Health and social care delivery research最新文献

{"title":"Exploring the use of pre-hospital pre-alerts and their impact on patients, Ambulance Service and Emergency Department staff: a mixed-methods study.","authors":"Fiona C Sampson, Jaqui Long, Joanne Coster, Rachel O'Hara, Richard Pilbery, Fiona Bell, Steve Goodacre, Aimee Boyd, Peter Webster, Esther Herbert, Alexis Foster, Rob Spaight, Andy Rosser, Mark Millins, Andrew Pountney, Jamie Miles, Janette Turner","doi":"10.3310/GJFS4321","DOIUrl":"10.3310/GJFS4321","url":null,"abstract":"<p><strong>Background: </strong>Ambulance clinicians use pre-alert calls to emergency departments to enable them to prepare for the arrival of a patient. This can lead to improved time-critical treatment. However, pre-alerts should be used judiciously, as over-alerting may add pressures on busy emergency departments, while under-alerting may lead to delays in time-critical patient care. We undertook a mixed-methods study to explore how pre-alerts are used and their impact on patients, ambulance and emergency department staff.</p><p><strong>Method and design: </strong>The mixed-methods study integrated data from: (1) linked routine data set of 12 months' (2020-1) electronic patient records (3 ambulance services), clinician information and routine hospital statistics, (2) semistructured interviews with 34 ambulance clinicians and 40 emergency department staff and 162 hours non-participant observation of pre-alerts across 6 emergency departments, (3) national online survey of ambulance clinicians (1298 responses). Multivariate logistic regression was undertaken in R™ (The R Foundation for Statistical Computing, Vienna, Austria) to identify factors associated with pre-alert rates in terms of patient (National Early Warning Score 2, working diagnosis, age, sex), ambulance clinician (experience, role, sex, time to end of shift) and hospital factors (journey time, percentage of ambulances waiting > 30 minutes). Qualitative data were analysed using thematic analysis in NVivo™ (QSR International, Warrington, UK). Findings were integrated using a triangulation protocol.</p><p><strong>Findings: </strong>Pre-alerts are key to enabling emergency department staff to prepare physically and psychologically for critically ill patients, particularly when resources are constrained. We identified significant variation in pre-alert practice and pre-alert rates at both individual and organisational level that was not explained by patient case mix. Pre-alert decisions were based on clinician risk perception, clinical experience (pattern recognition), protocols and anticipated response by emergency department staff, including consideration of different emergency department expectations regarding pre-alerts. Pre-alert calls included advice calls, 'courtesy' or 'heads up' calls where clinicians had no immediate clinical concern, but called due to protocol requirements or concern about the potential for subsequent deterioration during a handover delay. Frustrations arose from different individual expectations of a pre-alert. Inconsistent guidance between ambulance services and emergency departments, and limited clinician knowledge and awareness of guidance, led to uncertainty and misunderstanding regarding who required pre-alerting. Understanding how to pre-alert was based primarily on learning 'on the job' and informal feedback mechanisms rather than formal training and feedback, including emergency department response to previous pre-alerts. Pre-alert calls created inter","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 9","pages":"1-46"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated pharmacist and third sector outreach support for people experiencing homelessness: a synopsis of the PHOENIx community pharmacy-based pilot randomised controlled trial.","authors":"Richard Lowrie, Vibhu Paudyal, Andrew McPherson, Helena Heath, Jane Moir, Shabana Akhtar, Versha Cheed, Lee Jonathan Middleton, Nigel Barnes, Parbir Jagpal, Andrea E Williamson","doi":"10.3310/ALSP7746","DOIUrl":"10.3310/ALSP7746","url":null,"abstract":"<p><strong>Background: </strong>People experiencing homelessness face up to 12 times higher mortality rates than the general population. People experiencing homelessness have multiple, unmet health and care needs, including poor physical and mental health, substance use disorder and lack of stable and safe housing, yet they do not find services accessible or tailored to their needs.</p><p><strong>Aim: </strong>The aim of this study was to assess the feasibility of conducting a larger, definitive trial evaluating an integrated clinical pharmacist/homeless third-sector support (Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx) for people experiencing homelessness, in a community pharmacy setting.</p><p><strong>Design: </strong>Randomised, multicentre, open, parallel group external pilot trial with parallel economic and qualitative process evaluation.