People with a learning disability often experience health inequalities. Inquiries and reports have detailed the possible catastrophic consequences of inadequate healthcare for people with learning disabilities, their families and carers. This is despite the Equality Act 2010 specifying that providers have a legal duty to make reasonable adjustments to enable the delivery of adequate and efficient services.
This article reviews the literature on reasonable adjustments to explore if the introduction of colour-coded patient identification wristbands for people with learning disabilities who are admitted to general hospitals could improve safety, experience and outcomes and influence the provision of a reasonably adjusted healthcare service. To read the full article, log in using your MPFT NHS OpenAthens details.
To determine whether the Mini‐Cog can be applied by nursing staff to hospitalized elderly patients for cognitive impairment associated risk stratification.. To read the full article, log in using your NHS Athens details. To access full-text: click “Log in/Register” (top right hand side). Click ‘Institutional Login’ then select 'OpenAthens Federation', then ‘NHS England’. Enter your Athens details to view the article.
The authors took part in a national research project that evaluated an intervention to enhance person-centred care for people with dementia in hospital. The Person, Interactions, Environment (PIE) programme involves staff observing care on a ward, focusing on these three areas. Findings from observations form the basis for introducing changes to ward practices. To read the full article, log in using your MPFT NHS OpenAthens details.
The Healthcare Safety Investigation Branch (HSIB) has today published its latest report highlighting the variation in mental health care across emergency departments and setting out four recommendations aimed at improving patient care.
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Open access. Hospitalisation for an eating disorder is rare, however treatment in the acute medical setting can be a life-saving admission. While the multidisciplinary team delivers overall patient care, medical decisions are the responsibility of the treating physicians. Treatment decisions directly impact on patient care and outcomes. This study aimed to explore the considerations that influence the medical decisions of physicians when treating patients with eating disorders in the acute setting.
In response to increasing numbers of older people in general hospitals who have cognitive impairment such as dementia and delirium, many hospitals have developed education and training programmes to prepare staff for this area of clinical practice.. To read the full article, log in using your MPFT NHS OpenAthens details.
Little is known about the hospitalisation rate of adults with severe/profound intellectual disability (PID) presenting at emergency services or about the appropriateness of hospital admissions in this population. Examining the possible differences in the patterns of hospitalisation between people with PID and those without intellectual disability (ID) may shed light on aspects of health and illness in these patients and may in turn make it possible to differentiate more clearly between mild-moderate ID and PID. To read the full article, log in using your SSSFT NHS OpenAthens details. SSOTP - You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
aring for patients with dementia emerging from general anaesthesia in the recovery room can be very challenging. Sedation is sometimes necessary in order to nurse patients effectively and avoid any negative consequences of poor post-anaesthetic care. No local or national guidelines could be found to suggest best nursing practice in this situation. Three small-scale innovations were introduced into the recovery room in one hospital as part of a quality improvement project to give alternatives to chemical restraint.
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A general practitioner may support four to eight patients with psychotic disorder and see one new presentation each year. Other non-specialist doctors will encounter patients presenting to an emergency department or complicating comorbid illness.
Psychosis often emerges for the first time in adolescence and young adulthood. In around four out of five patients symptoms remit, but most experience relapses and further difficulties. The first two to five years of psychosis are considered a critical period for intervening to improve long term outcome.567 The non-specialist plays a key role in early identification.
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Identification of psychotic symptoms in non-specialist settings is key to initiating timely pathways to care. A systematic review of 30 observational studies of pathways to care of first-episode psychosis showed that first contact was more usually through a physician than through emergency services. This article is aimed at generalists, primary care physicians, and hospital doctors, who play a critical role and who require a low threshold for referral for specialist assessment, sometimes before diagnosis is certain.
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The Healthcare Safety Investigation Branch (HSIB) was made aware of a woman experiencing a mental health crisis who, having presented to her general practitioner, ambulance service and the emergency department of her local hospital, subsequently took her own life.
The initial investigation reviewed the care pathway of the woman spanning the two years before her death. The full investigation will explore the systemic safety issues highlighted around the assessment and care of adult mental health patients who present at emergency departments.
Over half of older hospital inpatients have co-existing cognitive impairment but the majority do not have a preadmission diagnosis of dementia [1]. Delirium (acute confusional state) is highly prevalent, affecting around one-fifth of acute medical admissions and reaching rates of over 40% in the oldest old [2, 3]. Delirium, perhaps even more than dementia, is associated with high care needs and poor outcomes [4, 5], but is often poorly recognised by staff who are more focussed on physical aspects of illness, or may not be trained in the care of complex older patients [6, 7].. To read the full article, log in using your MPFT NHS OpenAthens details.
Efficient response to health care needs when clinical resources are limited is a critical issue in health care delivery. Technologies such as telemedicine hold promise to support adaptive service delivery models to address these issues. The authors explore how a simple, low-tech approach to telemedicine paired with an on-demand staffing model to create a virtual pool of consultants may improve capacity and flexibility for providing inpatient consultation-liaison psychiatric services.. Login at top right hand side of page using your SSSFT NHS OpenAthens for full text. SSOTP- Please contact the library to receive a copy of this article - http://bit.ly/1Xyazai
We are in the process of developing a standardised treatment and management plan for people with confusion in hospital. (By confusion we mean people with dementia, delirium, or unspecified cognitive impairment.)
Open access. Mechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. A small number of logic models have been developed, but they fail to capture the complexity of clinical practice. We synthesised data from a variety of sources including a large national survey, 73 in-depth interviews with acute and liaison staff working in hospitals with different types of liaison mental health services, and relevant local, national and international literature. We generated logic models for two common performance indicators used to assess organisational outcomes for LMHS: response times in the emergency department and hospital length of stay for people with mental health problems. We identified 8 areas of complexity that influence performance, and 6 trade-offs which drove the models in different directions depending upon the balance of the trade-off. The logic models we developed could only be captured by consideration of more than one pass through the system, the complexity in which they operated, and the trade-offs that occurred. Our findings are important for commissioners of liaison services. Reliance on simple target setting may result in services that are unbalanced and not patient-centred. Targets need to be reviewed on a regular basis, together with other data that reflect the wider impact of the service, and any external changes in the system that affect the performance of LMHS, which are beyond their control.
For the first time, the College has developed an audit toolkit to support Emergency Ddepartments treating children to monitor how well they are meeting the 70 “Facing the Future” standards. Dr John Criddle and Dr Virginia Davies discuss the development of the toolkit and its impact for children in mental health crisis.
Results FAST screening was completed for 71 patients and none were FAST-positive for alcohol misuse, yet using MAST-G, 18 patients scored positively for alcohol misuse. FAST screening failed to identify 8 patients with a documented history of alcohol misuse.