Watchdog brands two thirds of NHS trusts as “fair” or “weak”
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ABSTRACT:
SUBMITTER: O'Dowd A
PROVIDER: S-EPMC1601984 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Health care systems in OECD countries are increasingly facing economic challenges and funding pressures. These normally demand interventions (political, financial and organisational) aimed at improving the efficiency of the health system as a whole and its single components. In 2009, the English NHS Chief Executive, Sir David Nicholson, warned that a potential funding gap of £20 billion should be met by extensive efficiency savings by March 2015. Our study investigates possible drivers of differential Trust performance (productivity) for the financial years 2010/11-2012/13.Following accounting practice, we define Productivity as the ratio of Outputs over Inputs. We analyse variation in both Total Factor and Labour Productivity using ordinary least squares regressions. We explicitly included in our analysis factors of differential performance highlighted in the Nicholson challenge as the sources were the efficiency savings should come from. Explanatory variables include efficiency in resource use measures, Trust and patient characteristics, and quality of care.We find that larger Trusts and Foundation Trusts are associated with lower productivity, as are those treating a greater proportion of both older and/or younger patients. Surprisingly treating more patients in their last year of life is associated with higher Labour Productivity.
| S-EPMC5540600 | biostudies-literature
Project description:ObjectivesTo understand organisational technology adoption (initiation, adoption decision, implementation) by looking at the different types of innovation knowledge used during this process.DesignQualitative, multisite, comparative case study design.SettingOne primary care and 11 acute care organisations (trusts) across all health regions in England in the context of infection prevention and control. PARTICIPANTS AND DATA ANALYSIS: 121 semistructured individual and group interviews with 109 informants, involving clinical and non-clinical staff from all organisational levels and various professional groups. Documentary evidence and field notes were also used. 38 technology adoption processes were analysed using an integrated approach combining inductive and deductive reasoning.Main findingsThose involved in the process variably accessed three types of innovation knowledge: 'awareness' (information that an innovation exists), 'principles' (information about an innovation's functioning principles) and 'how-to' (information required to use an innovation properly at individual and organisational levels). Centralised (national, government-led) and local sources were used to obtain this knowledge. Localised professional networks were preferred sources for all three types of knowledge. Professional backgrounds influenced an asymmetric attention to different types of innovation knowledge. When less attention was given to 'how-to' compared with 'principles' knowledge at the early stages of the process, this contributed to 12 cases of incomplete implementation or discontinuance after initial adoption.ConclusionsPotential adopters and change agents often overlooked or undervalued 'how-to' knowledge. Balancing 'principles' and 'how-to' knowledge early in the innovation process enhanced successful technology adoption and implementation by considering efficacy as well as strategic, structural and cultural fit with the organisation's context. This learning is critical given the policy emphasis for health organisations to be innovation-ready.
| S-EPMC3329608 | biostudies-literature
Project description:OBJECTIVE:To investigate documentation of antimicrobial allergy and to determine prescribing adherence to local antibiotic guidelines for inpatients with and without reported penicillin allergy treated for infection in a National Health Service (NHS) context. SETTING:Data were collected at two English hospital NHS trusts over two time-periods: June 2016 and February 2017. DESIGN:Cohort study. Trust 1 data were sourced from prospective point prevalence surveys. Trust 2 data were extracted retrospectively from an electronic report. PARTICIPANTS:Inpatients treated for urinary tract infection (UTI), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and skin and soft tissue infection (SSTI). Data on allergy were collected, and antibiotic selection assessed for adherence to trust guidelines with differences between groups presented as adjusted ORs. RESULTS:A total of 1497 patients were included, with 2645 antibiotics orders. Patients were treated for CAP (n=495; 33.1%), UTI (407; 27.2%), HAP (330; 22%) and SSTI (265; 17.7%). There were 240 (16%) patients with penicillin allergy. Penicillin allergy was recorded as allergy (n=52; 21.7%), side effect (27; 11.3%) and no documentation (161; 67.1%). Overall, 2184 (82.6%) antibiotic orders were guideline-adherent. Adherence was greatest for those labelled penicillin allergy (453 of 517; 87.6%) versus no allergy (1731 of 2128; 81.3%) (OR 0.52 (95% CI 0.37 to 0.73)?p<0.001). Guideline-adherence for CAP was higher if penicillin allergy (151 of 163; 92.6%) versus no allergy (582 of 810; 71.9%) (OR 0.20 (95% CI 0.10 to 0.37)?p<0.001). There was no difference in adherence between those with and without penicillin allergy for UTI, HAP or SSTI treatment. CONCLUSIONS:A relatively high proportion of patients had a penicillin allergy and two thirds of these had no description of their allergy, which has important implications for patient safety. Patients with penicillin allergy treated for CAP, received more guideline adherent antibiotics than those without allergy. Future studies investigating the clinical impact of penicillin allergy should include data on adherence to antibiotic guidelines.
