ObjectivesMisuse of investigations, medications and hospital beds is costing the National Health Service (NHS) billions of pounds with little evidence that approaches centred on reducing overuse are sustainable. Our previous study demonstrated that twice-daily consultant ward rounds reduce inpatient length of stay and suggested a reduction in overuse of investigations and medications. This study aims to assess the impact of daily consultant ward rounds on the use of investigations and medications and estimate the potential cost benefit.SettingsThe study was performed on two medical wards in a major city university teaching hospital in Liverpool, UK, receiving acute admissions from medical assessment and emergency departments.Participants and interventionThe total number of patients admitted, investigations performed and pharmacy costs incurred were collected for 2 years before and following a change in the working practice of consultants from twice-weekly to twice-daily consultant ward rounds on the two medical wards.Outcome measuresWe performed a cost-benefit analysis to assess the net amount of money saved by reducing inappropriate investigations and pharmacy drug use following the intervention.ResultsDespite a 70% increase in patient throughput (p<0.01) the investigations and pharmacy, costs per patient reduced by 50% over a 12-month period (p<0.01) and were sustained for the next 12 months. The reduction in investigations and medication use did not have any effect on the readmission or mortality rate (p=NS), whereas, the length of stay was almost halved (p<0.01). Daily senior clinician input resulted in a net cost saving of £336 528 per year following the intervention.ConclusionsDaily consultant input has a significant impact on reducing the inappropriate use of investigations and pharmacy costs saving the NHS more than £650K on the two wards over a 2-year period.

Considering the profound societal change taking place in several developing countries, the objective of this paper is to reflect on work-family conflict (WFC) both as a concept and a social phenomenon. Given that WFC is a concept rooted in academic debate focusing on developments in Western, largely individualistic, societies, this paper reconsiders WFC’s value added as applied in a context of a collectivist society in a developing country. The objective of this paper is thus threefold, i.e., (i) to assess WFC’s applicability in a context of a collectivist society in a developing country, where the position and role of women gradually changes; (ii) to develop a culturally adjusted/sensitive scale to measure the scope of WFC in Pakistan, whereby the latter is treated here as a case study; and (iii) to reflect on the possibility of devising a set of good practices that would allow a smooth inclusion of women in the formal workforce, while at the same time mitigating the scope and scale of WFC. The value added of this paper stems from these three objectives.

No abstract

No abstract

Availability of respiratory polymerase chain reaction (PCR) result within 3 hours of the decision to do test and within 1 hour of sample collection to enable timely decision making for patients with suspected influenza.