NICE Guideline for safe staffing of Emergency Departments

Draft guidelines for Safe staffing for nursing in A&E Departments have been released for consultation by the National Institute for Health and Care Excellence (NICE) in the UK.  The aim is to ensure that A&E departments have the capacity to provide all necessary emergency care, including specialist input for children, older people or those with mental health needs.

The guidelines recommend minimum ratios based on the seriousness of a patient's condition and/or the level of care needed.  For example, they recommend two registered nurses to one patient in cases of major trauma or cardiac arrest and one registered nurse to four cubicles in either ‘majors’ or ‘minors’.

What are incident reports telling us? Australian study

This report published in the International Journal for Quality in Health Care compared reported medical errors in two Australian hospitals. It revealed that only a small number of clinically important prescribing errors were captured in the incident systems, with some 78.1% going undetected.

The authors of the paper, "What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system", conclude that there are inaccuracies inherent in the practice of using incident frequency to compare patient risk or quality performance within or across hospitals. They suggest that there are new approaches, such as data mining, which are needed to support better control of medication errors.

Westbrook JI, Li L, Lehnbom EC, Baysari MT, Braithwaite J, Burke R, I  International Journal for Quality in Health Care.  First published online, January 2015. ttp://dx.doi.org/10.1093/intqhc/mzu098

Improving the quality and safety of care on the medical ward

The medical ward is at the heart of inpatient care in hospital, but the evidence base for the organisation of care here is disjointed.  This paper, "Improving the quality and safety of care on the medical ward: a review and synthesis of the evidence base"is the first review of the literature on this subject.  The authors found five common themes where interventions could be targeted: staffing levels and team composition; interdisciplinary communication and collaboration; standardisation of care; early recognition and treatment of the deteriorating patient; and local safety climate.  The authors emphasise that clinicians should be open to incorporating evidence based practice at the ward level.

Ask your health librarian for a full-text copy of the article:

Pannick S, Beveridge I, Wachter RM, Sevdalis N.  European Journal of Internal Medicine. 2014;25(10):874-87. http://dx.doi.org/10.1016/j.ejim.2014.10.013 

Ask for Evidence

Do you want to query a claim about promises of detox diets, super-foods and high-tech work out plans? Before you pay out for them, take a moment to consider whether the claims are based on solid science, or if they are just seductive marketing claims designed to part you from your pennies. With support from the Wellcome Trust, the charity Sense About Science has launched a new interactive website, that lets you ask individuals and companies directly for evidence behind claims they make. Although this is a British website, it does make for relevant reading and is more than suitable for Australians.

Ask for Evidence website: http://www.askforevidence.org/index

Atrial Fibrillation Epidemic?

Australians need to watch their weight and be aware of their blood pressure if they want to avoid atrial fibrillation (AF), a heart condition that can lead to stroke, experts say. New research predicts AF or heart rhythm disorder will swell to "epidemic proportions" in the coming decades in Australia.

This recent study from the Australian Catholic University's Mary MacKillop Institute of Health Research in Melbourne lays out the facts quite clearly. Professor Simon Stewart, co-author of the paper in the MJA says, "We need to start making some inroads with things like high blood pressure and weight levels, we can't afford not to."

Jocasta Ball, David R Thompson, Chantal F Ski, Melinda J Carrington, Tracey Gerber and Simon Stewart (2015). Estimating the current and future prevalence of atrial fibrillation in the Australian adult population,  Med J Aust ; 202 (1): 32-35. (open access)

Global Status Report on Noncommunicable Diseases

The World Health Organization (WHO) has just released its Global Status Report on Noncommunicable Diseases, the second in a series tracking worldwide progress in the prevention and control of cancers, lung disease, diabetes and cardiovascular disease. 
Non-communicable diseases, which are sometimes called “lifestyle” or “chronic diseases”, are caused by common risk factors. The good news is that they can also be prevented by largely shared strategies. Tobacco control, for example, helps reduce cancers, heart disease, stroke and lung diseases – all of which are non-communicable diseases. Improving the diet of populations will help avoid obesity, cancer, diabetes and heart attacks – also all non-communicable disease.

