In-depth review of the acute medical care workforce – Centre for Workforce Intelligence (CfWI) [UK] – 26 February 2015Read Full Post | Make a Comment ( Comments Off on In-depth review of the acute medical care workforce – Centre for Workforce Intelligence (CfWI) [UK] – 26 February 2015 )
NHS hospitals under pressure: trends in acute activity up to 2022 – Nuffield Trust – 6 October 2014 “In this analysis we look at trends in admissions and bed use over the last few years, and use population projections to explore the likely pressures on hospitals in the future.”Read Full Post | Make a Comment ( Comments Off on NHS hospitals under pressure: trends in acute activity up to 2022 – Nuffield Trust – 6 October 2014 )
“We are all too aware that the urgent and emergency care system has been under pressure for some time with increasing emergency admissions, rising levels of acuity and a lack of effective alternatives to the emergency department. This growing pressure is not sustainable and there is a risk that the quality of patient care will be compromised. Significant measures are needed to avoid an annual crisis and to build a resilient system which is fit for purpose.
Given the continuing challenges experienced by patients and those working in acute and emergency care services the College of Emergency Medicine convened an emergency summit with the Royal College of Paediatrics and Child Health, the Royal College of Physicians, the Royal College of Surgeons and the NHS Confederation. On 4th March 2014 key policy makers, opinion formers and leaders in acute healthcare were brought together to develop solutions to the challenges and to strengthen the system for future service demands.
Acute and emergency care – prescribing the remedy contains the consensus recommendations of this summit. The consensus nature of the proposals reflecting, the needs of patients whether ill or injured, the elderly and children is unique.
This report co-authored by the College of Emergency Medicine, Royal College of Paediatrics and Child Health, Royal College of Physicians and Royal College of Surgeons sets out 13 recommendations for Government, national bodies, commissioners, providers, professional bodies and clinicians, to take forward at local and national levels. Implementing these measures will help build an urgent and emergency care system that is sustainable and resilient to cope with future service demands.”Read Full Post | Make a Comment ( Comments Off on Acute and emergency care: prescribing the remedy – The College of Emergency Medicine – 16 July 2014 )
Dementia care in the acute hospital setting: issues and strategies – Alzheimer’s Australia – 16 June 2014
Extract from the executive summary
“Australia is facing a huge healthcare challenge with an ever increasing demand for appropriate acute care services for people with dementia. Yet, people with dementia still struggle to get the care they need in the acute care setting. People with dementia experience unacceptably worse clinical outcomes, longer lengths of stay as well as a higher likelihood for readmission compared to people without dementia at a high cost to the health care system.1
With good care, the costs of dementia care in hospital may be the same but the outcomes for people with dementia would be improved leading to a more efficient use of health care spending.
Alzheimer’s Australia held a Dementia Care in Hospitals Symposium in Sydney on the 29th of April 2014, where the most recent Australian research in dementia care in hospitals was presented and discussed by leading researchers and experts. This included latest findings on current dementia care as well as interventions and strategies to improve the quality of care. This report provides a summary of the issues and strategies that were discussed at this Symposium.”
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Evaluating the Care Quality Commission’s acute hospital regulatory model: emerging findings – Care Quality Commission – 14 March 2014
“In September 2013, the Care Quality Commission asked a team from Manchester Business School and the King’s Fund to undertake a formative evaluation of CQC’s new acute hospital regulatory model.
The design of the new acute hospital regulatory model is described in the inspection framework  and guidance, and in other CQC documents such as the logic model . It is an almost complete departure from the approach used by CQC in recent years. The key differences– as described in those documents and to us in interviews – are:”
… continues on the site
“We commissioned the Kings Fund and Manchester Business School to carry out this evaluation and will use this information to improve the way it inspects. The full report will be published in May.
The paper published today explored whether the new approach provides a better analysis of the performance of an acute hospital – whether:
the measures used are valid and reliable.
the data is meaningful.
it adds significantly to what is already known.
it helps to not just assess performance but to understand the causes of performance variation.
