reporting to: Title Sponsoring Director Trust Board National Inpatient Survey Director of Nursing and Quality Paper 6 Author(s) Sarah Bloomfield, Director of Nursing and Quality, Sally Allen, Clinical

More information

Who should see eye casualties?: a comparison of eye care in an accident and emergency department with a. dedicated eye casualty INTRODUCTION SUMMARY

Who should see eye casualties?: a comparison of eye care in an accident and emergency department with a. dedicated eye casualty INTRODUCTION SUMMARY Journal of Accident and Emergency Medicine 1995 12, 23-27 Who should see eye casualties?: a comparison of eye care in an accident and emergency department with a dedicated eye casualty D.i. FLITCROFT1,

More information

DISCHARGE AGAINST MEDICAL ADVICE (DAMA) A STUDY

DISCHARGE AGAINST MEDICAL ADVICE (DAMA) A STUDY The West London Medical Journal 2010 Vol 2 No 3 pp 17-27 DISCHARGE AGAINST MEDICAL ADVICE Siba Prosad Paul 1 Rowena M. Remorin 2 ABSTRACT Objective: To establish the cause of DAMA in paediatric practice

More information

Practice nurses in 2009

Practice nurses in 2009 Practice nurses in 2009 Results from the RCN annual employment surveys 2009 and 2003 Jane Ball Geoff Pike Employment Research Ltd Acknowledgements This report was commissioned by the Royal College of Nursing

More information

Casemix Measurement in Irish Hospitals. A Brief Guide

Casemix Measurement in Irish Hospitals. A Brief Guide Casemix Measurement in Irish Hospitals A Brief Guide Prepared by: Casemix Unit Department of Health and Children Contact details overleaf: Accurate as of: January 2005 This information is intended for

More information

children to the accident and emergency department

children to the accident and emergency department Archives of Emergency Medicine, 1988, 5, 228-232 Patterns of presentation of abused children to the accident and emergency department D. B. OLNEY Accident and Emergency Department, St J'ames's SUMMARY

More information

Specialised Services Service Specification: Inherited Bleeding Disorders

Specialised Services Service Specification: Inherited Bleeding Disorders Specialised Services Service Specification: Inherited Bleeding Disorders Document Author: Assistant Specialised Services Planner Cardiac and Cancer Specialised Services Planner Cancer and Blood Executive

More information

Evaluation of a Mental Health Information and Referral Service

Evaluation of a Mental Health Information and Referral Service Evaluation of a Mental Health Information and Referral Service Doris A. Berlin, M.D., M.P.H. ABSTRACT: This paper reports on the application of a method for evaluating public health programs to a mental

More information

Neurosurgery. Themes. Referral

Neurosurgery. Themes. Referral 06 04 Neurosurgery The following recommendations were produced by the British Society of Neurological Surgeons to highlight where resources could be released in NHS neurological services, while maintaining

More information

Department of Health. Managing NHS hospital consultants. Findings from the NAO survey of NHS consultants

Department of Health. Managing NHS hospital consultants. Findings from the NAO survey of NHS consultants Department of Health Managing NHS hospital consultants Findings from the NAO survey of NHS consultants FEBRUARY 2013 Contents Introduction 4 Part One 5 Survey methodology 5 Part Two 9 Consultant survey

More information

Seven Day Services Clinical Standards September 2017

Seven Day Services Clinical Standards September 2017 Seven Day Services Clinical Standards September 2017 11 September 2017 Gateway reference: 06408 Patient Experience 1. Patients, and where appropriate families and carers, must be actively involved in shared

More information

Hendrick Center for Extended Care. Community Health Needs Assessment Implementation Plan

Hendrick Center for Extended Care. Community Health Needs Assessment Implementation Plan Hendrick Center for Extended Care Community Health Needs Assessment Implementation Plan - 2014-2016 Overview: Hendrick Center for Extended Care ( HCEC ) is a Long Term Acute Care Hospital, within Hendrick

