National survey of the injury prevention activities of children's centres

Children's centres were established across England to provide a range of services including early education, social care and health to pre‐school children and their families. We surveyed children's centres to ascertain the activities they were undertaking to prevent unintentional injuries in the under fives. A postal questionnaire was sent to a sample of children's centre managers (n = 694). It included questions on current activities, knowledge and attitudes to injury prevention, health priorities and partnership working. Responses were received from 384 (56%) children's centres. Overall, 58% considered unintentional injury prevention to be one of the three main child health priorities for their centre. Over half the respondents (59%) did not know if there was an injury prevention group in their area, and 21% did not know if there was a home safety equipment scheme. Knowledge of how child injury deaths occur in the home was poor. Only 11% knew the major cause of injury deaths in children under five. Lack of both staff time and funding were seen as important barriers by children's centre staff to undertake injury prevention activities. Nearly all stated that training (97%) and assistance with planning injury prevention (94%) would be helpful to their centres. Children's centres need further support if they are to effectively tackle this important public health area.     

Patients’ experiences and views of an emergency and urgent care system

Background Surveys of patients’ experiences and views of health care usually focus on single services. During an unexpected episode of ill health, patients may make contact with different services and therefore experience care within an emergency and urgent care system. We developed the Urgent Care System Questionnaire and used it to describe patients’ experiences and views of an emergency and urgent care system in England. Methods A market research company used quota sampling and random digit dialling to undertake a telephone survey of 1000 members of the general population in July 2007. Results 15% (151/1000) of the population reported using the emergency and urgent care system in the previous 3 months. Two thirds of users (68%, 98/145) contacted more than one service for their most recent event, with a mean of 2.0 services per event. Users entered the system through a range of services: the majority contacted a daytime GP in the first instance (59%, 85/145), and 12% (18/145) contacted either a 999 emergency ambulance or an emergency department. Satisfaction with all aspects of care diminished when four or more services had been contacted. Conclusions This is the first study to describe patients’ experiences and views of the emergency and urgent care system. The majority of patients experienced a system of care rather than single service care. There was an indication that longer pathways resulted in lower levels of patient satisfaction. Health care organisations can undertake similar surveys to identify problems with their system or to assess the impact of changes made to their system.     

The risk factors for hospital re‐admission in medical patients in Singapore

Unplanned hospital re‐admissions are common, expensive and often unpreventable in the community. The study aimed to identify risk factors associated with unplanned hospital re‐admission in Singapore. In a cross‐sectional survey, 1509 patients admitted to the medical wards of a large acute hospital in Singapore during 2010 were recruited (78.8% response rate), data being collected using a structured questionnaire based on the Andersen behavioural model underlying healthcare use. The dependent variable was re‐admission within 28 days, with independent variables in the four areas of predisposing characteristics, needs, enabling resources and health behaviour. Hierarchical logistic regression was used to evaluate the risk factors associated with unplanned hospital re‐admission. There were 222 inpatients re‐admitted (14.7%) within 28 days and the final model showed that patients who were unemployed (OR = 1.5; 95% CI = 1.1–2.1) and had chronic obstructive pulmonary disease (OR = 2.0; 95% CI = 1.1–3.7) with abnormal respiratory patterns (OR = 1.6; 95% CI = 1.1–2.2) were more likely to be re‐admitted. Less likely to be re‐admitted were patients doing regular daily activities (OR = 0.7; 95% CI = 0.5–0.9), those assisted by a social worker (OR = 0.3; 95% CI = 0.2–0.6), those referred to other health professionals when sick (OR = 0.6; 95% CI = 0.4–0.7) and those who had received health education programmes before discharge in the previous admission (OR = 0.7; 95% CI = 0.4–0.9). Unplanned re‐admissions are a concern to healthcare providers because this suggests that patients are discharged with unresolved problems that reflect ineffective care in hospital. This study provides evidence to prompt more effective discharge educational care programmes that incorporate patients' enabling and need outcomes, thereby reducing re‐admission rates. Community‐based healthcare should play an important role in reducing patients' re‐admission rates.