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Paton F, Wright K, Ayre N, Dare C, Johnson S, Lloyd-Evans B, Simpson A, Webber M, Meader N. Improving outcomes for people in mental health crisis: a rapid synthesis of the evidence for available models of care. Health Technol Assess 2016; 20:1-162. [PMID: 26771169 DOI: 10.3310/hta20030] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Crisis Concordat was established to improve outcomes for people experiencing a mental health crisis. The Crisis Concordat sets out four stages of the crisis care pathway: (1) access to support before crisis point; (2) urgent and emergency access to crisis care; (3) quality treatment and care in crisis; and (4) promoting recovery. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of the models of care for improving outcomes at each stage of the care pathway. DATA SOURCES Electronic databases were searched for guidelines, reviews and, where necessary, primary studies. The searches were performed on 25 and 26 June 2014 for NHS Evidence, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database, and the Health Technology Assessment (HTA) and PROSPERO databases, and on 11 November 2014 for MEDLINE, PsycINFO and the Criminal Justice Abstracts databases. Relevant reports and reference lists of retrieved articles were scanned to identify additional studies. STUDY SELECTION When guidelines covered a topic comprehensively, further literature was not assessed; however, where there were gaps, systematic reviews and then primary studies were assessed in order of priority. STUDY APPRAISAL AND SYNTHESIS METHODS Systematic reviews were critically appraised using the Risk Of Bias In Systematic reviews assessment tool, trials were assessed using the Cochrane risk-of-bias tool, studies without a control group were assessed using the National Institute for Health and Care Excellence (NICE) prognostic studies tool and qualitative studies were assessed using the Critical Appraisal Skills Programme quality assessment tool. A narrative synthesis was conducted for each stage of the care pathway structured according to the type of care model assessed. The type and range of evidence identified precluded the use of meta-analysis. RESULTS AND LIMITATIONS One review of reviews, six systematic reviews, nine guidelines and 15 primary studies were included. There was very limited evidence for access to support before crisis point. There was evidence of benefits for liaison psychiatry teams in improving service-related outcomes in emergency departments, but this was often limited by potential confounding in most studies. There was limited evidence regarding models to improve urgent and emergency access to crisis care to guide police officers in their Mental Health Act responsibilities. There was positive evidence on clinical effectiveness and cost-effectiveness of crisis resolution teams but variability in implementation. Current work from the Crisis resolution team Optimisation and RElapse prevention study aims to improve fidelity in delivering these models. Crisis houses and acute day hospital care are also currently recommended by NICE. There was a large evidence base on promoting recovery with a range of interventions recommended by NICE likely to be important in helping people stay well. CONCLUSIONS AND IMPLICATIONS Most evidence was rated as low or very low quality, but this partly reflects the difficulty of conducting research into complex interventions for people in a mental health crisis and does not imply that all research was poorly conducted. However, there are currently important gaps in research for a number of stages of the crisis care pathway. Particular gaps in research on access to support before crisis point and urgent and emergency access to crisis care were found. In addition, more high-quality research is needed on the clinical effectiveness and cost-effectiveness of mental health crisis care, including effective components of inpatient care, post-discharge transitional care and Community Mental Health Teams/intensive case management teams. STUDY REGISTRATION This study is registered as PROSPERO CRD42014013279. FUNDING The National Institute for Health Research HTA programme.
