Patients' experiences of clinical team meetings (ward rounds) at an adult in-patient eating disorders ward: mixed-method service improvement project.

AIMS: Ward rounds are key to treatment-related decision-making, but are often stressful. This project aimed to explore and improve patients' experiences of the clinical team meeting (CTM; historically known as ward round) in an adult in-patient eating disorders unit. A mixed-method approach was adopted with in vivo observations, two focus groups and an interview. Six patients participated. Two former patients contributed to data analysis, co-production of service improvement initiatives and write-up. RESULTS: The mean CTM duration was 14.3 min. Patients spoke half of the time, followed by psychiatry colleagues. 'Request' was the most discussed category. Three themes were identified: CTMs are important but impersonal, a sense of palpable anxiety was generated and staff and patients had divergent views regarding CTM goals. CLINICAL IMPLICATIONS: The co-produced changes to CTMs were implemented and improved patient's experiences despite COVID-19 challenges. Factors beyond CTMs, including the ward's power hierarchy, culture and language, need addressing to facilitate shared decision-making.

Why do patients with nonurgent conditions present to the Emergency Department despite the availability of alternative services?

The aim of this study was to investigate why nonurgent patients present to the Emergency Department (ED) despite availability of alternative services; also to assess impact of the UK Choose Well Campaign. A convenience sample of nonurgent ED attenders was surveyed in North Wales, UK. More than half of patients sought advice from friends, family, carer or GP before attending ED. Of the one-third of patients who had not tried an alternative service before presenting to ED, reasons given included patients thinking that they might need a radiograph (46%), believing that GP would be unable to help (29%) or stating that GP was not available (19%). Twenty per cent of patients reported they would have changed their decision about attending ED if they had known more about alternatives. Only 12% were aware of Choose Well. Analysis suggests that though Choose Well effectively provides information on alternatives, it does not translate into more appropriate attendance.

Forming, managing and sustaining alliances for health promotion.

ISSUE ADDRESSED: To create consistency among the health promotion alliances in which it engages, the National Heart Foundation of Australia (NHFA) undertook to develop guidelines for the formation, management and sustainability of alliances for cardiovascular health. METHODS: A condensed review of the key themes in the literature and survey of staff who were involved in health promotion alliances were conducted to guide the development of a checklist and template Memorandum of Understanding (MOU) for use by staff when engaging in health promotion alliances. RESULTS: The essential factors for forming, managing and sustaining alliances are explored extensively throughout the literature. Here we provide a condensed overview of the key themes relating to the advantages and barriers of health promotion alliances, plus a useful set of principles for forming, managing and, where applicable, sustaining health promotion alliances. CONCLUSIONS: Alliances are a crucial part of the cardiovascular health work of the NHFA and, indeed, broader approaches to promote health. These alliances may involve simply sharing knowledge and creating networks, or they may involve complex arrangements to address broad health issues.

Effect of feedback regarding urinary cotinine and brief tailored advice on home smoking restrictions among low-income parents of children with asthma: a controlled trial.

BACKGROUND: Since most smoker parents of children with asthma are unable to quit, an alternative measure that would reduce their children's exposure to environmental tobacco smoke (ETS) is to ban smoking in the home. METHODS: Compared with 136 usual-care controls, 128 intervention-group parents recruited from South Australian pediatric hospital outpatient waiting rooms were given written and verbal feedback about their 1- to 11-year-old child's urinary cotinine-to-creatinine level, information booklets, and two telephone calls encouraging a ban on smoking at home. RESULTS: At 6 months, 49.2% of the intervention group reported having banned smoking in the home compared with 41.9% of controls, but the differential rate of change from baseline was not significant (P = 0.40). At follow-up, there were no significant differences between groups in the percentage reporting bans on smoking in the car, the mean reduction from baseline in total daily consumption or consumption in front of the child, children's urinary cotinine level, or parental smoking cessation. CONCLUSIONS: The intervention did not change parents' propensity to create or maintain bans on smoking in their homes or otherwise change smoking habits to reduce their children's exposure to ETS. More intensive interventions may be required to achieve change among low-income smoker parents of children with asthma.