</p><p><strong>Methods: </strong>People experiencing homelessness ≥ 18 years were recruited from community pharmacies in Glasgow and Birmingham, United Kingdom. Participants were randomised 1 : 1 to receive Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx intervention in addition to usual care or usual care only. The Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx intervention is a collaboration between National Health Service pharmacist independent prescribers and third-sector homelessness charity workers offering weekly community pharmacy and/or outreach-based consultations for people experiencing homelessness to address health (e.g. health screening, treatment and prescribing), housing and social needs (e.g. welfare benefits, housing support). A range of health, social and care outcomes were evaluated at baseline, 3 and 6 months from both usual-care and intervention participants. The primary outcome was to evaluate the feasibility of a subsequent definitive randomised controlled trial according to pre-specified progression criteria classified as green (go ahead), amber (minor amendment in procedures required for definitive trial) and red (substantial changes needed). These related to recruitment; retention; intervention adherence; and collection of clinical and social outcomes data, including emergency department visits, rough sleeping and criminal justice encounters.</p><p><strong>Results: </strong>Progression criteria were met (4 green and 1 amber) as follows: (1) recruitment (target 55% conversion rate): 100 people experiencing homelessness were recruited as planned from 5 community pharmacies, 100/183, that is, 55% eligible consented to participate - green; (2) retention (target 60%): 72 (72%) participants remained in the study at 6 months - green; (3) collection of routine healthcare utilisation data (target 60%): 91 (91%) had emergency department visit and mortality data available at 6 months - green; (4) completion of questionnaire booklet (target 60%): 72 (72%) completed the booklet at 6 months - green; (5) i","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 12","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifeguard Pharmacy - A feasibility trial of a novel pharmacy-based intervention for people experiencing domestic abuse and/or suicidal ideation.","authors":"Josie Solomon, Rebecca Barnes, Ana Maria Barcelos, Tracey Latham-Green, Peter Knapp, Darrin Baines, Graham Law, Claire Henderson, Elise Rowan, Hayley Gorton, Mark Gussy","doi":"10.3310/TNFT6414","DOIUrl":"10.3310/TNFT6414","url":null,"abstract":"<p><strong>Background: </strong>Domestic abuse and suicidal ideation are highly prevalent in the United Kingdom, often co-occurring. Numerous practical and psychosocial barriers inhibit help-seeking. This study explored whether community pharmacy could offer an accessible setting for a domestic abuse and suicidal ideation response service.</p><p><strong>Methods: </strong>The design was a randomised cluster feasibility trial. Twelve pharmacies were recruited from one pharmacy organisation, randomised into eight intervention pharmacies and four controls. Thirty-seven pharmacy staff were trained to deliver the Lifeguard Pharmacy intervention, which involved providing a consultation and structured referral or signposting to customers identified as experiencing domestic abuse and/or suicidal ideation. Staff learning from the training was evaluated using the validated Continuing Professional Development reaction questionnaire, analysed using a paired <i>t</i>-test. The intervention ran from January to July 2023 and was accompanied by a nested process evaluation consisting of staff focus groups and a multistakeholder final evaluation workshop with a mix of lay, pharmacy staff and representatives from referral organisations. Data were collected on number and category of client contacts from intervention and control pharmacies; descriptive analyses were performed.</p><p><strong>Results: </strong>After intervention training, pharmacy staff showed statistically significant improvements in their levels of perceived ability, ease and confidence in responding to and referring people in need of help for domestic abuse and suicidal ideation with increased confidence in the ability of other pharmacy staff to support domestic abuse and suicidal ideation. During the intervention period, staff responded to 24 cases in intervention pharmacies: 8 for suicidal ideation, 9 for domestic abuse and 7 for both domestic abuse and suicidal ideation. Of these, 22 were staff-initiated and 2 were client-initiated. Two cases (one suicidal ideation and one domestic abuse) were identified in control pharmacies. Staff participants had a positive perception of the service and its impact on them and their clients. The multistakeholder workshop findings confirmed the feasibility of a staff-initiated response service for both domestic abuse and suicidal ideation in a community pharmacy setting. However, there were challenges marketing and delivering a client-initiated service, and the study was not able to collect all of the information required to inform a future trial.