Health bulletin
-
To establish the appropriateness of bed usage for acute care within the medical directorates of two district general hospitals using a validated assessment tool, the Emergency Admission Review (EAR). This tool assesses the appropriateness of day of care against strict criteria and allows classification of care as either acute or non-acute. ⋯ The use of the EAR is a systematic and objective approach to the assessment of appropriateness of acute care. It applies strict criteria to determine the reason for a patient's continued hospital stay. From the results it is clear that a significant proportion of medical emergency admissions in both Hospital A and B remain in hospital for care that is deemed non-acute and therefore in theory could be performed in another setting. This information has significant potential in identifying the opportunities for streamlining services within hospitals to reduce short-term delays and also to inform the development of intermediate care services both within and outwith the acute hospital setting.
-
To examine the impact of providing a specialist addictions trained psychiatric nurse on outcome of alcohol treatment in patients presenting to general medical and surgical wards of a district general hospital. Before introducing the specialist alcohol liaison service, a range of staff including a consultant liaison psychiatrist, junior psychiatrists and community psychiatric nurses trained in liaison psychiatry assessed this patient group. ⋯ Specialist addictions trained staff in the assessment and management of alcohol dependent patients in medical and surgical wards produce a better immediate outcome than their non-specialist colleagues. This may have implications for service design.
-
Health Impact Assessment (HIA) provides a method of predicting the health impacts of policies and activities, in order to recommend changes that would improve health. We piloted approaches to health impact assessment and made recommendations for its use as part of the planning and policy making processes in Scotland. ⋯ Health impact assessment can make explicit the health consequences of decisions in different sectors, including impacts on health inequalities. Health Impact Assessment should be done as part of community planning and other partnership activities. Consideration of health impacts should become part of routine decision making.
-
To survey NHS services providing emergency psychiatric assessment in Scotland and to compare the findings with those of the survey conducted 8 years ago. ⋯ Planning the most appropriate emergency and crisis service for any population depends on suitable data being available. Eight years after the first survey there is still no systematic collection of data on emergency contacts in Scotland. The systematic collection of National data is required for effective audit, planning and development of these services. The working definitions proposed in the first survey would be suitable for coding.
-
Two recommendations of NCEPOD were the introduction of dedicated emergency theatres and a higher level of consultant involvement in emergency cases. In May 1998 a dedicated emergency theatre was introduced in the Royal Hospital for Sick Children, Glasgow. At the same time the on-call rota of the Consultant Paediatric Surgeons was changed from days on-call to a period of one week, during which elective commitments were cancelled. ⋯ The provision of a dedicated emergency theatre increased the proportion of emergency cases performed during normal working hours, particularly before 1 pm. Cancelling elective commitments for Consultant Paediatric Surgeons ensured higher levels of consultant input into daytime emergency cases.