It also explored:
whether the new model works in practice.
how the inspections are prepared, carried out and reported.
whether it could be done more effectively.
Author Professor Kieran Walshe presented themes from the paper at our board meeting today. The report says:”
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Controlling the cost of care: a billion dollar hospital opportunity – Grattan Institute – 4 March 2014
by Stephen Duckett and Peter Breadon
“A better pricing system for public hospital treatment would show where costs are too high, and free up $1 billion for more and better health care.
The gulf between treatments in high and low-cost hospitals in Australia is vast, with no good reason for such variation. In New South Wales, for example, the difference in the cost of a common gall bladder treatment between the highest and lowest-cost hospitals is more than $4,000, and the difference in the cost of a hip replacement more than $16,000. In many states the gap between the most and least expensive hospitals is more than $1,500 for every admission — and in some states it is much greater — even when all legitimate funding differences among hospitals that we can measure are taken into account.
This money is not being used to provide better care – it is simply being spent inefficiently and could be used for much better ends.
To achieve the savings, the report urges state governments to make three reforms. They should pay hospitals for treatments on the basis of an average price once all avoidable costs we can measure have been removed.
Second, they should make data available to hospitals so they can compare themselves to their peers and see where they can cut costs. Third, governments need to be tougher and hold hospital boards to account when they fail to control costs. But even with these changes, it is up to hospital leaders, managers and doctors to find the best ways to improve.
Hospital spending is the fastest growing area of government spending, and is projected to increase with new technologies and an ageing population. We have to keep health care affordable and the health budget under control. Rooting out inefficiencies in public hospital systems is a good place to start.”Read Full Post | Make a Comment ( Comments Off on Controlling the cost of care: a billion dollar hospital opportunity – Grattan Institute – 4 March 2014 )
Costing seven day services: The financial implications of seven day services for acute emergency and urgent services and supporting diagnostics – Healthcare Financial Management Association (HFMA) – 17 December 2013
Costing seven day services: The financial implications of seven day services for acute emergency and urgent services and supporting diagnostics – Healthcare Financial Management Association (HFMA) – 17 December 2013Read Full Post | Make a Comment ( Comments Off on Costing seven day services: The financial implications of seven day services for acute emergency and urgent services and supporting diagnostics – Healthcare Financial Management Association (HFMA) – 17 December 2013 )
“This publication offers case studies and examples of how hospitals, community health and social care services across the country are working together to deliver routine services seven days a week. Recent listening events have shown that patients and the public want us to act now to make seven day services a reality in our NHS.”
NHS Services, Seven Days a Week Forum. Summary of Initial Findings – 15 December 2013
“New clinical standards backed by rewards and sanctions
NHS England’s National Medical Director Sir Bruce Keogh today sets out a plan to drive seven day services across the NHS over the next three years, starting with urgent care services and supporting diagnostics.”Read Full Post | Make a Comment ( Comments Off on NHS Services open seven days a week: Every day counts – NHS Improving Quality – 16 December 2013 )
Acute care toolkit 7: Acute oncology on the acute medical unit – Royal College of Physicians – October 2013
“Advances in cancer management continue to improve patient outcomes, but this has been accompanied by a steady increase in emergency admissions with disease- or treatment-related complications. The acute medical unit (AMU) currently shoulders much of this burden. Providing efficient and excellent care to this complex patient group in a busy AMU presents a key challenge. A good working partnership between the AMU and acute oncology service (AOS) can result in a significant improvement in patient care together with opportunities for admission avoidance and early discharge.”Read Full Post | Make a Comment ( Comments Off on Acute care toolkit 7: Acute oncology on the acute medical unit – Royal College of Physicians – October 2013 )
Staff, patients and families experiences of giving and receiving care during an episode of delirium in an acute hospital care setting – Healthcare Improvement Scotland – September 2013
A Report by Professor Belinda Dewar, University of West of Scotland, Penny Bond, Michelle Miller and Karen Goudie, Healthcare Improvement Scotland
“This report provides details of a project undertaken to explore staff, patients’ and families’ experience of episodes of delirium in an acute hospital setting. The Improving Care for Older People in Acute Care workstream has been working with colleagues from the Scottish Delirium Association and others to design, develop and test a delirium bundle to support staff with the early identification and management of delirium in caring for older people in the acute care setting. As part of this development, the project team was keen to explore what it felt like to both give and receive care during an episode of delirium to:
enhance our learning about caring for patients and family during an episode of delirium
help us to improve communication, and
contribute to the development of a guidance document for the delirium bundle.”
