Electronic patient medical records: Agility in the management of medical-expert information in the aeronautical health boards

The Electronic Patient Record (EPR) is already a reality in the practice of many offices, diagnostic centers and hospitals. The Federal Council of Medicine (FCM) regulated its use, through FCM Resolution n° 1,821/2007 In the Health Boards (HB) of the COMAER, agencies responsible for doing the medical-expert examinations of the military force, the paper record is still the rule. There is no automatic sharing of information between HB. In this context, it is perceived the need for the implementation of the unified EPR for the COMAER HB, because it speeds up the sharing of medical-expert information of the military and allows the military to carry out their health inspections in different locations, not interfering in the planning of missions so peculiar to the force, saving time and costs, speeding up the release of the results and control of inspections. The research thus consists of the qualitative approach, with exploratory objective and bibliographic procedure, carried out in the Scielo and Google Scholar databases, based on the discussion in ten articles, in addition to the FCM Resolutions. It was noted that the perspective that EPR has direct advantages for the Institution, however, requires an abrupt cultural change to the model that is made today, to provide a greater speed among the HB, even if in the transition phase, it is chosen to use in parallel in paper and Information and Communication Technologies. Therefore, the implementation of EPR in HB can provide both multidisciplinary teams and users of COMAER HB, a more efficient medical-expert assistance by promoting information sharing and agility in the performance of Health Inspections.

Incorporating gout guideline advice into urate reports is associated with reduced hospital admissions: results of an observational study

Objective To evaluate the impact of incorporating treatment guidance into reporting of urate test results. Methods Urate targets for clinically confirmed gout were added to urate results above 0.36 mmol/l requested after September 2014 within NHS Lothian. Scotland-wide data on urate-lowering therapy prescriptions and hospital admissions with gout were analysed between 2009 and 2020. Local data on urate tests were analysed between 2014 and 2015. Results Admissions with a primary diagnosis of gout in Lothian reduced modestly following the intervention from 111/year in 2010–2014 to 104/year in 2015–2019, a non-significant difference (P = 0.32). In contrast there was a significant increase in admissions to remaining NHS Scotland health boards (556/year vs 606/year, P < 0.01). For a secondary diagnosis of gout the number of admissions in NHS Lothian reduced significantly (58/year vs 39/year, P < 0.01) contrasting with a significant increase in remaining Scottish health boards (220/year vs 290/year, P < 0.01). The relative rate of admissions to NHS Lothian compared with remaining Scottish boards using a 2009 baseline were significantly reduced for both primary diagnosis of gout (1.06 vs 1.25, P < 0.001) and secondary diagnoses of gout (0.64 compared with 1.4, P < 0.001) after the intervention; however, there was no difference before the intervention. A relative increase in the prescription rates of allopurinol 300 mg tablets and febuxostat 120 mg tablets may have contributed to the improved outcomes seen. Conclusion Incorporation of clinical guideline advice into routine reporting of urate results was associated with reduced rates of admission with gout in NHS Lothian, in comparison with other Scottish health boards.

Health boards' governance of quality and risk: quality improvement agenda for the board

PurposeThis study explores key governance, leadership and management activities that have impact on quality, risk and safety within Australian healthcare organisations.Design/methodology/approachCurrent non-executive directors (n = 12) of public and private health boards were interviewed about contemporary approaches to fiduciary and corporate responsibilities for quality assurance and improvement outcomes in the context of risk and safety management for patient care. Verbatim transcripts were subjected to thematic analysis triangulated with Leximancer-based text mining.FindingsBoards operate in a strong legislative, healthcare standards and normative environment of quality and risk management. Support and influence that create a positive quality and risk management culture within the organisation, actions that disseminate quality and risk broadly and at depth for all levels, and implementation and sustained development of quality and risk systems that report on and contain risk were critical tasks for boards and their directors.Practical implicationsFindings from this study may provide health directors with key quality and risk management agenda points to expand or deepen the impact of governance around health facilities' quality and risk management.Originality/valueThis study has identified key governance activities and responsibilities where boards demonstrate that they add value in terms of potential improvement to hospital and health service quality care outcomes. The demonstrable influence identified makes an important contribution to our understanding of healthcare governance.

