Managing to make a difference

This site brings together stuff from Bandolier relevant to managing health services. It also includes all articles from ImpAct. In addition to this we continue to searche the literarature for reports to abstract to add to this site, and we also add a range of stories that would have been in ImpAct but for the pressure of space. ImpAct was discontinued in May 2001, but PDF versions of every issue are available. The site is supported from Bandolier's own resources, and with help from the NHSE in England and the NeLH. Michael Dunning co-edits ImpAct and has contributed to these pages.

Essays about improving healthcare management and delivery Delivering better health care 1: What goes wrong when implementing evidence-based practice Delivering better health care 2: Seeing the woods for the trees Delivering better health care 3: Learning to implement change in clinical practice PACE programme

Adverse drug events in hospital patients (systematic review) Trust Initiatives to improve quality of care 1999 National Survey of NHS Patients: coronary heart disease Reducing and preventing adverse drug events to decrease hospital costs

Evidence about healthcare management Testing the two-week rule Nurse staffing, mortality and burnout Death and profit Profit and haemodialysis Physician staffing and ICU outcomes Treatment protocol effectiveness Treatment protocol for LRTI Evidence matters: myocardial infarction Nurse staffing and ITU complications Waiting for cataracts

NHS Learning Network Welcome to the NHS learning network! Learning Centres A proven approach to quality management Applying re-engineering principles to health care Better management of emergency admissions SDP database Theory of constraints How to 'succeed' with cardiac care in primary care Tackling cardiac care - being part of 'SUCCEED' SDO Programme Beacon services The PCDQ (Primary Care Data Quality) Programme

Hospitals Rationing critical care beds Cancer diagnostic assessment centres Discharge planning for CHFFragmment score (sic) for pressure ulcers Reading and rheumatoid arthritis Death and profit Increasing handwashing in healthcare workers Warfarin audit in a teaching hospital An A-Z of winter pressures Speeding up cardiac care Developing the colposcopy service in South Tees Do-it-yourself pain control Breaking bad news to patients Transforming gynaecology services Focusing on ophthalmology waiting lists Improving attendance at ENT clinics Tackling DNAs in a community trust Tackling dual diagnosis: getting the balance right Improving stroke services Shared care prostate clinic Breat cancer care pathway Caring for older people after acute illness Predicting non-elective hospital re-admissions Improving A&E services Understanding why patients are readmitted ICUs Reducing the length of stay for upper GI haemorrhage Improving the quality of A&E services at Whittington Hospital in North London

Primary Care Counselling in primary care Rural GPs: getting them and keeping them RCT of computer-aided anticoagulation Variability of AF guidelines Anticoagulant decision analysis and guideline Anticoagulation works in clinical practice Improving care for chronic illness Improving management of atrial fibrillation Disease management programmes in heart failure Beta blockers, mortality and hospital admission in heart failure Clinical effectiveness of anticoagulation for stroke prevention in AF Implementing EBM in general practice - antithrombotic AF treatment Managing menorrhagia in primary care Translating guidelines into practice Patient-centred care of diabetes Improving the quality of primary care in East Kent Creating a toolkit for working with the community Sexual Health Service Promoting interest in evidence-based practice in primary care Exercising the way to better cardiac health Self help for primary care Practice-based mental health practitioner Improving the handling of repeat prescribing Pharmacists in primary care Reducing DNAs at a vasectomy clinic A physiotherapy outreach service Nurse-led hypertension clinic Improved prescribing in a group of small practices Nursing home repeat prescribing - better quality, lower costs Improving prescribing across a group of small practices in the North Walsall Primary Care Group Collaboration between two practices in Exeter points the way to rational prescribing Sharing knowledge for better prescribing

Primary/Secondary interface Creating a 24-hour mental health service Sharing images for better dermatology care Measuring quality of diabetes care Shared care in diabetes Making better use of nurses' time Multi-disciplinary assessments across boundaries of health and social care Special needs children need special action

Professional development Developing the role of nurse practitioners Exploring the role of therapy assistants Developing a rapid source of advice for GPs in Gwent Equipping junior doctors for a career in primary care Computer skills make staff better Making space for clinical governance Developing role of therapy assistants

Laboratories and tests Making the best use of laboratory tests Unnecessary laboratory tests have huge financial implications Blunders and errors in laboratory testing Doing the right test right Review of cholesterol screening Making sense of testing Ottawa knee rule Ottawa ankle rule Thyroxine - too many people get the wrong dose PSA test can obviate need for bone scan in prostate cancer X-rays for mild head injury are not helpful

Drug issues Reducing and preventing adverse drug events to decrease hospital costs Adverse drug reactions Do formularies work? Cost of change - or why bother? Using computers to manage hypertension in primary care Increasing aspirin use for secondary prevention of IHD Calculating the risk of NSAID GI hospital admission Better quality and lower cost in prescribing for reflux Reducing antibiotic prescribing Improving oral postoperative analgesia Prophylactic antibiotics and meningitis in skull fracture Reducing unnecessary laxative prescribing in a health authority Better prescribing of NSAIDs High rates of adverse drug events More on high risks of adverse drug events Reducing unnecessary benzodiazepine use Getting thyroxine treatment right What pharmaceutical representatives say Statins reduce risk of fractures Computer systems prevent errors HRT and tooth loss Salt and prescribing behaviour - a visual aid to change prescribing behaviour Low dose aspirin - harm and benefits

Patient information Sexual health education to help reduce risk of cervical cancer Electronic communications with patients Fight it together for cancer patients Contraception and abortion in Sweden Decision aids help menopausal women make decisions Volunteering is beneficial for older people Sources of evidence-based information for GPs Evidence-informed Patient Choice Obesity and health

Understanding risk Understanding risk, behaviour and numbers Putting risks into perspective Risks and society Simple guide for risk calculation - rule of three A different way of demonstrating risk Identifying patients likely to fall in hospital

Outcomes Outcome after hip fracture Broken hips: measuring performance What happens after prostate cancer surgery

Improving healthcare management Improving depression management in primary care Evidence-based guidelines Quality Circles in ambulatory care in Germany: Progress in their development Better documentation for quality circles in Germany ATTRACT - Frequently asked questions (TRIP Database) Reminders for immunisations work Review: why patients do not attend and how to improve it Handwashing protocols reduce hospital acquired infection rates Handwashing reduces hospital acuired infection (2) Technology and change: the evidence cart Adverse drug reactions are common and expensive Audit flags for better management Cost-effectiveness of antiseptic-impregnated central venous catheters Hospital acquired infection Preventing medical errors Computer systems prevent errors Continuous quality improvement in maternity

Management makes a difference Education, assessment and postoperative pain management Re-engineering elective surgery Hospital at Home: is it an effective approach? Breast cancer: specialist centres do best Preventing homelessness Nurses training programme reduces childhood asthma admissions Positive attitudes from GPs makes more patients better Quality improvement by audit: Pain relief after day surgery Acting on the evidence Different ways of helping the elderly Environments improve outcomes in hospital GRiP - Steroids in Preterm Delivery Glue ear review D&C in women under 40: getting a GRiP Systematic review of shared care for diabetes Audit facilitators in childhood asthma Audit improves pain after day case surgery Developing a community approach to cardiac care in Finchingfield, Essex

Miscellaneous Family/parenting interventions for delinquency Endoscopic agreement and safety Law of diminishing returns: the laparoscope Nutritional assessment tools Which Graduated Compression Stocking? Respirators are useless for TB protection Health, deprivation and health promotion Right treatment, right patient Silver alloy catheters prevent bacteriuria Baths are major problem for older people Where doctors get information

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