Emergency Care and Emergency Services 2013 – View from the frontline – Foundation Trust Network [UK] – 5 June 2013
“The FTN has surveyed its members operating at the frontline on the urgent and emergency care pathway.Our survey shows that acute, ambulance,community and mental health have different perspectives but there are also some clear common messages. We share some of our initial findings here.”Read Full Post | Make a Comment ( Comments Off on Emergency Care and Emergency Services 2013 – View from the frontline – Foundation Trust Network [UK] – 5 June 2013 )
High quality care for all, now and for future generations: transforming urgent and emergency care services in England – June 2013
High quality care for all, now and for future generations: transforming urgent and emergency care services in England – June 2013
Emerging Principles from the Urgent and Emergency Care Review
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Acute care toolkit 5: teaching on the acute medical unit – Royal College of Physicians – 27 November 2012
This toolkit helps clinicians and trainees ensure there is a focus on quality education as well as delivering essential care. It focuses on maximising opportunities for teaching and learning, and includes technical tips and examples for weaving teaching and learning into the daily work of an acute unit.
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What are the benefits and challenges of “bedside” nursing handovers? – Policy+ Issue 36 – November 2012
King’s College London
“In acute hospital settings nursing handover (also known as ‘change of shift’ or ‘nursing report’) has become the traditional and dominant form of communication between nurses caring for patients on one shift to the next . A substantial body of nursing research appraising nurse handover has evolved and the necessity of such handover seems undisputed for enabling nurses to exchange information . The literature identifies four main types of nurse handover: bedside, verbal, taped and nonverbal. However, the impact of the various handover methods on nursing care and patient outcomes remains unclear .
In the UK and internationally, some hospitals are moving towards handovers at the patient’s bedside to support patient-centred care . However, there are no national guidelines or standards in England and some have raised concerns about whether bedside handover complicates, rather than streamlines, nursing processes and puts patient’s confidentiality at risk. In this Policy+ we examine different approaches to implementation, evidence of the benefits, and challenges associated with bedside handover in acute hospital settings.”Read Full Post | Make a Comment ( Comments Off on What are the benefits and challenges of “bedside” nursing handovers? – Policy+ Issue 36 – November 2012 )
Acute care toolkit 4: delivering a 12-hour, 7-day consultant presence on the acute medical unit – Royal College of Physicians – 11 October 2012
“Acute medical illness is a 7-day problem – patients are just as likely to develop an acute illness requiring an emergency admission on a Saturday or Sunday as on a weekday. Evidence that patients admitted at weekends have poorer outcomes than those admitted on weekdays, and that patient mortality is higher at weekends, led to the RCP and the Society of Acute Medicine (SAM) recommending that a consultant physician ‒ dedicated to the care of acutely ill patients ‒ should be available on site to review patients for at least 12 hours a day, every day.
This toolkit provides practical guidance to senior hospital managers and clinical staff on how to organise acute medical services to ensure that the 12-hour consultant presence delivers consistent high-quality care to acutely ill patients.
The guidance provides answers to key questions including:
How many consultants are required to provide a daily 12-hour presence on the acute medical unit (AMU)?
How many patients should a consultant be expected to review during their shift on the AMU and how long should this shift be?
How should consultant working and support services be organised in order to provide high-quality patient care every day of the week?”
