RESUMEN

Introduction: The use of mobile devices on hospital wards to record patient vital signs and Early Warning Scores provides opportunity for secondary analysis of the data collected. This research investigated how such analysis can contribute to the understanding of the complexities of managing clinical care in hospital environments. Methods: The influence of ward type and the distribution of patient observation intervals was evaluated in relation to the timing of vital signs observation patterns in data collected from eight adult in-patient wards over a 12-month period. Actual and projected observation times were compared across patients with higher and lower National Early Warning Scores (NEWS). Results: Both ward type and the distribution of patient observation intervals were significant predictors of temporal observation patterns. Observation patterns showed evidence of grouping of observation recordings. This was, however, not found for observations of patients with higher NEWS scores (3 or more). Conclusions: Secondary analysis of vital signs observation data can reveal insights into how ward operate. The patterns of observation recordings within a ward are a reflection of ward type and the distribution of patient observation intervals. The grouping of observation recordings of patients with low NEWS (<3) result in late or early observations to fit activity peaks characteristic of the ward culture.

RESUMEN

NHS Direct Wales provides a single point of access where members of the public can telephone and seek medical support and/or advice. The service is provided for all the Health Boards in Wales by a single virtual call centre run from a main location in Swansea with 2 satellite locations. Patients in Wales can also access a local General Practitioner service during the evenings and at weekends, by phoning their Out of Hours service. The introduction of a '111' service is intended to combine these two operations on a pan-Wales basis using the existing NHS Direct Wales call centre and staff, with the existing Health Board Out of Hours 'hubs'. The merger of the two services is intended to improve the overall performance of both services. This paper focuses on the planned introduction of '111' in Cwm Taf and Hywel Dda University Health Boards. The purpose of the case study was to support the merger of the two telephony systems from both an organisational and service delivery perspective, by developing a Discrete Event Simulation to model the impact on service levels and staffing. In particular, to examine the percentage increase / decrease in the staffing requirements needed under partial or full integration of the two services. The results from the scenario analysis highlight that extra staffing resources would be required in certain groups (nurses and call handlers) whilst savings could be achieved in others, provided that there wasn't an increase in call volume after implementation of the new service.

Asunto(s)

RESUMEN

The aim of this study was to improve emergency theatre efficiency via the introduction of a theatre booking form and morning briefing meeting. Process mapping was used to engage staff and consider if the emergency theatre may benefit from the application of a structured process of communication. A theatre booking form and morning briefing meeting were implemented to promote change. Efficiency was measured by theatre utilisation and characterised into neutral time, efficient time and inefficient time. The results demonstrated a 12.9% increase in efficient time, 3.3% fall in inefficient time and 9.6% fall in neutral time post-implementation, during the high volume work period of 08:00 to 17:59 on weekdays. No improvement in efficiency was demonstrated outside these hours or on weekends during lower volume workloads. Utilisation of a theatre booking form and morning briefing meeting improved emergency theatre efficiency during high volume work periods by the application of a structured process of communication.

Asunto(s)