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Affiliation(s)
- Fiona Paton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Ceri Dare
- Department of Health Sciences, University of York, York, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | | | - Alan Simpson
- School of Health Sciences, City University London, London, UK
| | - Martin Webber
- Department of Social Policy and Social Work, University of York, York, UK
| | - Nick Meader
- Centre for Reviews and Dissemination, University of York, York, UK
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McKenzie R, Dunt D, Yates A. Patient intention and self-reported compliance in relation to emergency department attendance after using an after hours GP helpline. Emerg Med Australas 2016; 28:538-43. [DOI: 10.1111/1742-6723.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/07/2016] [Accepted: 05/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Rosemary McKenzie
- Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - David Dunt
- Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Allison Yates
- Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
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Bianchi M, Bressan V, Cadorin L, Pagnucci N, Tolotti A, Valcarenghi D, Watson R, Bagnasco A, Sasso L. Patient safety competencies in undergraduate nursing students: a rapid evidence assessment. J Adv Nurs 2016; 72:2966-2979. [PMID: 27222204 DOI: 10.1111/jan.13033] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 11/29/2022]
Abstract
AIMS To identify patient safety competencies, and determine the clinical learning environments that facilitate the development of patient safety competencies in nursing students. BACKGROUND Patient safety in nursing education is of key importance for health professional environments, settings and care systems. To be effective, safe nursing practice requires a good integration between increasing knowledge and the different clinical practice settings. Nurse educators have the responsibility to develop effective learning processes and ensure patient safety. DESIGN Rapid Evidence Assessment. DATA SOURCES MEDLINE, CINAHL, SCOPUS and ERIC were searched, yielding 500 citations published between 1 January 2004-30 September 2014. REVIEW METHODS Following the Rapid Evidence Assessment process, 17 studies were included in this review. Hawker's (2002) quality assessment tool was used to assess the quality of the selected studies. RESULTS Undergraduate nursing students need to develop competencies to ensure patient safety. The quality of the pedagogical atmosphere in the clinical setting has an important impact on the students' overall level of competence. Active student engagement in clinical processes stimulates their critical reasoning, improves interpersonal communication and facilitates adequate supervision and feedback. CONCLUSION Few studies describe the nursing students' patient safety competencies and exactly what they need to learn. In addition, studies describe only briefly which clinical learning environments facilitate the development of patient safety competencies in nursing students. Further research is needed to identify additional pedagogical strategies and the specific characteristics of the clinical learning environments that encourage the development of nursing students' patient safety competencies.
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Affiliation(s)
| | | | | | | | | | | | - Roger Watson
- School of Nursing and Midwifery, University of Hull, UK
| | | | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Italy
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Greenhalgh T, Vijayaraghavan S, Wherton J, Shaw S, Byrne E, Campbell-Richards D, Bhattacharya S, Hanson P, Ramoutar S, Gutteridge C, Hodkinson I, Collard A, Morris J. Virtual online consultations: advantages and limitations (VOCAL) study. BMJ Open 2016; 6:e009388. [PMID: 26826147 PMCID: PMC4735312 DOI: 10.1136/bmjopen-2015-009388] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Remote video consultations between clinician and patient are technically possible and increasingly acceptable. They are being introduced in some settings alongside (and occasionally replacing) face-to-face or telephone consultations. METHODS To explore the advantages and limitations of video consultations, we will conduct in-depth qualitative studies of real consultations (microlevel) embedded in an organisational case study (mesolevel), taking account of national context (macrolevel). The study is based in 2 contrasting clinical settings (diabetes and cancer) in a National Health Service (NHS) acute trust in London, UK. Main data sources are: microlevel--audio, video and screen capture to produce rich multimodal data on 45 remote consultations; mesolevel--interviews, ethnographic observations and analysis of documents within the trust; macrolevel--key informant interviews of national-level stakeholders and document analysis. Data will be analysed and synthesised using a sociotechnical framework developed from structuration theory. ETHICS APPROVAL City Road and Hampstead NHS Research Ethics Committee, 9 December 2014, reference 14/LO/1883. PLANNED OUTPUTS We plan outputs for 5 main audiences: (1) academics: research publications and conference presentations; (2) service providers: standard operating procedures, provisional operational guidance and key safety issues; (3) professional bodies and defence societies: summary of relevant findings to inform guidance to members; (4) policymakers: summary of key findings; (5) patients and carers: 'what to expect in your virtual consultation'. DISCUSSION The research literature on video consultations is sparse. Such consultations offer potential advantages to patients (who are spared the cost and inconvenience of travel) and the healthcare system (eg, they may be more cost-effective), but fears have been expressed that they may be clinically risky and/or less acceptable to patients or staff, and they bring significant technical, logistical and regulatory challenges. We anticipate that this study will contribute to a balanced assessment of when, how and in what circumstances this model might be introduced.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Joe Wherton
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emma Byrne
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
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Vessey JA, McCrave J, Curro-Harrington C, DiFazio RL. Enhancing Care Coordination Through Patient- and Family-Initiated Telephone Encounters: A Quality Improvement Project. J Pediatr Nurs 2015; 30:915-23. [PMID: 26048646 DOI: 10.1016/j.pedn.2015.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 05/22/2015] [Accepted: 05/23/2015] [Indexed: 11/17/2022]
Abstract
Telehealth activities are often conducted by ambulatory nurses to assist with care coordination; these activities are especially important for children with complex, chronic conditions. This quality-improvement project examines specific components of nursing care delivered to children on the neurology and gastroenterology services through patient-initiated telephone encounters. Metrics and nurse-sensitive indicators explored include the type of services requested, the nurses' ability to resolve patients' concerns while eliminating otherwise unnecessary care, and associated costs with providing this care. The usefulness of a standardized instrument, the care coordination management tool, used in this project is discussed.