National early warning score. Standardising the assessment of acute illness severity in the NHS – Royal College of Physicians – July 2012
Early detection, timeliness and competency of clinical response are a triad of determinants of clinical outcome in people with acute illness. Numerous recent national reports on acute clinical care have advocated the use of so-called ‘early warning scores’ (EWS), ie ‘track-and-trigger systems’ to efficiently identify and respond to patients who present with or develop acute illness. A number of EWS systems are currently in use across the NHS, however, the approach is not standardised. This variation in methodology and approach can result in a lack of familiarity with local systems when staff move between clinical areas/hospitals – the various EWS systems are not necessarily equivalent or interchangeable. Put simply, when assessing acutely ill patients using these various scores, we are not speaking the same language and this can lead to a lack of consistency in the approach to detection and response to acute illness. This lack of standardisation also bedevils attempts to embed a culture of training and education in the assessment and response to acute illness for all grades of healthcare professionals across the NHS. Building upon recommendations in the RCP’s Acute Medicine Task Force report Acute medical care: the right person, in the right setting – first time, published in 2007, the RCP commissioned a multidisciplinary group to develop a National Early Warning Score (NEWS).”
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Economics of Patient Safety in Acute Care: Final Report – Canadian Patient Safety Institute – 9 July 2012
Investigators: Dr. Edward Etchells (Team Lead), Dr. Nicole Mittmann (Co-Lead), Ms. Marika Koo, Dr. Michael Baker, Dr. Murray Krahn, Dr. Kaveh Shojania, Dr. Andrew McDonald, Ms. Rupinder Taggar, Dr. Anne Matlow, Dr. Nick Daneman
Patient safety has received considerable public, professional, political, and scientific attention over the past 12 years. Adverse events are injuries caused by healthcare, rather than the patient’s underlying condition, leading to disability (prolonged length of stay, morbidity at the time of discharge, or death). Although the human burden associated with adverse events is well established, the economic burden has received less attention. A fuller understanding of the economic burden of unsafe care may inform Canadian health policy, health services research priorities, patient safety research programs, and patient safety improvement priorities for healthcare organizations.
Our objectives were to:
1. Summarize the scope and quality of published studies on the economic burden of adverse events in the acute care setting.
2. Summarize the scope and quality of published comparative economic evaluations (cost effectiveness analyses) of patient safety improvement strategies in the acute care setting.
3. Estimate the economic burden of adverse events on the Canadian acute care system.
4. Provide a framework and guidelines for performing economic burden studies and comparative economic evaluations (cost effectiveness analyses) in patient safety.
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The Silver Book. Quality Care for Older People with Urgent and Emergency Care Needs – University of Leicester, Department of Cardiovascular Sciences
Despite the majority of urgent care being delivered in the primary care setting, an increasing number of older people are attending emergency departments and accessing urgent health and social care services. This is partly related to the demographic shift that has resulted in a rapid increase in the number of older people, but may also be due to lower thresholds for accessing urgent care. Over the next 20 years, the number of people aged 85 and over is set to increase by two-thirds, compared with a 10 per cent growth in the overall population. Recent national reports including from Patient UK, Care Quality Commission, NCEPOD and the Health Service Ombudsman highlighted major deficiencies in the care of older people in acute hospitals ranging from issues around privacy and dignity to peri-operative care. Older people are admitted to hospital more frequently, have longer length of stay and occupy more bed days in acute hospitals compared to other patient groups. There is a pressing need to change how we care for older people with urgent care needs, to improve quality, outcomes and efficiency. Emergency departments need to be supported to deliver the right care for these patients, as no one component of the health and social care systems can manage this challenge in isolation; implementation of improved care for older people requires a whole system approach.
Important factors in primary care that impact on the use of urgent care services include a timely primary care response and ready access to general practitioners. More community based services with a rapid response time may reduce the need to access secondary care. There needs to be better communication between ‘in-hours’ and out of hours services. The ambulance service has a key role to play and can be an important contributor in doing things differently – for example, referring non-conveyed patients directly to urgent care, community and primary care services, including falls services.
