Clinical governance in an adolescent forensic inpatient service

2004 ◽  
Author(s):  
Marie Boles
Keyword(s):  
Clinical Governance ◽  
Inpatient Service ◽  
Forensic Inpatient

Profiling referrals to a trauma support service: needs and outcomes for staff working in a secure adult developmental disorder pathway

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Elanor Lucy Webb ◽  
Annette Greenwood ◽  
Abbey Hamer ◽  
Vicky Sibley
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Developmental Disorder ◽  
Psychological Needs ◽  
Support Service ◽  
Traumatic Experiences ◽  
Inpatient Service ◽  
Care Providers ◽  
Content Type ◽  
Forensic Inpatient

Purpose Forensic health-care workers are frequently exposed to behaviours that challenge and traumatic material, with notably high levels in developmental disorder (DD) services. The provision of support is key in alleviating distress and improving work functioning. This paper aims to incite clarity on whether staff in DD services are more likely to access trauma support. The prevailing needs and outcomes for this population are also explored. Design/methodology/approach Data was extracted retrospectively from a database held by an internal trauma support service (TSS) for staff working in a secure psychiatric hospital. Overall, 278 permanent clinical staff accessed the TSS between 2018 and 2020, 102 (36.7%) of whom worked in an adult DD forensic inpatient service. Findings Staff working in DD services were over-represented in referrals to the TSS with a greater number of referrals per bed in DD services than in non-DD services (0.94 vs 0.33). DD staff were comparatively more likely to access support for non-physical, psychologically traumatic experiences. Psychological needs and outcomes following support were comparable between staff across services. Practical implications The findings highlight the more frequent need for trauma support of staff in forensic inpatient DD settings. Embedding a culture of safety and openness, and establishing appropriate and responsive models of staff support reflect key priorities for inpatient DD health-care providers, for the universal benefit of the organisation, workforce and service users. Originality/value This study offers novel insight into levels of access to support for staff working with people with DDs.

Clinical governance in Australia

2015 ◽  
Vol 20 (2) ◽  
pp. 56-73 ◽  
Author(s):  
Allan D Spigelman ◽  
Shane Rendalls
Keyword(s):  
Web Sites ◽  
Service Providers ◽  
Service Level ◽  
Clinical Governance ◽  
Success Factor ◽  
Quality And Safety ◽  
Funding Policy ◽  
Content Type ◽  
Health Service Providers ◽  
Governance Systems

Purpose – The purpose of this paper is to overview, background and context to clinical governance in Australia, areas for further development and potential learnings for other jurisdictions. Design/methodology/approach – Commentary; non-systematic review of clinical governance literature; review of web sites for national, state and territory health departments, quality and safety organisations, and clinical colleges in Australia. Findings – Clinical governance in Australia shows variation across jurisdictions, reflective of a fragmented health system with responsibility for funding, policy and service provision being divided between levels of government and across service streams. The mechanisms in place to protect and engage with consumers thus varies according to where one lives. Information on quality and safety outcomes also varies; is difficult to find and often does not drill down to a service level useful for informing consumer treatment decisions. Organisational stability was identified as a key success factor in realising and maintaining the cultural shift to deliver ongoing quality. Research limitations/implications – Comparison of quality indicators with clinical governance systems and processes at a hospital level will provide a more detailed understanding of components most influencing quality outcomes. Practical implications – The information reported will assist health service providers to improve information and processes to engage with consumers and build further transparency and accountability. Originality/value – In this paper the authors have included an in depth profile of the background and context for the current state of clinical governance in Australia. The authors expect the detail provided will be of use to the international reader unfamiliar with the nuances of the Australian Healthcare System. Other studies (e.g. Russell and Dawda, 2013; Phillips et al., n.d.) have been based on deep professional understanding of clinical governance in appraising and reporting on initaitives and structures. This review has utilised resources available to an informed consumer seeking to understand the quality and safety of health services.

scholarly journals Pyometra: An Atypical Cause of Abdominal Pain

2021 ◽  
Vol 9 ◽  
pp. 232470962110224
Author(s):  
Leonidas Walthall ◽  
Marc Heincelman
Keyword(s):  
Abdominal Pain ◽  
Vaginal Discharge ◽  
Elderly Women ◽  
Lower Abdominal Pain ◽  
Endometrial Biopsy ◽  
Laboratory Evaluation ◽  
Inpatient Service ◽  
Gynecologic Malignancy ◽  
Intravenous Contrast ◽  
Lower Quadrant