</p><p><strong>Limitations: </strong>There were challenges to collecting data and obtaining informed consent from Lifeguard Pharmacy clients, especially when distressed or time-pressured. Consequently, full data sets were only collected from 4 of the 24 people who used the service. All 12 participating pharmacies were located in 1 region of England, hence a future study would need to test implementation across a broader ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"47-72"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Tired of spinning plates': Synopsis of mixed methods exploration of mental health experiences of adult/older carers of adults with learning disabilities.","authors":"Katherine Runswick-Cole, Sara Ryan, Martina Smith, Chris Hatton, Patty Douglas, Clare Kassa, Rosemary Cisneros, Liz Croot","doi":"10.3310/GJKR4724","DOIUrl":"10.3310/GJKR4724","url":null,"abstract":"<p><strong>Background: </strong>This research addresses the mental health of family carers of adults with learning disabilities. We investigated participants' perceptions of their mental health and views on the accessibility and quality of support.</p><p><strong>Design and methods: </strong>The research involved seven work packages which included public involvement, a rapid scoping review of evidence about family carers' mental health and support, an online exhibition, interviews with parent and sibling carers, digital storytelling workshops, key stakeholder discussions and the creation of learning and teaching materials.</p><p><strong>Results: </strong>Caregiving driven by love is often exploited by health and social care services which deny basic support, information and kindness. Enduring struggle for support and worries about the future are often the cause of mental distress. Participants know what supports mental well-being but have little time to look after themselves due to the lack of support. Social services were described as 'hostile' or absent and participants viewed themselves as exhausted by the lack of support, rather than depressed. Medication can help but can be offered without consideration of their caring role or because there are no alternatives. Participants ask for their statutory entitlements for health and social care support to be met with kindness.</p><p><strong>Outputs and dissemination: </strong>We delivered: (1) an expansive public engagement model; (2) an innovative and creative participatory approach to generate stories of care; (3) a dissemination strategy to raise awareness of the mental health of family carers and (4) the development of general practitioner resources. We published journal articles, blogs, magazine articles, an online exhibition, films and presented findings at international conferences.</p><p><strong>Public and stakeholder involvement and engagement: </strong>Family carers and people with learning disabilities were involved across the study, and in the Study Steering Group.</p><p><strong>Limitations: </strong>Recruitment was slower than expected. Carers were unable to use care replacement costs because of a lack of alternative care. There were challenges involving marginalised communities. We engaged with fewer respondents through the Exhibition than the planned survey; however, it was important to respond to participants' views.</p><p><strong>Conclusions: </strong>Health and care services often fail to recognise or adjust support for family carers despite provision under the Equality Act. The role of love in caring relationships, the absence of consideration of this in research, and the exploitation of this love by service systems which rely heavily on family carers were highlighted. Provisions in The Care Act and The Equalities Act are not always upheld, family carers struggle to gain support over years and even the 'feeblest' acts of kindness make a difference in health and care delivery. There","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 6","pages":"1-35"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intervening to eliminate the centre-effect variation in home dialysis use: a synopsis of Inter-CEPt, an exploratory sequential mixed-methods study.","authors":"Simon Davies, Kerry Allen, Hilary Bekker, David Coyle, Lisa Dikomitis, Sarah Damery, James Fotheringham, Harry Hill, Mark Lambie, Jessica Potts, Ivonne Solis-Trapala, Iestyn Williams","doi":"10.3310/MZSO4004","DOIUrl":"10.3310/MZSO4004","url":null,"abstract":"<p><strong>Background: </strong>There is a substantial variation in the use of home dialysis between kidney services, which disproportionally affects people from ethnic minorities and socioeconomically deprived areas.</p><p><strong>Objective: </strong>To create an evidence-based, user-centred intervention, enabling kidney services to optimise access to home dialysis, thereby eliminating unwarranted centre-level variation in its uptake.