Attendance at the Emergency Department is associated with a high risk of admission for older people, so the nature of the service and the environment in which it is provided needs to change to reflect the changing nature of health care in the 21st century, the bulk of which relates to older people, and increasingly frail older people. Dedicated teams delivering comprehensive geriatric assessment can support this, but in themselves are not sufficient to realise whole system change. Services in all settings including health and social care need to improve their communication and handover, and greater use of the voluntary sector is to be encouraged. In acute medical units, greater use of geriatric liaison services should increase the proportion of older people able to be managed in the community setting.”
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Acute care toolkit 3: acute medical care for frail older people – Royal College of Physicians – 24 April 2012
“The third in the series of acute care toolkits from the Royal College of Physicians aims to improve the care of the frail older patient.
Older people make up 60–70% of hospital inpatients, and most are admitted through an Acute Medical Unit (AMU), making this a key area in which care for older people can be influenced. It can be difficult for doctors to assess frail older patients as they can often arrive at hospital with multiple symptoms or conditions which can make it difficult to deduce the true cause of the admission.
The new six-page toolkit, produced in collaboration with the British Geriatrics Society, recommends procedures for both initial assessment on admission and later Comprehensive Geriatric Assessment (CGA).”
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New hospital nutrition standards – NSW Health media release – 15 December 2011
“New food and nutrition standards for NSW public hospitals will set the benchmark for hospital food in Australia, the Minister for Health and Minister for Medical Research, Jillian Skinner, announced today.
The new standards will provide a comprehensive statewide guide to the preparation of more than 22 million hospital meals each year.”
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“Consultant physicians are at the forefront of delivering care to patients presenting to hospital with medical emergencies. Delivering this care depends on competent and expert clinical staff, organised with optimal working arrangements to match patient demand, supported by the right level of resources and facilities.
This toolkit, the second in a series on acute care, focuses on the delivery of high-quality acute care, looking at current problem areas and factors threatening care delivery, and suggesting a range of recommendations for improving quality.
The toolkit is accompanied by two appendices: the RCP position statement on out-of-hours care, and guidance notes on the provision of 12-hours-per-day, 7-days-per-week consultant care.”Read Full Post | Make a Comment ( Comments Off on Acute care toolkit 2: High quality acute care – Royal College of Physicians – 21 October 2011 )
“With the changing landscape of shorter working hours, the main pitfalls appear to be at the front line of acute medical services. There is increasing evidence of sub-standard care delivered to patients admitted to hospital in the evenings and at weekends. The RCP recognises the need to ensure consistent high-quality care, 24 hours a day, seven days a week, 365 days a year across the NHS, which is reflected in the recent RCP statement recommending consultant presence 12 hours a day, seven days a week in acute care settings.
A series of toolkits
Currently there are clear difficulties in providing high-quality service and training within the constraints of the shorter working hours. To tackle this issue, this year RCP will prepare a series of toolkits with the goal of ensuring that patients get access to the highest quality of acute medical care wherever and whenever it is needed. Each toolkit will include concise practical guidance to enhance patient safety, medical effectiveness and high quality service and training within current working patterns. The first toolkit in the series will address handover.”
Preventing Pressure Ulcers in Hospitals – A Toolkit for Improving Quality of Care – AHRQ – April 2011
“Each year, more than 2.5 million people in the United States develop pressure ulcers. These skin lesions bring pain, associated risk for serious infection, and increased health care utilization. The aim of this toolkit is to assist hospital staff in implementing effective pressure ulcer prevention practices through an interdisciplinary approach to care.”