More information

Ambulatory Emergency Care in South Wales

Ambulatory Emergency Care in South Wales Ambulatory Emergency Care in South Wales The Ambulatory Care Score ( Amb Score) Les Ala Consultant Acute Physician Royal Glamorgan Hospital LLantrisant, South Wales ROYAL GLAMORGAN HOSPITAL Format Our

More information

Developing an urgent care strategy for South Tees how you can have your say July/August 2015

Developing an urgent care strategy for South Tees how you can have your say July/August 2015 Developing an urgent care strategy for South Tees how you can have your say July/August 2015 Foreword Commissioning high quality, accessible urgent care services is a high priority for South Tees Clinical

More information

Integrated care for asthma: matching care to the patient

Integrated care for asthma: matching care to the patient Eur Respir J, 1996, 9, 444 448 DOI: 10.1183/09031936.96.09030444 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1996 European Respiratory Journal ISSN 0903-1936 Integrated care for asthma:

More information

Emergency admissions to hospital: managing the demand

Emergency admissions to hospital: managing the demand Report by the Comptroller and Auditor General Department of Health Emergency admissions to hospital: managing the demand HC 739 SESSION 2013-14 31 OCTOBER 2013 4 Key facts Emergency admissions to hospital:

More information

North Staffordshire Local Medical Committee. General Practitioner Visiting Guidelines

North Staffordshire Local Medical Committee. General Practitioner Visiting Guidelines North Staffordshire Local Medical Committee General Practitioner Visiting Guidelines Amended July 2012 1 REASONS BEHIND THE NEED TO RATIONALISE GP HOME VISITING 1. QUALITY OF MEDICAL CARE a. A doctor s

More information

NHS performance statistics

NHS performance statistics NHS performance statistics Published: 8 th February 218 Geography: England Official Statistics This monthly release aims to provide users with an overview of NHS performance statistics in key areas. Official

More information

Patient survey report Mental health acute inpatient service users survey gether NHS Foundation Trust

Patient survey report Mental health acute inpatient service users survey gether NHS Foundation Trust Patient survey report 2009 Mental health acute inpatient service users survey 2009 The mental health acute inpatient service users survey 2009 was coordinated by the mental health survey coordination centre

More information

Seven day hospital services: case study. South Warwickshire NHS Foundation Trust

Seven day hospital services: case study. South Warwickshire NHS Foundation Trust Seven day hospital services: case study South Warwickshire NHS Foundation Trust March 2018 We support providers to give patients safe, high quality, compassionate care within local health systems that

More information

Thank you for joining us today!

Thank you for joining us today! Thank you for joining us today! Please dial 1.800.732.6179 now to connect to the audio for this webinar. To show/hide the control panel click the double arrows. 1 Emergency Room Overcrowding A multi-dimensional

More information

Kingston Hospital NHS Foundation Trust Length of stay case study. October 2014

Kingston Hospital NHS Foundation Trust Length of stay case study. October 2014 Kingston Hospital NHS Foundation Trust Length of stay case study October 2014 The hospital has around 520 beds and provides acute medical services for a population of around 320,000 in Kingston, Richmond,

More information

2011 National NHS staff survey. Results from London Ambulance Service NHS Trust

2011 National NHS staff survey. Results from London Ambulance Service NHS Trust 2011 National NHS staff survey Results from London Ambulance Service NHS Trust Table of Contents 1: Introduction to this report 3 2: Overall indicator of staff engagement for London Ambulance Service NHS

More information

An evaluation of the National Cancer Survivorship Initiative test community projects. Report of the baseline patient experience survey

An evaluation of the National Cancer Survivorship Initiative test community projects. Report of the baseline patient experience survey An evaluation of the National Cancer Survivorship Initiative test community projects Report of the baseline patient experience survey HELEN SHELDON AND STEVE SIZMUR PICKER INSTITUTE EUROPE 26 NOVEMBER

More information

What are the potential ethical issues to be considered for the research participants and

