Factors influencing temporally consistent care in nursing assessments, CT scans and thrombolysis | Adapting and extending roles |
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Creating continuities between different times of day |
HASU staff created continuities between team members operating at different times of day/week. Handover meetings, multidisciplinary team meetings and ward rounds.
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Building relationships and trust |
Strong, trusting relationships with, eg, ED and neuroradiology staff. Reduced decision-making delays, helped maintain pace of assessment and delivery clinical interventions (especially when more than one patient in ED).
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Prioritisation of ‘front door’ interventions |
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Unintended consequences of adaptations |
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Factors influencing temporally inconsistent care in ward admissions, consultant assessments in 12 and 24 hours and therapy assessments in 72 hours | Variations in medical, managerial and allied health professional staffing by time of day |
Likelihood of admission to HASU within 4 hours was influenced by the number of potential patients arriving at hospital. Undergoing consultant assessment within 12 hours and 24 hours depending on patients reaching the ward during period 09:00–12:00.
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Variations in delivering therapist assessments |
Therapists worked ‘in hours’ shifts—patients arriving at hospital in the morning were less likely to be assessed within 24 hours unless assessed on the day of arrival. London standards specified therapy staffing levels to fully cover only 5 days per week. Various attempts to cover weekend working, but no current staffing model permits consistent therapy provision.
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Variations in repatriation processes |
Patients admitted at weekends less likely to be seen by therapists. Social services, care homes, stroke units and community rehabilitation units were significantly less likely to accept new cases at weekends.
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