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Affiliation(s)
- Judith A Vessey
- Medicine Patient Services, Boston Children's Hospital, Boston, MA; Boston College, William F. Connell School of Nursing, Chestnut Hill, MA.
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Turner J, Coster J, Chambers D, Cantrell A, Phung VH, Knowles E, Bradbury D, Goyder E. What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03430] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.
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Affiliation(s)
- Janette Turner
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Viet-Hai Phung
- College of Social Science, University of Lincoln, Lincoln, UK
| | - Emma Knowles
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Kaakinen P, Kyngäs H, Tarkiainen K, Kääriäinen M. The effects of intervention on quality of telephone triage at an emergency unit in Finland: Nurses' perspective. Int Emerg Nurs 2015; 26:26-31. [PMID: 26433605 DOI: 10.1016/j.ienj.2015.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 09/04/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to investigate the effects of a nurse training intervention on the assessment of patients' care needs in telephone triage at an emergency unit. The objective of this study was to generate information about nurse training that can be utilized when developing telephone triage and health care education. BACKGROUND With the growing number of patients coming into emergency departments and a lack of resources in healthcare, it would be valuable to determine an effective training intervention in telephone triage, particularly when assessing the training needs of nurses. DESIGN The study was quasi-experimental, with a pre- and post-test design. METHODS The data were collected from the nurses at the emergency department and joint emergency service of the Central Hospital in Northern Finland (baseline n = 28, post-test n = 26). The descriptive statistic, Fisher's χ(2) test and McNemar's test were used to analyse the data. RESULTS The intervention improved nurses' skills to evaluate patients' needs and health condition via the telephone triage. There was a statistically significant difference in the resources, knowledge, skills and attitudes of the nurses between the baseline and post-test measurements. CONCLUSIONS The nurse training intervention improved the quality of telephone triage. RELEVANCE TO CLINICAL PRACTICE Nurses should receive continuous training in telephone triage in order to maintain and reinforce their professional competence. When planning the training, the age and relevant work experience of the nurses should be taken into consideration as well, since the results indicate that they lead to variation in the nurses' competence.
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Affiliation(s)
- Pirjo Kaakinen
- Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.
| | - Helvi Kyngäs
- Unit of Nursing Science and Health Management, Northern Ostrobothnia Hospital District, University of Oulu, Oulu, Finland
| | | | - Maria Kääriäinen
- Unit of Nursing Science and Health Management, University of Oulu, University Hospital of Oulu, Finland
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Howell T. ED Utilization by Uninsured and Medicaid Patients after Availability of Telephone Triage. J Emerg Nurs 2015; 42:120-4. [PMID: 26409919 DOI: 10.1016/j.jen.2015.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 08/08/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
Abstract
PROBLEM For emergency departments experiencing crowding and a high percentage of patients leaving without being seen, a telephone triage service can provide other care options for low-acuity patients. METHODS A nonexperimental pre- and postintervention comparative design was used to measure ED visit volumes from Medicaid and uninsured patients presenting with a low-acuity health care problem. Visit volumes for the 12 months before and 12 months after the initiation of telephone triage were compared. RESULTS The overall low-acuity visit volume increased in the first 12 months of telephone triage availability. However, the proportion of low-acuity Medicaid and uninsured patients seeking ED care decreased. For the first 12 months of operation, telephone triage received 10,055 calls. Sixty percent of the calls (N = 6086) were from uninsured and Medicaid patients. More than 43% of the calls resulted in a self-care decision. IMPLICATIONS FOR PRACTICE A telephone triage service may help decrease ED crowding by communicating other care options to patients with low-acuity health problems.
