Delays and Interruptions in the Acute Medical Unit clerking process – an observational study

Objectives: It is recommended that patients are seen within 4 h of arrival in Acute Medical Units in English hospitals. This study explored the frequency and nature of interruptions and delays potentially affecting the duration of the Acute Medical Unit admission process and the quality of care provided. Design: The admission process was directly observed for patients admitted to the Acute Medical Unit over four one week periods, November 2009 to April 2011. Setting: UK teaching hospital Acute Medical Unit. Participants: Hospital staff n¼36. Main outcome measures: Patient waiting times, duration of clerking, number of interruptions and/or delays. Results: Thirty-five doctors and one nurse practitioner were observed admitting 71 medical patients, 48/71 (68%) patients were clerked within 4 h of arrival. A delay and/or interruption affected 49/71 (69%) patients. Sixty-six interruptions were observed in 36/71 (51%) of admissions, of these 19/36 (53%) were interrupted more than once. The grade of doctor had no bearing on the frequency of interruption; however, clerking took significantly longer when interrupted; overall doctors grade ST1 and above were quicker at clerking than foundation doctors. Delays affected 31/71 (44%) of admissions, 14/31 (45%) involved X-rays or ECGs; other causes of delays included problems with equipment and computers. Conclusion: Interruptions and delays regularly occurred during the admission process in the study hospital which impacts adversely on patient experience and compliance with the recommended 4-h timeframe, further work is required to assess the impact on patient safety. Data obtained from this observational study were used to guide operational changes to improve the process

Uneven progress in reducing exposure to violence at home for New Zealand adolescents 2001–2012: a nationally representative cross‐sectional survey series

Objective: To explore trends, and identify risk factors, that may explain changes in adolescent exposure to family violence over time.Methods: Data for this study was drawn from the Youth 2000 series of cross‐sectional surveys, carried out with New Zealand high school students in 2001, 2007 and 2012. Latent class analysis was used to understand different patterns of exposure to multiple risks for witnessing violence at home among adolescents.Results: Across all time periods, there was no change in witnessing emotional violence and a slight decline in witnessing physical violence at home. However, significant differences were noted between 2001 and 2007, and 2007 and 2012, in the proportion of adolescents who reported witnessing emotional and physical violence. Four latent classes were identified in the study sample; these were characterised by respondents' ethnicity, concerns about family relationships, food security and alcohol consumption. For two groups (characterised by food security, positive relationships and lower exposure to physical violence), there was a reduction in the proportion of respondents who witnessed physical violence but an increase in the proportion who witnessed emotional violence between 2001 and 2012. For the two groups characterised by poorer food security and higher exposure to physical violence, there were no changes in witnessing of physical violence in the home.Implications for public health: In addition to strategies directly aimed at violence, policies are needed to address key predictors of violence exposure such as social disparities, financial stress and alcohol use. These social determinants of health cannot be ignored

Urban and river flooding: Comparison of flood risk management approaches in the UK and China and an assessment of future knowledge needs

Increased urbanisation, economic growth, and long-term climate variability have made both the UK and China more susceptible to urban and river flooding, putting people and property at increased risk. This paper presents a review of the current flooding challenges that are affecting the UK and China and the actions that each country is undertaking to tackle these problems. Particular emphases in this paper are laid on (1) learning from previous flooding events in the UK and China, and (2) which management methodologies are commonly used to reduce flood risk. The paper concludes with a strategic research plan suggested by the authors, together with proposed ways to overcome identified knowledge gaps in flood management. Recommendations briefly comprise the engagement of all stakeholders to ensure a proactive approach to land use planning, early warning systems, and water-sensitive urban design or redesign through more effective policy, multi-level flood models, and data driven models of water quantity and quality

Stimulating the innovation potential of 'routine' workers through workplace learning

Governments worldwide seek to upgrade the ‘basic skills' of employees deemed to have low literacy and numeracy, in order to enable their greater productivity and participation in workplace practices. A longitudinal investigation of such interventions in the United Kingdom has examined the effects on employees and on organizations of engaging in basic skills programmes offered in and through the workplace. ‘Tracking’ of employees in selected organizational contexts has highlighted ways in which interplay between formal and informal workplace learning can help to create the environments for employees in lower grade jobs to use and expand their skills. This workplace learning is a precondition, a stimulus and an essential ingredient for participation in employee-driven innovation, as workers engage with others to vary, and eventually to change, work practices. © 2010, SAGE Publications. All rights reserved

Social policy and the government of waste

This article argues that key elements of contemporary social policy can be fruitfully analysed through the lens of waste. Drawing on work identifying the importance of waste and waste disposal in the history of modernity and early liberal theory, the article develops two concepts of waste – waste as inertia and waste as excess – and uses these to shed light on aspects of recent social policy in the areas of unemployment, health care, and higher education. In particular, it is argued that the theme of waste is able to capture the desire of recent governments to deploy social policy explicitly to economic ends – including economic growth and capital – and the consequences it sets in motion for citizens who fail to comply with stipulated obligations. It is also argued that the government of waste is a source of political legitimacy for the state

Making a target work: messages from a pilot of the six-month time limit on care proceedings in England

Since 2014, it has been a legal requirement in England and Wales for child care proceedings to be concluded, apart from ‘exceptional cases’, within 26 weeks. When this was first proposed there were concerns that it might lead to poorer decision-making, or to delay being squeezed to either side of the court proceedings, before or afterwards. This paper reports on the messages from a pilot programme to hit the 26-week target that took place in London in 2012-13. The study compared the progress of the cases from the pilot year with those the year before, 180 cases in total, involving 256 children. The local authorities involved were able to achieve considerable improvements in timeliness, not just in the proceedings, but for the pre- and post-court processes too; and the quality and fairness of decisions did not seem to be impaired, in terms of the plans for the children and subsequent outcomes over a period of two years. ‘Targets’ do not generally find a warm welcome in the social work literature, but this paper shows that when collaboratively implemented, with a measure of flexibility and adequate resources, they can be an effective way of helping to achieve positive change