What are the potential ethical issues to be considered for the research participants and What are the potential ethical issues to be considered for the research participants and researchers in the following types of studies? 1. Postal questionnaires 2. Focus groups 3. One to one qualitative

More information

An evaluation of child health clinic services in Newcastle upon Tyne during

An evaluation of child health clinic services in Newcastle upon Tyne during British Journal of Preventive and Social Medicine, 1977, 31, 1-5 An evaluation of child health clinic services in Newcastle upon Tyne during 1972-1974 H. STEINER From the University of Newcastle upon Tyne

More information

Case study O P E N A C C E S S

Case study O P E N A C C E S S O P E N A C C E S S Case study Discharge against medical advice in a pediatric emergency center in the State of Qatar Hala Abdulateef 1, Mohd Al Amri 1, Rafah F. Sayyed 1, Khalid Al Ansari 1, *, Gloria

More information

NHS Performance Statistics

NHS Performance Statistics NHS Performance Statistics Published: 8 th March 218 Geography: England Official Statistics This monthly release aims to provide users with an overview of NHS performance statistics in key areas. Official

More information

Organisational factors that influence waiting times in emergency departments

Organisational factors that influence waiting times in emergency departments ACCESS TO HEALTH CARE NOVEMBER 2007 ResearchSummary Organisational factors that influence waiting times in emergency departments Waiting times in emergency departments are important to patients and also

More information

British Medical Association National survey of GPs The future of General Practice 2015

British Medical Association National survey of GPs The future of General Practice 2015 British Medical Association National survey of GPs The future of General Practice 2015 Extract of Findings December February 2015 A report by ICM on behalf of the BMA Creston House, 10 Great Pulteney Street,

More information

Mental Health Measure Clinician survey

Mental Health Measure Clinician survey Mental Health Measure Clinician survey Dr Raman Sakhuja Consultant Psychiatrist Cwm Taf Health Board Chair of Faculties of General Adult & Addiction Psychiatry- RCPsych in Wales Background Legislation

More information

Perceptions of the role of the hospital palliative care team

Perceptions of the role of the hospital palliative care team NTResearch Perceptions of the role of the hospital palliative care team Authors Catherine Oakley, BSc, RGN, is Macmillan lead cancer nurse, St George s Hospital NHS Trust, London; Kim Pennington, BSc,

More information

Business Case Authorisation Cover Sheet

Business Case Authorisation Cover Sheet Business Case Authorisation Cover Sheet Section A Business Case Details Business Case Title: Directorate: Division: Sponsor Name Consultant in Anaesthesia and Pain Medicine Medicine and Rehabilitation

More information

Mental Health Short Stay

Mental Health Short Stay Mental Health Directorate Central Adelaide Local Health Network Mental Health Short Stay Model of Care January 2016 Extracted from Improving Unplanned Emergency Access pathways (IUEAP) Model of Care: Mental

More information

Increases in rationing are leading to a growing postcode lottery

Increases in rationing are leading to a growing postcode lottery NHS INCORPORATED SURVEY REVEALS NHS ON ROAD TO US-STYLE HEALTHCARE NEW EVIDENCE OF NHS HOSPITALS CHARGING FOR ESSENTIAL TREATMENTS THAT WERE PREVIOUSLY FREE AND STILL FREE ELSEWHERE THOUSANDS OF PEOPLE

More information

City and Hackney Clinical Commissioning Group Prospectus May 2013

City and Hackney Clinical Commissioning Group Prospectus May 2013 City and Hackney Clinical Commissioning Group Prospectus May 2013 Foreword We are excited to be finally live as a CCG, picking up our responsibilities as commissioners for the bulk of the NHS. The changeover

More information

Community Health Network of San Francisco Committee on Interdisciplinary Practice

Community Health Network of San Francisco Committee on Interdisciplinary Practice Community Health Network of San Francisco Committee on Interdisciplinary Practice Title: Pain Consultation Service - Clinical Pharmacist I. Policy Statement A. It is the policy of the Community Health

More information

Improving patient access to general practice

Improving patient access to general practice Report by the Comptroller and Auditor General Department of Health and NHS England Improving patient access to general practice HC 913 SESSION 2016-17 11 JANUARY 2017 4 Key facts Improving patient access

More information

Better Healthcare in Bucks Reconfiguring acute services

Better Healthcare in Bucks Reconfiguring acute services service redesign case study March 2013 No. 3 Reconfiguring acute services Key points Reach a shared understanding of the case for change across the local health economy. Start public engagement as early

More information

Psychiatric rehabilitation - does it work?