| S-EPMC6398633 | biostudies-literature
Project description:IntroductionHospital-acquired infection with COVID-19 (HAI) has reduced from 14.3% to 4.2% over the last year, but substantial differences still exist between English NHS hospital trusts.MethodsWe assessed rates of HAI, comparing NHS hospital trusts using airborne respiratory protection (RPE, eg FFP3 masks) for all staff, as a marker of measures to reduce airborne spread, against those using mostly droplet precautions (eg surgical masks).Results/discussionRPE use was associated with a 33% reduction in HAI odds in the Delta wave, and 21% in the Alpha wave (p<0.00001). We recommend all hospitals make airborne mitigations a priority.
| S-EPMC8631043 | biostudies-literature
Project description:ObjectivesTo describe current use of electronic prescribing (EP) in English acute NHS hospital trusts, and the use of multiple EP systems within the same hospital.DesignDescriptive cross-sectional postal survey.SettingAcute NHS hospital trusts in England.ParticipantsThe survey was sent to chief pharmacists in all acute English NHS hospital trusts in 2011. Where trusts comprised multiple hospitals, respondents were asked to complete the questionnaire for their main acute hospital.Main outcome measuresPrevalence of EP use in acute NHS hospitals; number of different EP systems in each hospital; stages of the patient pathway in which EP used; extent of deployment across the hospital; comprehensiveness regarding the drugs prescribed; decision support functionalities used.ResultsWe received responses from 101 trusts (61%). Seventy (69%) respondent hospitals had at least one form of EP in use. More than half (39;56%) of hospitals with EP had more than one system in use, representing 60 different systems. The most common were systems used only for discharge prescribing, used in 48 (48% of respondent hospitals). Specialist chemotherapy EP systems were second most common (34; 34%). Sixteen specialist inpatient systems were used across 15 hospitals, most commonly in adult critical care. Only 13 (13%) respondents used inpatient electronic prescribing across all adult medical and surgical wards. Overall, 24 (40%) systems were developed 'in-house'. Decision support functionality varied widely.ConclusionsIt is UK government policy to encourage the adoption of EP in hospitals. Our work shows that EP is prevalent in English hospitals, although often in limited clinical areas and for limited types of prescribing. The diversity of systems in use, often within the same hospital, may create challenges for staff training and patient safety.
| S-EPMC3835329 | biostudies-literature
Project description:OBJECTIVES:To examine the association between financial performance as measured by operating margin (surplus/deficit as a proportion of turnover) and clinical outcomes in English National Health Service (NHS) trusts. SETTING:Longitudinal, observational study in 149 acute NHS trusts in England between the financial years 2011 and 2016. PARTICIPANTS:Our analysis focused on outcomes at individual NHS Trust-level (composed of one or more acute hospitals). PRIMARY AND SECONDARY OUTCOMES:Outcome measures included readmissions, inpatient satisfaction score and the following process measures: emergency department (Accident and Emergency (A&E)) waiting time targets, cancer referral and treatment targets and delayed transfers of care (DTOCs). RESULTS:There was a progressive increase in the proportion of trusts in financial deficit: 22% in 2011, 27% in 2012, 28% in 2013, 51% in 2014, 68% in 2015 and 91% in 2016. In linear regression analyses, there was no significant association between operating margin and clinical outcomes (readmission rate or inpatient satisfaction score). There was, however, a significant association between operating margin and process measures (DTOCs, A&E breaches and cancer waiting time targets). Between the best and worst financially performing Trusts, there was an approximately 2-fold increase in A&E breaches and DTOCs overall although this variation decreased over the 6 years. Between the best and worst performing trusts on cancer targets, the magnitude of difference was smaller (1.16 and 1.15-fold), although the variation slowly rose during the 6 years. CONCLUSIONS:Operating margins in English NHS trusts progressively worsened during 2011-2016, and this change was associated with poorer performance on several process measures but not with hospital readmissions or inpatient satisfaction. Significant variation exists between the best and worst financially performing Trusts. Further research is needed to examine the causal nature of relationships between financial performance, process measures and outcomes.
