Who sets the business agenda?

Business planning is now a key activity in health care organizations and is affecting the way in which both managers and professionals carry out their work. This paper starts by examining some of the recent changes affecting business planning in a number of health care sectors. It then suggests that the business agenda can be based on four possible models—financial, marketing, needs or power. The evidence is examined, looking at input, output and process information, and some conclusions reached on what, in reality, influences the business agenda, as well as what doesn't, but perhaps should. The overwhelming importance of financial and power features of agenda setting are recognized and the paper concludes by suggesting how the contents of the agenda may be shifted by allowing the voices of a wider group of participants to be heard. Perhaps a new model will be developed based initially on information sharing but moving to real communication between the different perspectives now in existence.     

Characteristics and outcomes of patients requiring unplanned transfer from subacute to acute care

The study aims to identify the reasons for, and outcomes from, unplanned transfers from subacute care to acute care. A retrospective patient record review of patients requiring unplanned transfer from subacute to an acute care emergency department (ED) from 1 July 2008 to 30 June 2009 was undertaken. Data collected included patient demographics, clinical characteristics in preceding transfer, and on ED arrival and outcome data. There were 136 patients included in the study with a median age of 81 years. The most common reasons for transfer were respiratory problems and altered conscious state. In the 24 h preceding transfer, 92.6% of patients had ≥ 1 physiological abnormality and 10.3% of patients had no physiological parameters documented. On ED arrival, 75% of patients had physiological abnormalities. Hospital admission occurred in 75% of patients and the inpatient mortality rate was 14.7%. Factors associated with inpatient mortality were tachypnoea and severe hypoxaemia in 24 h preceding transfer and tachypnoea, hypoxaemia, hypoxaemia, severe hypoxaemia and hypothermia on ED arrival. Patients requiring unplanned transfer had higher inpatient mortality than older hospital users. Reasons for unplanned transfer reflect known predictors of in‐hospital adverse events so predictive use of physiological data and patient characteristics might optimize patient safety.     

A scoping study: children,policy and cultural shifts in homelessness services in South Australia: are children still falling through the gaps?

Homeless families are the fastest growing segment of the homelessness population. Homelessness services are often the first to know when children are at risk of disengagement with health, welfare and education services. Changes to Australian policy to explicitly attend to the needs of children are attempts to address the complexity of, and provide better outcomes for, homeless children. There are mounting levels of evidence describing some of the needs of children who are homeless. Using the scoping study methodological framework, this review of academic and grey literature identified the extent to which service providers provide for the needs of homeless children. The literature search was conducted from September 2012 to April 2013 using ProQuest, Science Direct, Sage and OVID databases. Therefore, the objectives of this scoping study were to: (i) identify the specific needs of children in homelessness; (ii) describe recent changes in policy relating to care for children in homelessness services; (iii) explore the evidence on how service providers can enact care for children in homelessness services; (iv) identify the types of practice changes that are needed to optimise outcomes for children; and (v) identify the gaps in service delivery. This article describes the Australian policy changes and explores the potential impact of subsequent sector reforms on the internal practices in front‐line homelessness services, in order to overcome structural and systemic barriers, and promote opportunities for children in homeless families. This scoping study literature review contributes to the understanding of the impact of policy change on front‐line staff and suggests possible practice changes and future research options.     

Diabetic eye disease among adults in Fiji with self‐reported diabetes

Background: To characterize diabetic eye disease and its management among adults aged ≥40 years with self‐reported diabetes in Fiji. Methods: During a population‐based cross‐sectional survey using multistage cluster random sampling, participants reported health information, including whether a doctor had diagnosed diabetes. HbA1c and visual acuity were measured. Diabetic eye disease was assessed using 90‐dioptre lens dilated funduscopy. Results: Of those enumerated, 1381 (73.0%) participated, with 222 reporting diabetes. Twenty fundi were not examined (19 due to cataract). Of the remaining 424 eyes, 75.5% had no diabetic disease, 1.2% had proliferative retinopathy, 7.5% had active significant maculopathy and 0.7% had burnt‐out/treated disease. By person, 27.2% had retinopathy and/or maculopathy in at least one eye. Mean HbA1c (9.9 ± 2.3%) for this group was significantly higher (P = 0.004) than for those without eye disease. Vision‐threat occurred in at least one eye of 11.5%. Diabetes (predominantly maculopathy) caused pinhole acuity <6/18, <6/60 and <3/60 for 3.8%, 1.1% and 0.7% of eyes, respectively. No person was bilaterally blind (<6/60) due to diabetes, but 2.3% (all on oral antiglycaemics alone) were 6/60 bilaterally. Compared with recent diabetes diagnosis, diagnosis >10 years ago was predictive of any (odds ratio [OR] 8.13; 95% confidence interval [CI] 3.28–20.21; P < 0.001) and vision‐threatening (OR 5.25; 95% CI 1.71–16.12; P = 0.004) eye disease. Although 80.6% claimed regular general diabetes checkups, only 36.5% recalled previous dilated ocular examination. Four eyes had received laser treatment. Conclusion: There was evidence of failure of management of diabetes and its eye complications. Both need to be improved if increasing diabetes‐related visual disability is to be avoided.     

The Carmarthen audit project

Experience within East Dyfed Mental Health Services of using externally designed audit tools has indicated a lack of ownership of the audit process by clinical staff. A project has been developed to initiate standard setting and measurement at clinical level, with an assumption that the development of an audit culture through an audit process is synonymous with ownership. An external appraisal system is being developed which can validate internal standard setting and measurement.