ABSTRACT
Restructuring junior doctors' patterns of work has led to several changes, including the increasing implementation of shift and partial-shift rotas. These changes heighten the necessity for good communication between the doctors responsible at different times for the patients. We sent a questionnaire to all junior doctors in two district general hospitals; the results showed that existing handover systems are frequently not as good as doctors would wish. In our opinion, the lack of advice and guidance on the structure of handover has impeded good practice, and a standard of professional practice needs to be set. Opportunities exist within the NHS to utilise information systems to obtain the necessary information and to improve the format of the handover.
Subject(s)
Continuity of Patient Care/organization & administration , Interprofessional Relations , Medical Staff, Hospital/organization & administration , Continuity of Patient Care/standards , Humans , Professional Practice/standards , Surveys and Questionnaires , United KingdomABSTRACT
We studied the appropriateness of admissions to our acute geriatric unit to determine whether they were clinically indicated and to test the Appropriateness Evaluation Protocol (AEP), an instrument previously validated for general hospital admissions. An admission is appropriate according to the AEP if at least 1 of its 16 criteria is met. At the next ward round, a consultant would judge, given the clinical details available on admission, whether the admission was appropriate, regardless of the AEP. All emergency admissions during a three week period were eligible. Of 186 admissions, 146 (78.5%) were available for analysis. The rates of inappropriateness according to consultants and AEP were 13% and 11% respectively. The AEP had a sensitivity of 97%, specificity of 63%, positive and negative predictive values of 95% and 75% respectively. The overall agreement between consultants and AEP was 92% (kappa = 0.62). There are no data on the optimal level of appropriateness but our rate of 87% (89% using the AEP) appears favourable. This study also shows the AEP to be a suitable tool to monitor the appropriateness of acute geriatric admissions.
Subject(s)
Emergencies , Patient Admission , Regional Health Planning , Aged , Aged, 80 and over , England , Female , Geriatrics , Humans , Male , Patient Admission/standards , Patient Admission/statistics & numerical data , Regional Health Planning/methods , Regional Health Planning/standards , Regional Health Planning/trends , Sensitivity and Specificity , Severity of Illness IndexABSTRACT
Few of the major advances in information science and technology have yet been successfully introduced in health care. Their implementation could improve both quality of care and the working environment of clinicians, but this will not be achieved by investing in hardware and software alone. Investment in education is also required.
Subject(s)
Education, Medical/methods , Information Science/methods , Attitude to Computers , Curriculum , Education, Medical/organization & administration , Education, Medical/standards , Humans , Information Science/organization & administration , Organizational Culture , Organizational Objectives , United KingdomABSTRACT
In order to improve inpatient facilities for terminal care for elderly people, a special ward has been opened to maximize the quality of remaining life and to achieve 'death with dignity'. The ward is based within a geriatric department and in a District General Hospital. The work of the first year is described. It is considered to have been successful.