Global status report on noncommunicable diseases 2014    

Review on Antimicrobial Resistance

The Review on Antimicrobial Resistance was commissioned in mid 2014 by the UK Prime Minister, David Cameron, who stated, "If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine".  The aim of the review (chaired by Jim O'Neill) is to tackle the threat of drug-resistant infections on an international level and by consulting widely and globally, come up with a package of actions for recommendation by mid 2016.

The Review has now published its first paper, Antimicrobial resistance: tackling a crisis for the health and wealth of nations.  In the paper you can read a description of the problems of antimicrobial resistance and its primary and secondary health effects with details on current research.  There is also a description of the economic cost to the world of this problem, and a call for an optimistic approach to the future.

Patient safety risks associated with telecare

A recent open access article in BMC Health Services Research examined the literature on telecare for patients at home and identified eleven types of risks to patient safety.  Risks included lack of patient or staff knowledge and understanding, technology issues, changes to staff workload, accessibility problems, lack of clear guidelines, poor patient compliance and the nature of the homecare environment.

The authors concluded that there is a need to better identify risks and thus avoid potential harm to patients utilising telecare services.  They offer some suggestions as to how this could be done.

Patient safety risks associated with telecare:a systematic review and narrative synthesis of the literature  Guise V, Anderson J, Wiig S.  BMC Health Services Research. 2014 Nov 25;14(1):588. 

Cancer Information website from Macquarie University

The Library at Macquarie University in Sydney has set up a very useful Cancer Information Website, supported by the Macquarie University Cancer Institute.  Much of the material can be freely accessed online and it particularly relates to breast, brain, renal, lung, bowel, skin, head and neck and prostate cancer.  There are links to useful websites, programs and support groups and a list of practical tips.  The site was set up in consultation with consumers and constantly responds to user suggestions so is very easy to use and packed with great information.

Rural training encourages doctors move to regional areas?

A study published in the Medical Journal of Australia this month looks at how doctors' rural background and years of rural clinical school training affect their decisions to take up subsequent rural clinical practice.  Determinants of rural practice: positive interaction between rural background and rural undergraduate training reports on a cohort study of medical graduates from the University of Queensland between 2002 and 2011.  The results showed a significant correlation between rural background and rural clinical school exposure with current rural practice.  The authors believe this has strengthened the argument for enhancing the efficacy of Australia's rural clinical school programs.

Srinivas Kondalsamy-Chennakesavan, Diann S Eley, et al.  MJA Online First doi: 10.5694/mja14.00236  

The Economics of Preventing Hospital Falls

A recent article in the January 2015 issue of the Journal of Nursing Administration (JONA), looked at a study which assessed the cost savings associated with implementing nursing approaches to prevent in-hospital falls.

Hospital rating programs often report fall rates, and performance-based payment systems force hospitals to bear the costs of treating patients after falls. Some interventions have been demonstrated as effective for falls prevention. Often net costs are calculated for implementing a falls-prevention program as compared with not making improvements in patient fall rates and the results showed that falls-prevention programs can reduce the cost of treatment. But in many scenarios, the costs of falls-prevention programs were shown to be greater than potential cost savings.

Spetz, J., Brown, Diane S., Aydin, C. (2015). The Economics of Preventing Hospital Falls: Demonstrating ROI Through a Simple Model. Journal of Nursing Administration, 45(1), 50-57.

