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Journal articleCowling TE, Harris M, Watt H, et al., 2015,
Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data
, BMJ Quality & Safety, Vol: 25, Pages: 432-440, ISSN: 2044-5415Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes.Objective To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department.Methods Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics.Results The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England.Conclusions Among hospital inpatients admitted as an emergency, patients
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Journal articleHughes-Hallett A, Browne D, Mensah E, et al., 2015,
Assessing the impact of mass media public health campaigns. Be Clear on Cancer ‘blood in pee’: a case in point
, BJU International, Vol: 117, Pages: 570-575, ISSN: 1464-4096 -
Journal articleHarris M, Burgess CP, Kringos DS, 2015,
Hope for US health care despite strong headwinds
, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 65, Pages: 367-367, ISSN: 0960-1643 -
Journal articleMacinko J, Harris MJ, 2015,
INTERNATIONAL HEALTH CARE SYSTEMS Brazil's Family Health Strategy - Delivering Community-Based Primary Care in a Universal Health System
, New England Journal of Medicine, Vol: 372, Pages: 2177-2181, ISSN: 1533-4406 -
Journal articleCooper CS, Eeles R, Wedge DC, et al., 2015,
Analysis of the genetic phylogeny of multifocal prostate cancer identifies multiple independent clonal expansions in neoplastic and morphologically normal prostate tissue (vol 47, pg 367, 2015)
, NATURE GENETICS, Vol: 47, Pages: 689-689, ISSN: 1061-4036- Author Web Link
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- Citations: 5
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Conference paperMensah EE, Hounsome LH, Verne JV, et al., 2015,
Cardiovascular outcomes in kidney cancer patients
, Annual Meeting of the British-Association-of-Urological-Surgeons (BAUS), Publisher: WILEY-BLACKWELL, Pages: 47-48, ISSN: 1464-4096 -
Conference paperKockelbergh R, Mayer E, Hounsome L, et al., 2015,
Bladder cancer recurrence; evidence of wide variation in England
, Publisher: WILEY-BLACKWELL, Pages: 75-76, ISSN: 0961-5423 -
Journal articleJilka SR, Callahan R, Sevdalis N, et al., 2015,
"Nothing About Me Without Me": An Interpretative Review of Patient Accessible Electronic Health Records
, Journal of Medical Internet Research, Vol: 17, ISSN: 1439-4456BackgroundPatient accessible electronic health records (PAEHRs) enable patients to access and manage personalclinical information that is made available to them by their health care providers (HCPs). It is thought thatthe shared management nature of medical record access improves patient outcomes and improves patientsatisfaction. However, recent reviews have found that this is not the case. Furthermore, little research hasfocused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers.ObjectiveWe provide a systematic review of reviews of the impact of giving patients record access from both apatient and HCP point of view. The review covers a broad range of outcome measures, including patientsafety, patient satisfaction, privacy and security, self-efficacy, and health outcome.MethodsA systematic search was conducted using Web of Science to identify review articles on the impact ofPAEHRs. Our search was limited to English-language reviews published between January 2002 andNovember 2014. A total of 73 citations were retrieved from a series of Boolean search terms including“review*” with “patient access to records”. These reviews went through a novel scoring system analysiswhereby we calculated how many positive outcomes were reported per every outcome measureinvestigated. This provided a way to quantify the impact of PAEHRs.Results1 1 2 1112Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well asHCPs were found but eight were included for the analysis of outcome measures. We found mixedoutcomes across both patient and HCP groups, with approximately half of the reviews showing positivechanges with record access. Patients believe that record access increases their perception of control;however, outcome measures thought to create psychological concerns (such as patient anxiety as a result ofseeing their medical record) are still unanswered. Nurses are more likely th
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Journal articleJohnston M, Arora S, Anderson O, et al., 2015,
Escalation of care in surgery: a systematic risk assessment to prevent avoidable harm in hospitalized patients
