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Outcome of in-patient falls in hospitals with 100% single rooms and multi-bedded wards
- Authors:
- SINGH Inderpal, OKEKE Justin, EDWARDS Christine Anne
- Journal article citation:
- Age and Ageing, 44(6), 2015, pp.1032-1035.
- Publisher:
- Oxford University Press
Background: Falls in hospital account for almost two-fifths of the patient safety incidents reported to the National Reporting and Learning System in UK. Studies have suggested an increased incidence of falls in single-bedded hospitals. Objective: To compare the outcome of in-patient falls occurring in units with 100% single rooms (SRs) and multi-bedded wards (M-BWs). Sampling design and methods: an observational study. Retrospective standard incident reporting data (DATIX) on in-patient falls and associated injury were obtained from both sites over 18 months each. There was no change in demographics, size and characteristics of population except change in the geography of new hospitals. Results: The total number of in-patient fall incidents reported over the 3 years was 1,749. The mean age of patients on M-BW and SR sites was 81.0 ± 2.4 (51.3% females) and 80.3 ± 10.3 (50.7% females), respectively. The mean incidence of falls/1,000 patient-bed days on M-BW and SR sites was 5.44 ± 4.76 and 15.82 ± 19.56, respectively (P < 0.01). Overall fracture incidence/1,000 patient-bed days on M-BW and SR sites was 0.07 ± 0.48 and 0.36 ± 1.52 (P < 0.01), respectively. The hip fracture incidence/1,000 patient-bed days on M-BW and SR sites was 0.04 ± 0.38 and 0.15 ± 1.00 (P < 0.01), respectively. One-year mortality from the date of first incident fall was lower in M-BWs (41.1%) compared with SRs (47.1%), but this is not significant (P = 0.12). Conclusion: This observational study shows a significantly increased incidence of falls and fracture in a hospital design with SRs compared with a multi-bedded facility. Consideration should be given to increased incidence of falls and falls-related injury in SRs when deciding on the percentage of single-room provision in new hospitals to admit frail older adults.
Dignified care: one year on. The experiences of older people in hospital in Wales
- Author:
- OLDER PEOPLE'S COMMISSIONER FOR WALES
- Publisher:
- Older People's Commissioner for Wales
- Publication year:
- 2012
- Pagination:
- 32p.
- Place of publication:
- Cardiff
A stay in hospital can often be stressful in itself, but to be treated with a lack of dignity and respect causes real distress. In March 2011 the Older People’s Commission for Wales published the findings of its Dignified Care? Review. The report contained 12 recommendations aimed at improving the delivery of hospital care and subsequent patient experience for older people across Wales. One year on, this report sets out the Commissioner’s assessment of the progress made and outline how further review will be undertaken. The report finds there has been an improvement in how seriously the NHS and Welsh Government are taking the issue of dignity in care, and that there is real action underway. Some Health Boards report more progress than others, with all reporting that work has begun across the 12 recommendations. However, it is not yet possible to judge the extent to which a tangible improvement in the hospital experience of patients is being delivered at a ward level. The findings demonstrate that there is still significant unacceptable practice taking place on hospital wards. Chief Executives of Health Boards must ensure that within the next 18 months they move to full compliance with the agreed action plans.
A patient's experience of an NHS hospital: complaint and outcomes
- Author:
- WENGER G. Clare
- Journal article citation:
- Quality in Ageing, 9(2), June 2008, pp.4-11.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
The author presents a personal account of her experiences of six days in an NHS hospital in Wales. The article details the authors complaints and actions and comments made following the complaints.
Audit of availability and awareness of guidelines for the management of confusion in older patients on general wards
- Authors:
- EVANS Ceri G., et al
- Journal article citation:
- Psychiatric Bulletin, 32(4), April 2008, pp.143-145.
- Publisher:
- Royal College of Psychiatrists
Confusion in an older patient on a general hospital ward requires prompt and appropriate management. To this end, evidence-based guidelines have been produced and disseminated by Gwent Healthcare NHS Trust. An audit was carried out when it became apparent that junior doctors might not be aware of the guidelines and that their availability on the wards was limited. An action plan was generated and a second audit carried out. The aim was to establish whether the doctors’ knowledge of the guidelines and their availability on wards changed as a result of the action plan and audit. The audit consisted of a survey of general wards at the Royal Gwent Hospital and at St Woolos Hospital to assess availability of the guidelines and a questionnaire administered to a sample of junior doctors. The guidelines were available on 17% of wards; 11% of junior doctors were aware of them. Results of the audit informed implementation of an action plan. The second audit showed a limited improvement in availability (increased to 34%) and awareness (increased to 15%) of the guidelines, with no statistically significant difference. Apparently well-thought-out action plans may produce minimal change, but unless the audit cycle is completed this fact cannot be corroborated. In generating action plans, more consideration may need to be given to the factors that influence the spread of change in healthcare systems.