</p><p><strong>Design and methods: </strong>We used exploratory, sequential mixed-methods to understand the centre-level characteristics associated with home dialysis use: an ethnography study to explore the organisational and cultural factors associated with home dialysis use that informed a national survey of centre-level characteristics from all kidney services in England, and quantitative analysis (sequence of regressions) to determine the factors associated with increased odds of going on home dialysis. A multistate model was constructed to determine transitions between dialysis modalities, transplantation and death. A health economic model, drawing upon the multistate model, estimated the quality-adjusted life-years and National Health Service costs over a patient's lifetime. A user-centred iterative intervention design method to interpret the findings and identify components for a service-level intervention, coproduced with relevant stakeholders (patients, families/carers, doctors, nurses, policy makers and industry).</p><p><strong>Setting and participants: </strong>Ethnography: Four centres, 43 observations of consultations, meetings and education sessions; 72 patient and staff interviews.</p><p><strong>Main outcome measure: </strong>Being on dialysis at home within 12 months of starting treatment.</p><p><strong>Data source: </strong>United Kingdom Renal Registry: Sequence of regressions: 32,400 patients initiating dialysis 2015-20; multistate model: 93,452 initiating dialysis 2005-20; the economic evaluation simulated a cohort of 2000 patients.</p><p><strong>Results: </strong>Both the ethnography and the national surveys found that organisational culture and leadership were more closely associated home dialysis uptake than how services were organised. Several centre-level factors were found to be important [odds ratio (95% confidence intervals: of being on home dialysis by 1 year)], including: engagement in quality improvement, 1.94 (1.36 to 2.76), availability of assisted peritoneal dialysis, 1.89 (1.39 to 2.57) and a negative association with Home Dialysis staff capacity 0.60 (0.45 to 0.81). Initiating dialysis at home yielded an additional 0.30 quality-adjusted life-years and saved £13,545 compared centre dialysis. Components of the proposed 'Location of Dialysis Care in Kidney Life' intervention include engagement with targeted quality improvement, the implementation of leadership roles to embed organisation culture, use of assisted peritoneal dialysis and investing in home dialysis. Economic evaluation","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 8","pages":"1-30"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of restrictive practices in the everyday care of people living with dementia in hospital settings: an ethnographic study.","authors":"Andy Northcott, Shadreck Mwale, Megan Wyatt, Lucy Series, Karen Harrison Dening, Katie Featherstone","doi":"10.3310/GJKF0714","DOIUrl":"10.3310/GJKF0714","url":null,"abstract":"<p><strong>Background: </strong>Inquiries, National Health Service serious incident reviews and media reports identify people living with dementia at significant risk of experiencing restrictive practices during an unscheduled acute hospital admission. However, to date, this has not been the true focus of substantive empirical research.</p><p><strong>Objectives: </strong>To explore the use of restrictive practices in the care of people living with dementia during an unscheduled acute hospital admission. To identify evidence-based (and alternative) strategies in the care of people living with dementia that are achievable, safe and transferrable.</p><p><strong>Design: </strong>An ethnographic study (observation, ethnographic interviews, documentary analysis) in the symbolic interactionist research tradition, with the goal to deliver an in-depth empirically driven analysis of everyday acute care.</p><p><strong>Setting: </strong>This ethnography was carried out for 225 days over an 18-month period between 2023 and 2024. In total, nine wards were observed across six National Health Service trusts in England, covering six acute wards (assessment and older peoples care) and three mental health wards (specialist older people mental health). Sites were chosen for diversity of demographic, geographic and practice variables.</p><p><strong>Participants: </strong>One hundred and sixty-eight individuals consented to participate directly in this study, also contributing to 1116 ethnographic interviews.