Out of hours activity (Anaesthesia)

2014 ◽  
Author(s):  
Dr Kathleen Ferguson ◽  
Dr Ramana Alladi ◽  
Dr Les Gemmell ◽  
Dr William Harrop-Griffiths ◽  
Dr Richard Griffiths ◽  
...  
Keyword(s):  
Out Of Hours

‘No-one knows where you are’: Veterinary perceptions regarding safety and risk when alone and on-call

2019 ◽  
Author(s):  
Amy Irwin ◽  
Janika Vikman ◽  
Hannah Ellis
Keyword(s):  
Quantitative Data ◽  
Qualitative Data ◽  
Safety Climate ◽  
Potential Hazard ◽  
Personal Safety ◽  
Out Of Hours ◽  
Remote Locations ◽  
High Workload ◽  
Quantitative Results ◽  
Large Animals

Background: Veterinary work is considered high risk and involves working with a range of hazards including large animals, high workload and long hours. A key potential hazard is making home visits and providing out of hours emergency care where vets often work alone, without support, and must travel long distances. The current study aimed to examine UK veterinary perceptions of safety climate, lone working and on-call tasks to gain a deeper understanding of the risk and hazards involved. Method: An online mixed-methods survey was used to gather quantitative data relevant to practice safety climate, and qualitative data regarding veterinary perception of lone working and on-call work. A sample of 76 UK veterinarians were recruited.Results: The quantitative results suggest that there may be practice safety climate issues around a lack of communication and discussion pertaining to safety, particularly in terms of maintaining personal safety. Key themes within the qualitative data included feeling pressure to treat patients, dealing with difficult clients, travel concerns and feeling unsafe when meeting clients alone and in remote locations. Conclusion: These findings indicate that personal safety requires more attention and discussion within veterinary practices, and that safety protocols and requirements should be shared with clients.

scholarly journals Trends in Antibiotic Prescribing in Out-of-Hours Primary Care in England from January 2016 to June 2020 to Understand Behaviours during the First Wave of COVID-19

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 32
Author(s):  
Nina J. Zhu ◽  
Monsey McLeod ◽  
Cliodna A. M. McNulty ◽  
Donna M. Lecky ◽  
Alison H. Holmes ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Patient Outcomes ◽  
Broad Spectrum ◽  
Antibiotic Prescribing ◽  
Broad Spectrum Antibiotic ◽  
Out Of Hours ◽  
Broad Spectrum Antibiotics ◽  
National Quality ◽  
General Practices

We describe the trend of antibiotic prescribing in out-of-hours (OOH) general practices (GP) before and during England’s first wave of the COVID-19 pandemic. We analysed practice-level prescribing records between January 2016 to June 2020 to report the trends for the total prescribing volume, prescribing of broad-spectrum antibiotics and key agents included in the national Quality Premium. We performed a time-series analysis to detect measurable changes in the prescribing volume associated with COVID-19. Before COVID-19, the total prescribing volume and the percentage of broad-spectrum antibiotics continued to decrease in-hours (IH). The prescribing of broad-spectrum antibiotics was higher in OOH (OOH: 10.1%, IH: 8.7%), but a consistent decrease in the trimethoprim-to-nitrofurantoin ratio was observed OOH. The OOH antibiotic prescribing volume diverged from the historical trend in March 2020 and started to decrease by 5088 items per month. Broad-spectrum antibiotic prescribing started to increase in OOH and IH. In OOH, co-amoxiclav and doxycycline peaked in March to May in 2020, which was out of sync with seasonality peaks (Winter) in previous years. While this increase might be explained by the implementation of the national guideline to use co-amoxiclav and doxycycline to manage pneumonia in the community during COVID-19, further investigation is required to see whether the observed reduction in OOH antibiotic prescribing persists and how this reduction might influence antimicrobial resistance and patient outcomes.

Prioritization and management of calls from older people to GP out-of-hours services

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Suzanne Smith ◽  
Lucia Carragher
Keyword(s):  
Older People ◽  
Service Provision ◽  
Emergency Services ◽  
Oldest Old ◽  
Community Dwelling ◽  
Third Party ◽  
Older Person ◽  
Out Of Hours ◽  
Accident And Emergency ◽  
Community Dwelling Older People

Abstract Background Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours services including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. Objective The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. Methods An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. Results Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also reflected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The findings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. Conclusion Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP office hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living.