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Tricco AC, Antony J, Zarin W, Strifler L, Ghassemi M, Ivory J, Perrier L, Hutton B, Moher D, Straus SE. A scoping review of rapid review methods. BMC Med 2015; 13:224. [PMID: 26377409 PMCID: PMC4574114 DOI: 10.1186/s12916-015-0465-6] [Citation(s) in RCA: 491] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/28/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Rapid reviews are a form of knowledge synthesis in which components of the systematic review process are simplified or omitted to produce information in a timely manner. Although numerous centers are conducting rapid reviews internationally, few studies have examined the methodological characteristics of rapid reviews. We aimed to examine articles, books, and reports that evaluated, compared, used or described rapid reviews or methods through a scoping review. METHODS MEDLINE, EMBASE, the Cochrane Library, internet websites of rapid review producers, and reference lists were searched to identify articles for inclusion. Two reviewers independently screened literature search results and abstracted data from included studies. Descriptive analysis was conducted. RESULTS We included 100 articles plus one companion report that were published between 1997 and 2013. The studies were categorized as 84 application papers, seven development papers, six impact papers, and four comparison papers (one was included in two categories). The rapid reviews were conducted between 1 and 12 months, predominantly in Europe (58 %) and North America (20 %). The included studies failed to report 6 % to 73 % of the specific systematic review steps examined. Fifty unique rapid review methods were identified; 16 methods occurred more than once. Streamlined methods that were used in the 82 rapid reviews included limiting the literature search to published literature (24 %) or one database (2 %), limiting inclusion criteria by date (68 %) or language (49 %), having one person screen and another verify or screen excluded studies (6 %), having one person abstract data and another verify (23 %), not conducting risk of bias/quality appraisal (7 %) or having only one reviewer conduct the quality appraisal (7 %), and presenting results as a narrative summary (78 %). Four case studies were identified that compared the results of rapid reviews to systematic reviews. Three studies found that the conclusions between rapid reviews and systematic reviews were congruent. CONCLUSIONS Numerous rapid review approaches were identified and few were used consistently in the literature. Poor quality of reporting was observed. A prospective study comparing the results from rapid reviews to those obtained through systematic reviews is warranted.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute of St Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, ON, M5B 1 W8, Canada.
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, ON, M5T 3 M7, Canada.
| | - Jesmin Antony
- Li Ka Shing Knowledge Institute of St Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, ON, M5B 1 W8, Canada.
| | - Wasifa Zarin
- Li Ka Shing Knowledge Institute of St Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, ON, M5B 1 W8, Canada.
| | - Lisa Strifler
- Li Ka Shing Knowledge Institute of St Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, ON, M5B 1 W8, Canada.
- Institute for Health Policy Management and Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3 M6, Canada.
| | - Marco Ghassemi
- Li Ka Shing Knowledge Institute of St Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, ON, M5B 1 W8, Canada.
| | - John Ivory
- Li Ka Shing Knowledge Institute of St Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, ON, M5B 1 W8, Canada.
| | - Laure Perrier
- Institute for Health Policy Management and Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3 M6, Canada.
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa Methods Centre, Ottawa, ON, Canada.
| | - David Moher
- Ottawa Hospital Research Institute, Ottawa Methods Centre, Ottawa, ON, Canada.
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, ON, M5B 1 W8, Canada.