</p><p><strong>Results: </strong>Our analysis identified a culture of containment within acute wards. The use of restrictive practice in the care of people living with dementia was an embedded aspect of routine ward care, within all shifts observed within acute wards, regardless of the ward, time of day and day of the week. Raised bedside rails, ward furniture and verbal commands were most frequently used, often quickly escalating to the use of enhanced observation, typically carried out at pace, to contain and restrict movement to the bedside. Recordable methods included the use of physical force and sedation. Our analysis demonstrates these apparently diverse range of practices cannot be understood in isolation but were utilised multiply in the care of individuals and cohorts of people living with dementia. Because their use was embedded within timetabled care, ward staff found defining and identifying restrictive interventions in their routine practices challenging, meaning these forms of restrictive practices were typically unrecognised and unrecorded. Staff experienced significant emotional impacts from using restrictive practices in patient care. We identified a range of practices to support the reduction of restrictive practice within the acute setting. These included engagement with people living with dementia, making full use of the activity resources available to the ward, and supporting people living with dementia to leave the bedside to walk within the","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 7","pages":"1-97"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing research resources and minimum data set for care homes' adoption and use (DACHA).","authors":"Claire Goodman, Gizdem Akdur, Lisa Irvine, Jennifer Kirsty Burton, Barbara Hanratty, Anne Killett, Julienne Meyer, Ann-Marie Towers, Adam L Gordon, Rachael Carroll, Stacey Rand, Kerry Micklewright, Karen Spilsbury, Therese Lloyd, Liz Crellin, Stephen Allan, Guy Peryer, Vanessa Davey, Freya Tracey, Kaat de Corte, Nick Smith, Jo Day, Iain Lang, Liz Jones","doi":"10.3310/PKFR6453","DOIUrl":"10.3310/PKFR6453","url":null,"abstract":"<p><strong>Background: </strong>In England, care homes are the primary providers of long-term care for older adults. The increasing recognition of the importance of social care underscores the importance of collaboration between the National Health Service and care homes. The lack of data sharing among stakeholders limits opportunities for co-ordinated care, service development and research.</p><p><strong>Objectives: </strong>Identify how to support research, service development and innovation in care homes. Combine existing evidence with care home-generated resident data to create a minimum data set that is relevant and usable for stakeholders, including residents, relatives, practitioners, researchers, regulators and commissioners.</p><p><strong>Design and methods: </strong>The study used a mixed-methods approach, structured into five work packages, supported by patient and public involvement and engagement with residents, carers and staff: <b>Work package 1:</b> Conducted two evidence reviews on outcome measures and factors enhancing research productivity in care homes. <b>Work package 2:</b> Created a trial archive for secondary data analysis. <b>Work package 3:</b> Conducted a scoping review, a realist review and a national survey to define minimum data set content and assess implementation challenges in English care homes. <b>Work package 4:</b> Linked residents' data from National Health Service and social care data sets with data from study care homes, deriving useful minimum data set variables and assessing data quality. <b>Work package 5:</b> Piloted the minimum data set at two points in care homes within three integrated care systems, conducted focus groups and interviews with care home and integrated care system staff. Three national consultations explored how stakeholders use resident information, measure quality of life and minimum data set usefulness. Additionally, subprojects examined data availability in domiciliary settings, staff reasoning when assessing resident well-being and completing research during rapid policy changes.</p><p><strong>Findings: </strong>The reviews revealed significant heterogeneity in outcome measurement and questioned the appropriateness of some methods and measures used for care home research. The Virtual International Care Home Trials Archive merged data from 6 United Kingdom randomised controlled trials with 5674 residents across 308 care homes. International minimum data set studies are a valuable resource for international comparative research. The wide range of measures used are mostly clinical with under-representation of measures important to care homes (e.g. quality of life). A national survey of care homes demonstrated the range of information, including clinical measures being routinely collected. The realist review identified motivation, front-line staff monitoring and embedded recording systems as important for minimum data set implementation. The pilot study recruited 996 residents from 45 ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 3","pages":"1-44"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilisation of the support workforce in diagnostic imaging: a mixed-methods investigation.","authors":"Julie Nightingale, Beverly Snaith, Sarah Etty, Trudy Sevens, Robert Appleyard, Shona Kelly, Sally Fowler-Davis","doi":"10.3310/GJJN0626","DOIUrl":"10.3310/GJJN0626","url":null,"abstract":"<p><strong>Background: </strong>Demand for imaging in England massively outstrips supply in terms of workforce capacity, with well-documented shortages of both radiographers and radiologists. The COVID-19 pandemic exacerbated already stretched services, which have remained 'in crisis'. Three high profile national reports highlighted the urgent need to develop the capacity and capability of the imaging support workforce, yet it is unclear how this vital workforce is utilised.