4,074 research outputs found

    Conceptual modelling of the flow of frail elderly through acute-care hospitals: An evidence-based management approach

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    This is the author accepted manuscript. The final version is available from Emerald via the DOI in this record.The ageing of the world’s population is causing an increase in the number of frail patients admitted to hospitals. In the absence of appropriate management and organisation, these patients risk an excessive length of stay and poor outcomes. To deal with this problem, we propose a conceptual model to facilitate the pathway of frail elderly patients across acute-care hospitals, focused on avoiding improper wait times and treatment during the process. The conceptual model is developed to enrich the standard flowchart of a clinical pathway in the hospital. The modified flowchart encompasses new organisational units and activities carried out by new dedicated professional roles. The proposed variant aims to provide a correct assessment of frailty at the entrance, a better management of the patient’s stay during different clinical stages and an early discharge, sending the patient home or to other facilities, avoiding a delayed discharge. The model is completed by a set of indicators aimed at measuring performance improvements and creating a strong database of evidence on the managing of frail elderly’s pathways, providing proper information that can validate the model when applied in current practice. The paper proposes a design of the clinical path of frail patients in acute-care hospitals, combining elements that, according to an evidence-based management approach, have proved to be effective in terms of outcomes, costs and organisational issues. We can therefore expect an improvement in the treatment of frail patients in hospital, avoiding their functional decline and worsening frailty conditions, as often happens in current practice following the standard path of other patients The framework proposed is a conceptual model to manage frail elderly patients in acute-care wards. Our research approach lacks application to real data and proof of effectiveness. Further work will be devoted to implementing a simulation model for a specific case study and verifying the impact of the conceptual model in real care settings. The framework proposed is a conceptual model to manage frail elderly patients in acute-care wards. Our research approach lacks application to real data and proof of effectiveness. Further work will be devoted to implementing a simulation model for a specific case study and verifying the impact of the conceptual model in real care settings. This paper fulfills an identified need to study and provide solutions for the management of frail elderly patients in acute-care hospitals, and generally to produce value in a patient-centred model

    What does it take to make integrated care work? A ‘cookbook’ for large-scale deployment of coordinated care and telehealth

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    The Advancing Care Coordination & Telehealth Deployment (ACT) Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and telehealth (CC&TH) services on a large scale. A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU. Examples are: Perceptions between managers, frontline staff and patients do not always match; Organisational structure does influence the views and experiences of patients: a dedicated contact person is considered both important and helpful; Successful patient adherence happens when staff are engaged; There is a willingness by patients to participate in healthcare programmes; Patients overestimate their level of knowledge and adherence behaviour; The responsibility for adherence must be shared between patients and health care providers; Awareness of the adherence concept is an important factor for adherence promotion; The ability to track the use of resources is a useful feature of a stratification strategy, however, current regional case finding tools are difficult to benchmark and evaluate; Data availability and homogeneity are the biggest challenges when evaluating the performance of the programmes

    East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

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    Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

    A Literature Review on Care at the End-of-Life in the Emergency Department

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    The hospitalisation and management of patients at the end-of-life by emergency medical services is presenting a challenge to our society as the majority of people approaching death explicitly state that they want to die at home and the transition from acute care to palliation is difficult. In addition, the escalating costs of providing care at the end-of-life in acute hospitals are unsustainable. Hospitals in general and emergency departments in particular cannot always provide the best care for patients approaching end-of-life. The main objectives of this paper are to review the existing literature in order to assess the evidence for managing patients dying in the emergency department, and to identify areas of improvement such as supporting different models of care and evaluating those models with health services research. The paper identified six main areas where there is lack of research and/or suboptimal policy implementation. These include uncertainty of treatment in the emergency department; quality of life issues, costs, ethical and social issues, interaction between ED and other health services, and strategies for out of hospital care. The paper concludes with some areas for policy development and future research

    Health and Care Infrastructure Research and Innovation Centre final report 2014

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    Improving healthcare, while containing costs, demands sophisticated understanding of three core elements in healthcare systems: infrastructure, technology and services. Their tripartite relationship is extremely complex, not least because the pace of change for each is different. That creates considerable challenges in planning for future needs and makes the management of innovation and change difficult. [Continues.