Regional variation in COVID-19 positive hospitalisation across Scotland during the first wave of the pandemic and its relation to population density: A cross-sectional observation study

Background There have been large regional differences in COVID-19 virus activity across the UK with many commentators suggesting that these are related to age, ethnicity and social class. There has also been a focus on cases, hospitalisations and deaths rather than on hospitalisation rates expressed per 100,000 population. The purpose of our study was to examine regional variation in COVID-19 positive hospitalisation rates in Scotland during the first wave of the pandemic and the possibility that these might be related to population density. Methods and findings This was a repeated point prevalence study. The number of COVID-19 positive patients hospitalised in the eleven Scottish mainland health boards peaked at 1517 on 19th April, then fell to a low of 243 on 16th August before rising slightly to 262 on 15th September. In July, August and September only four boards had more than 5 hospitalised patients. There was a statistically significant relationship between hospitalisation rates and population density on 97.7% of individual days during the first wave of the pandemic (Pearson’s r 0.62–0.93, with 123 of a possible 174 days having p values <0.001). Multiple linear regression analyses performed on data from the 11 mainland boards across six time points suggest that population density accounted for 70.2% of the variation in hospitalisation rate in April, 72.3% in May, 81.2% in June, 91.0% in July, 91.0% in August, and 88.1% in September. Neither population median age nor median social deprivation score at health board level were statistically significant in the final model for hospitalisation. Conclusion There were large differences in crude COVID-19 hospitalisation rates across the 11 mainland Scottish health boards, that were significantly related to population density. Given that lockdown was originally introduced to prevent the NHS from being overwhelmed, we believe our results support a regional rather than a national approach to lifting or reimposing more restrictive measures, and that hospitalisation rates should be part of the decision making process.

P–466 Fertility preservation for medical reasons: International and intra-national variation in provision and the gap between guideline and practice

Study question What is the gap between guidance and practice of fertility preservation between countries and within countries with common clinical guidelines? Summary answer Substantial variation in provision of FP exists between countries and within individual countries with gaps between national and international guidelines and policies governing provision. What is known already A robust guideline on female FP was published by ESHRE in 2020, advising the application of FP in cancer and other conditions where treatment with cytotoxic agents or surgery will compromise reproductive function. Across Europe, in 13 countries (43.3%) FP is funded for all available FP procedures, in 13 countries (43.3%) no FP funding is available, and in 4 countries (13.3%) at least one FP option is funded. Variation in state provision of fertility care in different countries in Europe was highlighted in the ESHRE guidance. It did not specifically examine individual national policies or whether a national policy exists. Study design, size, duration Five clinicians performing FP in Europe were contacted to collect current FP provision data. Policies retrieved from the internet were not included as they could not be verified. Finally, FP funding policies for 135 Clinical Commissioning Groups (CCGs) in England, 14 Health Boards in Scotland, 7 Health Boards in Wales and 5 Trusts in Northern Ireland and 17 policies for regional heath services in Spain were included were included. Participants/materials, setting, methods Policies on FP for the UK and Spain were reviewed (n = 178), including policies from the 161 regions from the four nations of the UK and policies of 17 autonomous bodies in Spain. Information on funded procedures, type of conditions included for funding and duration of storage were extracted. The provision of FP was compared to the current European Society of Human Reproduction and Embryology (ESHRE) and National Institute for Health and Care Excellence (NICE) guidelines. Main results and the role of chance In England, 127/128 (99%) CCGs fund cryopreservation of oocytes, sperm and embryos. Cancer is the exclusive indication in 11%. Provision of FP for transgender individuals is specified in 28%, ovarian tissue cryopreservation is funded in 8% and storage funding varies from five to ten years. In Scotland, a national policy is applied. All 14 health boards equitably fund cryopreservation of oocytes, sperm, embryos and ovarian and testicular tissue. Funding is provided for cancer, medical conditions which may impair fertility and transgender individuals. Storage funding is based on a five yearly review until age 43 in women and 60 in men. In Wales and Northern Ireland, cryopreservation of oocytes, sperm and embryos is funded for people undergoing medical or surgical treatment that is likely to make them infertile, provision for transgender individuals is not specified and ovarian tissue cryopreservation is not funded. In Spain, all 17 Health Services fund cryopreservation of oocytes, sperm and embryos for patients whose fertility is at risk due to gonadotoxic treatments or other pathological processes. Ovarian tissue cryopreservation is funded in 94%, provision for transgender individuals is specified in 12%, and storage funding is available until the age of 50 in women and 55 in men. Limitations, reasons for caution Inability to retrieve fertility preservation policies for every country in Europe is a limitation, for which ongoing collaboration is sought. The variable nature of FP provision is likely to be multi-factorial; a lag in publication of guidelines and updated policies, ethical considerations and resource distribution may govern health policies. Wider implications of the findings: The study highlights that provision of FP not only varies between countries but is also inconsistent within the same country. It is clear that there is a gap between ideal, evidence-based practice and actual provision. Variation in policies limits uniform access to care for patients. Trial registration number Not applicable.