</p><p><strong>Aim: </strong>To investigate the development, deployment and contribution of the support workforce to diagnostic imaging activity across England to determine effective models of practice that will support future workforce transformation and re-design. Research question: What models of deployment of the support workforce exist within diagnostic imaging departments and what service, hospital, regional and national factors may encourage or inhibit implementation of these models?</p><p><strong>Design: </strong>The study employed a mixed-methods explanatory research design, comprising six consecutive workstreams spanning 27 months: (Workstream 1) scoping review; (Workstream 2) census of imaging workforce; (Workstream 3) engagement with imaging networks; (Workstream 4) deep dive review of selected trusts; (Workstream 5) qualitative case studies; (Workstream 6) determinant framework.</p><p><strong>Setting and participants: </strong>All National Health Service diagnostic imaging (radiology) services and imaging networks located within England were in scope. Participants included imaging network representatives (<i>n</i> = 18), radiology service managers (<i>n</i> = 24), and Imaging Support Workers and Assistant Practitioners, their supervisors and department managers (WS5, <i>n</i> = 113).</p><p><strong>Interventions: </strong>This was an exploratory observational study.</p><p><strong>Outcome measures: </strong>Findings were synthesised to create a determinant framework (Maturity Matrix) for the effective deployment of the imaging support workforce. A Public Summary encapsulated the key findings for imaging services, the wider healthcare community, and for patients and the public.</p><p><strong>Data sources: </strong>National Health Service Electronic Staff Record database (<i>n</i> = 144 National Health Service Trusts); interviews (<i>n</i> = 38); focus groups (<i>n</i> = 15); documentary analysis (<i>n</i> = 48).</p><p><strong>Results: </strong>The support workforce (National Health Service pay Bands 2-4) constitutes 23.6% of the non-medical imaging workforce (22.2% median, interquartile range 14.9-29.1). Opposing deployment models were identified, based on grade preference (Band 2 or Band 3) and role flexibility (static or rotational). Wide variations in job titles, roles, grades, competencies and scopes of practice are evident both between National Health Service Trust hospitals and within individual imaging departments. With the exception of breast imaging, assista","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 4","pages":"1-44"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147277820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National stakeholder consultation on how to measure care home residents' quality of life.","authors":"Gizdem Akdur, Lisa Irvine, Stacey Rand, Ann-Marie Towers, Lucy Webster, Karen Spilsbury, Liz Jones, Claire Goodman","doi":"10.3310/NPYT7562","DOIUrl":"10.3310/NPYT7562","url":null,"abstract":"<p><strong>Background: </strong>The Developing research resources And minimum data set for Care Homes' Adoption and use or DACHA study aims to create a prototype minimum data set combining residents' information recorded by care homes with their data held in health and social care data sets. The DACHA minimum data set will contain information on quality of life. Internationally and in the UK, there is no consensus on collecting information on quality of life in a standardised format equivalent to the consensus for health measures.</p><p><strong>Objective: </strong>This paper describes an online consultation with stakeholder representatives about how to measure the quality of life of residents in UK older-adult care homes, for inclusion in the DACHA minimum data set.</p><p><strong>Design: </strong>We drew on principles of the Delphi technique, identifying participants knowledgeable about living, working in and visiting care homes, and preference scoring.</p><p><strong>Setting: </strong>We used a bespoke online research engagement platform (Thiscovery, www.thiscovery.org, Cambridge, UK) to engage the participants.</p><p><strong>Participants: </strong>Participants included care home staff and managers, old age specialists (clinical/research), commissioners/providers/regulators, primary care professionals, relatives/family carers of care home residents. The consultation is complementary to DACHA's research and patient and public involvement and engagement activities, which have involved people living in care homes; thus, care home residents were not included in this consultation.