Lost in hospital: a qualitative interview study that explores the perceptions of NHS inpatients who spent time on clinically inappropriate hospital wards

Background

Prior research suggests that the placement of patients on clinically inappropriate hospital wards may increase the risk of experiencing patient safety issues.

Objective

To explore patients'' perspectives of the quality and safety of the care received during their inpatient stay on a clinically inappropriate hospital ward.

Design

Qualitative study using semi‐structured interviews.

Participants and setting

Nineteen patients who had spent time on at least one clinically inappropriate ward during their hospital stay at a large NHS teaching hospital in England.

Results

Patients would prefer to be treated on the correct specialty ward, but it is generally accepted that this may not be possible. When patients are placed on inappropriate wards, they may lack a sense of belonging. Participants commented on potential failings in communication, medical staff availability, nurses'' knowledge and the resources available, each of which may contribute to unsafe care.

Conclusions

Patients generally acknowledge the need for placement on inappropriate wards due to demand for inpatient beds, but may report dissatisfaction in terms of preference and belonging. Importantly, patients recount issues resulting from this placement that may compromise their safety. Hospital managers should be encouraged to appreciate this insight and potential threat to safe practice and where possible avoid inappropriate ward transfers and admissions. Where such admissions are unavoidable, staff should take action to address the gaps in safety of care that have been identified.     

Information needs and preferences of low and high literacy consumers for decisions about colorectal cancer screening: utilizing a linguistic model

Context  The use of written decision aids (DAs) in clinical practice has proliferated. However, few DAs have been developed for low literacy users, despite this group having low knowledge about healthcare and lacking involvement in health decisions.
Objective  To explore the information needs and understanding of adults with varying literacy in relation to colorectal cancer screening, and to consider their responses to two versions of a decision aid.
Participants  Thirty-three men and women aged 45–74 years were recruited from Adult Basic Education classes ( n  = 17) and University Continuing Education programs ( n  = 16).
Methods  We used qualitative methods (in-depth, semi-structured interviews) to compare and contrast the views of adults with lower and higher literacy levels, to gain a better understanding of how people with lower literacy value and interpret specific DA content and components; and determine whether needs and preferences are specific to lower literacy groups or generic across the broad literacy spectrum.
Results  Regardless of literacy perspective, participants' interpretations of the DA were shaped by their prior knowledge and expectations, as well as their values and preferences. This influenced perceptions of the DAs role in supporting informed decision making. A linguistic theoretical model was applied to interpret the findings. This facilitated considerations beyond the traditional focus on the readability of materials.
Conclusion  Decision aids developers may find it useful to apply alternative approaches (linguistic) when creating DAs for consumers of varying literacy.     

Consulted but not heard: a qualitative study of young people's views of their local health service

Objectives  The objective of this study was to identify what children and young people in a health district in a large urban area experience as positive – and not so positive – about their local health services, in the light of a growing expectation that users play a more central role in the design and delivery of services. Design  A qualitative study incorporating a range of methods, including interviews, play techniques and a website. Setting  Schools, nurseries, community groups, in‐ and outpatient settings in an inner London health authority. Participants  Young people aged between 4 and 19 years, from community (n = 92) and clinical (n = 57) settings. This included ‘hard‐to‐reach’ children, including those leaving care, those in touch with the criminal justice system, asylum seekers, and those with learning disabilities. Results  Alongside planning and environment issues, young people particularly emphasized the impact of communication and relationships with staff on their experience of health services. Discussion and conclusions  Using a range of flexible and age‐appropriate techniques, young people, even those as young as 4 or 5, are able to comment helpfully on their experiences of service provision. What children had to say is revealing but not astonishing to those working in the National Health Service (NHS). Clinicians and managers, to whom our findings were fed back, made this clear. If we have known for so long that the issues raised here are problems, why are we so poor at acting on this knowledge? The authors suggest four explanations.     

Discourses of joint commissioning

Increasing attention has focused on the role of joint commissioning in health and social care policy and practice in England. This paper provides an empirical examination of the three discourses of joint commissioning developed from an interpretative analysis of documents by Dickinson et al. (2013; BMC Health Services Research, 13) and applied to data from our study exploring the role of knowledge in commissioning in England. Based on interviews with 92 participants undertaken between 2011 and 2013, our analysis confirms that the three discourses of prevention or empowerment or efficiency are used by professionals from across health and social care organisations to frame their experiences of joint commissioning. However, contrary to Dickinson et al., we also demonstrate that commissioners and other stakeholders combine and trade off these different discourses in unexpected ways. Moreover, at sites where the service user experience was central to the commissioning process (joint commissioning as empowerment), a greater sense of agreement about commissioning decisions appeared to have been established even when the other discourses were also in play.     

Diagnostic error in a national incident reporting system in the UK

Rationale, aims and objectives Diagnostic errors and delays carry potentially grave consequences for patients and feature prominently in studies of adverse events in health care. Diagnostic errors present a particular challenge for error/incident reporting systems because they involve clinical reasoning and are difficult to define precisely. The aim of the present study was to investigate what insights can be gained about diagnostic error from an incident reporting system. Methods Diagnostic errors reported to the UK's National Reporting and Learning System (NRLS) between November 2003 and October 2005 were investigated. We analysed reported level of harm to the patient and incident location and we compared diagnostic with non‐diagnostic incidents. We also assessed the quality of reporting in a subset of reports associated with a patient's death. Results Of 316 589 incidents reported in the period under investigation, 1674 were diagnostic (0.5%). Diagnostic incidents were more likely than other incidents to be associated with moderate or severe harm, or a patient's death and were more likely to occur in a hospital emergency department than other incidents. Diagnostic incidents in emergency departments were more likely to be associated with greater harm than similar incidents in wards. Observed reporting quality (detail; clarity) was very variable. Conclusion These findings replicate findings from studies in emergency departments and suggest that reporting systems have a role to play in understanding diagnostic errors alongside other sources of error analysis. Accurate and complete reporting of adequate volume enhances the potential contribution of an incident reporting system to understanding diagnostic error.     

Overseas Outbreaks of Infectious Intestinal Disease Identified in Scotland, 2003 to 2007

Background.  This article presents information on all potential outbreaks of infectious intestinal disease (IID) identified by Health Protection Scotland (HPS) involving residents of Scotland. Unlike other systems, this alert system covers potential outbreaks of IID rather than apparently sporadic cases and covers all gastrointestinal pathogens, all visited countries, and all groups of travelers.
Methods.  HPS collects information on all potential outbreaks of IID in residents of Scotland where infection is believed to have been acquired abroad and disseminates this to all public health teams in Scotland so other linked cases can be identified. Where possible HPS also disseminates the details to the national surveillance center in the country where infection is believed to have been acquired, enabling them to facilitate any investigations or control measures they believe necessary. The rate of outbreaks associated with travel to particular countries was determined using the number of visits reported for residents of Scotland from Travel Trends data from the Office of National Statistics.
Results.  Between 2003 and 2007, 319 such potential outbreaks were identified. Spain was the most frequently identified country reflecting the fact that it was also the most frequently visited country; the rate per 100,000 visits to Spain was 1.4, very similar to the overall rate for all countries of 1.3, while the highest rate of 46.7 per 100,000 visitors was associated with travel to Egypt. Salmonella sp was the most frequently identified pathogen within which Salmonella enteritidis was the most frequently identified serotype.
Conclusions.  The system provides a rapid alert mechanism for potential outbreaks of IID outside Scotland, allowing their investigation and control as appropriate and demonstrates the risks of outbreaks associated with different countries and pathogens.