Psychiatric rehabilitation - does it work? The Ulster Medical Joumal, Volume 59, No. 2, pp. 168-1 73, October 1990. Psychiatric rehabilitation - does it work? A three year retrospective survey B W McCrum, G MacFlynn Accepted 7 June 1990. SUMMARY

More information

Sarah Bloomfield, Director of Nursing and Quality

Sarah Bloomfield, Director of Nursing and Quality Reporting to: Trust Board - 25 June 2015 Paper 8 Title CQC Inpatient Survey 2014 Published May 2015 Sponsoring Director Author(s) Sarah Bloomfield, Director of Nursing and Quality Graeme Mitchell, Associate

More information

SCHEDULE 2 THE SERVICES Service Specifications

SCHEDULE 2 THE SERVICES Service Specifications SCHEDULE 2 THE SERVICES Service Specifications Service Specification No Service ParaDoc Commissioner City and Hackney CCG Commissioner Lead Leah Herridge Provider CHUHSE Provider Lead Date of Review September

More information

2016 National NHS staff survey. Results from Surrey And Sussex Healthcare NHS Trust

2016 National NHS staff survey. Results from Surrey And Sussex Healthcare NHS Trust 2016 National NHS staff survey Results from Surrey And Sussex Healthcare NHS Trust Table of Contents 1: Introduction to this report 3 2: Overall indicator of staff engagement for Surrey And Sussex Healthcare

More information

Paediatric Escalation Policy

Paediatric Escalation Policy Paediatric Escalation Policy Specialty: Paediatrics Approval Body: WCH Quality and Safety Group Approval Date: 21 st January 2015 Date of Review: December 2018 PAEDIATRIC SERVICES ESCALATION POLICY FOR

More information

The costs and benefits of asking patients for their opinions about general practice

The costs and benefits of asking patients for their opinions about general practice Family Practice Oxford University Press 1996 Vol. 13, No. 1 Printed in Great Britain The costs and benefits of asking patients for their opinions about general practice Hilary Hearnshaw, Richard Baker,

More information

NHS Lanarkshire. Radiology Review. August 2011

NHS Lanarkshire. Radiology Review. August 2011 NHS Lanarkshire Radiology Review August 2011 Review of Radiology Services 1. Background NHS Lanarkshire has been undertaking a review of acute and community radiology services over the past 18 months.

More information

National Cardiac Arrest Audit Report

National Cardiac Arrest Audit Report National Cardiac Arrest Audit Report St Elsewhere Hospital 1 April 212 to 3 September 212 (n = 122) Date of report: 14/1/213 ncaa@icnarc.org Supported by Resuscitation Council (UK) and Intensive Care National

More information

The Community Musculoskeletal Service

The Community Musculoskeletal Service Page 60 The Community Musculoskeletal Service Cathy Lennox FRCS(Orth)Ed, Consultant Orthopaedic Surgeon Atle Karstad MBA, BSc Hons, MCSP, HPC, Consultant Physiotherapist Improving the After retirement

More information

Seven Day Working: in Practice Clinicians Perspective. Jonathan Vickers Consultant surgeon Dec 2015

Seven Day Working: in Practice Clinicians Perspective. Jonathan Vickers Consultant surgeon Dec 2015 Seven Day Working: in Practice Clinicians Perspective Jonathan Vickers Consultant surgeon Dec 2015 Why me? Mr. Hunt argued that hospitals like Salford Royal and Northumbria have instituted seven-day working