, Annals of Surgery, Vol: 261, Pages: 831-838, ISSN: 0003-4932Objective: To systematically risk assess and analyze the escalation of care process in surgery so as to identify problems and provide recommendations for intervention.Background: The ability to escalate care appropriately when managing deteriorating patients is a hallmark of surgical competence and safe postoperative care. Healthcare-Failure-Mode-Effects-Analysis (HFMEA) is a methodology adapted from safety-critical industries, which allows for hazardous process failures to be prospectively identified and solutions to be recommended.Methods: Forty-two hours of ethnographic observations on surgical wards in 3 London hospitals (phase 1) formed the basis of an escalation process diagram. A risk-assessment survey identified failures associated with process steps and attributed hazard scores (phase 2). Patient safety and clinical risk experts validated hazard scores through a group consensus meeting (phase 3). Hazardous failures were taken forward to multidisciplinary HFMEA where cause analysis was applied and interventions were recommended (phase 4).Results: Observations identified 33 steps in the escalation process. The risk-assessment survey (30 surgical staff members, 100% response) and expert consensus group identified 18 hazardous failures associated with these steps. The HFMEA team identified 3 adequately controlled failures; therefore, 15 were subjected to cause analysis. Outdated communication technology, understaffing, and hierarchical barriers were identified as root causes of failure. Participants recommended interventions based on these findings including defined escalation protocols, human factors education, enhanced communication technology, and improved clinical supervision.Conclusions: Failures in the escalation process amenable to intervention were systematically identified. This mapping of the escalation process will allow tailored interventions to enhance surgical training and patient safety.
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Journal articleKeown OP, Darzi A, 2015,
The quality narrative in health care
, LANCET, Vol: 385, Pages: 1367-1368, ISSN: 0140-6736 -
Journal articleHarris MJ, Dadwal V, Wu A, et al., 2015,
It takes threat of Ebola to see lessons from low income countries
, Globalization and Health, Vol: 11, ISSN: 1744-8603 -
Journal articleCowling TE, Harris MJ, Majeed A, 2015,
Evidence and rhetoric about access to UK primary care.
, BMJ, Vol: 350 -
Journal articleWatt H, Harris M, Noyes J, et al., 2015,
Development of a composite outcome score for a complex intervention - measuring the impact of Community Health Workers
, Trials, Vol: 16, ISSN: 1745-6215BackgroundIn health services research, composite scores to measure changes in health-seeking behaviour and uptake of services do not exist. We describe the rationale and analytical considerations for a composite primary outcome for primary care research. We simulate its use in a large hypothetical population and use it to calculate sample sizes. We apply it within the context of a proposed cluster randomised controlled trial (RCT) of a Community Health Worker (CHW) intervention.MethodsWe define the outcome as the proportion of the services (immunizations, screening tests, stop-smoking clinics) received by household members, of those that they were eligible to receive. First, we simulated a population household structure (by age and sex), based on household composition data from the 2011 England and Wales census. The ratio of eligible to received services was calculated for each simulated household based on published eligibility criteria and service uptake rates, and was used to calculate sample size scenarios for a cluster RCT of a CHW intervention. We assume varying intervention percentage effects and varying levels of clustering.ResultsAssuming no disease risk factor clustering at the household level, 11.7% of households in the hypothetical population of 20,000 households were eligible for no services, 26.4% for 1, 20.7% for 2, 15.3% for 3 and 25.8% for 4 or more. To demonstrate a small CHW intervention percentage effect (10% improvement in uptake of services out of those who would not otherwise have taken them up, and additionally assuming intra-class correlation of 0.01 between households served by different CHWs), around 4,000 households would be needed in each of the intervention and control arms. This equates to 40 CHWs (each servicing 100 households) needed in the intervention arm. If the CHWs were more effective (20%), then only 170 households would be needed in each of the intervention and control arms.ConclusionsThis is a useful first step towards a proce
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Journal articleMayer EK, Sevdalis N, Rout S, et al., 2015,
Surgical checklist implementation project: the impact of variable WHO checklist compliance on risk-adjusted clinical outcomes after national implementation: a longitudinal study.
