Welcome to the MAP Community

MAP is a community to help frontline NHS library staff to demonstrate the impact of their services.  MAP keeps you informed about current NHS drivers, hot topics and policies and offers a forum to share good (and bad) ideas. Engaging in the MAP community supports you to be informed, inspired and innovative!

On MAP you will find the following resources which can be repurposed for dissemination in your own organisation or just used to expand your own personal knowledge!

  • Drivers for Change: Summaries of newly emerging health publications highlighting the implications for libraries
  • Hot Topics: Summaries of newly emerging health policy or topics
  • Templates to enable you to create an Ideas Capture or a MAP Stories case study
  • Evidence Summaries: What is the evidence in key health areas

Meet the MAP community

Advertisements

Hot Topic: Patient Flow

A Word version of this briefing aimed at health care professionals is available for LKS staff to share in their own organisations. Please feel free to reproduce it (with acknowledgement) for your own purposes.

Impact on library policy/practice:

  • Skilled librarians can locate the evidence for different approaches to patient flow. The evidence may not always be accessible through bibliographic databases, but librarians have the skill to locate other sources of evidence such as case studies or reports
  • Library staff can support the publication and sharing of patient flow initiatives, either as published documents or as poster presentations
  • Library services can provide point of care information tools that can speed up the diagnosis and treatment of patients, and that can support junior medical staff to make decisions when there are fewer senior staff available

What does ‘patient flow’ mean?

Patient flow is about the avoidance of delays in transfers of care, from for instance hospital to home or from A&E to a ward. It can also encompass admission avoidance, but this will be looked at in a separate Hot Topic.

One definition is ‘the right care, in the right place, at the right time’.

Why has patient flow become a hot topic?

The majority of delayed transfers are still due to NHS delays (such as awaiting further non-acute NHS care) but the proportion due to social care (such as awaiting a care package in own home) has risen steeply since 2014. In October 2017 there were 170,100 total delayed bed days (3)

An audit by NHS Benchmarking showed that while only 5 per cent of people aged over 65 who are admitted to hospital stay for more than 21 days, that 5 per cent accounts for more than 40 per cent of all bed days (1). Longer stays in hospital are associated with increased risk of infection, low mood and reduced motivation, which can affect a patient’s health after they’ve been discharged and increase their chances of readmission to hospital (3).

When bed occupancy is higher than recommended, it can lead to difficulties finding beds for new admissions, with knock-on effects in other departments such as A&E. (4)

There is also an argument that due to the way the figures for delayed transfers are defined, there are many more cases of patients that could be cared for in other settings, such as forms of intermediate care. (4)

What are the consequences of poor patient flow?

Some of the consequences (2) are:

  • A&E departments become crowded, stressful and unsafe
  • Patients are admitted as ‘outliers’ to wards that are not best suited to manage their care, which may mean they have worse clinical outcomes
  • Ambulatory care services, clinical decision units, even catheter labs and endoscopy units may fill with patients waiting for ward admission
  • Inpatients are shuffled between wards to make room for newcomers
  • Clinical outcomes are measurably worse, particularly for frail older people, who suffer more harm events and may lose muscle tone due to extended periods in hospital beds

What is being done to improve patient flow?

Three approaches for improving flow are: shape or reduce demand, match capacity and demand, and redesign the system.

There are lots of potential ways to improve patients flow that follow one of more of three aproaches, with one of the ideas being tried that of Accountable Care Organisations which bring health and social care providers together to take responsibility for the care for a defined population.

Other suggestions for improving flow in hospitals include (2),(6):

  • Deploying ambulance managers (sometimes termed ‘HALOs’) to help manage the hospital–ambulance interface and release ambulances quicker
  • Co-location of primary care facilities in A&E department to stream patients
  • Using Clinical Decision Units outside of A&E for patients who can be discharged following a short period of observation, investigation or treatment
  • Assessing patients for frailty when they present at A&E so they can begin to receive specialist care and get the right level of support when they are ready to be discharged.
  • Using the SAFER patient flow bundle and ‘Red2Green days’ tools
  • Using lean or Six Sigma approaches to quality improvement 

Further reading and references

  1. NHS Benchmarking, 2017, Older People’s Care in Acute Settings: National Report
  2. NHS Improvement, 2017, Good practice guide: Focus on improving patient flow
  3. King’s Fund, 2018, Delayed transfers of care: a quick guide
  4. Nuffield Trust, 2017, What’s behind delayed transfers of care?
  5. BMJ Quality and Safety, Six ways not to improve patient flow: a qualitative study
  6. The Health Foundation, 2013, Unblocking a Hospital in Gridlock South Warwickshire NHS Foundation Trust’s experience of the Flow Cost Quality improvement programme

Primary audience: LKS staff and their wider organisations

Date last updated: May 2018

Due for review: May 2019

Group member responsible: JC

Evidence Bites: Technology on ward rounds

An evidence summary inspired by safety discussions held at the Wirral University Teaching Hospital NHS Foundation Trust’s Safety Summit

Why are ward rounds a patient safety concern? Ward rounds are complex clinical activities, critical to providing high quality, safe care for patients in a timely, relevant manner. They provide an opportunity for the multidisciplinary team to come together to review a patient’s condition and develop a co-ordinated plan of care, while facilitating full engagement of the patient and/or carers in making shared decisions about care.

Date of publication: May 2018

Spending on and Availability of Health Care Resources: Policy Briefing

A policy briefing is available for LKS staff to share in their organisations.  Produced by the JET Library at Mid Cheshire Hospitals NHS Foundation Trust.  Feel free to reproduce it (with acknowledgement).

