Quality and safety of inpatient medical care Not Applicable
Conditions
Interventions
A prompt-led team briefing (HEADS-UP) to help multidisciplinary medical ward teams discuss clinical and administrative challenges, including adverse events, of the preceding 24 hours. Regular feedback
Sponsors
NIHR Imperial Patient Safety Translational Research Centre
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Health professionals on participating medical wards available to take part in the HEADS-UP briefings 2. All patients admitted to those wards during the study period, unless they meet one of the exclusion criteria
Exclusion criteria
Exclusion criteria: Patient exclusion criteria: 1. Time spent on the specified ward comprising less than 50% of the total inpatient stay 2. Discharge to a new skilled care facility or other hospital (i.e., not the patient’s address at the time of admission; discharge to a new facility typically incurs substantial delays, outside of the ward team’s control) 3. Multiple intra-hospital ward transfers. A single transfer from the initial admissions unit to a downstream medical ward is permitted. One further transfer to an escalation area to facilitate discharge (whereby the patient spends less than 24 hours in the escalation area immediately prior to their discharge home) is also permitted 4. Admission to the high dependency unit or ICU 5. Elective admission or direct admission from another hospital 6. Surgeon-directed care for more than 24 hours during the inpatient stay
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Excess length of stay (a surplus stay of 24 hours or more, compared to peer institutions' Healthcare Resource Groups-predicted length of stay), measured in each cluster each month (according to the stepped wedge design) over the course of the 14-month study period | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Excess length of stay or readmission within 30 days, measured in each cluster each month 2. In-hospital death or death/readmission within 30 days, measured in each cluster each month 3. Complications of care (hospital-acquired infections and pressure ulcers), measured in each cluster each month 4. Processes of escalation of care (use of the ICU outreach service, unplanned ICU admissions, and cardiac arrest calls), measured in each cluster each month 5. Staff engagement with incident reporting, measured in each cluster each month 6. Patient safety and teamwork subsections of the Safety Attitudes Questionnaire, at baseline and then 6 months later | — |
Countries
United Kingdom
Outcome results
None listed