- Department of Medicine, Faculty of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada.
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Valleley RJ, Hine JF, Clare A, Evans JH. Phone Consultation for Behavioral Health–Related Referrals in Integrated Primary Care. J Prim Care Community Health 2015; 6:260-3. [DOI: 10.1177/2150131915598129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Behavioral health (BH) providers add value to primary care teams. This descriptive study illustrates one such role that the BH provider can serve. The on-site BH provider responded to patient phone inquiries regarding BH topics for pediatricians over the course of 15 months. The majority of these calls were for children 10 years and younger and related to externalizing problems. Phone calls were relatively brief (ie, 11-15 minutes). More than half of these phone calls resulted in families scheduling an appointment with nearly 75% showing up for the initial session. Providing this type of adjunctive service may result in earlier access to care and efficiently assigning responsibilities to the appropriate team member.
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Affiliation(s)
| | | | - Ann Clare
- University of Nebraska Medical Center, Omaha, NE, USA
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Saan MC, Boeije HR, Sattoe JNT, Bal MI, Missler M, van Wesel F. Recording and accounting for stakeholder involvement in systematic reviews. Health Info Libr J 2015; 32:95-106. [PMID: 25899465 DOI: 10.1111/hir.12099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 02/23/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The use of stakeholders in systematic reviews is increasingly valued, but their influence on the systematicity of the review is often unclear. The aim of this study was to describe some of the processes of involvement of stakeholders and to demonstrate a Tool for Recording and Accounting for Stakeholder Involvement (TRASI). METHODS We demonstrate the TRASI in two worked examples. In one project, the reviewers collaborated with the end-user and an expert during the literature search. In the other project, experts were consulted to generate keywords before searching the literature. RESULTS In the first project, disagreements about keywords to identify studies for the research topic were solved by informal discussion. In the second project, difficulties arose in reaching agreement between experts and reviewers about the core construct and the meaningful keywords associated with it. DISCUSSION The TRASI aids researchers to systematically and transparently account for the decisions taken. The TRASI supports information specialists and librarians to shape the search strategy to match the objectives of the review. CONCLUSIONS We propose the TRASI as a first step in resolving the challenges of detecting and reconstructing stakeholder influences. Potential new applications of the TRASI are discussed.
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Affiliation(s)
- Marieke C Saan
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
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Wheeler SQ, Greenberg ME, Mahlmeister L, Wolfe N. Safety of clinical and non-clinical decision makers in telephone triage: a narrative review. J Telemed Telecare 2015; 21:305-22. [PMID: 25761468 DOI: 10.1177/1357633x15571650] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/20/2014] [Indexed: 11/17/2022]
Abstract
Patient safety is a persistent problem in telephone triage research; however, studies have not differentiated between clinicians' and non-clinicians' respective safety. Currently, four groups of decision makers perform aspects of telephone triage: clinicians (physicians, nurses), and non-clinicians (emergency medical dispatchers (EMD) and clerical staff). Using studies published between 2002-2012, we applied Donabedian's structure-process-outcome model to examine groups' systems for evidence of system completeness (a minimum measure of structure and quality). We defined system completeness as the presence of a decision maker and four additional components: guidelines, documentation, training, and standards. Defining safety as appropriate referrals (AR) - (right time, right place with the right person), we measured each groups' corresponding AR rate percentages (outcomes). We analyzed each group's respective decision-making process as a safe match to the telephone triage task, based on each group's system structure completeness, process and AR rates (outcome). Studies uniformly noted system component presence: nurses (2-4), physicians (1), EMDs (2), clerical staff (1). Nurses had the highest average appropriate referral (AR) rates (91%), physicians' AR (82% average). Clerical staff had no system and did not perform telephone triage by standard definitions; EMDs may represent the use of the wrong system. Telephone triage appears least safe after hours when decision makers with the least complete systems (physicians, clerical staff) typically manage calls. At minimum, telephone triage decision makers should be clinicians; however, clinicians' safety calls for improvement. With improved training, standards and CDSS quality, the 24/7 clinical call center has potential to represent the national standard.
