Learning from Bristol: reflections from a health economistBrian A. Ferguson
doi: 10.1108/14664100210446605pmid: N/A
The Kennedy Report will almost certainly become a defining moment in the history of UK healthcare. On the whole the NHS is poor at learning from history and there is a wealth of important information to be drawn from the report and the whole experience of Bristol. This article distils the essential clinical governance messages that risk being lost. While many of the issues can be viewed from an economic perspective, much of what is required is a change in attitude across whole health economies. The contribution that economics can make is to design appropriate incentive mechanisms to bring about desired behavioural change. It can also continue to promote informed debate on the proper meaning of efficiency and to highlight the features required for an appropriate and effective regulatory framework.
Nomenclature issues in aseptic preparation of medicinesRob Gandy; Karen Kershaw; Ian Beaumont
doi: 10.1108/14664100210446614pmid: N/A
Nomenclature is of fundamental importance in healthcare. Different professionals interpret different terms in different ways. This has implications for measurement, clinical governance, risk management and any comparative studies where clear definitions are not predetermined. A project to determine how aseptic dispensing activity in pharmacies and clinical areas should be measured found this to be the case, primarily between nurses and pharmacists. It was essential to have consistently used terms and definitions for the purposes of the project. A preliminary list was audited with senior staff in clinical areas to ascertain local views and practices. Commonly used alternatives and other relevant terms were identified. The results were validated by a multidisciplinary workshop to determine a final list. Evaluation of these and wider examples highlights the many implications and the need for the issue to be directly addressed, particularly in a multi-professional environment.
Online patient support systems – is there a need?Tomasz J. Spyt; Pamela A.C. Watt; Maria C. Boehm; Paul R. Stafford
doi: 10.1108/14664100210446623pmid: N/A
A survey of cardiac patients, their relatives and friends and local GPs was conducted to establish whether there is a need for an online patient support system. In November 2000, 859 patients, 360 relatives and 160 friends attending cardiac out-patients completed a questionnaire, 159 GPs were contacted by postal survey. Participants were asked if they use e-mail and the World Wide Web and if obtaining relevant health information via an online support system would be beneficial. Participants were also asked to select preferred subject options. The survey showed clear interest in the provision of a Web-based support service for cardiac patients and a pilot would be pursued.
Clinical governance and education: the views of clinical governance leads in the south west of EnglandChristopher E. Clark; Lindsey F.P. Smith
doi: 10.1108/14664100210446641pmid: N/A
This qualitative study examined the views of clinical governance leads in South West England on the development of clinical governance, and its relationship to education in primary care. Information was obtained from semi‐structured interviews with clinical governance leads, and supplementary methods were used to confirm key findings. Four principal themes emerged: education, support, barriers, and evolution. Education is central to achieving the clinical governance agenda. There is a range of educational needs within primary care and these must be integrated into practice professional development plans, which will be shaped by national and local priorities. A need for PCG clinical governance tutors to support this process emerged. A range of supporting mechanisms was identified, as were barriers: principally inadequate resources and a rigid agenda imposed from above. Existing educationalists will need to change their role within the new structures, and this should be an evolutionary rather than a revolutionary process.
A multi‐district model for the management of disease‐modifying treatments in multiple sclerosisHelen L. Ford; Michael Johnson; Jon Fear
doi: 10.1108/14664100210446650pmid: N/A
This paper's objective is to develop a model for the appropriate and equitable use of disease-modifying treatments in multiple sclerosis. The prevalence and incidence of multiple sclerosis was established in Leeds. A specialist multiple sclerosis team with two consultant neurologists and a multiple sclerosis support nurse was based at one centre. The team co-operated with purchasers to develop a model of care. This included a referral protocol, strict prescribing criteria, counselling and education of patients, the use of patient-centred outcome measures and training and feedback to other neurologists. A total of 217 people with multiple sclerosis were assessed from April 1997 to March 2000. Our experience suggests that a centralised multi-district clinic developed by close collaboration between clinicians and health purchasers and operating under agreed rules is a feasible and effective model for the managed introduction of new treatments to the NHS.
