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  • Journal article
    Johnston M, Arora S, King D, Stroman L, Darzi Aet al., 2014,

    Escalation of care and failure to rescue: a multicenter, multiprofessional qualitative study

    , Surgery, Vol: 155, Pages: 989-994, ISSN: 0039-6060

    BackgroundThe escalation of care process has not been explored in surgery, despite the role of communication failures in adverse events. This study aimed to develop a conceptual framework of the influences on escalation of care in surgery allowing solutions to facilitate management of sick patients to be developed.MethodsA multicenter qualitative study was conducted in three hospitals in London, UK. A total of 41 participants were recruited, including 16 surgeons, 11 surgical PGY1s, six surgical nurses, four intensivists, and four critical care outreach team members. Participants were submitted to semistructured interviews that were analyzed using grounded theory methodology.ResultsA decision to escalate was based upon five key themes: patient, individual, team, environmental, and organizational factors. Most participants felt that supervision and escalation of care were problematic in their hospital, with unclear escalation protocols and poor availability of senior surgical staff the most common concerns. Mobile phones and direct conversation were identified to be more effective when escalating care than hospital pager systems. Transparent escalation protocols, increased senior clinician supervision, and communication skills training were highlighted as strategies to improve escalation of care.ConclusionThis is the first study to describe escalation of care in surgery, a key process for protecting the safety of deteriorating surgical patients. Factors affecting the decision to escalate are complex, involving clinical and professional aspects of care. An understanding of this process could pave the way for interventions to facilitate escalation in order to improve patient outcome.
  • Journal article
    Keown OP, Al-Thani HA, Al-Dafa MB, Pellegrini CA, Darzi AWet al., 2014,

    World Innovation Summit for Health provides a global perspective on surgery

    , Bulletin of the American College of Surgeons, Vol: 99
  • Journal article
    Mastellos N, Gunn L, Harris M, Majeed A, Car J, Pappas Yet al., 2014,

    Assessing patients' experience of integrated care: a survey of patient views in the North West London Integrated Care Pilot.

    , Int J Integr Care, Vol: 14, ISSN: 1568-4156

    INTRODUCTION: Despite the importance of continuity of care and patient engagement, few studies have captured patients' views on integrated care. This study assesses patient experience in the Integrated Care Pilot in North West London with the aim to help clinicians and policymakers understand patients' acceptability of integrated care and design future initiatives. METHODS: A survey was developed, validated and distributed to 2029 randomly selected practice patients identified as having a care plan. RESULTS: A total of 405 questionnaires were included for analysis. Respondents identified a number of benefits associated with the pilot, including increased patient involvement in decision-making, improved patient-provider relationship, better organisation and access to care, and enhanced inter-professional communication. However, only 22.4% were aware of having a care plan, and of these only 37.9% had a copy of the care plan. Knowledge of care plans was significantly associated with a more positive experience. CONCLUSIONS: This study reinforces the view that integrated care can improve quality of care and patient experience. However, care planning was a complex and technically challenging process that occurred more slowly than planned with wide variation in quality and time of recruitment to the pilot, making it difficult to assess the sustainability of benefits.
  • Conference paper
    Vamos EP, Pape UJ, Curcin V, Harris MJ, Valabhji J, Majeed A, Millett Cet al., 2014,

    Influenza vaccine effectiveness against hospitalisation and death in people with Type 2 diabetes

    , Publisher: WILEY-BLACKWELL, Pages: 74-75, ISSN: 0742-3071
  • Journal article
    Keown OP, Darzi A, 2014,

    Surgical Statistics: Let's Act Fast and Grasp the Opportunity

    , ANNALS OF SURGERY, Vol: 259, Pages: E12-E13, ISSN: 0003-4932
  • Conference paper
    Johnston M, Arora S, King DC, Stroman L, Darzi Aet al., 2014,

    Escalation of Care in Surgery: a Systematic, Pro-active Risk Assessment of Clinical Supervision

    , American College of Surgeons Accredited Educational Institutions
  • Journal article
    Greenfield G, Ignatowicz AM, Majeed A, Harris Met al., 2014,

    Patient narratives on person-centeredness in the integrated care context

    , INTERNATIONAL JOURNAL OF INTEGRATED CARE, Vol: 14, ISSN: 1568-4156
  • Conference paper
    King DC, 2014,

    Designing digital interventions using behavioural economics

    , Healthcare revolution: Big data and smart analytics
  • Conference paper
    King DC, 2014,