| S-EPMC6352807 | biostudies-other
Project description:BackgroundCarbapenem-resistant Enterobacteriaceae (CRE) pose a significant threat to global public health as these organisms have the potential to cause infections which are easily spread and are associated with high mortality rates.Aim/objectiveThe aim of this study was to establish which screening strategies acute NHS trusts in England have chosen to adopt and whether or not that strategy has prevented or is likely to prevent the cross-border spread of CRE.MethodsAll acute NHS trusts in England were invited to participate in a multicentre quantitative study. Participants were asked to complete a questionnaire relating to their local CRE screening protocol.Findings/resultsOf the 91 participating trusts, 83 (91.2%) adhere to Public Health England (2013) guidance. However, only 22 (24.2%) trusts have adopted the European Centre for Disease Prevention and Control (2016) recommendations. In total, 31 (34.1%) trusts reported incidences of person-to-person transmission, of which 45.2% were related to foreign travel. Furthermore, 31 (34.1%) trusts reported that patients who have had an admission to a hospital in the UK not known to have a high prevalence of healthcare-associated CRE in the last 12 months had screened positive.DiscussionThis study has demonstrated that inter-hospital transmission is as much of a concern as cross-border spread. Mandatory participation in enhanced surveillance could provide PHE with the epidemiological evidence required to support this stance and help to develop new national guidance.
| S-EPMC7607406 | biostudies-literature
Project description:The El Niño Southern Oscillation (ENSO) peaked strongly during the boreal winter 2015-2016, leading to food insecurity in many parts of Africa, Asia and Latin America. Besides ENSO, the Indian Ocean Dipole (IOD) and the North Atlantic Oscillation (NAO) are known to impact crop yields worldwide. Here we assess for the first time in a unified framework the relationships between ENSO, IOD and NAO and simulated crop productivity at the sub-country scale. Our findings reveal that during 1961-2010, crop productivity is significantly influenced by at least one large-scale climate oscillation in two-thirds of global cropland area. Besides observing new possible links, especially for NAO in Africa and the Middle East, our analyses confirm several known relationships between crop productivity and these oscillations. Our results improve the understanding of climatological crop productivity drivers, which is essential for enhancing food security in many of the most vulnerable places on the planet.
| S-EPMC5871885 | biostudies-literature
Project description:Understanding the molecular mechanisms of liver regeneration is essential to improve the survival rate of patients after surgical resection of large amounts of liver tissue. Focal adhesion kinase (FAK) regulates different cellular functions, including cell survival, proliferation and cell migration. The role of FAK in liver regeneration remains unknown. In this study, we found that Fak is activated and induced during liver regeneration after two-thirds partial hepatectomy (PHx). We used mice with liver-specific deletion of Fak and investigated the role of Fak in liver regeneration in 2/3 PHx model (removal of 2/3 of the liver). We found that specific deletion of Fak accelerates liver regeneration. Fak deletion enhances hepatocyte proliferation prior to day 3 post-PHx but attenuates hepatocyte proliferation 3 days after PHx. Moreover, we demonstrated that the deletion of Fak in liver transiently increases EGFR activation by regulating the TNF?/HB-EGF axis during liver regeneration. Furthermore, we found more apoptosis in Fak-deficient mouse livers compared to WT mouse livers after PHx.ConclusionOur data suggest that Fak is involved in the process of liver regeneration, and inhibition of FAK may be a promising strategy to accelerate liver regeneration in recipients after liver transplantation.
| S-EPMC5039626 | biostudies-literature
Project description:Transposable elements (TEs) are conventionally identified in eukaryotic genomes by alignment to consensus element sequences. Using this approach, about half of the human genome has been previously identified as TEs and low-complexity repeats. We recently developed a highly sensitive alternative de novo strategy, P-clouds, that instead searches for clusters of high-abundance oligonucleotides that are related in sequence space (oligo "clouds"). We show here that P-clouds predicts >840 Mbp of additional repetitive sequences in the human genome, thus suggesting that 66%-69% of the human genome is repetitive or repeat-derived. To investigate this remarkable difference, we conducted detailed analyses of the ability of both P-clouds and a commonly used conventional approach, RepeatMasker (RM), to detect different sized fragments of the highly abundant human Alu and MIR SINEs. RM can have surprisingly low sensitivity for even moderately long fragments, in contrast to P-clouds, which has good sensitivity down to small fragment sizes (?25 bp). Although short fragments have a high intrinsic probability of being false positives, we performed a probabilistic annotation that reflects this fact. We further developed "element-specific" P-clouds (ESPs) to identify novel Alu and MIR SINE elements, and using it we identified ?100 Mb of previously unannotated human elements. ESP estimates of new MIR sequences are in good agreement with RM-based predictions of the amount that RM missed. These results highlight the need for combined, probabilistic genome annotation approaches and suggest that the human genome consists of substantially more repetitive sequence than previously believed.
| S-EPMC3228813 | biostudies-literature