Improving clinician-carer communication for safer hospital care: a study of the 'TOP 5' strategy in patients with dementia International Journal for Quality in Health

Abstract Objective: To examine the impact of implementing a clinician-carer communication tool for hospitalized patients with dementia. Design: Surveys were conducted with clinicians and carers about perceptions and experiences. Implementation process and costs were explored through surveys of local staff. Time series analysis was conducted on incident-reported falls, usage of non-regular anti-psychotics and one-to-one nursing. Setting: Twenty-one hospitals in Australia. Participants: Surveys were returned by 798 clinicians, 240 carers and 21 local liaison staff involved in implementation. Intervention: Implementation of a communication tool over 12 months. Main outcome measures: The process of implementation was documented. Outcome measures included clinician and carer perceptions, safety indicators (incident-reported falls and usage of non-regular anti-psychotics), resource use and costs. Results: Clinicians and carers reported high levels of acceptability and perceived benefits for patients. Clinicians rated confidence in caring for patients with dementia as being significantly higher after the introduction of TOP 5, (M = 2.93, SD = 0.65), than prior to TOP 5 (M = 2.74, SD = 0.75); F(1,712) = 11.21, P < 0.05. When analysed together, there was no change in incident-reported falls across all hospitals. At one hospital with a matched control ward, an average of 6.85 fewer falls incidents per month occurred in the intervention ward compared with the matched control ward (B = −6.85, P < 0.05). Conclusions: Our findings indicate that the use of a simple, low-cost communication strategy for patient care is associated with improvements in clinician and carer experience with potential implications for patient safety. Minimally, TOP 5 represents 'good practice' with a low risk of harm for patients

Quantifying Spread in Spatiotemporal Changes of Upper-Ocean Heat Content Estimates: An Internationally Coordinated Comparison

The Earth system is accumulating energy due to human-induced activities. More than 90% of this energy has been stored in the ocean as heat since 1970, with similar to 60% of that in the upper 700 m. Differences in upper-ocean heat content anomaly (OHCA) estimates, however, exist. Here, we use a dataset protocol for 1970-2008-with six instrumental bias adjustments applied to expendable bathythermograph (XBT) data, and mapped by six research groups-to evaluate the spatiotemporal spread in upper OHCA estimates arising from two choices: 1) those arising from instrumental bias adjustments and 2) those arising from mathematical (i.e., mapping) techniques to interpolate and extrapolate data in space and time. We also examined the effect of a common ocean mask, which reveals that exclusion of shallow seas can reduce global OHCA estimates up to 13%. Spread due to mapping method is largest in the Indian Ocean and in the eddy-rich and frontal regions of all basins. Spread due to XBT bias adjustment is largest in the Pacific Ocean within 30 degrees N-30 degrees S. In both mapping and XBT cases, spread is higher for 1990-2004. Statistically different trends among mapping methods are found not only in the poorly observed Southern Ocean but also in the well-observed northwest Atlantic. Our results cannot determine the best mapping or bias adjustment schemes, but they identify where important sensitivities exist, and thus where further understanding will help to refine OHCA estimates. These results highlight the need for further coordinated OHCA studies to evaluate the performance of existing mapping methods along with comprehensive assessment of uncertainty estimates