More information

DRAFT 2. Specialised Paediatric Services in Scotland. 1 Specialised Services Definition

DRAFT 2. Specialised Paediatric Services in Scotland. 1 Specialised Services Definition Specialised Paediatric Services in Scotland 1 Specialised Services Definition Services provided for low numbers of patients. They require a critical mass of staff, facilities and equipment and are delivered

More information

1. Working as a primary health care NP Please complete the entire questionnaire

1. Working as a primary health care NP Please complete the entire questionnaire PART 1: EMPLOYMENT STATUS We are interested in hearing whether you are currently employed as an NP. Whether you are employed as an NP or not, it is very important that you complete this questionnaire and

More information

Paper 5.0 SHAPING A HEALTHIER FUTURE PAEDIATRIC TRANSITION: ANTICIPATED BENEFITS OF THE TRANSITION AND PROPOSED MODEL OF CARE.

Paper 5.0 SHAPING A HEALTHIER FUTURE PAEDIATRIC TRANSITION: ANTICIPATED BENEFITS OF THE TRANSITION AND PROPOSED MODEL OF CARE. SHAPING A HEALTHIER FUTURE PAEDIATRIC TRANSITION: ANTICIPATED BENEFITS OF THE TRANSITION AND PROPOSED MODEL OF CARE December 2015 Version 2.2 Paper 5.0 1 Purpose This document sets out the proposed new

More information

Frequently Discussed Topics

Frequently Discussed Topics Frequently Discussed Topics L.A. Care Health Plan Please read carefully. What are Copayments (Other Charges)? Aside from the monthly premium, you may be responsible for paying a charge when you receive

More information

Female perineal injuries in children and adolescents presenting to a Paediatric Emergency Department

Female perineal injuries in children and adolescents presenting to a Paediatric Emergency Department Female perineal injuries in children and adolescents presenting to a Paediatric Emergency Department Dr. Damian Roland 1,2 BMedSci BMBS PhD 1. Paediatric Emergency Medicine Leicester Academic (PEMLA) Group,

More information

MINIMUM STANDARDS FOR INTENSIVE CARE UNITS SEEKING ACCREDITATION FOR TRAINING IN INTENSIVE CARE MEDICINE

MINIMUM STANDARDS FOR INTENSIVE CARE UNITS SEEKING ACCREDITATION FOR TRAINING IN INTENSIVE CARE MEDICINE College of Intensive Care Medicine of Australia and New Zealand ABN: 16 134 292 103 Document type: Policy Date established: 1994 Date last reviewed: 2015 MINIMUM STANDARDS FOR INTENSIVE CARE UNITS SEEKING

More information

Delayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta

Delayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta Delayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta Abstract Introduction: Day care units are playing an increasingly important role in healthcare provision,

More information

Same day emergency care: clinical definition, patient selection and metrics

Same day emergency care: clinical definition, patient selection and metrics Ambulatory emergency care guide Same day emergency care: clinical definition, patient selection and metrics Published by NHS Improvement and the Ambulatory Emergency Care Network June 2018 Contents 1.

More information

Efficiency in mental health services

Efficiency in mental health services the voice of NHS leadership briefing February 211 Issue 214 Efficiency in mental health services Supporting improvements in the acute care pathway Key points As part of the current focus on improving quality,

More information

National Patient Experience Survey Mater Misericordiae University Hospital.

National Patient Experience Survey Mater Misericordiae University Hospital. National Patient Experience Survey 2017 Mater Misericordiae University Hospital /NPESurvey @NPESurvey Thank you! Thank you to the people who participated in the National Patient Experience Survey 2017,

More information

Scottish Hospital Standardised Mortality Ratio (HSMR)

Scottish Hospital Standardised Mortality Ratio (HSMR) ` 2016 Scottish Hospital Standardised Mortality Ratio (HSMR) Methodology & Specification Document Page 1 of 14 Document Control Version 0.1 Date Issued July 2016 Author(s) Quality Indicators Team Comments

More information