IntroductionIn April 2010, the government introduced a new Statement of Fitness to Work or ’Fit Note' for patients requiring time off of work or adaptations to their work due to illness. Responsibility to issue these documents has shifted from primary to secondary care. Hospital clinicians are required to issue for inpatients and for outpatients where clinical responsibility has not been taken over by the general practitioner (GP). However, awareness of this change is lacking. Misdirecting patients to their GP for the sole purpose of receiving a ’Fit Note' is an unnecessary use of appointment time and negatively impacts on patients. King’s College Hospital NHS Trust receives a number of quality alerts from primary care regarding this issue.MethodsA trust-wide educational initiative was designed and implemented to increase staff awareness of Fit Notes and their correct usage in order to reduce the number of patients being misdirected to their GP to obtain one. Interventions included direct staff engagement, a trust-wide promotional campaign and creation of an electronic version of the document.ResultsUptake of the electronic version of the Fit Note has steadily increased and there has been a fall in the number of quality alerts received by the trust. However, staff awareness on the whole remains low.ConclusionsPatients being misdirected to their general practice for Fit Notes is an important issue and one on which the baseline level of awareness among hospital clinicians is low. Challenges during this intervention have been in penetrating a trust of this size and getting the message across to staff. However, digitising the Fit Note can help to increase its use.
Abstract. Introduction: Guidelines and consensus statements do not support routine preoperative
testing for asymptomatic bacteriuria (ASB) prior to elective arthroplasty.
Despite this, urine testing remains commonplace in orthopaedic practice.
This mixed methods stepwise quality improvement project aimed to develop and
implement a guideline to reduce unnecessary preoperative testing for asymptomatic bacteriuria prior to elective arthroplasty within a single
centre. Methods: Step 1 – description of current practice in preoperative urine testing prior to arthroplasty within a single centre;
Step 2 – examination of the association between preoperative urine culture and pathogens causing prosthetic joint infection (PJI);
Step 3 – co-design of a guideline to reduce unnecessary preoperative testing for asymptomatic bacteriuria prior to elective arthroplasty;
Step 4 – implementation of a sustainable guideline to reduce unnecessary preoperative testing for asymptomatic bacteriuria prior to elective
arthroplasty. Results: Retrospective chart review showed inconsistency in mid-stream urine (MSU)
testing prior to elective arthroplasty (49 % preoperative MSU sent) and in antimicrobial prescribing for urinary tract infection (UTI) and ASB. No
association was observed between organisms isolated from urine and joint
aspirate in confirmed cases of PJI. Co-design of a guideline and decision
support tool supported through an implementation strategy resulted in rapid
uptake and adherence. Sustainability was demonstrated at 6 months. Conclusion:
In this stepwise study, implementation science methodology was used to
challenge outdated clinical practice, achieving a sustained reduction in
unnecessary preoperative urine testing for ASB prior to elective
arthroplasty.
This article shows evidence of a teaching programme which improves the confidence of the multidisciplinary team in facilitating interprofessional bedside teaching.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.