Practical Patient Care : All Issues

Connected health is fuelling a new model of healthcare delivery, moving care from the hospital or doctor’s surgery into patients’ homes. By leveraging information technology, connected health programmes are helping providers and patients manage chronic conditions, maintain health and wellness, and improve adherence, engagement and clinical outcomes. Using ubiquitous technologies that automatically collect and present accurate physiologic and behavioural data to patients and providers, these initiatives facilitate data-driven coaching and as-needed provider involvement to achieve patient care goals. Healthcare providers are using technology to efficiently and effectively manage care, and hospitals are adopting new strategies to connect with patients once they leave the hospital or doctor’s surgery. Increasingly, patients are at the centre of their healthcare. Payers are also seeking out and implementing programmes to help individuals manage their health and stay healthy at home.

Lord Ara Darzi and Professor Quang-Zhong Yang look at the difference in healthcare provision between the developed and developing world and the newly established Institute of Global Health Innovation’s efforts to close the gap.,

With hospitals and other healthcare facilities now, more than ever before, aware of the dangers posed by healthcare-acquired infections (HAIs), many have taken steps to eradicate it from their wards. The old adage of prevention being better than cure is never truer; however, patients are still falling victim and, as Dr Nicola Parker of the University of Leicester’s School of Psychology has discovered, it’s not only the physical damage it can do that healthcare professionals should focus on.

Dr Caroline E Fife addresses recent research into efficient and cost-effective wound care practices and highlights the need to continually look for the right product.

This issue also covers healthcare facility architecture and the measures being taken to prevent cardiovascular disease.

The need for caregivers to respect a person's wishes is essential. Dr Dimitrina Petrova of The Equal Rights Trust warns that policymakers will struggle to balance the matter of treating people equally, yet understanding and appreciating their religious or spiritual beliefs throughout the process.

As the push to digitalise healthcare goes on, the issues of patient confidentiality and data security remain problematic. Such breaches are, at least in the UK, almost an everyday occurrence, but as Mick Gorrill, assistant information commissioner at the Information Commissioner's Office, tells Ian Duncan, many of them can be avoided if clinicians and managers take responsibility for their actions.

While the loss of data is a major concern for healthcare providers it rarely poses a threat to life. Dr Andreas Valentin tells Nic Paton how accidentally administering the wrong amount or even wrong drug can, has and continues to, result in the death of patients.

The H1N1 virus has led the news since mid-April. In this issue's cover story Ian Dalton, national director for NHS Flu Resilience, and Dr Laurence Buckman, chairman of the GP committee of the British Medical Association, discuss the preparations being made by the UK's NHS as the annual flu season approaches.

The US is also readying itself for a new wave of swine flu cases. Unofficially, the number infected is already in the millions, putting huge pressure on medical services. However, the country faces another crisis as Angela Gardner, president, American College of Emergency Physicians, warns that its emergency system is broken.

Despite the good work being done by stakeholders around the world, the number of cases of healthcare-acquired infection continues to rise. According to Patricia Stone, there is an argument that the best form of defence is attack, with the screening of all patients at the point of care perhaps the best weapon against HAIs.

The general public is more aware today than ever before of the causes and results of HAIs, but is this a good thing? Lorrie Kelly looks at the effects of high-profile media campaigns that have, in the UK at least, raised awareness but potentially led to more complacency people assume the war against the superbug is won.

Meanwhile, the US Centers for Medicare and Medicaid Services has implemented new regulations increasing the scrutiny on pressure ulcer prevention. This might seem like a good thing, reducing the suffering of patients, but it is also an attempt to cut costs through focusing on preventable conditions. Lee Ann Krapfl asks whether the financial pressures outweigh the focus on patient safety and staffing levels. Finally, our cover story on focuses on abusive and insulting behaviour among medical staff. It is not only damaging to the individual and the collective morale of a facility, it can also compromise patient outcomes, as author Joseph Grenny explains.

It is now accepted that the spread of more virulent forms of bacteria, their consequences and the strategies employed to reduce patient exposure to HCAIs will shape the type of care provision offered. Healthcare providers have to devote increasing resources to better manage the risk. Some of the steps taken are easily manageable while others require much more attention.

One such step is the educating of staff on the importance of good hygiene. Dr Rabih O Darouiche discusses the importance of ongoing education, warning that changing clinical practices to become more aware of individual circumstances and their risks is essential. He also emphasises the importance of ensuring staff are provided with the right tools to do their jobs.

Encouraging a dramatic shift in culture is the subject of Lorrie Kelly's piece on needlestick injuries. She describes how many healthcare professionals are, worryingly, known not to report a sharps incident and looks into the reasons

In this edition we look at the African healthcare system which is blighted by incidents of needlestick injury. Efforts are being made by all stakeholders to reduce and eventually eradicate this, as Ron Stoker and Laura Baker explain.

But such incidents are increasing in frequency according to official figures. Lorrie Kelly talks to Dr Fortune Ncube and Jane Perry to see how the sectors in North America and Europe are responding to this situation.

Meanwhile, the issue of hospital-acquired infections remains a hot topic. A leading team of infection specialists investigate the issue of MRSA and the dangers it poses within a facility, particularly ICU departments. Professor Didier Pittet of the University Hospital of Geneva draws attention to the impact of this issue on the developing world.