Booking patients for hospital admissions: evaluation of a pilot programme for day cases

Problem NHS patients requiring elective surgery usually have to wait before being treated and are usually told when a date becomes available.Design 18 month pilot programme to enable day case patients to book date of hospital admission at time of decision to operate.Background and setting 24 pilot sites in England with relatively short waiting times and some experience of booking appointments.Key measures for improvement Proportion of patients with booked or “to come in” date during and after pilot programme, proportion not attending for admission, and proportion waiting ≥ 6 months. Comparison of pilot sites with non-pilot sites.Strategies for change National Patients'' Access Team established to help pilot sites enable patients to book admission dates. Provision of £9.9m to pilot sites to employ project managers, purchase equipment, buy extra time from clinical and other staff, and invest in information and communications technology.Effects of change Proportion of patients with booked or “to come in” date increased from 51.1% to 72.7% between end of March 1999 and end of March 2000, and then fell to 66.2% by end of March 2001. Over the same periods, the proportion of patients waiting ≥ 6 months fell from 10.9% to 10.5% and then increased to 11.9%. The proportion of patients failing to attend fell from 5.7% to 3.1% between the first quarter of 1999 and the first quarter of 2000, and then increased to 4.0% in the first quarter of 2001. Pilot sites varied widely in performance during and after the pilot phase. Pilot sites had higher proportions of patients with booked or “to come in” date than non-pilot sites at end of each period.Lessons learnt Increasing the proportion of patients who book their date of hospital admission is possible, but there are difficulties in sustaining this. Several factors facilitated or hindered the implementation of booking, and the roll out of the programme across the NHS is seeking to incorporate these factors.     

Development of oral home telecare programme for the home-dwelling elderly: a pilot study

Objectives: The aim of the pilot study was to develop and evaluate a telecare programme for home‐dwelling elderly to provide education on oral and general health care. Design: A field trial with a computer system linking a university with a structured network. Subjects: A group of home‐dwelling elderly males with a mean age of 73.3 years. Methods: Qualitative assessment following videophone interviews with clients and their families. Results: Clients and families were able to gain a better understanding and knowledge of oral health care particularly the skills required to perform new oral care procedures. Conclusions: Preventive oral homecare via videophone offers the potential for providing a long‐term structure for maintaining oral health particularly with limited social resources.     

Maternal serum alpha-fetoprotein screening: report of a Canadian pilot project.

A pilot project of maternal serum alpha-fetoprotein (MSAFP) screening was carried out in Ontario from 1982 to 1985 to examine the feasibility and acceptability of screening a prenatal population for open fetal neural tube defects. A total of 8140 patients at low genetic risk were screened. Patient acceptance was excellent. Blood samples were taken at 16 to 18 weeks'' gestation. If the MSAFP level was elevated, the assay was repeated and an ultrasound examination performed. Amniocentesis was offered to 67 women with unexplained persistently elevated levels. The outcome of pregnancy was known in 7473 patients (91.8%). Seven of nine known open fetal neural tube defects were detected. All were confirmed, and no unaffected fetuses were aborted on the basis of the screening results. The rates of perinatal death (6.7%), intrauterine growth retardation (11.7%) and prematurity (23.3%) were significantly higher among the patients with unexplained elevated MSAFP levels than among those with normal levels (p less than 0.001). Of 20 patients with unexplained low levels, 10 subsequently had spontaneous abortions and 10 gave birth to term appropriate-for-gestational-age infants. Seven of nine patients who gave birth to infants with autosomal trisomy had MSAFP values below the median. The findings indicate that MSAFP screening is feasible, accurate and acceptable in a low-risk area.     

Adults with a history of child sexual abuse: evaluation of a pilot therapy service.