, Annals of Surgery, Vol: 263, Pages: 58-63, ISSN: 1528-1140OBJECTIVE: To evaluate impact of WHO checklist compliance on risk-adjusted clinical outcomes, including the influence of checklist components (Sign-in, Time-out, Sign-out) on outcomes. BACKGROUND: There remain unanswered questions surrounding surgical checklists as a quality and safety tool, such as the impact in cases of differing complexity and the extent of checklist implementation. METHODS: Data were collected from surgical admissions (6714 patients) from March 2010 to June 2011 at 5 academic and community hospitals. The primary endpoint was any complication, including mortality, occurring before hospital discharge. Checklist usage was recorded as checklist completed in full/partly. Multilevel modeling was performed to investigate the association between complications/mortality and checklist completion. RESULTS: Significant variability in checklist usage was found: although at least 1 of the 3 components was completed in 96.7% of cases, the entire checklist was only completed in 62.1% of cases. Checklist completion did not affect mortality reduction, but significantly lowered risk of postoperative complication (16.9% vs. 11.2%), and was largely noticed when all 3 components of the checklist had been completed (odds ratio = 0.57, 95% confidence interval: 0.37-0.87, P < 0.01). Calculated population-attributable fractions showed that 14% (95% confidence interval: 7%-21%) of the complications could be prevented if full completion of the checklist was implemented. CONCLUSIONS: Checklist implementation was associated with reduced case-mix-adjusted complications after surgery and was most significant when all 3 components of the checklist were completed. Full, as opposed to partial, checklist completion provides a health policy opportunity to improve checklist impact on surgical safety and quality of care.
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Journal articleCowling TE, Harris MJ, Majeed A, 2015,
Access to primary care in England.
, JAMA Intern Med, Vol: 175 -
Journal articleDarzi A, Keown OP, Chapman S, 2015,
Is a smoking ban in UK parks and outdoor spaces a good idea?
, BMJ-BRITISH MEDICAL JOURNAL, Vol: 350, ISSN: 0959-535X- Author Web Link
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- Citations: 1
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Journal articleHughes-Hallett A, Mayer EK, Pratt PJ, et al., 2015,
Quantitative analysis of technological innovation in minimally invasive surgery
, British Journal of Surgery, Vol: 102, Pages: e151-e157, ISSN: 1365-2168BackgroundIn the past 30 years surgical practice has changed considerably owing to the advent of minimally invasive surgery (MIS). This paper investigates the changing surgical landscape chronologically and quantitatively, examining the technologies that have played, and are forecast to play, the largest part in this shift in surgical practice.MethodsElectronic patent and publication databases were searched over the interval 1980–2011 for (‘minimally invasive’ OR laparoscopic OR laparoscopy OR ‘minimal access’ OR ‘key hole’) AND (surgery OR surgical OR surgeon). The resulting patent codes were allocated into technology clusters. Technology clusters referred to repeatedly in the contemporary surgical literature were also included in the analysis. Growth curves of patents and publications for the resulting technology clusters were then plotted.ResultsThe initial search revealed 27 920 patents and 95 420 publications meeting the search criteria. The clusters meeting the criteria for in-depth analysis were: instruments, image guidance, surgical robotics, sutures, single-incision laparoscopic surgery (SILS) and natural-orifice transluminal endoscopic surgery (NOTES). Three patterns of growth were observed among these technology clusters: an S-shape (instruments and sutures), a gradual exponential rise (surgical robotics and image guidance), and a rapid contemporaneous exponential rise (NOTES and SILS).ConclusionTechnological innovation in MIS has been largely stagnant since its initial inception nearly 30 years ago, with few novel technologies emerging. The present study adds objective data to the previous claims that SILS, a surgical technique currently adopted by very few, represents an important part of the future of MIS.
