A framework for measuring quality in the emergency department

There is increasing concern that medical care is of variable quality, with variable outcomes, safety, costs and experience for patients. Despite substantial efforts to improve patient safety, some studies suggest little evidence of reductions in adverse events. Furthermore, there is limited agreement about what outcomes are expected and whether increased expenditure results in a real improvement in outcome or experience. In emergency medicine, many countries have developed specific indicators to help drive improvements in patient care. Most of these are time based and there is a lack of consensus regarding which indicators are high priority and what an appropriate framework for measuring quality should look like

A Stream Continuum Analysis of Bacteria Community Assembly in Association with Crayfish and their Symbionts

Undergraduate Applie

Safer clinical systems : interim report, August 2010

Safer Clinical Systems is the Health Foundation’s new five year programme of work to test and demonstrate ways to improve healthcare systems and processes, to develop safer systems that improve patient safety. It builds on learning from the Safer Patients Initiative (SPI) and models of system improvement from both healthcare and other industries. Learning from the SPI highlighted the need to take a clinical systems approach to improving safety. SPI highlighted that many hospitals struggle to implement improvement in clinical areas due to inherent problems with support mechanisms. Clinical processes and systems, rather than individuals, are often the contributors to breakdown in patient safety. The Safer Clinical Systems programme aimed to measure the reliability of clinical processes, identify defects within those processes, and identify the systems that result in those defects. Methods to improve system reliability were then to be tested and re-developed in order to reduce the risk of harm being caused to patients. Such system-level awareness should lead to improvements in other patient care pathways. The relationship between system reliability and actual harm is challenging to identify and measure. Specific, well-defined, small-scale processes have been used in other programmes, and system reliability has been shown to have a direct causal relationship with harm (e.g. care bundle compliance in an intensive care unit can reduce the incidence of ventilator-associated pneumonia). However, it has become evident that harm can be caused by a variety of factors over time; when working in broader, more complex and dynamic systems, change in outcome can be difficult to attribute to specific improvements and difficulties are also associated with relating evidence to resulting harm. The overall aim of Phase 1 of the Safer Clinical Systems programme was to demonstrate proof-of-concept that using a systems-based approach could contribute to improved patient safety. In Phase 1, experienced NHS teams from four locations worked together with expert advisers to co-design the Safer Clinical Systems programme

Investigations of the Fragmentation Spectra of Peptides Containing Lysine and its Non-Protein Amino Acid Homologs

In this study, we investigated the fragmentation spectra of dipeptides containing lysine or ornithine and pentapeptides containing lysine, ornithine, Daba, or Dapa. Lysine is one of the 20 protein amino acids whereas ornithine, Daba, and Dapa are non-protein amino acids that resemble lysine. Each of these homologs has an amine side chain that is consecutively shorter than lysine\u27s, making their differing effects on fragmentation interesting to observe. By looking at the fragments created by each peptide upon collision-induced dissociation (CID) in an ESI ion trap mass spectrometer, we could compare the fragments between the peptides and interpret those differences as a result of structural differences. Performing CID on lysine containing peptides, produced many more significant fragments than ornithine, and to similar extent, Daba, and Dapa containing peptides. Ornithine-containing pentapeptides consistently gave a dominant b fragment in which ornithine was the C-terminal of that fragment. Dapa and Daba-containing pentapeptides seemed to favor the loss of water from the parent in fragmentation, yet they also produced peaks that were in good agreements with the lysine containing pentapeptides. The amount of peaks for each amino acid did not follow a set pattern from lysine to Dapa, as the Daba-containing did at times contain more significant peaks than the ornithine. These comparisons are only a preliminary investigation into better understanding the mechanism with which amine side chains can affect fragmentation of the peptide backbone during CID

A fisherman\u27s heritage

I would not be a fisherman today, if it were not for my father. He taught me to fish, cast, tie a fisherman’s knot, identify one species of fish from another. He also taught me courage. Often when we fished from one of Kelley’s Island’s many limestone shores, Dad stopped casting and dropped to his knees beside a rock. With a quick hand, he snatched brown water snakes as long as his arm. Holding the writhing serpent in front of my face, he would order me to touch it. When we were not fishing together, Dad let me wander off, fish by myself, ride my bike through the woods alone, and fish from my favorite spots. Back home in Ironton, Ohio, I was not allowed to ride anywhere alone, much less to the riverbank for some fishing; but for whatever reason, when we were on Kelley’s Island, my dad left me to my own devices. If I had rod and reel and tackle box in hand, Dad trusted me