Providing care after stillbirth

Six babies are stillborn in Australia every day. The Stillbirth Foundation Australia has funded a research project of the Joanna Briggs Institute. The objective of this review was to identify effective, meaningful and/or appropriate non-pharmacological, psychosocial supportive care interventions and strategies for families to improve their psychological well-being following stillbirth. Associate Professor Edoardo Aromataris says that “the findings of the review showed that parents can be comforted by healthcare professionals who are prepared to involve them collaboratively in decision-making, and to provide empathetic, sensitive and respectful care at all times.” As a result, these three publications are now freely available on the Stillbirth Foundation website: 

1. Evidence-based guidance for healthcare professionals providing care for parents from diagnosis to birth
2. Evidence-based guidance for healthcare professionals providing care for parents immediately after birth
3. Providing care for families who have experienced stillbirth: a comprehensive systematic review 

Electronic Cigarettes: getting the science right and communicating it accurately

Electronic cigarettes are being used by millions of people worldwide, mostly in an attempt to reduce smoking or stop altogether. Policy makers, smokers, clinicians and the public in general need accurate information on their safety and potential for reducing smoking rates. Unfortunately in some notable cases the science is being misused, with findings being distorted, misinterpreted or 

misrepresented. 

The journal Addiction, presents 19 articles in a free virtual issue in an attempt to clarify the debate over e-cigarettes. The title of the virtual issue is Electronic cigarettes: getting the science right and communicating it accurately.

You can also read the latest themed virtual issues and online collections from Addiction here.

Anatomy and Neurophysiology of Cough: CHEST Guideline

In this free to view article in the journal Chest, an update to the 2006 Diagnosis and Management of Cough: ACCP Evidence-Based Clinical Practice Guidelines is provided by detailing the recent research, including an increasing number of studies conducted in human subjects designed to elucidate the anatomic and neurophysiologic components of cough. The article gives a clinical perspective with particular emphasis on what is known about cough in patients as well as mechanisms accounting for the excessive coughing and cough hypersensitivity associated with acute, subacute, and chronic conditions associated with cough.

Brendan J. Canning, PhD; Anne B. Chang, MBBS, PhD, MPH; Donald C. Bolser, PhD; Jaclyn A. Smith, MBChB, PhD; Stuart B. Mazzone, PhD, FCCP; Lorcan McGarvey, MD, Anatomy and Neurophysiology of Cough: CHEST Guideline and Expert Panel Report. Chest. 2014;146(6):1633-1648. doi:10.1378/chest.14-1481 

Daily sitting time among a sample of Australian office-based employees

Prolonged time spent in sedentary behaviours (e.g. too much sitting) has emerged as a new behavioural risk factor for chronic diseases, independent of the amount of time spent in leisure-time physical activity. Work setting is important, given that employed adults spend more than half of their waking hours in the workplace.

This study published in the Australian and New Zealand Journal of Public Health aims to examine prevalence estimates of total and domain-specific sitting time among Australian desk-based employees, and to help inform who is most at risk of extended sitting time, and in which domain this occurs.  Public health strategies to reduce daily sitting levels in desk-based workers should particularly focus on younger, overweight/obese and insufficiently active individuals, as it seems that they are at the highest risk of this health-risk behaviour. The article is on open access.

Bennie, J. A., Pedisic, Z., Timperio, A., Crawford, D., Dunstan, D., Bauman, A., van Uffelen, J. and Salmon, J. (2014), Total and domain-specific sitting time among employees in desk-based work settings in Australia. Australian and New Zealand Journal of Public Health. doi: 10.1111/1753-6405.12293

Cardiovascular disease, diabetes and chronic kidney disease-Australian facts: Morbidity

Cardiovascular disease, diabetes and chronic kidney disease-Australian facts is a series of 5 reports by the National Centre for Monitoring Vascular Diseases at the Australian Institute of Health and Welfare that describes the combined burden of cardiovascular disease (including coronary heart disease and stroke), diabetes and chronic kidney disease.

This report on Morbidity presents up-to-date statistics as well as trends on hospitalisations from these chronic diseases. It examines age and sex characteristics, and variations across population groups, including among Aboriginal and Torres Strait Islander people, by geographical location, and by socioeconomic disadvantage.

Download the report here.