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Affiliation(s)
- Sheila Q Wheeler
- Assistant Clinical Professor Northern Arizona University 3895 N. Business Center Dr. Ste 120 Tucson, Arizona 85705, USA
| | - Mary E Greenberg
- President, Mahlmeister and Associates Clinical Professor University of California San Francisco San Francisco, California 1567 Winding Way Belmont, California 94002, USA
| | | | - Nicole Wolfe
- Department of Social and Behavioral Sciences 3333 California St, Suite 455 San Francisco, CA 94118, USA
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O'Cathain A, Knowles E, Turner J, Nicholl J. Acceptability of NHS 111 the telephone service for urgent health care: cross sectional postal survey of users' views. Fam Pract 2014; 31:193-200. [PMID: 24334420 PMCID: PMC3969523 DOI: 10.1093/fampra/cmt078] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2010, a new telephone service, NHS 111, was piloted to improve access to urgent care in England. A unique feature is the use of non-clinical call takers who triage calls with computerized decision support and have access to clinical advisors when necessary. Aim. To explore users' acceptability of NHS 111. DESIGN Cross-sectional postal survey. SETTING Four pilot sites in England. METHOD A postal survey of recent users of NHS 111. RESULTS The response rate was 41% (1769/4265), with 49% offering written comments (872/1769). Sixty-five percent indicated the advice given had been very helpful and 28% quite helpful. The majority of respondents (86%) indicated that they fully complied with advice. Seventy-three percent was very satisfied and 19% quite satisfied with the service overall. Users were less satisfied with the relevance of questions asked, and the accuracy and appropriateness of advice given, than with other aspects of the service. Users who were autorouted to NHS 111 from services such as GP out-of-hours services were less satisfied than direct callers. CONCLUSION In pilot services in the first year of operation, NHS 111 appeared to be acceptable to the majority of users. Acceptability could be improved by reassessing the necessity of triage questions used and auditing the accuracy and appropriateness of advice given. User acceptability should be viewed in the context of findings from the wider evaluation, which identified that the NHS 111 pilot services did not improve access to urgent care and indeed increased the use of emergency ambulance services.
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Affiliation(s)
- Alicia O'Cathain
- Medical Care Research Unit, The School of Health and Related Research, University of Sheffield, Sheffield UK
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Locatelli SM, LaVela SL, Talbot ME, Davies ML. How do patients respond when confronted with telephone access barriers to care? Health Expect 2014; 18:2154-63. [PMID: 24612441 DOI: 10.1111/hex.12184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To gain an in-depth understanding of patient barriers to accessing telephone care, subsequent responses to telephone access issues and recommendations for system improvement within a large integrated health-care system. STUDY DESIGN Cross-sectional qualitative focus group study. METHODS One focus group was conducted at each of 17 Veterans Affairs facilities with a total of 123 Veteran users of VA health care. All facilities followed a focus group discussion guide, and purposively sampled patients receiving care at their VA facility in primary and/or specialty care. Focus groups' recordings were sent to the authors' independent evaluation centre, transcribed verbatim and analysed using qualitative content analysis methodology. RESULTS Participants described many issues with the phone system that resulted in delays to care needs being addressed, including difficulty getting someone to answer the phone, out-dated phone directories, frequent disconnections and incorrect transfers. Participants most frequently responded to access issues by doing nothing or waiting to contact at a later time, or seeking unscheduled in-person care in the emergency department or primary care clinic. Participants offered recommendations for improving telephone care, including access to direct extensions, and upgrades to the telephone system. CONCLUSIONS Telephone access issues could result in increased patient harm and/or increased wait times for in-person primary care or emergency services. Periodic evaluation of telephone systems is necessary to ensure telephone systems adequately meet patient needs while using resources efficiently to optimize the delivery of high quality, safe health care.