OBJECTIVE--To evaluate a pilot service offering therapy specifically to adults with a history of child sexual abuse. DESIGN--Questionnaire survey. SETTING--Specialised therapy unit, Breakfree, which offers care, therapy, and support. SUBJECTS--116 clients presenting to the service who were offered therapy. MAIN OUTCOME MEASURES--Scores from three psychological questionnaires--the social activities and distress scale, the general health questionnaire, and the delusions, symptoms, and states inventory--and from questionnaires about the clients'' abuse, previous use of health services, and opinion of the Breakfree service. RESULTS--Clients had received previous help from health services and other agencies without apparent effect; they were highly distressed according to their psychological scores; and they were very frequent users of the health services. The clients showed significant improvement in their psychological scores (Wilcoxon''s matched pairs signed ranks test): social activities and distress scale, z = -3.3, P = 0.001; general health questionnaire, z = -5.8, P < 0.00001; delusions, symptoms, and states inventory, z = -4.8, P < 0.00001). This was most pronounced for those who had completed therapy by the end of the study. Whereas 82/88 clients had a score for the general health questionnaire that indicated clinical distress at the start, only 28/58 did so at the end of the study (only 17/35 among those who had finished therapy). CONCLUSIONS--This group of adults with a history of child sexual abuse were highly disturbed and previous high users of the health service. The specialist service Breakfree was effective in the short term and, if the benefits are sustained, would yield a net cost saving to the health service.     

Health and social status of elderly Asians: a community survey.

A sample based on general practices was the starting point for a community survey of Asians aged 65 years and over to describe: family structure and social contact; aspects of lifestyle; language and communication; capacity for self care; and knowledge about and use of services. A total of 726 (95% of those approached) old people were interviewed in their own languages. Almost all had been born in India, mainly in Gujarat or the Punjab, but most had come to Britain via east Africa. Over half of the over 75s were not fully independent in basic activities of daily living, and a fifth were occasionally or often incontinent of urine, though these levels of incapacity were little different from those found in the indigenous elderly. Few elderly Asians were aware of social services, such as meals on wheels, home helps, social workers, and particularly chiropody. Language also excluded them: 37% of men and only 2% of women could speak English. Moreover, two thirds of elderly Asian women were illiterate in all languages. Health education initiatives directed at these people must understand these cultural and language barriers and perhaps use alternative methods, such as Asian radio programmes and home videos, in providing information on health and welfare services.     

World Health Organization's programme for vaccine development

Summary The very impressive scientific developments in the biomedical sciences which have occurred in recent years provide the prospect of new, more effective vaccines against those communicable diseases for which at present there are either no vaccines or for which existing vaccines are less than satisfactory. These developments include identification of protective antigens by the use of monoclonal antibody techniques and their production by recombinant DNA technology and peptide synthesis. In addition, there is much new information on the functioning of the immune system which provides a basis for rational vaccine design. In October 1983, WHO held a meeting on New Approaches to Vaccine Development. The meeting was attended by eminent scientists in microbiology, immunology, biochemistry, vaccine production and vaccine control. A major recommendation of the meeting to WHO was for the Organization to establish with urgency a programme for vaccine development. The Organization responded positively to this recommendation, agreeing that the gathering momentum of biotechnological research provided WHO with the opportunity to play a crucial role in encouraging, coordinating and developing priorities on new vaccines so that the great potential of recent progress was harnessed for the maximum benefit of all countries. WHO could take advantage of its unique position of being deeply involved in all problems of communicable diseases in the developing world and having at the same time knowledge of scientific achievements in the most privileged countries. The same general view was expressed by the WHO Advisory Committee on Medical Research at its October 1983 session. Since the development of vaccines in most areas is intimately related to the development of diagnostic tools (including reagents), such activities, when appropriate, are considered as part of the Programme. Mankind is now on the threshold of a new era in the technology of vaccine development and production and it behoves WHO to take the leadership in this endeavour.