Use of a proforma for reporting staging CT scans of the thoraxChristopher S. Keeling‐Roberts
doi: 10.1108/14664100210446669pmid: N/A
The aim of this study was to devise a simple proforma for reporting staging CT scans of the thorax, to ensure that all essential information is included on the report, in a logical manner, and that a TNM classification and tumour stage is given. Once the design of the proforma had been agreed, its utilisation and effectiveness was audited. In an initial six month period, every proforma filled in had resulted in a TNM classification being given, although in only 20 out of 40 (50 per cent) had a tumour stage been given. In a subsequent six month period, 39 out of 44 patients (89 per cent) with lung cancer undergoing a staging CT scan had proformas completed, and a TNM classification and tumour stage given (95 per cent CI is (0.75, 0.96)). Therefore, a proforma can be a useful aid to reporting staging scans, and is an effective method of ensuring that tumours are staged as fully as possible, radiologically. In addition, relevant information is presented in a clear format that allows accurate collection of data for audit purposes.
A structured examination in labour improves documentationSudipta Paul; David J. Rowlands
doi: 10.1108/14664100210446678pmid: N/A
A structured sticker for examination of women in labour was introduced at Arrowe Park Hospital in 1998 to improve documentation of examination findings. This study was undertaken to assess whether the use of the sticker improved documentation of examination findings and second, compliance of sticker use. A retrospective analysis was performed on 64 cases randomised by random number generated on Arcus Quickstat from 470 women who were induced by prostaglandin during 1 January 1998 to 31 December 1998 at Arrowe Park Hospital. Women were induced by prostaglandin were chosen as the study population to obtain data from early labour. A total of 229 examinations were performed in these areas. Statistical analysis was undertaken on Arcus Quickstat, and ?2 and Fisher's exact tests were applied to check for statistical significance.
Beware of the patient safety juggernautsDavid Birnbaum; William Scheckler
doi: 10.1108/14664100210446687pmid: N/A
Patient safety and medical error have become prominent issues following publication of Institute of Medicine reports in the USA. The USA, Australia, and now Canada have followed a national "medical error" studies path that uses language rejected by the interdisciplinary group of experts described previously in this column, and continues using methods considered seriously flawed as well as incomplete by noteworthy hospital epidemiologists. Preliminary review of British hospitals by similar methods also has been published. Proven and more cost-effective surveillance methods are pertinent methods developed over the past several decades by hospital epidemiology and infection control professionals who have more experience, but this heritage has been ignored in recent patient safety juggernauts. It is time to question why retrospective physician chart review approaches remain in vogue with national bodies to enumerate adverse patient outcomes and attribute them with "medical error" when better alternatives exist.
Learning by doing: training general practitioners to be appraisersDebbie Wall; Maurice Conlon; Ron Cullen; Aidan Halligan
doi: 10.1108/14664100210446696pmid: N/A
Effective appraisal is one of the key underpinning systems to allow the practical implementation of clinical governance. Between March and July 2002, over 800 GPs have attended the national GP "Training the Appraisers" Programme, funded by the Department of Health, and run by the NHS Clinical Governance Support Team (CGST) in partnership with Edgecumbe Consulting Ltd. The one day programme, which includes practical "real life" appraisal sessions for GPs, is well on the way to meeting its remit of training 900 GP appraisers (an average of three appraisers per PCT) in 2002. Once they have completed the course, trained appraisers can begin the process of conducting the first round of appraisals in their local primary care organisations. The GP Appraisal Programme recognises the potential of an effective system of appraisal to develop over time, so that patients can be confident that their family doctor is supported in taking regular, structured steps to ensure they are identifying and fulfilling their professional development needs and thereby enhancing the delivery of high quality care.