Considering Harm and Safety in Youth Mental Health: A Call for Attention and Action

The possibility of harm from mental health provision, and in particular harm from youth mental health provision, has been largely overlooked. We contend that if we continue to assume youth mental health services can do no harm, and all that is needed is more services, we continue to risk the possibility that the safety of children and young people is unintentionally compromised. We propose a three level framework for considering harm from youth mental health provision (1. ineffective engagement, 2. ineffective practice and 3. adverse events) and suggest how this framework could be used to support quality improvement in services

Perspectives of paediatric hospital staff on factors influencing the sustainability and spread of a safety quality improvement programme

OBJECTIVE: Situation Awareness For Everyone (SAFE) is a quality improvement programme aiming to improve situation awareness in paediatric clinical teams. The aim of our study was to examine hospital staff perceptions of the facilitators and barriers/challenges to the sustaining and subsequent spread of the huddle, the key intervention of the SAFE programme. SETTING: Interviews were held on two wards in two children hospitals and on two children wards in two district general hospitals. METHOD: Semistructured interviews were conducted with 23 staff members from four National Health Service paediatric wards. A deductive thematic analysis was conducted, drawing on an existing framework, which groups the factors influencing programme sustainability into four categories: innovation, leadership, process and context. PARTICIPANTS: 23 staff in two children’s hospitals and two children’s wards across four UK hospitals, comprising of nurses and doctors, administration or housekeeping staff, ward managers and matrons, and allied professionals. PRIMARY OUTCOME: Understanding factors contributing to the sustaining and spread of a quality improvement intervention. RESULTS: Perceptions of the benefits, purpose and fit of the huddle, team commitment, sharing learning, adaptation of the method and senior leadership were identified as facilitators. High staff turnover, large multiple specialty medical staff teams, lack of senior leadership and dislike of change were identified as barriers/challenges. CONCLUSIONS: Sustaining and spreading quality improvement interventions in a complex clinical setting requires understanding of the interplay between the actual innovation and existing leadership, process and contextual factors. These must be considered at the planning stage of an innovation to maximise the potential for sustainability and spread to other settings

Utilisation of outpatient services at Red Cross War Memorial Children's Hospital, Cape Town

The demand for outpatient services continues to grow at Red Cross War Memorial Children's Hospital (RCCH). To determine current utilisation patterns, we conducted a 2-week survey in the outpatient department (OPD). In addition, we reviewed the RCCH Annual Reports for the period 1961 - 1988. Annual outpatient attendances have increased from around 42000 in 1957 to their highest level ever; nearly 350000 in 1988. This steady rise in outpatient attendance was stemmed during the 1970s by the expansion of health services in the greater Cape Town area, in particular the introduction ofday hospitals. In general, blacks are utilising the OPD as a primary community hospital for the treatment of infectious and environmentally induced diseases. In contrast, the white outpatient profile is more characteristic of a tertiary referral centre, with a higher proportion of specialist clinic attendances. The utilisation patterns for coloured children are intermediate. Analysis of the residential address of patients and their presenting diagnoses indicates an urgent demand for primary health care services in the most recently settled and poorest suburbs of Cape Town, many of which are remote from the hospital

A realistic evaluation of situation awareness for everyone (SAFE) on paediatric wards: Study protocol

INTRODUCTION: Evidence suggests that health outcomes for hospitalised children in the UK are worse than other countries in Europe, with an estimated 1500 preventable deaths in hospital each year. It is presumed that some of these deaths are due to unanticipated deterioration, which could have been prevented by earlier intervention, for example, sepsis. The Situation Awareness For Everyone (SAFE) intervention aims to redirect the ‘clinical gaze’ to encompass a range of prospective indicators of risk or deterioration, including clinical indicators and staff concerns, so that professionals can review relevant information for any given situation. Implementing the routine use of huddles is central to increasing situation awareness in SAFE. METHODS AND ANALYSIS: In this article, we describe the realistic evaluation framework within which we are evaluating the SAFE programme. Multiple methods and data sources are used to help provide a comprehensive understanding of what mechanisms for change are triggered by an intervention and how they have an impact on the existing social processes sustaining the behaviour or circumstances that are being targeted for change. ETHICS AND DISSEMINATION: Ethics approval was obtained from London—Dulwich Research Ethics Committee (14/LO/0875). It is anticipated that the findings will enable us to understand what the important elements of SAFE and the huddle are, the processes by which they might be effective and—given the short timeframes of the project—initial effects of the intervention on outcomes. The present research will add to the extant literature by providing the first evidence of implementation of SAFE and huddles in paediatric wards in the UK

