Hidden hunger and malnutrition in the elderly

This report from the All Party Parliamentary Group on Hunger calls on the government to look more closely at malnutrition in older people which is estimated to cost the NHS and social care £15.7 billion a year by 2030. It argues that targeted investment in services which protect older people from malnutrition would deliver significant annual savings to the NHS, not least by reducing the number of hospital admissions and limiting the number of days older people spend in hospital.

NIHR Signal Alternative drug may prevent atrial fibrillation following heart surgery

After heart surgery around a third of people have atrial fibrillation, an abnormal heart rhythm, which impedes their recovery and lengthens hospital stay. Colchicine treatment could reduce this complication by about a third.

About 11 people would need this treatment to prevent one of them developing atrial fibrillation. Using amiodarone, an alternative drug commonly used in this situation, other research shows that about seven people would be treated to prevent one person suffering fibrillation.

From the NIHR Dissemination Centre

Study shows home-based service for acute lung patients frees NHS beds

An acute ‘hospital-at-home’ scheme for patients with lung disease could save the NHS millions if replicated nationally. A study of the multidisciplinary service, which includes physiotherapists, found that it had reduced hospital stays from an average of 9.1 days to 2.5 days, saving £1,400 per case and has proven to be as effective as purely hospital-based treatment when measured by the number of re-admissions.

Red2Green: making a difference to our patients

A helfpul video from NHS Improvement for other trusts looking for ways to reduce delayed discharges. It explains the processes put in place across Hampshire Hospitals NHS Foundation Trust to speed up discharges and how they have been successfully implemented.

The main focus is Red2Green, but it also talks about the reasons why these measures have been brought in, with particular reference to the fact that 10 days in bed equates to 10 years worth of muscle wastage in patients over the age of 80.

Preparing for winter

The Preparing for winter guidance from the Royal College of Physicians covers the delivery of care, patient flow, wellbeing of the workforce and minimising unnecessary hospital occupancy.

The SAFER patient flow bundle and Red2Green days approach

NHS Improvement has provided resources that will help you implement the SAFER patient flow bundle and Red2Green days in your organisation. When followed consistently, these can reduce length of stay and improve patient flow and safety.

See also:

• SAFER patient flow bundle: board rounds
• SAFER patient flow bundle: ward rounds

Reviewing ‘stranded’ patients in hospital – what are patients waiting for?

These resources will help NHS Organisations undertake a stranded patient review in any setting, from the acute trust to reablement services. These should be multi-agency in approach. The result should support the patient along their journey, providing data and evidence to inform system change discussions.

GIRFT: national general surgery report

The report found that reducing unwarranted variations between hospitals in areas such as effective procedures, length of stay, infection rates and procurement costs will improve patient outcomes and help the NHS save £160 million in efficiencies each year.

A critical care unit has introduced band 4 physiotherapy associate practitioners to provide seven-day enhanced mobilisation to elective surgical post-operative patients

The associate posts were introduced as part of a pilot service improvement project at Newcastle upon Tyne Hospitals NHS Trust, but now have ongoing funding.

During the pilot, which started in April 2016, patients showed improvement in functional mobility scores at discharge from critical care. The Modified Rivermead Mobility Index showed an improvement from 19 to 26.

There was also a reduction in length of stay and a significant increase in critical care activity in this elective surgical patient group during the pilot phase, from 326 admissions to 363.

The band 4 practitioners, Zoe Gray and Laurie Zebik, were pivotal in the success of the service improvement project and were finalists at the chief allied health professions officer’s awards in London on 21 June.

Catheter-free nephrectomy: A safe change to routine practice

Journal of Clinical Urology.  First Published May 26, 2017 

The aim of this article is to assess any difference in length of stay (LOS), complications and readmission rates between patients who had catheter-free nephrectomy compared to those who had a catheter inserted as routine peri-operatively.

UHCW Research: E. F. Zimmermann.

Seven-day Services - England, October 2015 - September 2016, Experimental statistics

This report from NHS Digital on 7-day services includes indicators on the following topics: Mortality within 30 days of admission by week-part of admission to hospital, emergency readmissions within seven days of discharge from hospital by day of discharge, length of stay following an emergency admission to hospital.

