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Clinical Updates

‘One Stop Cancer Clinic’ will reduce worry and speed up diagnosis for patients

Before the clinic was set up patients would need three separate visits.

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Worried Patient
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The new service will combine a consultant assessment and a transnasal endoscopy in the same appointment.

A new ‘one-stop’ clinic for patients with suspected oesophageal or gastric cancer will assess patients and give them their results on the same day.

The new ground-breaking service at Nottingham University Hospitals (NUH) is the first of its kind in the country.

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This new service will combine an assessment by the consultant and a transnasal endoscopy in the same appointment. Patients who require a further CT scan will also have this carried out on the same day.

Before the clinic was set up patients would need three separate visits to the hospital before results were presented.

The one-stop clinic currently runs one day a week but will soon be offered to patients on a Monday to Friday basis, meaning patients can have their first appointment within seven days of seeing a GP.

Reducing stress and worry.

James Catton, Cancer Lead for NUH said: “This is a ground breaking process that has not been done anywhere in the country before and we are extremely proud to offer it to our patients.

“We can now streamline a patient’s cancer pathway and it helps us to get them treated within a 28 day period.

“The Transnasal endoscopy uses a very fine scope through the nose that allows a patient to sit upright and breathe normally and allows us to see the oesophagus and stomach where Upper GI cancer is found. It also has a significantly reduced recovery time.”

The clinic was officially opened by NUH Chief Executive Tracy Taylor who said: “This is a wonderful service for people who may be showing the symptoms of oesophageal or gastric cancer as it speeds up the whole process.

“One of the biggest concerns for patients with suspected cancer symptoms is the wait between appointments, this service will reduce the wait whilst at the same time removing some of the stress and worry associated with the whole process.”

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Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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