Assessing the impact of the introduction of an electronic hospital discharge system on the completeness and timeliness of discharge communication: a before and after study

Background: Hospital discharge summaries are a key communication tool ensuring continuity of care between primary and secondary care. Incomplete or untimely communication of information increases risk of hospital readmission and associated complications. The aim of this study was to evaluate whether the introduction of a new electronic discharge system (NewEDS) was associated with improvements in the completeness and timeliness of discharge information, in Nottingham University Hospitals NHS Trust, England. Methods: A before and after longitudinal study design was used. Data were collected using the gold standard auditing tool from the Royal College of Physicians (RCP). This tool contains a checklist of 57 items grouped into seven categories, 28 of which are classified as mandatory by RCP. Percentage completeness (out of the 28 mandatory items) was considered to be the primary outcome measure. Data from 773 patients discharged directly from the acute medical unit over eight-week long time periods (four before and four after the change to the NewEDS) from August 2010 to May 2012 were extracted and evaluated. Results were summarised by effect size on completeness before and after changeover to NewEDS respectively. The primary outcome variable was represented with percentage of completeness score and a non-parametric technique was used to compare pre-NewEDS and post-NewEDS scores. Results: The changeover to the NewEDS resulted in an increased completeness of discharge summaries from 60.7% to 75.0% (p < 0.001) and the proportion of summaries created under 24 h from discharge increased significantly from 78.0% to 93.0% (p < 0.001). Furthermore, five of the seven grouped checklist categories also showed significant improvements in levels of completeness (p < 0.001), although there were reduced levels of completeness for three items (p < 0.001). Conclusion: The introduction of a NewEDS was associated with a significant improvement in the completeness and timeliness of hospital discharge communication

Phosphodiesterase 4D5 in human airway smooth muscle cells

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User-centred design of patient information for hospital admissions and patient experience

This paper describes a user-centred approach to information design in an Acute Medical Unit (AMU). It presents a process for inclusion of clinical staff, nurses and patients in the design of information to be used for improving the efficiency of patient admissions to the wards and to increase patient understanding and satisfaction with the service. Human factors expertise was sought to assess the environment, admissions to the AMU and patient clerking by junior doctors. The paper outlines the challenges of designing for multiple users with varying needs and the intricacies of information design and provision when developing a patient leaflet for use in the NHS.</p

The incidence of cancer in patients with idiopathic pulmonary fibrosis and sarcoidosis in the UK

SummaryBackgroundThe aim of this study was to use a longitudinal computerised health care dataset (The Health Improvement Network) to provide information on the overall incidence of cancer, and on the incidence of organ-specific cancers, in people with idiopathic pulmonary fibrosis (IPF) and sarcoidosis in comparison to the general population.MethodsIncident cases of IPF and sarcoidosis were identified with up to four controls matched by age, gender and general practice. Cancer incidence rates were compared between cohorts using Cox regression and adjusting for age, gender and smoking habit.ResultsOne thousand and sixty-four incident cases of IPF (mean age at diagnosis 71.5 years; 62.4% male) were identified. Overall, the incidence of cancer was increased in people with IPF compared to the general population (rate ratio 1.51; 95% CI 1.20–1.90), but this was largely due to a marked increase in the incidence of lung cancer (rate ratio 4.96; 95% CI 3.00–8.18). One thousand one hundred and fifty-three incident cases of sarcoidosis (mean age at diagnosis 47.0 years; 47.2% male) were identified. There was an overall increased incidence of cancer in sarcoidosis (rate ratio 1.65; 95% CI 1.22–2.24) and this was largely explained by an increase in the incidence of skin cancers (rate ratio 1.86; 95% CI 1.11–3.11).ConclusionsThis study provides further evidence of a marked increase in the incidence of lung cancer in people with IPF, but we found no increase in the risk of other cancers. People with sarcoidosis did have an increase risk of skin cancers, but not cancers at other sites

Developing a simulator to help junior doctors deal with night shifts

Outside of the Monday to Friday, 9 to 5 of hospital operation a skeleton staff of junior doctors, support workers, and nurses must provide safe and timely care in hospitals. Junior doctors currently receive little training to help them deal with the unique demands of 'Out of Hours' care. We aim to rectify this situation by exploiting a unique data resource to accurately simulate a night shift. This paper will explore the need to develop a simulator to increase junior doctor's skills for prioritizing their high and changing workload, making key decisions on contacting other services and specialists, planning complex routes around large and potentially unfamiliar hospitals, managing their personal needs for rest and sustenance, and handing over succinctly and accurately at the end of their shift.</p

Developing a simulator to help junior doctors deal with night shifts

Outside of the Monday to Friday, 9 to 5 of hospital operation a skeleton staff of junior doctors, support workers, and nurses must provide safe and timely care in hospitals. Junior doctors currently receive little training to help them deal with the unique demands of 'Out of Hours' care. We aim to rectify this situation by exploiting a unique data resource to accurately simulate a night shift. This paper will explore the need to develop a simulator to increase junior doctor's skills for prioritizing their high and changing workload, making key decisions on contacting other services and specialists, planning complex routes around large and potentially unfamiliar hospitals, managing their personal needs for rest and sustenance, and handing over succinctly and accurately at the end of their shift.</p