16 e-Letters

  • Proposed Interdisciplinary Approach on Reducing Hospital Readmissions

    To: Dr. David Gallagher

    As an aspiring informatics nurse and masters of science student at Jacksonville University, previous Intensive Care Unit (ICU) nurse, and current case management nurse at Mayo Clinic, I would like to respond to the article: Inpatient Pharmacists Using a Readmission Risk Model in Supporting Discharge Medication Reconciliation to Reduce Unplanned Hospital Readmissions: A Quality Improvement Intervention (Gallagher et al., 2022). Beginning with applauding the insightful evidence provided, I would also like to reflect upon the model’s impact upon personal and organizational practices.

    Experiences within education and personal practices are almost, if not as important as the supporting evidence. As referred to in the article, the Epic Readmission Risk Assessment (RRS) is incredibly helpful and accessible for healthcare team members to distinguish within charting systems. Involvement of pharmacy professionals is essential, however I propose an interdisciplinary approach that involves the healthcare team in its entirety.

    Recommendations for this approach includes designating an advanced practice nurse as a healthcare team representative to ensure potential readmission risks are identified (Rovito & Fagan, 2022). Ideally, this position would replace a pharmacist’s role with the addition of collaboration among healthcare professionals to support readmissio...

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  • UK vs Switzerland Healthcare Systems: A Comparative Analysis with Recent Updates and Personal Experiences

    Healthcare systems mirror a nation's values, priorities, and societal challenges. The healthcare systems of the United Kingdom (UK) and Switzerland are frequently praised for their exceptional quality of care; however, they employ distinctive approaches to healthcare provision. Recent updates and personal experiences illuminate the evolving complexities and challenges confronted by these two systems. This article aims to offer a brief comparative analysis of the healthcare systems in the UK and Switzerland, accentuating their funding mechanisms, quality of care, contemporary challenges, and potential avenues for mutual learning.

    Funding and Access
    United Kingdom: The UK's healthcare system is predominantly financed through taxation and is renowned for providing free healthcare at the point of use. The National Health Service (NHS) is the cornerstone of healthcare provision in the UK, guaranteeing universal access to all residents.(1)
    Switzerland: Switzerland employs a decentralised, market-driven approach governed by the Confederation LAMal constitution. Each Canton is responsible for managing its health system, with budgets allocated to health insurance providers who determine costs based on insurance types: basic, private, or semi-private.(2)

    A Swiss resident of Canton de Vaud , illustrates to me the financial strain that the Swiss healthcare system can place on families. He reveals that his family's annual basic insurance costs a...

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  • Research Medal Winners for 2022: Silver Medals

    Jospehine McCullagh - Transfusion Science
    Paper: Making every drop count: reducing wastage of a novel blood component for transfusion of trauma patients
    Publication: BMJ 30 June 2021
    Well done Jo!

  • Letter to the Editor

    Dear Editor,

    I really enjoyed reading your article. This topic that you chose to do your research on is very important in the health care field especially when dealing with hospitalized patients. It is so important for patients to feel safe and respected especially when it involves making a decision that can potentially be life or death. A nurse role is to be an advocate for the patient, therefore improving the comfort of our patients is what we should be about. I loved the research experiment and I would really like to see this experiment carried out across healthcare facilities.

  • Turnover times on the same day are not statistically independent

    Riveros Perez et al. analysed 636 turnover times from a surgical suite with 16 theatres before and after intervention, a dedicated nurse anaesthetist for each of four theatres [1]. Their “overall” statistical analysis, reported in their abstract, seems to treat all turnovers as statistically independent events (i.e., treated the sample size as 16 x # analysed days). That probably was incorrect because the 636 turnover times likely were correlated among theatres on the same day [2]. The authors’ Wilcoxon-Mann-Whitney overall P-value (0.0121) likely is an underestimate of the correct result [2].

    To understand, consider that the authors’ intervention was one extra nurse anaesthetist for four theatres. If there were more than one turnover among the four theatres simultaneously, the nurse anaesthetist’s efforts would be diluted. That is precisely what happens routinely (e.g., for housekeeping staff [3,4]). Earlier, we showed validity and reliability of choosing the optimal number of shared personnel (e.g., nurse anaesthetist) by analysing those simultaneous turnovers [3].

    The authors state in their paper that the turnover times were skewed. Analysis methods tested by Monte-Carlo simulation for accurate P-values and confidence intervals are to take the mean of the turnovers among the 16 theatres, for each day, although the median could be used [2]. There then is one number per day as a summary measure. By central limit theorem (and in practice [2,5]), those means g...

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  • Improving access to PrEP using a pharmacist-centric model

    The Virginia Mason Medical Center’s Department of Primary Care partnered with their Proudly VM LGBTQIA+ interest group to increase the number of patients receiving new PrEP prescriptions in Seattle. VM’s initiative targeted PCPs instead of pharmacist as the main touch point for PrEP prescribing citing scope of practice concerns (Lumsden et al., 2022). The Lumsden article demonstrated that the program helped to increase new PrEP prescriptions but there were limitations. Research indicates that Pharmacist may be better positioned than PCPs to not only increase new PrEP prescriptions, but also increase PrEP adherence.