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Resumen Los importantes desarrollos científicos que han ocurrido en el campo de las ciencias biomedicas en los últimos años proporcionan prospectos de vacunas nuevas y más efectivas contra aquellas enfermedades contagiosas para las cuales o no las había previamente, o si las había no eran totalmente satisfactorias. Entre estos avances se incluyen la identificatión de antigenos protectores mediante el uso de anticuerpos monoclonales y su producción mediante técnicas de ADN recombinante y de síntesis de peptídos. Existe además nueva información sobre el funcionamiento del sistema inmune, lo que proporciona la base para un diseño racional de vacunas. En octubre de 1983 la OMS celebró una reunión sobre Nuevas Tendencias en el Desarrollo de Vacunas. En la reunión participaron eminentes científicos especialistas en microbiología, inmunología, bioquímica, producción y control de vacunas. La recomendación más importante de la reunión para la OMS fue la de establecer con urgencia un programa para el desarrollo de vacunas. La Organización respondió positivamente a esta recomendación, estando de acuerdo en que la situación de las investigaciones biotecnológicas proporcionaba a la OMS la oportunidad de jugar un papel crucial en el apoyo, coordinación y desarrollo de prioridades en las investigaciones sobre nuevas vacunas, de forma que el gran potencial de los progresos recientes fuera aplicado hacia la consecución del maximo beneficio para todos los países. La OMS pudo aprovechar su situación privilegiada de estar profundamente implicada en todos los problemas relativos a las enfermedades contagiosas en los países en desarrollo y de tener simultaneamente conocimiento de los logros cientificos de los países más privilegiados. Este mismo punto de vista fue expresado por el Consejo Asesor de la OMS sobre temas de Investigación Médica en su sesión de octubre de 1983. Puesto que el desarrollo de las vacunas en la mayoría de las áreas esta intimamente relacionado con el desarrollo de medios de diagnóstico (incluyendo reactivos), tales actividales, cuando son apropiadas, se consideran como parte del Programa. La humanidad se halla en el umbral de una nueva era en la tecnología del desarrollo y produción de vacunas, y corresponde a la OMS tomar el liderazgo de este esfuerzo.

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Résumé Les très impressionants progrès des sciences médicales au cours de ces dernières années ouvrent la perspective de vaccins nouveaux et plus efficaces contre les maladies contagieuses pour lesquelles il n'existe pas encore de vaccins, ou celles pour lesquelles les vaccins existants ne sont pas satisfaisants. Ces nouveaux développements comprennent l'identification, grâce à l'utilisation des anti-corps mono-clonaux, d'antigènes protecteurs et leur production par les techniques d'ADN-recombinant ou de synthèse peptidique. De plus, en ce qui concerne le fonctionnnement du système immunitaire, on dispose de beaucoup d'informations nouvelles susceptibles de constituer une base rationelle pour l'élaboration de nouveaux vaccins. En octobre 1983, l'OMS a organisé une réunion sur les nouvelles voies d'approche pour le développement des vaccins. Cette réunion a rassemblé d'éminents scientifiques dans les domaines de la microbiologie, de l'immunologie, de la biochimie, de la production des vaccins et du contrôle des vaccinations. Une recommendation majeure adressée à l'OMS a été d'établir d'urgence un programme pour le développement des vaccins. L'Organisation a répondu favorablement. Elle s'est déclarée d'accord pour constater que la convergence rapide des recherches en biotechnologie donne à l'OMS l'occasion de jouer un rôle crucial en encourageant, coordonnant et établissant des priorités en matière de nouveaux vaccins, de façon à ce que l'immense potentiel des progrès récents soit mis au service de tous les pays et pour leur plus grand bénéfice possible. L'OMS peut prendre avantage de sa position unique. Elle est, en effet, profondément engagée dans tous les problèmes relatifs aux maladies contagieuses dans le monde en développement, et, d'autre part, elle est informée des réalisations scientifiques dans les pays les plus privilégiés. La même vue générale a été exprimée par le Comité Consultatif de l'OMS pour la recherche médicale à sa session d'octobre 1983. Comme, dans la plupart des régions, le développement des vaccins est étroitement lié à celui des moyens de diagnostic (y compris les réactifs), ces dernières activités seront, lorsque cela est approprié, considérées comme faisant partie du Programme. L'humanité est aujourd'hui à la veille d'une ère nouvelle en ce qui concerne le développement et la production des vaccins, et il appartient à l'OMS de prendre la tête de cette entreprise.

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Invited paper presented at the VII International Conference on the Global Impacts of Applied Microbiology, Helsinki, 12–16 August 1985. Session 5