The Paranormal is (Still) Normal: The Sociological Implications of a Survey of Paranormal Experiences in Great Britain

Historically, there has been limited sociological interest in the paranormal and no systematic study of reported paranormal experiences. There are also few medium-to-large-scale survey results with nationally representative populations focusing on paranormal experiences. This paper provides details of an exploratory survey conducted in 2009 with a nationally representative sample of 4,096 adults aged 16 years and over across Great Britain. Our findings show that 37% of British adults report at least one paranormal experience and that women, those who are middle-aged or individuals resident in the South West are more likely to report such experiences. These results establish incidence levels of reported paranormal experiences in contemporary Britain. We argue also that they merit a more sustained sociological consideration of the paranormal. In this respect we renew and update the robust justification and call for serious research positioning the paranormal as a social phenomenon, originally proposed well over thirty years ago by Greeley (1975)

Prevalence and severity of patient harm in a sample of UK-hospitalised children detected by the Paediatric Trigger Tool

The measurement and examination of adverse events (AEs) that occur in children during hospital admissions is essential if we are to prevent, reduce or ameliorate the harm experienced. The UK Paediatric Trigger Tool (UKPTT) is a method of retrospective case note review that measures harm in hospitalised children. Objectives: To examine the harm resulting from the processes of healthcare in hospitalised children from centres providing data to the National Health Service (NHS) Institute UKPTT data portal, to understand the positive predictive values of triggers and to make recommendations for the further development of the trigger tool. Setting: 25 hospitals across the UK, including secondary, tertiary and quaternary paediatric centres. Participants: Randomly selected children who were admitted to hospital for longer than 24 h. Outcome measures: The primary outcome measure was the rate of harm (the percentage of children experiencing one or more AEs during a hospital admission). Secondary measures were the severity of harm and performance of triggers. Results: Data from 3992 patient admissions were reviewed across the hospitals and submitted to the trigger tool portal from February 2008 to November 2011. At least one AE was reported for 567 (14.2%) patients, with 211 (5.3%) experiencing more than one event. There were 1001 AEs identified. Where harm occurred, it was considered temporary for 923 (92.2%) AEs; however, 43 (4.3%) AEs resulted in the need for life-sustaining interventions, 18 (1.8%) AEs led to permanent harm and for 17 children (1.7% of AEs) the AE was believed to have contributed to death. Conclusions: There is a significant, measurable level of harm experienced by children admitted to hospitals in the UK. While most of this harm is temporary, some of it is serious. The UKPTT offers organisations the means to measure and examine the AEs occurring in their hospital in order to reduce harm

Books

Current Ocular Therapy. Ed. by F. T. Fraunfelder, F. Hampton Roy and S. Martha Meyer. Pp. xiii + 792. Illustrated. £55. Nonhmead: WB Saunders. 1989.Dysfunctional Uterine Bleeding and Menorrhagia. Bailliere's Clinical Obstetrics and Gynaecolcgy: International Practice and Research, June 1989. Ed. by J. O. Drife. Pp. 217 + 428. Illustrated. £18,50. Northmead: WE Saunders.1989.Treatment of Cancer. 2nd ed. Ed. by Karol Sikora and Keith E. Halnan. Pp. ix + 916. Illustrated. Price £99,50. London: Chapman and Hall Medical. 1990.Ocular Syndromes and Systemic Diseases. 2nd edition. Ed. by F. Hampton Roy. Pp. xlvii + 470. £40. Northmead: WE Saunders. 1989.Non-invasive Cardiac Imaging. British Medical Bulletin. Vol. 45, No. 4. Ed. by D. G. Gibson. Pp. 830 + 1109. Illustrated. £25 (UK) or £31,50 (overseas). New York: Churchill Livingstone. 1989.Laparoscopic Surgery. Bailliere's Clinical Obstetrics and Gynaecology: International Practice and Research, September 1989. Ed. by C. J. G. Sunon. Pp. 429 + 686. Illustrated. £18,50. Northmead: WB Saunders. 1989.Management ofMinor Head Injuries. Ed. by I. J. Swann and D. W. Yates. Pp. x + 102. Illustrated: £14,95. Hampshire: Chapman & Hall Medical. 1989.ABC of Child Abuse. Ed. by Roy Meadow. Pp. 59. Illustrated. London: BMJ. 1989.The Facts of Life. Ed. by Marina Petropulos. Pp. 1 + 222. Illustrated. R19,95 exc!. GST. Cape Town: Tafelberg. 1990.Physical Examination of the Heart and Circulation. 2nd ed. Ed. by Joseph K. Perloff. Pp. viii + 292. Illustrated. £17,95. Northmead: WB Saunders. 1989.Growth Regulation of Thyroid Gland and Thyroid Tumours: Frontiers ofHormone Research. Vo!. 18. Ed. by P. E. Goretzki, and H. D. Roher. Pp. viii + 163. Illustrated. £68,80. Basel: S. Karger. 1989.Topical Diagnosis in Neurology: Anatomy, Physiology, Signs, Symptoms. 2nd revised ed. Ed. by P. Duus. Pp. x + 337. Illustrated. DM 370. Stungart: Georg Thieme Verlag. 1989

