Hornerhatcher3005

Acute stroke care demands real-time, specialist-led treatment decisions, including thrombolysis and referral for mechanical thrombectomy. Pathways designed to deliver time-critical interventions for stroke patients are under intense pressure due to the impact of COVID-19 pandemic. Olaparib concentration In response to this unprecedented burden on acute care services, stroke clinicians are having to reconfigure existing clinical pathways both within and between hospitals. Incorporating artificial intelligence and digital communication support into clinical pathways offers an opportunity to mitigate the disruption to acute stroke care. In this case study we describe how Royal Berkshire Hospital, working collaboratively with Brainomix, a UK-based artificial intelligence software company, adopted technological innovation and integrated it into the hyperacute stroke pathway. A case is presented to demonstrate how this innovation can support patient care and deliver successful patient outcomes. We believe this model can be adopted in other hospitals and networks to deliver safe and efficient hyperacute stroke care.COVID-19 presents an unprecedented challenge to hospitals and the systems in which they operate. The primary exponential surge of COVID-19 cases is arguably the most devastating event a hospital will face. In some countries, these surges during the initial outbreak of the disease have resulted in hospitals suffering from significant resource strain, leading to excess patient mortality and negatively impacting staff wellbeing. As experience builds in managing these surges, it has become evident that agile, tailored planning tools are required. The comprehensive hospital agile preparedness (CHAPs) tool provides clinical planners with six key domains to consider that frequently create resource strain during COVID-19; it also allows local planners to identify issues unique to their hospital, system or region. Although this tool has been developed from COVID-19 experiences, it has potential to be modified for a variety of pandemic scenarios according to transmission modes, rates and critical care resource requirements.The COVID-19 pandemic looks set to significantly change how we practice medicine. It is vital that the vulnerable and immunocompromised members of our workforce are protected, which may mean that they do not go into clinical areas. While the medical field has been slower than many professional areas to catch on to working from home, many trusts are already moving towards telephone or video outpatient appointments during COVID-19. We describe the equipment needed to set up working from home for healthcare practitioners (HCPs) and discuss a variety of other opportunities for home-based HCPs, including teaching, learning, carrying out audit and quality improvement work and offering psychological support for colleagues working on the front line.Delivery of routine and established medical care has been significantly disrupted by the COVID-19 pandemic. Acutely unwell patients are being prioritised, and large numbers of doctors and inpatient beds are required to deliver this care. We have recognised the impact that this disruption will have on patients with presumed and/or confirmed pleural and/or peritoneal malignancies. We present our service transformation and hope that the learning from this reconfiguration can be adopted by other organisations.We share our experience as medical students who have recently completed quality improvement projects in primary care. We have found that quality improvement projects, such as audits, are mutually beneficial for clinicians who may need to conduct annual appraisals and students who benefit from the educational experience.Hospital mortality rates have frequently been improved by identifying diagnostic groups with high mortality and targeting interventions to those specific groups. We found that high residual inpatient mortality persisted after targeted measures had achieved an initial reduction, and that the causes were spread across a wide range of diagnostic groups. Further interventions were put in place consisting of a structured electronic mortality form and systematised mortality scrutiny and reporting (primary intervention) accompanied by a number of quality improvement interventions arising from the mortality analysis (secondary interventions). We found that those interventions were associated with progressive improvements in mortality rates and average lengths of inpatient stay over the 5-year study period. Winter quarter mortality improvements reached a high level of statistical significance but could not be attributed to changes in any particular diagnostic groups. We conclude that progress with mortality improvements is probably best achieved by applying both code-targeted and general interventions simultaneously.Background Advance care plans (ACP) provide patients the opportunity to communicate their goals and wishes for future care. Local problem A retrospective case note review of 50 inpatient deaths in 2017 confirmed a doctor had discussed expected death in 90%, however only 2% had an ACP. Methods Patients appropriate for ACP were identified on a single geriatrics ward. Interventions were implemented with monthly data collection. Patients with an ACP were followed prospectively. The initiatives were subsequently applied across six geriatrics wards. Interventions Interventions included improved identification of patients appropriate for ACP, doctor education and improved communication to general practitioners and healthcare providers. Results Before initiation of interventions on the pilot ward, ACP was completed for 38% of appropriate patients; this increased to a mean of 78.6% over 4 months post-interventions. During the pilot, 44 patients had an ACP. Of those discharged, 75% avoided readmission over the following 6 months. After applying the interventions across all geriatric wards, ACPs increased to a mean of 81.2% and was maintained 12 months later at 72%. Conclusions The initiatives formed a structure to promote the use of ACP on the wards. Care plans focused on individualising care and effective communication resulted in reduction of readmissions.