Measuring access: how accurate are patient-reported waiting times?

Introduction: A national audit of waiting times in England’s genitourinary medicine clinics measures patient access. Data are collected by patient questionnaires, which rely upon patients’ recollection of first contact with health services, often several days previously. The aim of this study was to assess the accuracy of patient-reported waiting times. Methods: Data on true waiting times were collected at the time of patient booking over a three-week period and compared with patient-reported data collected upon clinic attendance. Factors contributing to patient inaccuracy were explored. Results: Of 341 patients providing initial data, 255 attended; 207 as appointments and 48 ‘walk-in’. The accuracy of patient-reported waiting times overall was 52% (133/255). 85% of patients (216/255) correctly identified themselves as seen within or outside of 48 hours. 17% of patients (17/103) seen within 48 hours reported a longer waiting period, whereas 20% of patients (22/108) reporting waits under 48 hours were seen outside that period. Men were more likely to overestimate their waiting time (10.4% versus 3.1% p<0.02). The sensitivity of patient-completed questionnaires as a tool for assessing waiting times of less than 48 hours was 83.5%. The specificity and positive predictive value were 85.5% and 79.6%, respectively. Conclusion: The overall accuracy of patient reported waiting times was poor. Although nearly one in six patients misclassified themselves as being seen within or outside of 48 hours, given the under and overreporting rates observed, the overall impact on Health Protection Agency waiting time data is likely to be limited

Ebookness

Since the mid-2000s, the ebook has stabilized into an ontologically distinct form, separate from PDFs and other representations of the book on the screen. The current article delineates the ebook from other emerging digital genres with recourse to the methodologies of platform studies and book history. The ebook is modelled as three concentric circles representing its technological, textual and service infrastructure innovations. This analysis reveals two distinct properties of the ebook: a simulation of the services of the book trade and an emphasis on user textual manipulation. The proposed model is tested with reference to comparative studies of several ebooks published since 2007 and defended against common claims of ebookness about other digital textual genres

Prescribing intravenous fluids: a review

This article highlights the multitude of considerations when prescribing intravenous fluids from the perspective of a trainee advanced practitioner, and emphasises that reassessment of the patient is key to safe fluid administration. Having identified that the practice of prescribing intravenous fluids is commonplace in acute care, this article will explore the level of training and education provided to clinicians, and highlights the importance of undertaking a systematic approach in assessing and decision making. In addition, this article will discuss the complexities of prescribing fluids and examine the considerations required for the assessment of fluid status, methods of determining the most appropriate fluid regime and selection of fluid for the patient, and the available evidence and guidance to aid decision making

Hyperosmolar, hyperglycaemic state: a case study

Hyperosmolar, hyperglycaemic state (HHS) is diagnosed from a triad of symptoms: severe hyperglycaemia, profound dehydration and a high serum osmolality. Often, patients are admitted confused, which emphasises the importance of obtaining good collateral histories where possible. This article will explore a case study and examine the clinical symptoms, pathophysiology and evidence-based management of HSS to highlight how the assessment, timely diagnosis and treatment of HHS is a complex and challenging task

Pulsed ventricular tachycardia: a case study

Ventricular tachycardia (VT) is an arrhythmia that originates from the ventricles of the heart and presents as a wide and prolonged QRS complex on the electrocardiograph of greater than 120 milliseconds, with a heart rate of over 100 beats per minute. VT can occur as a pulsed or pulseless rhythm. Pulseless VT occurs when the ventricles cannot effectively pump blood out of the heart, therefore resulting in no cardiac output. Pulsed VT can manifest with the patient presenting asymptomatically, or with symptoms of reduced cardiac output resulting from poor ventricular filling. There is the potential for the patient to quickly become haemodynamically unstable if not treated. This article discusses a case of pulsed VT, diagnosed and treated out of hours in an acute hospital

Septic pulmonary emboli: a case discussion

A septic pulmonary embolus occurs from the embolisation of an infected thrombus, typically from an infected source, such as an abscess, which enters the venous circulation, implanting in the lungs which in turn causes a parenchymal infection. This case discussion will give a candid reflection on the treatment and management of a patient who was a known intravenous drug user, with a past history of a deep vein thrombosis and new presentation of a groin abscess. He was initially reviewed by a trainee Advanced Clinical Practitioner, working out of hours in a hospital setting. This article will reflect on the patient presentation, the clinical examinations and investigations undertaken, which finally led to the diagnosis of septic pulmonary emboli. Although this condition is rare, having a high index of suspicion in patients with known risk factors may lead to early diagnosis and successful treatment