ABSTRACT
BACKGROUND: Healthwatch England estimated emergency readmissions have risen by 22.8% between 2012-13 and 2016-17. Some emergency readmissions could be avoided by providing patients with urgent out of hospital medical care or support. Sovereign Health Network (SHN) comprises of three GP practices, with a combined population of 38,000. OBJECTIVE: We will decrease the number of SHN patients readmitted within 30 days of discharge from Portsmouth Hospitals Trust following a non-elective admission (excluding Emergency Department attendance) by 40-60% by July 2020. METHODS: Four Plan, Do, Study, Act (PDSA) cycles were used to test the administrative and clinical processes. Our Advanced Nurse Practitioner reviewed all discharge summaries, added alerts to records, and proactively contacted patients either by text, telephone or home visit. RESULTS: 92 patients aged 23 days to 97 years were admitted onto the recent discharge scheme. Half of discharge summaries were received on the day of discharge, whilst 29% of discharge summaries were received more than 24 hours post-discharge, and one was received 11 days post-discharge. Following our interventions, there were 55% less than expected readmissions during the same time period. CONCLUSION: To allow proactive interventions to be instigated in a timely manner, discharge summaries need to be received promptly. The average readmission length of stay following a non-elective admission is seven days. Our proactive interventions saved approximately 102.9 bed days, with potential savings of 1,775 bed days over a year. We feel the results from our model are promising and could be replicated by other Primary Care Networks to result in larger savings in bed days.
Subject(s)
Patient Discharge , Patient Readmission , Humans , Length of Stay , Aftercare , Hospitals , Retrospective Studies , Emergency Service, HospitalABSTRACT
This article is the second in a two-part series aimed at quantifying strategies to reduce the probability of infection by airborne disease in the indoor environment. It focuses on the virus that causes COVID-19, SARS-CoV-2. A modified form of the Wells-Riley model is used to predict the conditional probability of infection within high occupant density indoor environments such as classrooms. Results are presented for three distinct airborne exposure scenarios and a range of protective measures that include facility-related factors such as air change rates and in-room recirculating air filtration, and the occupant-related factor of masks with varying levels of effective filtration efficiency. © 2021 Amer. Soc. Heating, Ref. Air-Conditoning Eng. Inc.. All rights reserved.
ABSTRACT
The COVID-19 pandemic poses multiple challenges for young children in the modern world. Listening to, and capturing, the experiences and perspectives of young children on the pandemic are congruent with our sense of an inclusive, democratic society which values solidarity and the right to be heard, yet too often the voices of young children are excluded from consideration. This paper reports on a trans-national, qualitative study in which practitioners in England, Scotland and New Zealand have been trained in Foebelian storytelling techniques and rigorous documentation and analysis of children's narratives. These have beeen used in their pedagogy to encourage young children to express and explore their COVID experiences through their sequenced play narratives, which have been documented, curated and then analysed by their key practitioners in dialogue with a team of early year's researchers. The praxeological project is informed by Freirean theoretical concepts of empowerment, conscientization, agency and voice. An initial thematic analysis of the play narratives reveals children are expressing a desire to regain their daily life and routines, be with their friends, have extended time to play, be outdoors, and have authentic information. Practitioners and policy makers should consider these expressed needs from young children as they develop their COVID responses.