    Nationally, the scope of care for pharmacist has been expanded through collaborative practice agreements (CPA). CPAs allow pharmacist to fulfil additional responsibilities under the supervision of a physician. Washington is 1 of 48 states that have legalized CPAs, which despite Lumsden’s findings would allow VM to empower pharmacist to be more involved in the recruitment and retention of PrEP patients (Lopez et al., 2020).

    Over 90% of Americans live within 5 miles of a pharmacy; making pharmacies one of the most accessible healthcare entry points (Tung et al., 2018). Moreover, populations that have high risk for HIV, such as POC LGBTQ+ individuals and intravenous drug users, tend to live in disadvantaged neighborhoods that have fewer physicians (Crawford et al., 2020). This population is likely to rely on resources that are easy to access within...

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  • SSCL adherence

    The authors have provided an admirable example of how the SSCL utilization can be improved via a dedicated and sustained effort. In some ways I wish they had been able to provide a pathway that didn't involve so many steps, as I think their observation that 'administrative' vs 'real' view of success of SSCL process is probably greatly wrong - it was in our hospital too.
    In our hospital the OR record is where the SSCL process is recorded and quite often the "briefing", "time-out" and "debriefing" components were "ticked" at a random time, often before they might actually have taken place. A four page form with a couple of hundred entries does not lend itself to accuracy!
    I was disappointed in their reported revision of the actual checklist. I thought it was still overlong, and I didn't feel it adequately reflected the most important point about the SSCL process, which is to develop a team from what is an often changing group of individuals, and thusly to engage all of the OR staff in the process.
    They state "the number of items on the form decreased from 21 to 19". I count 26 separate questions requiring responses. Gawande in The Checklist Manifesto" suggests that 5 or 7 is the optimal number of questions - less being better. This form has more and I do question whether they are all "necessary" in contributing to teamwork and safety.
    As a couple of...

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  • The continued use of Virtual Clinics post COVID-19: Patient feedback Study

    We read the report by Gilbert et al on the rapid implementation of virtual clinics in reponse to COVID-19, with particular interest into the high satisfaction scores given by patients and clinicians into the use of virtual clinics.

    We conducted a retrospective patient feedback survey at Brighton at Sussex University Hospital looking at patient feedback on the use of Virtual Clinics as an alternative to face to face clinic appointments in General Surgery during the COVID-19 pandemic. We found that virtual clinics are well accepted by patients and should continue to be utilised post COVID-19 forming part of integrated care pathways in outpatient care.

    The use of Virtual clinics are novel to the department and were implemented as a consequence of the social distancing measures introduced to stop the spread of coronavirus during the COVID-19 pandemic. We identified the need to seek feedback from the patients attending these clinics, recognising that patient opinion is invaluable to the development and sustainability of services.

    Over 100 patients were contacted asking them to fill out an online survey, patients who did not have an email address were asked if they wanted to complete a shorted survey over the telephone; 73 patients responded across both surveys.

    Data collected suggests that virtual clinics are well received by patients. 77.8% (n=42) reported that they had no problems accessing the virtual clinic. 87.7% (n=64) of patients reported...

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  • FMTVDM Quantification.

    We appreciate the recognition by the authors of FMTVDM quantification. We would note that it not only is applicable for SPECT imaging but also PET, planar and any nuclear imaging modality. Congratulations on your work and publication.

  • Managing a community eating disorder service with virtual clinics during Covid 19

    We read with interest the RNOH report regarding rapid implementation of virtual clinics due to Covid-19 (Gilbert et al, BMJ Open, 21 May 2020). The Royal Free Child and Adolescent Eating Disorder Service (RF-EDS) has similarly been required to adapt the service rapidly during the Covid-19 crisis, such that 95% of our patients have been treated by telephone or videoconferencing.

    The clinical needs of our patients to receive evidence-based treatment, needed to be balanced with the risks of Covid infection. Eating disorders have the highest mortality of all psychiatric disorders and early treatment has been shown to improve outcomes. Treatment is usually outpatient care with a minority requiring short hospital admissions for medical stabilisation. The RF-EDS has a day service, which has managed higher risk patients in the community as paediatric wards in North Central London have closed/relocated during the pandemic.

    Since the pandemic, all routine treatment to current patients has been via video or telephone, with high-risk patients continuing face-to-face care (socially distanced or with PPE). This can be stepped-up to prevent hospital admission. Meal support, a weekly parent support group and drop-in clinic have been set up to run via videoconference.

    From 23/03/20 to 01/05/20, the number of new referrals to the service was similar to the same period in 2019 (19). The number of outpatient contacts was 731 and 96% of these were treated in virtual cli...

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