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Affiliation(s)
- Sara M Locatelli
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mary E Talbot
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Michael L Davies
- Office of Systems Redesign, Veterans Affairs Central Office, Washington, DC, USA
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Arain M, Campbell MJ, Nicholl JP. Impact of a GP-led walk-in centre on NHS emergency departments. Emerg Med J 2014; 32:295-300. [PMID: 24406328 DOI: 10.1136/emermed-2013-202410] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the impact of the GP-led walk-in centre (WIC) in Sheffield (England) on the demand for emergency department (ED) care. METHODS A survey of patients visiting the Sheffield GP WIC was conducted over 3 weeks during September and October 2011. A short, postvisit questionnaire was also sent to those who agreed to determine if the patient had used another NHS service for the same problem. Routine data were obtained from the adult and children's EDs and minor injuries unit in Sheffield, 1 year before and 1 year after the opening of the GP WIC. A linear model of the number of minor daytime attendances (GP type) per month was used to estimate the impact of opening the GP WIC, after controlling for seasonal variation and a linear time trend. RESULTS A total of 529 patients responded to the survey (response rate 51%). Based on their self-reported intentions, 64 of these patients (53 adults and 11 children) were diverted from going to ED in the 3-week survey period as a result of the establishment of the GP WIC. From this we would have expected around a 26% monthly reduction in GP-type attendances at adult ED, and 7% reduction at children's ED. However, routine data only showed an 8% (95% CI 1% to 16%) reduction at the adult ED. Reductions in GP-type attendances at the children's ED and the minor injury unit at the time of the opening of the GP WIC were also found, but were not statistically significant. The estimated impact on children's ED was a 14% reduction (95% CI -38% to 8%), and for minor injuries unit (MIU) a 4% reduction (95% CI -18 to 9%). CONCLUSIONS There was a statistically significant reduction in GP-type daytime attendances at the adult ED after the opening of the GP WIC. Since this reduction was not mirrored in changes in night-time attendances (when the GP WIC was closed), and our survey responses suggested some people were diverted from going to the ED, it is possible that the opening of the GP WIC caused this reduction.
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Affiliation(s)
- M Arain
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - M J Campbell
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - J P Nicholl
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Turner J, O'Cathain A, Knowles E, Nicholl J. Impact of the urgent care telephone service NHS 111 pilot sites: a controlled before and after study. BMJ Open 2013; 3:e003451. [PMID: 24231457 PMCID: PMC3831104 DOI: 10.1136/bmjopen-2013-003451] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/23/2013] [Accepted: 09/25/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To measure the impact of the urgent care telephone service NHS 111 on the emergency and urgent care system. DESIGN Controlled before and after study using routine data. SETTING Four pilot sites and three control sites covering a total population of 3.6 million in England, UK. PARTICIPANTS AND DATA Routine data on 36 months of use of emergency ambulance service calls and incidents, emergency department attendances, urgent care contacts (general practice (GP) out of hours, walk in and urgent care centres) and calls to the telephone triage service NHS direct. INTERVENTION NHS 111, a new 24 h 7 day a week telephone service for non-emergency health problems, operated by trained non-clinical call handlers with clinical support from nurse advisors, using NHS Pathways software to triage calls to different services and home care. MAIN OUTCOMES Changes in use of emergency and urgent care services. RESULTS NHS 111 triaged 277 163 calls in the first year of operation for a population of 1.8 million. There was no change overall in emergency ambulance calls, emergency department attendances or urgent care use. There was a 19.3% reduction in calls to NHS Direct (95% CI -24.6% to -14.0%) and a 2.9% increase in emergency ambulance incidents (95% CI 1.0% to 4.8%). There was an increase in activity overall in the emergency and urgent care system in each site ranging 4.7-12%/month and this remained when assuming that NHS 111 will eventually take all NHS Direct and GP out of hours calls. CONCLUSIONS In its first year of operation in four pilot sites NHS 111 did not deliver the expected system benefits of reducing calls to the 999 ambulance service or shifting patients to urgent rather than emergency care. There is potential that this type of service increases overall demand for urgent care.
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Affiliation(s)
- J Turner
- Medical Care Research Unit, ScHARR, University of Sheffield, Sheffield, UK
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