Pyometra, a purulent infection of the uterus, is a rare cause of a very common complaint—abdominal pain. Risk factors include gynecologic malignancy and postmenopausal status. The classically described presentation includes abdominal pain, fever, and vaginal discharge. In this article, we present an atypical presentation of nonperforated pyometra in an 80-year-old female who was admitted to the internal medicine inpatient service. She initially presented with nonspecific subacute right lower quadrant abdominal pain. Physical examination did not demonstrate vaginal discharge. Laboratory evaluation failed to identify an underlying etiology. Computed tomography scan of the abdomen and pelvis with oral and intravenous contrast demonstrated a 6.5 × 6.1 cm cystic containing structure within the uterine fundus, concerning for a gynecologic malignancy. Pelvis ultrasound confirmed the mass. Endometrial biopsy did not reveal underlying malignancy, but instead showed frank pus, leading to the diagnosis of pyometra. This report illustrates that pyometra should be considered in the differential diagnosis of lower abdominal pain in elderly women.

scholarly journals Factors associated with higher healthcare costs in a cohort of homeless adults with a mental illness and a general cohort of adults with a history of homelessness

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathryn Wiens ◽  
Laura C. Rosella ◽  
Paul Kurdyak ◽  
Simon Chen ◽  
Tim Aubry ◽  
...  
Keyword(s):  
Mental Illness ◽  
Healthcare Costs ◽  
Service Use ◽  
Multinomial Logistic Regression ◽  
Service Planning ◽  
Inpatient Service ◽  
Homeless Adults ◽  
Targeted Interventions ◽  
Factors Associated ◽  
History Of

Abstract Background Healthcare costs are disproportionately incurred by a relatively small group of people often described as high-cost users. Understanding the factors associated with high-cost use of health services among people experiencing homelessness could help guide service planning. Methods Survey data from a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness were linked with administrative healthcare records in Ontario, Canada. Total costs were calculated using a validated costing algorithm and categorized based on population cut points for the top 5%, top 6–10%, top 11–50% and bottom 50% of users in Ontario. Multinomial logistic regression was used to identify the predisposing, enabling, and need factors associated with higher healthcare costs (with bottom 50% as the reference). Results Sixteen percent of the general homeless cohort and 30% percent of the cohort with a mental illness were in the top 5% of healthcare users in Ontario. Most healthcare costs for the top 5% of users were attributed to emergency department and inpatient service costs, while the costs from other strata were mostly for physician services, hospital outpatient clinics, and medications. The odds of being within the top 5% of users were higher for people who reported female gender, a regular medical doctor, past year acute service use, poor perceived general health and two or more diagnosed chronic conditions, and were lower for Black participants and other racialized groups. Older age was not consistently associated with higher cost use; the odds of being in the top 5% were highest for 35-to-49-year year age group in the cohort with a mental illness and similar for the 35–49 and ≥ 50-year age groups in the general homeless cohort. Conclusions This study combines survey and administrative data from two cohorts of homeless adults to describe the distribution of healthcare costs and identify factors associated with higher cost use. These findings can inform the development of targeted interventions to improve healthcare delivery and support for people experiencing homelessness.

scholarly journals 1129. Optimizing Feedback Strategies on the Infectious Diseases Inpatient Service

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S593-S594
Author(s):  
Eva Clark ◽  
Prathit Kulkarni ◽  
Mayar Al Mohajer ◽  
Stacey Rose ◽  
Jose Serpa ◽  
...  
Keyword(s):  
Medical Education ◽  
Infectious Diseases ◽  
Clinical Education ◽  
Mental Model ◽  
Inpatient Service ◽  
Shared Mental Model ◽  
Effective Feedback ◽  
Medical Trainees ◽  
Feedback Strategies ◽  
Giving Feedback