What does this mean for libraries?

With health care spending at lower levels than other countries, it is imperative that the best use is made of resources, and library and knowledge services should have a key role in ensuring health care practice and commissioning is evidence-based and effective.

Unfortunately, the potential understaffing identified in this report may make it more difficult for health care staff to always make effective use of the evidence base. Library and knowledge staff can support this by providing value-added and time-saving services such as evidence searches, current awareness alerts, point of care tools and more.

Source: King’s Fund

Link to main document

Date of publication: May 2018

Summary of driver:

  • The King’s Fund compared health spending in the UK to other OECD countries (excluding the U.S.)
  • The UK has 2.8 doctors per 1,000 population – below the OECD average of 3.6
  • The UK has 7.9 nurses per 1,000 population – also fewer than average. Germany has 13.3 and Switzerland 18
  • The UK has 2.6 beds per 1,000 population compared to an average of 4.4. This is similar to Canada and New Zealand but far below Germany and Austria
  • The UK has fewer residential beds for long-term care than average. We are just ahead of Spain and just behind Canada. The Netherlands and Switzerland have the most
  • We have the fewest CT scanners per 1,000,000 population. Australia and Denmark are top
  • We also have the fewest MRI scanners per 1,000,000 population
  • Spending on drugs – outside drugs in hospital – makes up about a sixth of spending
  • We spend £500 per person per year – below the average amount but this might be due to more efficient purchasing
  • Some companies finance their health service via taxation – the Beveridge model. These include the UK, Australia, Canada and New Zealand
  • Others have compulsory health insurance, the Bismarck model e.g. Germany and France
  • Since 2008 most countries have tried to contain health expenditure to some extent
  • Social care spending is now included in our health spending meaning the spending as a percentage of GDP has gone up from 8.7% to 9.8%
  • This is about average. Germany, France and Sweden spend about 11%
  • There are around 100,000 vacancies for clinical staff in the English NHS
  • Nearly half of nurses do not think there are enough staff to let them do their job properly
  • The UK is one of the best systems in the world at using cheaper, generic medicines
  • Thanks to more efficient use the number of hospital beds has halved in the last 30 years
  • BUT more than 90% of hospital beds are now occupied, higher than the recommended 85% level
  • Budgets for adult social care fell by 8% in real terms between 2009/10 and 2015/16

The Government’s Serious Violence Strategy: Policy Briefing

policy briefing is available for LKS staff to share in their organisations.  Produced by the JET Library at Mid Cheshire Hospitals NHS Foundation Trust.  Feel free to reproduce it (with acknowledgement).

What does this mean for libraries? 

Whilst this driver will be implemented at a national level, there are some things libraries can do to support it

  • The opportunity to deliver evidence and knowledge to teams experiencing issues with the impact of serious violence
  • Opportunity to link in with other sectors to raise awareness of the strategy

Source: HM Government

Link to main document 

Date of publication: April 2018

Summary of driver:  This document illustrates the Government’s approach to address the rise in serious violent crime in the UK. It outlines proposals with education, health, social services, housing, youth services and victim support in order to achieve this. The overarching message in this strategy is that tackling serious violence is not a law enforcement issue alone and it requires cross sector working involving a range of partners. In particular, it needs the support of communities thinking about what they can themselves do to help prevent violent crime happening in the first place and how they can support measures to get young people and young adults involved in positive activities.

Evidence Bites: Patient Discharge

An evidence summary inspired by safety discussions held at the Wirral University Teaching Hospital NHS Foundation Trust’s Safety Summit

Why is patient discharge a safety issue? A 2016 report published by the Parliamentary and Health Service Ombudsmen found that some NHS patients were being discharged unsafely from hospital. Case studies highlighted that patients were being discharged before they were well enough to go home, without a home care plan and without informing their family and carers. NICE’s social care guidance, ‘Transition between inpatient hospital settings and community or care home settings for adults with social care needs’ aimed to address these concerns and gaps in care.

Date of publication: Mar 2018

Evidence Bites: Staffing Pressure

An evidence summary inspired by safety discussions held at the Wirral University Teaching Hospital NHS Foundation Trust’s Safety Summit

Why is staffing pressure a patient safety concern? Ensuring NHS providers are staffed with the appropriate number and mix of clinical professionals is vital to the delivery of quality care and in keeping patients safe from avoidable harm. Pressure on staffing may have implications for patient safety incidents relating to human factors and interruptions / distractions in the clinical environment.

New publication: The risks to care quality and staff wellbeing of an NHS system under pressure
A report commissioned by The King’s Fund in Jan 2018 summarises the research evidence on the direct and indirect impact of staff health, wellbeing and engagement on patient care.

Date of publication: Feb 2018

Evidence Bites: Decisions Regarding CPR

An evidence summary inspired by safety discussions held at the Wirral University Teaching Hospital NHS Foundation Trust’s Safety Summit

Why is decision-making regarding Cardiopulmonary Resuscitation (CPR) a patient safety concern? Failures in Do Not Attempt CPR (DNACPR) policy, and gaps between policy and practice, are likely to lead to adverse consequences for patients and their families.
What guidance is available on decisions relating to CPR? The British Medical Association (BMA), the Resuscitation Council (UK), and the Royal College of Nursing (RCN) have issued guidance regarding anticipatory decisions about whether or not to attempt resuscitation in a person when their heart stops or they stop breathing.

Date of publication: Jan 2018