</p><p><strong>Results: </strong>The first round asked 30 participants to rank the most important principles and domains to consider when measuring quality of life in care homes. Responses to round 1 informed the selection of quality of life measures that round 2 (September 2022) participants were asked to report their familiarity with and confidence in a range of outcome measures all of which met the criteria identified as important in round 1. Recruitment was extended in round 2, and 72 individuals participated.</p><p><strong>Conclusion: </strong>Based on the rankings and the qualitative feedback in round 2, we included four of the shortlisted quality of life outcome measures in DACHA's prototype minimum data set for care homes. The qualitative feedback suggested a shared understanding across the different representative groups about the strengths and limitations of the selected measures. This work makes an important contribution, understanding the opportunities that quality of life measures pose for different stakeholder groups as regular users of care home resident data.</p><p><strong>Future work: </strong>In future DACHA work, interviews and focus groups will collect further data about the perceptions of care home staff who completed measures during the pilot study and about the usefulness of the data collected via these measures. The quality-of-life section of the DACHA","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"45-60"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital alerting to improve sepsis detection and patient outcomes in NHS Trusts: a multi-methods study.","authors":"Kate Honeyford, Graham Cooke, Anne Kinderler, John Welch, Andrew Brent, Ben Glampson, Sarah Tonkin-Crine, Runa Lazzarino, Shashank Patil, Peter Ghazal, Pippa Goodman, Ron Daniels, Anthony Gordon, Ceire Costelloe","doi":"10.3310/GJCC0605","DOIUrl":"10.3310/GJCC0605","url":null,"abstract":"<p><strong>Background: </strong>Identifying clinical deterioration is a global health priority. Sepsis is a leading cause of deterioration, responsible for around 46,000 deaths annually in the United Kingdom. Early warning scores based on patients' vital signs can be embedded into electronic patient records to digitally alert clinicians to those at risk. Rapid identification and treatment - particularly with targeted intravenous antibiotics - are critical to improving outcomes in sepsis patients.</p><p><strong>Research question: </strong>This study aimed to evaluate the effectiveness of digital alerts in improving outcomes for patients with sepsis. Using routine electronic patient record data from four United Kingdom National Health Service acute trusts, we investigated how digital alert systems influence patient outcomes and explored mechanisms and mediators of their effectiveness.</p><p><strong>Objectives: </strong>Map the types of digital alerts currently in use across United Kingdom hospitals for identifying patients at risk of sepsis (Workstream 1). Evaluate the impact of digital alerts on patient outcomes (Workstream 2). Examine how the implementation process affects alert performance, guided by the consolidated framework for implementation research (Workstream 3). Provide recommendations on alert effectiveness and implementation strategies using systems modelling and mediation analysis (Workstream 4).</p><p><strong>Methods: </strong>A mixed-methods approach was employed. A national survey assessed the use of digital sepsis alerts in English National Health Survey hospitals (Workstream 1). Qualitative interviews and focus groups explored the implementation process and its influence on alert performance (Workstream 3). A natural experiment with multilevel interrupted time series analysis examined the impact of sepsis screening tools and digital alerts on outcomes, primarily in-hospital mortality (Workstream 2). Routinely collected clinical data were processed following National Institute for Health Research-Health Information Collaborative standards. Combining quantitative and qualitative data enabled us to link implementation processes with patient outcomes.</p><p><strong>Results: </strong>All four trusts experienced reduced mortality rates among patients with serious infections following the introduction of digital sepsis screening tools. After adjustment for patient case-mix, admission patterns and pre-existing trends, one trust showed a statistically significant decrease in mortality linked to digital alert implementation. In two trusts, older patients experienced greater mortality reduction than younger ones following alert introduction. Qualitative findings highlighted factors contributing to more effective use of digital alerts: deployment in general wards rather than intensive care units; use by clinicians familiar with similar technologies; availability of 24/7 emergency outreach teams; robust technological infrastructure and alerts","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 5","pages":"1-23"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}