Increasing Short-Stay Unplanned Hospital Admissions among Children in England; Time Trends Analysis '97-'06

BACKGROUND: Timely care by general practitioners in the community keeps children out of hospital and provides better continuity of care. Yet in the UK, access to primary care has diminished since 2004 when changes in general practitioners' contracts enabled them to 'opt out' of providing out-of-hours care and since then unplanned pediatric hospital admission rates have escalated, particularly through emergency departments. We hypothesised that any increase in isolated short stay admissions for childhood illness might reflect failure to manage these cases in the community over a 10 year period spanning these changes. METHODS AND FINDINGS: We conducted a population based time trends study of major causes of hospital admission in children 2 days. By 2006, 67.3% of all unplanned admissions were isolated short stays <2 days. The increases in admission rates were greater for common non-infectious than infectious causes of admissions. CONCLUSIONS: Short stay unplanned hospital admission rates in young children in England have increased substantially in recent years and are not accounted for by reductions in length of in-hospital stay. The majority are isolated short stay admissions for minor illness episodes that could be better managed by primary care in the community and may be evidence of a failure of primary care services

International survey of COVID-19 management strategies

Background: While individual countries have gained considerable knowledge and experience in coronavirus disease of 2019 (COVID-19) management, an international, comparative perspective is lacking, particularly regarding the measures taken by different countries to tackle the pandemic. This paper elicits the views of health system staff, tapping into their personal expertise on how the pandemic was initially handled. Methods: From May to July 2020, we conducted a cross-sectional, online, purpose-designed survey comprising 70 items. Email lists of contacts provided by the International Society for Quality in Health Care, the Italian Network for Safety in Health Care and the Australian Institute of Health Innovation were used to access healthcare professionals and managers across the world. We snowballed the survey to individuals and groups connected to these organizations. Key outcome measures were attitudes and information about institutional approaches taken; media communication; how acute hospitals were re-organized; primary health organization; personal protective equipment; and staffing and training. Results: A total of 1131 survey participants from 97 countries across the World Health Organization (WHO) regions responded to the survey. Responses were from all six WHO regions; 57.9% were female and the majority had 10 or more years of experience in healthcare; almost half (46.5%) were physicians; and all other major clinical professional groups participated. As the pandemic progressed, most countries established an emergency task force, developed communication channels to citizens, organized health services to cope and put in place appropriate measures (e.g. pathways for COVID-19 patients, and testing, screening and tracing procedures). Some countries did this better than others. We found several significant differences between the WHO regions in how they are tackling the pandemic. For instance, while overall most respondents (71.4%) believed that there was an effective plan prior to the outbreak, this was only the case for 31.9% of respondents from the Pan American Health Organization compared with 90.7% of respondents from the South-East Asia Region (SEARO). Issues with swab testing (e.g. delay in communicating the swab outcome) were less frequently reported by respondents from SEARO and the Western Pacific Region compared with other regions. Conclusion: The world has progressed in its knowledge and sophistication in tackling the pandemic after early and often substantial obstacles were encountered. Most WHO regions have or are in the process of responding well, although some countries have not yet instituted widespread measures known to support mitigation, for example, effective swab testing and social control measures