Reliability and validity of an original nurse telephone triage tool for out-of-hours primary care calls: the SALOMON algorithm

2021 ◽  
pp. 1-7
Author(s):  
Edmond Brasseur ◽  
Allison Gilbert ◽  
Anne-Françoise Donneau ◽  
Justine Monseur ◽  
Alexandre Ghuysen ◽  
...  
Keyword(s):  
Primary Care ◽  
Reliability And Validity ◽  
Telephone Triage ◽  
Out Of Hours

450 Retrospective Analysis of Surgical Clerk-Ins Within the Acute Receiving Unit: A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Lee ◽  
A MacLeod ◽  
A Bradley
Keyword(s):  
Royal Infirmary ◽  
Improvement Project ◽  
Out Of Hours ◽  
Emergency Admissions ◽  
Vte Prophylaxis ◽  
Care Services ◽  
Documentation Quality ◽  
Patient Documentation ◽  
Patient Handovers

Abstract Introduction Accurate patient documentation at the ARU is vital to patient safety and ensuring smooth handovers to secondary care services. Because the nature of surgical treatment requires frequent patient handovers, and this increases the risk of miscommunication, we aimed to assess the quality of surgical clerk-ins and identify areas for improvement. Method Emergency admissions at the Dumfries Galloway Royal Infirmary were audited, looking at documentation quality under various clerk-in sections. Data was analysed before presentation to clinical governance. Results When 46 patient clerk-ins were examined, venous thromboembolism (VTE) prophylaxis plans were performed in only 24% of admissions - less than 1 in 4 patients. Comparing out-of-hours and in-hours patient documentation, much higher omission rates were identified in the out-of-hours documentation: in systemic enquiry (42 vs 100%) and family history (31% vs 66%). Conclusions These results brought to attention the effect of hospital admission timing on patient documentation quality, and the lack of VTE prophylaxis planning. In surgery, these plans are key to minimising risk of avoidable thromboembolic complications. A departmental meeting was convened to stress the importance of accurate and comprehensive clerk-ins to ARU doctors. Future audits could explore the factors influencing documentation quality for out-of-hours admissions, and ways to address these issues.

Models for charging in practice: how should farm veterinary surgeons earn their living?

Livestock ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 88-93
Author(s):  
Owen Atkinson
Keyword(s):  
Professional Services ◽  
Out Of Hours ◽  
Opinion Piece ◽  
Veterinary Surgeons ◽  
Veterinary Surgeon

There are many different ways that practices use for charging farm clients for their professional services. Ideally, the model is equitable for veterinary surgeon, client and animal. Different structures can influence how a practice's services are used and which services are successful. This article, which is an opinion piece, reviews common fee charging structures in UK farm practice. An argument is presented that if practices progressed towards a subscription-style charging model, at least for advisory work, and possibly for out-of-hours emergency work, this could be beneficial to farm businesses, veterinary businesses, farm veterinary surgeons, and the animals under their care.

scholarly journals Understanding decisions about antibiotic prescribing in ICU: an application of the Necessity Concerns Framework

2021 ◽  
pp. bmjqs-2020-012479
Author(s):  
Alyssa M Pandolfo ◽  
Robert Horne ◽  
Yogini Jani ◽  
Tom W Reader ◽  
Natalie Bidad ◽  
...  
Keyword(s):  
Focus Groups ◽  
Antibiotic Prescribing ◽  
Negative Consequences ◽  
Out Of Hours ◽  
Team Members ◽  
Clinical Vignettes ◽  
Molecular Microbiology ◽  
Semistructured Interviews ◽  
Decision Making Processes ◽  
The Individual

BackgroundAntibiotics are extensively prescribed in intensive care units (ICUs), yet little is known about how antibiotic-related decisions are made in this setting. We explored how beliefs, perceptions and contextual factors influenced ICU clinicians’ antibiotic prescribing.MethodsWe conducted 4 focus groups and 34 semistructured interviews with clinicians involved in antibiotic prescribing in four English ICUs. Focus groups explored factors influencing prescribing, whereas interviews examined decision-making processes using two clinical vignettes. Data were analysed using thematic analysis, applying the Necessity Concerns Framework.ResultsClinicians’ antibiotic decisions were influenced by their judgement of the necessity for prescribing/not prescribing, relative to their concerns about potential adverse consequences. Antibiotic necessity perceptions were strongly influenced by beliefs that antibiotics would protect patients from deterioration and themselves from the ethical and legal consequences of undertreatment. Clinicians also reported concerns about prescribing antibiotics. These generally centred on antimicrobial resistance; however, protecting the individual patient was prioritised over these societal concerns. Few participants identified antibiotic toxicity concerns as a key influencer. Clinical uncertainty often complicated balancing antibiotic necessity against concerns. Decisions to start or continue antibiotics often represented ‘erring on the side of caution’ as a protective response in uncertainty. This approach was reinforced by previous experiences of negative consequences (‘being burnt’) which motivated prescribing ‘just in case’ of an infection. Prescribing decisions were also context-dependent, exemplified by a lower perceived threshold to prescribe antibiotics out-of-hours, input from external team members and local prescribing norms.ConclusionEfforts to improve antibiotic stewardship should consider clinicians’ desire to protect with a prescription. Rapid molecular microbiology, with appropriate communication, may diminish clinicians’ fears of not prescribing or of using narrower-spectrum antibiotics.

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