AHRQ = US Agency for Healthcare Research and QualityRead Full Post | Make a Comment ( None so far )
Facing the Future: Standards for Paediatric Services – Royal College of Paediatrics and Child Health – 21 April 2011
“In this document the RCPCH specifies ten service standards, all of which have been approved by the College Council. The College considers the standards to represent a minimum requirement for all acute general paediatric services. Each standard is accompanied by an explanatory text that indicates in more detail what the standard is seeking to achieve, and how it will be implemented.”Read Full Post | Make a Comment ( None so far )
Australia’s hospitals 2009-10 at a glance – AIHW – 29 April 2011
“Australia’s hospital 2009-10 at a glance provides summary information on Australia’s 1,320 public and private hospitals. In 2009-10, there were: 8.6 million hospitalisations in public and private hospitals; 7.4 million presentations to accident and emergency departments, and 70% of patients were seen within recommended times for their triage category. This publication is a companion to the annual Australian hospital statistics 2009-10 publication.”
ISSN 1036-613X ; ISBN 978-1-74249-136-3; Cat. no. HSE 106; 36p.Read Full Post | Make a Comment ( None so far )
Avoiding hospital admissions: What does the research evidence say? – King’s Fund – 16 December 2010
“Summary: Emergency admissions to hospital are costly to the NHS and also cause disruption to planned health care. Considerable efforts have been made within the health service to reduce emergency admissions, but few primary care trusts have been successful, with some primary care trusts recording an increase.
In order to successfully reduce avoidable emergency admissions, we need to fully understand which interventions are the most effective. The King’s Fund commissioned this review of research evidence to establish which interventions work in avoiding emergency or unplanned hospital admissions.” … continuesRead Full Post | Make a Comment ( None so far )
The Impact of the H1N1 Pandemic on Canadian Hospitals – November 2010
“While the H1N1 global pandemic may not have resulted in as many severe cases as originally predicted, a new study released today by the Canadian Institute for Health Information (CIHI) shows that more than 15,000 Canadians were admitted to hospital for H1N1 in Canada between April and December 2009. This is about 6,500 more patients than the number of lab-confirmed hospitalization cases reported at the end of last year, as it includes the number of both confirmed and probable H1N1 acute care hospitalizations.
The Impact of the H1N1 Pandemic on Canadian Hospitals uses the combined total of probable and confirmed H1N1 cases to assess the impact on Canada’s acute care hospital system because many hospitalizations for unspecified influenza are assumed to have been H1N1. The number of cases released last year followed the World Health Organization’s guidelines and focused on lab-confirmed H1N1 only.”Read Full Post | Make a Comment ( None so far )
By: Arthur Lodge Kellermann, Emily R. Carrier, Stephen R. Pitts, Eugene C. Rich
Document Number: RB-9556
Less than half of acute care visits in the United States involve a patient’s personal physician. Emergency physicians, who comprise only 4 percent of doctors, handle 28 percent of all acute care encounters and nearly all after-hours and weekend care.
Full Document (pdf)
(File size < 0.1 MB, < 1 minute modem, < 1 minute broadband)
The State of our Public Hospitals – June 2010
“State of Our Public Hospitals June 2010 reports on public hospital activity in the 2008-09 financial year. This year’s report also provides information on private hospital data where available, and includes chapters on hospital use by Aboriginal and Torres Strait Islander people and maternity services.
The State of Our Public Hospitals June 2010 report also includes an overview on how the public hospital system performed over the life of the Australian Health Care Agreements, and changes that have been introduced by the Australian Government since 2007.”Read Full Post | Make a Comment ( None so far )
Funding sources for admitted patients in Australian hospitals, 2005-06
Australian Institute of Health and Welfare
Health and welfare expenditure series no. 39
Published 1 December 2009; ISSN 1323-5850; ISBN-13 978 1 74024 873 0; AIHW cat. no. HWE 44; 56pp.