Physiological correlates of performance in international-standard squash players

Tactical, technical and fitness factors are important for success in elite squash. While tactical and endurance fitness aspects have been explored, altered demands that have resulted from rule changes and absence of specific tests of high-intensity exercise capabilities have prevented identification of elements of fitness that correlate with performance in elite-standard players. Accordingly, the purpose of this study was to investigate relationships between test scores and player rank in such players. With institutional ethics approval, 31 players from the England Squash performance programme participated (11 women and 20 men, mean±SD body mass 62.4±5.5 kg and 73.1±7.5 kg respectively). After habituation, participants completed countermovement and drop-jump tests, squash-specific tests of change-of-direction speed and multiple-sprint ability and the multistage fitness test in one test session. Short recoveries were allowed between tests. World rank at the time of testing was obtained from the Professional Squash Association website. In men, change-of-direction speed (??=?0.59, p?=?0.02, n?=?14) multiple-sprint ability (??=?0.78, p<0.01, n?=?13) and fastest sprint from the multiple-sprint test (??=?0.86, p<0.01, n?=?13) correlated with world rank. In women, only fastest repetition from the multiple-sprint test correlated with world rank (??=?0.65, p?=?0.04, n?=?10). Measures of high-intensity exercise capability correlated with world rank in elite-standard men and women players. Endurance capability did not relate to rank in either the men or women. The results suggest that high-intensity, variable-direction exercise capabilities are important for success in elite squash

Scoping exercise on fallers’ clinics : report to the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO)

The National Service Framework for Older People has stated the need for fall-prevention programmes. An appraisal of fallers’ clinics launched by the National Institute for Health and Clinical Excellence (NICE) was suspended because of a lack of information regarding existing services and typology. This project aimed to determine the feasibility of conducting economic modelling to appraise fallers’ clinics. To achieve this a national survey of services and reviews of the evidence of effectiveness of various models of fallers’ clinics and screening tools were undertaken

Minor head injury in the Republic of Ireland : evaluation of written information given at discharge from emergency departments

Most patients presenting to the emergency department with minor head injuries are discharged with written information. Here the quality of minor head injury discharge leaflets in the Republic of Ireland is evaluated against a nationally accepted template. There was great variability in leaflet content. Most provided minimal information on emergency symptoms but 60% contained no information on post-concussional symptoms. No leaflet was available in audio-format or languages other than English. Information provided in minor head injury leaflets should be improved and standardised across Ireland

Systematic review of trends in emergency department attendances : an Australian perspective

Emergency departments (EDs) in many developed countries are experiencing increasing pressure due to rising numbers of patient presentations and emergency admissions. Reported increases range up to 7% annually. Together with limited inpatient bed capacity, this contributes to prolonged lengths of stay in the ED; disrupting timely access to urgent care, posing a threat to patient safety. The aim of this review is to summarise the findings of studies that have investigated the extent of and the reasons for increasing emergency presentations. To do this, a systematic review and synthesis of published and unpublished reports describing trends and underlying drivers associated with the increase in ED presentations in developed countries was conducted. Most published studies provided evidence of increasing ED attendances within developed countries. A series of inter-related factors have been proposed to explain the increase in emergency demand. These include changes in demography and in the organisation and delivery of healthcare services, as well as improved health awareness and community expectations arising from health promotion campaigns. The factors associated with increasing ED presentations are complex and inter-related and include rising community expectations regarding access to emergency care in acute hospitals. A systematic investigation of the demographic, socioeconomic and health-related factors highlighted by this review is recommended. This would facilitate untangling the dynamics of the increase in emergency demand

The role of dynamic trade-offs in creating safety - a qualitative study of handover across care boundaries in emergency care

The paper aims to demonstrate how the study of everyday clinical work can contribute novel insights into a common and stubborn patient safety problem – the vulnerabilities of handover across care boundaries in emergency care. Based on a dialectical interpretation of the empirical evidence gathered in five National Health Service organisations, the paper argues that performance variability is an essential component in the delivery of safe care, as practitioners translate tensions they encounter in their everyday work into safe practices through dynamic trade-offs based on their experience and the requirements of the specific situation. The findings may shed new light on the vulnerabilities of the handover process, and they might help explain why improvements to handover have remained largely elusive and what type of future recommendations may be appropriate for improving patient safety