Browsing by Author "Bloor, Karen"
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Item Support and follow-up needs of patients discharged from intensive care after severe COVID-19: a mixed-methods study of the views of UK general practitioners and intensive care staff during the pandemic's first wave(2021) Castro-Avila, Ana; Jefferson, Laura; Dale, Verónica; Bloor, KarenObjectives: To identify follow-up services planned for patients with COVID-19 discharged from intensive care unit (ICU) and to explore the views of ICU staff and general practitioners (GPs) regarding these patients' future needs and care coordination. Design: This is a sequential mixed-methods study using online surveys and semistructured interviews. Interview data were inductively coded and thematically analysed. Survey data were descriptively analysed. Setting: GP surgeries and acute National Health Service Trusts in the UK. Participants: GPs and clinicians leading care for patients discharged from ICU. Primary and secondary outcomes: Usual follow-up practice after ICU discharge, changes in follow-up during the pandemic, and GP awareness of follow-up and support needs of patients discharged from ICU. Results: We obtained 170 survey responses and conducted 23 interviews. Over 60% of GPs were unaware of the follow-up services generally provided by their local hospitals and whether or not these were functioning during the pandemic. Eighty per cent of ICUs reported some form of follow-up services, with 25% of these suspending provision during the peak of the pandemic and over half modifying their provision (usually to provide the service remotely). Common themes relating to barriers to provision of follow-up were funding complexities, remit and expertise, and communication between ICU and community services. Discharge documentation was described as poor and lacking key information. Both groups mentioned difficulties accessing services in the community and lack of clarity about who was responsible for referrals and follow-up. Conclusions: The pandemic has highlighted long-standing issues of continuity of care and complex funding streams for post-ICU follow-up care. The large cohort of ICU patients admitted due to COVID-19 highlights the need for improved follow-up services and communication between specialists and GPs, not only for patients with COVID-19, but for all those discharged from ICU.Item The effect of external inspections on safety in acute hospitals in the National Health Service in England: A controlled interrupted time-series analysis(2019) Castro-Avila, Ana; Bloor, Karen; Thompson, CarlObjectives: To evaluate the effect of Care Quality Commission (CQC) external inspections of acute trusts on adverse event rates in the English National Health Service (NHS). Methods: Interrupted time series analysis including all acute NHS trusts in England (n=155) using two control groups (new versus historical inspection regime and trusts not inspected). Multilevel random-coefficients modelling of 1) rates of falls with harm and 2) pressure ulcers, from April 2012 to June 2016, was undertaken using the new, resource-intensive regime of CQC inspections as an intervention. Data used in the model included dates and type of inspection, patient safety indicators, demographic characteristics and financial risk of hospitals. Results: In one year, CQC inspected 66 acute trusts (42% of all English trusts) using their new regime and 46 (30%) using their previous one. Prior to inspections being announced, rates of falls with harm and pressure ulcers were improving in both intervention and control hospitals. The announcement of an inspection did not affect either indicator. After inspections, rates of falls with harm improved more slowly and pressure ulcers rates no longer improved for trusts inspected using both regimes. Conclusions: Neither form of external inspection was associated with positive, clinically significant effects on adverse event rates. Any improvement happening before the announced CQC inspections slowed after the inspection.