    Imperial IdeasLab: Behaviour change through mHealth

    , World Economic Forum
  • Journal article
    King D, Jabbar A, Charani E, Bicknell C, Wu Z, Miller G, Gilchrist M, Vlaev I, Franklin BD, Darzi Aet al., 2014,

    Redesigning the 'choice architecture' of hospital prescription charts: a mixed methods study incorporating in situ simulation testing

    , BMJ OPEN, Vol: 4, ISSN: 2044-6055
  • Journal article
    Johnston M, Arora S, Anderson O, King DC, Behar N, Darzi Aet al., 2014,

    Escalation of Care in Surgery: A Systematic Risk Assessment to Prevent Avoidable Harm in Hospitalized Patients.

    , Annals of Surgery
  • Conference paper
    King DC, 2014,

    Creating healthier outcomes

    , World Economic Forum
  • Journal article
    Cowling TE, Harris MJ, Soljak MA, Majeed Aet al., 2013,

    Opening hours of general practices in England

    , British Medical Journal, Vol: 347
  • Journal article
    Cowling TE, Harris MJ, Majeed A, 2013,

    What Is Our Plan for Acute Unscheduled Care?

    , Annals of Internal Medicine, Vol: 159, Pages: 575-576
  • Journal article
    Birnbach DJ, King D, Vlaev I, Rosen LF, Harvey PDet al., 2013,

    Impact of environmental olfactory cues on hand hygiene behaviour in a simulated hospital environment: a randomized study

    , JOURNAL OF HOSPITAL INFECTION, Vol: 85, Pages: 79-81, ISSN: 0195-6701
  • Journal article
    Ahmed K, Wang TT, Ashrafian H, Layer GT, Darzi A, Athanasiou Tet al., 2013,

    The effectiveness of continuing medical education for specialist recertification

    , CUAJ-CANADIAN UROLOGICAL ASSOCIATION JOURNAL, Vol: 7, Pages: 266-272, ISSN: 1911-6470
  • Conference paper
    Rout S, Mayer E, Sevdalis N, Moorthy K, Darzi Aet al., 2013,

    Peri-operative safety checklist usage and patient outcomes

    , International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 86-86, ISSN: 0007-1323
  • Journal article
    Cowling T, Soljak M, Cecil E, Lee J, Millet C, Majeed A, Harris Met al., 2013,

    Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study

    , PLoS One, Vol: 8, ISSN: 1932-6203

    BackgroundThe number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England.MethodsA cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services.Main Result and ConclusionGeneral practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.
  • Journal article
    Aylin P, Alexandrescu R, Jen MH, Mayer EK, Bottle Aet al., 2013,

    Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics

    , BMJ-BRITISH MEDICAL JOURNAL, Vol: 346, ISSN: 1756-1833
  • Journal article
    Taylor MJ, Kaur M, Sharma U, Taylor D, Reed JE, Darzi Aet al., 2013,

    Using virtual worlds for patient and public engagement.

    , Int J Technol Knowl Soc, Vol: 9, Pages: 31-48, ISSN: 1832-3669

    Patient and public involvement is fundamental in healthcare and many methods attempt to facilitate this engagement. The present study investigated use of computer-generated environments known as 'virtual worlds' (VW) as an involvement method. The VW used in the present research was Second Life, which is 3-dimensional, publically accessible and internet-based. It is accessed using digital self-representations, or 'avatars', through which users navigate the virtual environment and communicate with one another. Participants were patients with long-term conditions, frequently involved in shaping health research and care. Some had mobility and communication difficulties, potentially making involvement through traditional face-to-face modes of engagement challenging. There were 2 stages to this study. Stage-1: Participants were introduced to VWs and Second Life. This was followed by a face-to-face focus group discussion (FGD) in order to gain their views on use of SL. Stage-2: An FGD attended by 8 people (4 patients, 3 researchers, 1 healthcare professional) was conducted in Second Life. Training and support on using Second Life had been provided for participants. The FGD took place successfully, although some technical and communication difficulties were experienced. Data was collected in the form of interviews and questionnaires from the patients about their experience of using the virtual world. Participants recognised the potential of VWs as a platform for patient engagement, especially for those who suffer from chronic conditions that impact severely upon their mobility and communication. Participant feedback indicated that potential barriers include technical problems with VW programs and potential user inexperience of using VWs, which may be counteracted by ensuring provision of continuous training and support. In conclusion, this study established the feasibility of using VWs for patient FGDs and indicates a potential of use of VWs for engagement in future, partic

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