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Journal articleRuss SJ, Sevdalis N, Moorthy K, et al., 2015,
A Qualitative evaluation of the barriers and facilitators toward implementation of the WHO surgical safety checklist across hospitals in England lessons from the "Surgical Checklist Implementation Project"
, Annals of Surgery, Vol: 261, Pages: 81-91, ISSN: 0003-4932Objectives: To evaluate how the World Health Organization (WHO) surgical safety checklist was implemented across hospitals in England; to identify barriers and facilitators toward implementation; and to draw out lessons for implementing improvement initiatives in surgery/health care more generally.Background: The WHO checklist has been linked to improved surgical outcomes and teamwork, yet we know little about the factors affecting its successful uptake.Methods: A longitudinal interview study with operating room personnel was conducted across a representative sample of 10 hospitals in England between March 2010 and March 2011. Interviews were audio recorded over the phone. Interviewees were asked about their experience of how the checklist was introduced and the factors that hindered or aided this process. Transcripts were submitted to thematic analysis.Results: A total of 119 interviews were completed. Checklist implementation varied greatly between and within hospitals, ranging from preplanned/phased approaches to the checklist simply “appearing” in operating rooms, or staff feeling it had been imposed. Most barriers to implementation were specific to the checklist itself (eg, perceived design issues) but also included problematic integration into preexisting processes. The most common barrier was resistance from senior clinicians. The facilitators revealed some positive steps that can been taken to prevent/address these barriers, for example, modifying the checklist, providing education/training, feeding-back local data, fostering strong leadership (particularly at attending level), and instilling accountability.Conclusions: We identified common themes that have aided or hindered the introduction of the WHO checklist in England and have translated these into recommendations to guide the implementation of improvement initiatives in surgery and wider health care systems.
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Journal articleRuss S, Rout S, Caris J, et al., 2015,
Measuring variation in use of the WHO surgical safety checklist in the operating room: a multicenter prospective cross-sectional study
, Journal of the American College of Surgeons, Vol: 220, Pages: 1-11.e4, ISSN: 1072-7515BackgroundFull implementation of safety checklists in surgery has been linked to improved outcomes and team effectiveness; however, reliable and standardized tools for assessing the quality of their use, which is likely to moderate their impact, are required.Study DesignThis was a multicenter prospective study. A standardized observational instrument, the “Checklist Usability Tool” (CUT), was developed to record precise characteristics relating to the use of the WHO's surgical safety checklist (SSC) at “time-out” and “sign-out” in a representative sample of 5 English hospitals. The CUT was used in real-time by trained assessors across general surgery, urology, and orthopaedic cases, including elective and emergency procedures.ResultsWe conducted 565 and 309 observations of the time-out and sign-out, respectively. On average, two-thirds of the items were checked, team members were absent in more than 40% of cases, and they failed to pause or focus on the checks in more than 70% of cases. Information sharing could be improved across the entire operating room (OR) team. Sign-out was not completed in 39% of cases, largely due to uncertainty about when to conduct it. Large variation in checklist use existed between hospitals, but not between surgical specialties or between elective and emergency procedures. Surgical safety checklist performance was better when surgeons led and when all team members were present and paused.ConclusionsWe found large variation in WHO checklist use in a representative sample of English ORs. Measures sensitive to checklist practice quality, like CUT, will help identify areas for improvement in implementation and enable provision of comprehensive feedback to OR teams.
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Journal articleJohnston MJ, King D, Arora S, et al., 2015,
Smartphones let surgeons know WhatsApp: an analysis of communication in emergency surgical teams
, American Journal of Surgery, Vol: 209, Pages: 45-51, ISSN: 0002-9610BackgroundOutdated communication technologies in healthcare can place patient safety at risk. This study aimed to evaluate implementation of the WhatsApp messaging service within emergency surgical teams.MethodsA prospective mixed-methods study was conducted in a London hospital. All emergency surgery team members (n = 40) used WhatsApp for communication for 19 weeks. The initiator and receiver of communication were compared for response times and communication types. Safety events were reported using direct quotations.ResultsMore than 1,100 hours of communication pertaining to 636 patients were recorded, generating 1,495 communication events. The attending initiated the most instruction-giving communication, whereas interns asked the most clinical questions (P < .001). The resident was the speediest responder to communication compared to the intern and attending (P < .001). The participants felt that WhatsApp helped flatten the hierarchy within the team.ConclusionsWhatsApp represents a safe, efficient communication technology. This study lays the foundations for quality improvement innovations delivered over smartphones.
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