Kissing Goodbye Sepsis at James Paget University Hospital

Case study from James Paget University about reducing length of stay for septic patients.

Hope for those stuck in mental health institutions

There is a chink of light that could transform the lives of thousands of people with learning disabilities, needlessly stuck in mental health institutions away from homes, families and communities. On Wednesday, the public affairs committee will hear from Simon Stevens, head of NHS England, and others, on reducing the number of people with learning disabilities in mental health hospitals to improve their quality of life.

Use of physostigmine in patients presenting to the emergency department with anticholinergic poisoning

New from BestBETs:

In [patients presenting to the emergency department with anticholinergic toxidrome], does the administration of [physostigmine] compared to [any other treatment] reduces [length of stay or need for intubation]?

In patients presenting to the ED with anticholinergic poisoning, the use of physostigmine might reduce the intubation rate, but not the mean length of stay. Unfortunately, the current data is very weak and prone to bias. Further prospective randomized studies on the subject are needed to support its use in anticholinergic toxicity.

Maternity report shows trends in hospital deliveries

Hospital Maternity Activity, 2015-16, presents the number of delivery episodes during the last financial year, broken down by categories including, but not limited to:

• Method of delivery
• Age and ethnicity of the woman
• How deprived the area is where the woman lives
• Type of anaesthetic used before or during the delivery
• Length of hospital stay
• Delivery and birth complications, where appropriate
• Miscarriage and ectopic pregnancies that resulted in an NHS hospital stay.

Three hospital trust indicators published to aid research into seven-day NHS provision

The experimental statistics provide a starting point for discussions on how to effectively measure improvement and variation in care provision across the week.  

The report, published by NHS Digital, is presented at trust level and includes the following indicators for the period between 1 April 2015 and 31 March 2016:

• Mortality within 30 days of admission by week-part2 of admission to hospital
• Emergency readmissions within seven days of discharge from hospital by day of discharge
• Length of stay following an emergency admission to hospital by day of admission

Quick Guide: Discharge to Assess: Transforming Urgent and Emergency Care Services in England

This quick guide from NHS England aims to support local health and social care systems to reduce the time people spend in hospital, at the point that they no longer need acute care. 

It provides practical tips and advice to commissioners and providers on discharge to assess (D2A) models, including best practice from across the country and should be read alongside the 2015 NICE guideline, Transition between inpatient hospital settings and community or care home settings for adults with social care needs.

“Case management” can prevent people with heart failure being admitted again

Case management that is initiated in hospital and led by specialist nurses may reduce unplanned hospital readmissions and length of hospital stay for adults with heart failure.

This NIHR review of organisational type research found quite a lot of studies: 17 trials and five other studies, including three from the UK. The interventions used by the individual studies in this review varied widely, which highlights some need for caution in interpreting the pooled findings. There was limited evidence that hospital-initiated case management is cost effective – particularly in relation to the NHS. A few studies examined case management that was started in the community.

The findings are promising and may lead to further studies that confirm these findings in the UK setting. Commissioners would also need to know other things too, such as the components of case management that are most beneficial and the costs.

From the NIHR Dissemination Centre

South Carolina Hospital’s Use of AHRQ Patient Safety Program Leads to Significant Drop in Urinary Infections

Implementation of an AHRQ patient safety program helped the Medical University of South Carolina (MUSC) hospital reduce catheter-associated urinary tract infections (CAUTI) from 8.6 percent in 2012 to 1.1 percent in 2015.
The patient safety resource—AHRQ's Comprehensive Unit-based Safety Program (CUSP)—is designed to prevent infections that can increase the length of hospital stays and costs, intensify patient suffering, and even lead to death.

Delayed Discharges And Hospital Type: Evidence From The English NHS

This Centre for Health Economics study investigated how delayed discharges vary by hospital type (acute, specialist, mental health, teaching), and the extent to which such differences can be explained by demography, case-mix, the availability of long-term care and hospital governance as reflected in whether the hospital has foundation trust status, which gives greater financial autonomy and flexibility in staffing and pay.