“This report provides information on sources of funding for the provision of care to admitted patients in Australian hospitals in 2005-06. The report compares funding for privately insured and public patients in public and private hospitals and, in particular, compares the Australian Government contributions for these patients. The Australian Government¿s average contribution per episode for public patients was $1,367 for the subset of AR-DRGs used in the analysis, compared to the average contribution for privately insured patients in private hospitals of $1,364 per episode.”Read Full Post | Make a Comment ( None so far )
More acute consultants means shorter hospital stays News : 18 June 2009
“New research published by the Royal College of Physicians shows that more consultants on Acute Medical Units (AMUs) can reduce hospital stays and prevent inappropriate admissions in the first place. AMUs are now found in hospitals all over the country, despite being a relatively new specialty. This is the first evidence to support arguments that they will bring benefits to patient care.”
1. The full team involved in the study consisted of: Dr Nicola Trepte, consultant physician in acute medicine; Dr Gregor McNeill, specialist registrar in acute medicine; Dr Darshan Brahmbhatt, academic foundation house officer 2 in cardiothoracic surgery; and A Toby Provost, medical statistician.
2. The article What is the effect of a consultant presence in an acute medical unit is published in this month’s edition of Clinical Medicine journal [June 2009].Read Full Post | Make a Comment ( None so far )
Hospitals in the 27 member states of the European Union – report January 2009
A publication produced in partnership with HOPE, the European Hospital and Healthcare FederationRead Full Post | Make a Comment ( None so far )
This document contains detailed guidance on the routine collection of PROMs for elective procedures from 1 April 2009. The document is intended to support providers and PCT commissioners to implement the requirement to collect PROMs contained in the standard NHS contract for acute services.Read Full Post | Make a Comment ( None so far )
It has been produced by the Steering Committee for the Review of Government Service Provision (SCRGSP). The report has been published in two volumes. Also released with the report are attachment tables, which are not part of the printed report but are available in the report sections.
Primary and Community Health
Breast cancer detection and management
Aged care services
Services for people with a disability
Supported accommodation and assistance services
Government services and Indigenous people (PDF – 99 Kb)
With increased attention on patient safety, efficiency and appropriate allocation of resources, health system planners and policy-makers are focused on patient pathways—including reasons for patient transfers. This report explores the characteristics of seniors 75 and older who have been transferred from a continuing care setting and admitted into acute care, including reasons for transfers, wait times and discharge following the acute care stay.
When: January 22, 2009Read Full Post | Make a Comment ( None so far )
January 14, 2009
Alternate Level of Care in Canada
Canadian Institute for Health Information
Most Canadians have never heard the phrase “alternate level of care,” or ALC. Yet since the mid-1980s, the public consciousness has embraced the idea that hospital beds are being occupied by patients who no longer need acute services, using limited, expensive resources while they wait to be discharged to a more appropriate setting. These non-acute hospital days are captured in hospitalization data as patients awaiting an alternate level of care (or ALC patients).
There is increasing concern that the ALC issue is growing and negatively affecting an already-taxed hospital system.1, 2 Some work has been done to improve continuity of care for patients as they transition out of acute care and into other parts of the health care system.3–5 In many cases, solutions to help reduce ALC stays in hospitals require collaboration from different sectors of the health care system, including community care and long-term care.1, 3–5
From a policy perspective, it is important to understand if the health care system has sufficient capacity to provide necessary care in the most appropriate setting. If capacity in community and long-term care is increased, will the overall cost to the health care system be reduced? Uncovering how ALC is being used in acute settings may inform discussions on these important health system questions.
This report is an initial look at the extent of the ALC challenge in hospitals. Understanding the patients who are most likely to be designated ALC and the type of care they are waiting for may help to improve care and reduce the ALC burden on acute hospitals. Although the ALC concept is also applied to other sectors such as rehabilitation facilities and hospital-based chronic care,1, 6 this report focuses only on ALC days that occur in acute care facilities.Read Full Post | Make a Comment ( None so far )
Also known as the Garling Report.
State of NSW through the Special Commission of Inquiry: Acute Care Services in New South Wales Public Hospitals
Final Report of the Special Commission of Inquiry: Acute Care in NSW Public Hospitals, 2008 – Overview (print)
Published 27 November 2008