The Show Did Go On

Using examples from Toronto’s newspapers, this article examines the impact of the 1918–19 Spanish flu pandemic on the city's theatre and the changes that followed in the twenties. Like during the COVID-19 pandemic, in 1918 health boards across Ontario ordered all theatres to close. However, after two weeks, theatres opened, and productions from New York City’s Broadway, such as the musical comedy Ask Dad, appeared at the Royal Alexandra Theatre, to rave reviews. Toronto’s stages became more diverse following the Spanish flu, with productions such as Shuffle Along, the first all-Black musical on Broadway, which hit the city’s stages in 1923, and one of the first locally cast shows, Amateur Minstrel Frolics, which appeared in 1924 at the Winter Garden Theatre. This article explores how and why the theatre changed after the last pandemic and what issues, such as those related to race and gender, lingered on.

National video consultation service- changing the way we deliver future care

AimsIn March 2020, when the COVID-19 outbreak emerged, Technology Enabled Care (TEC) Cymru went into partnership with the Welsh Government and CWTCH Cymru to offer a safe solution to protect the NHS and the public by developing and rolling-out a National Video Consulting (VC) Service on an All-Wales basis.The aim was to quickly develop and roll-out an NHS-approved communication platform (Attend Anywhere) to all primary, secondary and community care services, and into care homes, prisons, dentistry, optometry and pharmacy to offer video consultations to patients.MethodThe NHS Wales Video Consulting (VC) Service used a robust mixed methodology of surveys and interviews with patients, families and professionals. The real-time quality improvement approach was invaluable to the team as findings continually informed the approach and direction.ResultBased upon 10,000 survey responses from patients and professionals, and more than 300 interviews the results demonstrate that video consulting is consistently high in satisfaction, clinical suitability and acceptability across a wide range of patient demographics and clinical specialties in Wales. The key findings areVery high in patient and clinician satisfaction (slightly higher in patients).Clinically suitable across a wide range of specialties, care sectors and Health Boards.Very high in patient and clinician satisfaction (slightly higher in patients).High acceptability of VC, which is believed to be associated to the ‘Welsh Way’ of digital implementation processes.Consistent data patterns across patient demographics (age, gender, urban/rural location).Consistent data patterns across clinical settings and Health Boards.ConclusionThere is large appetite for VC in Wales, with high potential of sustainability and long-term use beyond COVID-19. The service is now working with clinicians, patients, carers and policy makers to explore the long-term use and sustainability of video consultations in Wales

The association between opening a short stay paediatric assessment unit and trends in short stay hospital admissions

Background Many inpatient facilities in Scotland have opened short stay paediatric assessment units (SSPAU) which are clinical areas separate from the usual inpatient ward area and these are where most short stay (also called zero day) admissions are accommodated. Here we describe the effect of opening short stay paediatric assessment units (SSPAU) on the proportion of zero day admissions relative to all emergency admissions. Methods Details of all emergency medical paediatric admissions to Scottish hospitals between 2000 and 2013 were obtained, including the number of zero day admissions per month and health board (i.e. geographic region). The month and year that an SSPAU opened in each health board was provided by local clinicians. Results SSPAUs opened in 7 health boards, between 2004 and 2012. Health boards with an SSPAU had a slower rise in zero day admissions compared to those without SSPAU (0.6% per month [95% CI 0.04, 0.09]. Across all 7 health boards, opening an SSPAU was associated with a 13% [95% CI 10, 15] increase in the proportion of zero day admissions. When considered individually, zero day admissions rose in four health boards after their SSPAU opened, were unchanged in one and fell in two health boards. Independent of SSPAUs opening, there was an increase in the proportion of all admissions which were zero day admissions (0.1% per month), and this accelerated after SSPAUs opened. Conclusion Opening an SSPAU has heterogeneous outcomes on the proportion of zero day admissions in different settings. Zero day admissions could be reduced in some health boards by understanding differences in clinical referral pathways between health boards with contrasting trends in zero day admissions after their SSPAU opens.

City region limits: Questioning city-centric growth narratives in medium-sized cities

This City Deal will provide the region and its partners with the new ways of working and resources to unlock significant economic growth across the Swansea Bay City Region. It is a Deal where both Welsh and UK Governments have committed to jointly invest, subject to the submission and approval of full business cases in relation to the 11 identified projects and the agreement of governance arrangements for the deal, up to £241 million on specific interventions which seek to support and further build on the region’s strengths which include health, energy and manufacturing sectors and are underpinned by a world-class digital infrastructure, successful universities and innovative health boards.