Help them home report: the challenges facing families of older people
- Author:
- ROYAL VOLUNTARY SERVICE
- Publisher:
- Royal Voluntary Service
- Publication year:
- 2015
- Pagination:
- 28
- Place of publication:
- Cardiff
This report explores the experiences of families of older patients during and after discharge from hospital and the support that is available to them. The report begins by reviewing the current health and social care context, with a focus on delayed discharges and the availability of social care. It then looks at key findings from an earlier report by the Royal Voluntary Service, 'Going Home Alone', which suggested that hospital readmission was closely related to whether individuals receive the support they need when discharged. Based on a sample of 1,000 adults in England, Scotland and Wales whose older parents had been discharged following a significant inpatient hospital stay, the report then looks at families' experiences and views of hospital care, available care and support at home, and how they would manage in the future. Results of the analysis found that: almost a third (30%) of respondents felt their family support network was not strong enough to cope without external help after hospital discharge; a quarter had concerns about the care received by their parent after post-discharge; and one in five of our respondents felt that discharge was too early. The report makes recommendations and identifies six key factors to ensure older people have a better experience of hospital discharge and that they have adequate support when they return home. (Edited publisher abstract)
‘I often worry about the older person being in that system’: exploring the key influences on the provision of dignified care for older people in acute hospitals
- Authors:
- CALNAN Michael, et al
- Journal article citation:
- Ageing and Society, 33(3), 2013, pp.511-538.
- Publisher:
- Cambridge University Press
Older age is one stage of the lifecourse where dignity maybe threatened due to the vulnerability created by increased incapacity, frailty and cognitive decline in combination with a lack of social and economic resources. Evidence suggests that it is in contact with health and welfare services where dignity is most threatened. This study explored the experiences of older people in acute National Health Service (NHS) Trusts in relation to dignified care and the organisational, occupational and cultural factors that affect it. These objectives were examined through an ethnography of four acute hospital Trusts in England and Wales, which involved interviews with older people (65+) recently discharged from hospital, their relatives/carers, and Trust managers, practitioners and other staff, complemented by evidence from non-participant observation. The picture which emerged was of a lack of consistency in the provision of dignified care which appears to be explained by the dominance of priorities of the system and organisation tied together with the interests of ward staff and clinicians. The emphasis on clinical specialism meant that staff often lacked the knowledge and skills to care for older patients whose acute illness is often compounded by physical and mental co-morbidities. The physical environment of acute wards was often poorly designed, confusing and inaccessible, and might be seen as ‘not fit for purpose’ to treat their main users, those over 65 years, with dignity. Informants generally recognised this but concluded that it was the older person who was in the ‘wrong place’, and assumed that there must be a better place for ‘them’. Thus, the present system in acute hospitals points to an inbuilt discrimination against the provision of high-quality care for older people. There needs to be a change in the culture of acute medicine so that it is inclusive of older people who have chronic co-morbidities and confusion as well as acute clinical needs. (Publisher abstract)
Aggression on psychiatric inpatient units for older adults and adults of working age
- Authors:
- CHAPLIN Robert, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(8), August 2008, pp.874-876.
- Publisher:
- Wiley
Staff and patients on acute psychiatric wards report higher rates of exposure to violence. This study aimed to compare numbers of staff and patients experiencing physical assault on older adult wards with those working on wards for adults of working age wards and to document the severity of aggression against nursing staff working on older adult wards. The results from the 3,332 questionnaires returned from 66 trusts are presented.
Hospital to a Healthier Home: evaluation of a winter pressures pilot service
- Author:
- CARE AND REPAIR CYMRU
- Publisher:
- Care and Repair Cymru
- Publication year:
- 2019
- Pagination:
- 36
- Place of publication:
- Cardiff
An evaluation of the Hospital to a Healthier Home pilot scheme, delivered by Care and Repair, which ran from 11 hospitals between January and March 2019. The scheme aimed to support older people to be safely and more quickly discharged from hospitals to their homes and prevent them being re-admitted by making their homes safe and more accessible. This evaluation describes how the Hospital to a Health Home case worker service started, what type of interventions have been provided to patients and hospital staff, costs, benefits and the difference it has made to patient well-being, quicker safe discharges, and preventing re-admissions. The pilot involved dedicated Care and Repair case workers based at each hospital to facilitate practical improvements to a patient’s home and offer practical support on issues such as benefits entitlements. During the evaluation period: 626 patients were referred through Hospital to a Healthier Home service; 508 patients received work that helped quicker safe discharge. Based on a local assessment of bed day savings, the evaluation found that service costs are fully substantiated, and return £2.80 for every £1 invested (both revenue and capital). NHS frontline staff interviewed for the evaluation study also felt the service was of significant benefit and had the potential to deliver more. (Edited publisher abstract)