Abstract Background Timely, efficient, and effective feedback strategies are crucial for enhancing faculty-trainee communication and trainee education. Here we describe attitudes, practices, and perceived behaviors regarding giving feedback to medical trainees rotating on Infectious Diseases (ID) inpatient consult services. Methods An anonymous survey on feedback strategies was distributed to our adult ID Section in February 2020 as part of a facilitated discussion on optimizing trainee clinical education. Results Twenty-six ID Section members completed the survey (18 faculty, 8 trainees). Most trainees (62.5%) and faculty (66.7%) felt that trainees are “sometimes” comfortable voicing concerns to faculty; however, no trainees but 11.1% of faculty indicated that trainees are “always” comfortable voicing concerns to faculty. Most trainees (87.5%) felt that conversations about team expectations occur “sometimes” or “often.” In contrast, most faculty (72.2%) felt that these conversations “always” occur. Although most faculty felt that both informal (94.4%) and formal (83.3%) feedback should be given to trainees, 22.2% of faculty responded that they do not explicitly use the term “feedback” when discussing feedback with a trainee. No trainees and 22.2% of faculty indicated that they utilize a feedback tool. Regarding quantity of feedback trainees perceive they receive from faculty, 37.5% of trainees felt they needed more feedback while 50% felt they received adequate feedback. Most faculty (88.9%) responded that they encourage trainees to give feedback to faculty, although most trainees (62.5%) responded “sometimes” regarding how comfortable they feel doing so. Conclusion In summary, we found differences between faculty and trainees regarding two important aspects of medical education: setting expectations and providing feedback. While most faculty feel that conversations regarding these topics occur invariably, trainees do not always share this perception. Trainees felt less comfortable voicing concerns and giving feedback to faculty than faculty perceived them to be. Overall, the data suggest that there is room for improvement to ensure that trainees and faculty are operating from a shared mental model regarding setting team expectations and providing/receiving feedback. Disclosures All Authors: No reported disclosures

scholarly journals An introduction to clinical governance in dentistry

BDJ ◽  
2021 ◽  
Vol 230 (8) ◽  
pp. 539-543
Author(s):  
Kishan Patel ◽  
Ian Jenkyn
Keyword(s):  
Clinical Governance

scholarly journals Quality management systems in Aboriginal Community Controlled Health Services: a review of the literature

2021 ◽  
Vol 10 (3) ◽  
pp. e001091
Author(s):  
Jenifer Olive Darr ◽  
Richard C Franklin ◽  
Kristin Emma McBain-Rigg ◽  
Sarah Larkins ◽  
Yvette Roe ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Management ◽  
Health Service ◽  
First Nations ◽  
Quality Management System ◽  
Grey Literature ◽  
Models Of Care ◽  
Clinical Governance ◽  
Aboriginal Community ◽  
Continuous Quality

BackgroundA national accreditation policy for the Australian primary healthcare (PHC) system was initiated in 2008. While certification standards are mandatory, little is known about their effects on the efficiency and sustainability of organisations, particularly in the Aboriginal Community Controlled Health Service (ACCHS) sector.AimThe literature review aims to answer the following: to what extent does the implementation of the International Organisation for Standardization 9001:2008 quality management system (QMS) facilitate efficiency and sustainability in the ACCHS sector?MethodsThematic analysis of peer-reviewed and grey literature was undertaken from Australia and New Zealand PHC sector with a focus on First Nations people. The databases searched included Medline, Scopus and three Informit sites (AHB-ATSIS, AEI-ATSIS and AGIS-ATSIS). The initial search strategy included quality improvement, continuous quality improvement, efficiency and sustainability.ResultsSixteen included studies were assessed for quality using the McMaster criteria. The studies were ranked against the criteria of credibility, transferability, dependability and confirmability. Three central themes emerged: accreditation (n=4), quality improvement (n=9) and systems strengthening (n=3). The accreditation theme included effects on health service expenditure and clinical outcomes, consistency and validity of accreditation standards and linkages to clinical governance frameworks. The quality improvement theme included audit effectiveness and value for specific population health. The theme of systems strengthening included prerequisite systems and embedded clinical governance measures for innovative models of care.ConclusionThe ACCHS sector warrants reliable evidence to understand the value of QMSs and enhancement tools, particularly given ACCHS (client-centric) services and their specialist status. Limited evidence exists for the value of standards on health system sustainability and efficiency in Australia. Despite a mandatory second certification standard, no studies reported on sustainability and efficiency of a QMS in PHC.

Sign in / Sign up

Export Citation Format

Share Document