Business, Finance and Performance
Expanding the strategic and clinical leadership role of accredited specialistsBackground: We sought to explore the value and benefits of accredited specialists employed in the National Health Service (NHS), and proposed strategies for expanding their role. Aims: To explore the core characteristics of accredited specialists and to examine how their skills could be further utilized to enhance occupational health (OH) services. Methods: Mixed methods comprising a survey and qualitative work. Results: OH survey was completed by 65 of 128 (51%) respondents. Nine accredited specialists and 16 stakeholders contributed qualitative data. Most OH departments were located in acute NHS trusts and additionally provided externally contracted services. We found a large variation in OH staffing and OH services delivered. The COVID pandemic created unprecedented challenges and required expansion in services to meet demand. The majority of respondents described greater recognition and appreciation by others of accredited specialists and OH teams for their specialist contribution during the pandemic. From the qualitative data, we identified two overarching themes. 'Professional credibility has currency' (Theme 1) and 'A visionary future' (Theme 2). A series of sub-themes are described. Conclusions: Accredited specialists employed in the NHS possess a core set of attributes and capabilities, and are skilful at delivering strong, influential and impactful clinical and strategic leadership across the NHS hierarchy and landscape. The COVID pandemic provided valuable opportunities for them to showcase their specialist clinical and leadership skills. The current wider reorientation of NHS clinical services offers bold new ways to expand their role beyond traditional clinical boundaries.
Transitioning EPMA applications in a large multisite teaching hospitalIntroduction: University Hospitals of Leicester (UHL) has co-developed and deployed a novel Electronic Prescribing and Medicines Administration (EPMA) application as part of the trust electronic patient record (EPR) programme that meets specific clinical demands and interoperability standards of the National Health Service (NHS) despite clinical pressures from the COVID-19 pandemic. Methods: Following an initial limited pilot deployment, a big-bang whole site-based approach allowed transition of 1844 acute adult inpatients beds from an existing standalone EMPA to the new system. This project used a frontline driven and agile management strategy. Clinical risk was managed using a combination of standard risk logs, robust clinical prototyping and robust disaster recovery plans. Early engagement with clinical teams allowed for advanced product configuration before live deployment and reduced the need for sustained transition support for clinical staff. Results: An iterative, well-governed approach, led by a combination of information technology (IT) and clinical staff with a responsive vendor, enabled a complex new EPMA system in a large acute NHS trust to be deployed with limited resources despite the ongoing COVID-19 pandemic. Discussion: The development and deployment of EMPA and EPR systems across NHS trusts is a key enabler for better healthcare delivery. This case study shows it is possible to deploy a new clinical IT system at scale without interruption of clinical services and with a relatively modest deployment team. Sustainability of the project was also ensured through a clear clinically led governance structure to manage risk quickly and carry lessons learnt onto new developments.
Predictors of adverse outcome in the first and second waves of the COVID-19 pandemic: results from a UK centreBackground/aims: Data concerning differences in demographics/disease severity between the first and second waves of COVID-19 are limited. We aimed to examine prognosis in patients presenting to hospital with COVID-19 amongst different ethnic groups between the first and second waves in the UK. Methods: In this retrospective cohort study, we included 1763 patients presenting to a regional hospital centre in Leicester (UK) and compared those in the first (n = 956) and second (n = 807) waves. Admission National Early Warning Scores, mechanical ventilation and mortality rate were lower in the second wave compared with the first. Results: Thirty-day mortality risk in second wave patients was approximately half that of first wave patients [adjusted hazard ratio (aHR) 0.55, 95% confidence interval (CI) 0.40-0.75]. In the second wave, Black patients were at higher risk of 30-day mortality than White patients (4.73, 1.56-14.3). Conclusion: We found that disporportionately higher risks of death in patients from ethnic minority groups were not equivalent across consecutive waves of the pandemic. This suggests that risk factors for death in those from ethnic minority groups are malleable and potentially reversible. Our findings need urgent investigation in larger studies.