    Optimising the use of ICTs by health & social care professionals in the community

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    This research was commissioned as part of the Department of Health's Information and Communication Technology (ICT) Research Initiative, to identify ways in which ICTs might provide benefits to health and social care professionals working across boundaries and to the clients/ patients that they serve. The project aimed to examine the use of existing ICTs in supporting isolated users in the community (principally professionals but also lay users), and to consider ways in which use of such ICTs might be improved, focusing initially on non-person identifiable information. A single patient group was selected as the main focus of the study - older people (and their carers). This group was chosen because the needs of older people and their carers reflect those of the wider isolated populations served by health and social welfare professionals in terms of their clinical, psychological and social care needs. Other isolated groups might include the physically disabled, the mentally ill, or those socially and potentially service isolated through geography, lifestyles or other factors. Older people would be represented in all these categories. Therefore, a study focusing on the information needs of professionals who support older patients or clients should provide findings that are generalisable to other groups, such as those mentioned above. Furthermore, it was evident that this is an important group on which to focus in terms of inter-agency working because of the various policy initiatives that aim to enhance working between professionals across the health and social care interface in relation to older people

    Implementing frailty assessment and management in oncology services

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    Frailty is defined as “A medical syndrome with multiple causes and contributors that is characterised by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability….” Frailty is common in patients with cancer. Patients with frailty are vulnerable to higher rates of treatment toxicity and surgical complications, and worse quality of life and survival outcomes. However, these can and should be improved with targeted assessment, support and management of frailty. Each step in the cancer pathway is an opportunity for assessing and managing frailty. Guidance published by the Joint Collegiate Council for Oncology, in association with the British Geriatrics Society, the International Society of Geriatric Oncology and Macmillan Cancer Support, is intended to encourage and support the implementation of frailty assessment and management in oncology services in the UK. It provides practical advice and recommendations to help ensure this becomes a routine part of clinical care. Frailty is everyone’s business and although aimed primarily at oncologists, this guidance is relevant to everyone involved in the care of adult patients with cancer across the wider multi-disciplinary team.<br/

    Design and decision making to improve healthcare infrastructure

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    This report presents summary and key findings of research projects undertaken within the Health and Care Infrastructure Research and Innovation Centre (HaCIRIC)by Loughborough University. These projects develop new knowledge and theory on how the built environment adds value to the healthcare delivery process and mainly relate to: ‘Theme 3, Innovative Design and onstruction’ undertaken during HaCIRIC Phase 1; and provide an excellent foundation for the work to be undertaken within the Optimising Healthcare Infrastructure Value (OHIV)project during HaCIRIC Phase 2

    A healthcare space planning simulation model for Accident and Emergency (A&E)

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    The National Health Service (NHS) in the United Kingdom provides a range service for its population including primary care and hospital services. The impact of the 2008 economic and financial crises prompted a tightening of public budgets including health. Over the next few years, and most likely beyond, the NHS is planning for unprecedented levels of efficiency saving in the order of £ billions. With little doubt, the NHS will need to review its way of working will need to do more with less. Simulation is an established technique with applications in many industries including healthcare. Potentially, there are huge opportunities for simulation use to make further inroads in the field of healthcare. Despite the potential, arguably, simulation has failed to make a significant impact in health. Some evidence has tended to suggest that within health there has been poor adaption along with poor linkage to real-world problems, as perceived by healthcare stakeholders. The aim of this thesis is to develop a model to help address real-world healthcare issues as recognised by healthcare stakeholders. In doing so, this thesis will focus on a couple of real-world problems, namely: What space is needed to meet service demand, when is it needed and what will it cost? What space do we have, how can it be used to meet service demand and at what cost? The developed simulation space demand model will demonstrate its value modelling dynamic systems over static models. The developed models will also show its value highlighting space demand issues by groups of patients, by time of day. Real, readily available data (arrival and length of stay, by patient group) would drive the model inputs, supporting ease of use and clarity for healthcare stakeholders. The model was modular by design to support rapid reconfiguration. Dynamically modelled space information allows service managers and Healthcare Planners to better manage and organise their space in a flexible way to meet service requirements. This work will also describe how space demand can linked with building notes to determine Schedules of Accommodation which can be used to cost floor space and consequent building or refurbishment costs. Furthermore, this information could be used to drive business plans and to develop operational cost pertaining to the floor area. This body of work debates using function-to-space ratios and attaching facilities management cost. Our findings suggest great variance in function-to-space ratios. Our findings also suggest that moving to median or lower quartile function-to-space ratios could potentially save hospitals £ millions in facilities management costs. This thesis will reflect on the level of modelling taking place in the healthcare industry by non-academic healthcare modellers, sometimes collectively known as Healthcare Planners, the Healthcare Planning role in space planning and their links with healthcare stakeholders. This reflection will also consider whether healthcare stakeholders perceive a great need for academic healthcare modelling, if they believe their modelling needs are met by Healthcare Planners. A central theme of this thesis is that academic modelling and Healthcare Planning have great synergy and that bringing together Healthcare Planners’ industry knowledge and stakeholder relationships with academic know-how, can make a significant contribution to the healthcare simulation modelling arena
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