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Within hospital environments, whiteboards have become tools to facilitate communication, coordinate patient care, and engage patients.1 2 Humber River Hospital, a large community hospital in Toronto Canada, moved into a new building with blank wall-mounted dry-erase whiteboards in each inpatient room. Although whiteboards were made available in these rooms, there was no standard practice in place to guide how information should be shared with patients and families using the whiteboards or how often this information should be updated. The aim of this study was to design a standardised whiteboard using human factors methods, such as semi-structured interviews, user-centred design, and usability testing to improve provider–patient communication. Between November 2017 and May 2018, a user-centred design process, an approach informed by the needs and understanding of a specific end-user group,3 was used to evaluate existing whiteboard utilisation, determine what information to standardise, and to create a single design to be implemented across inpatient units. A human factors specialist conducted pre-implementation semi-structured interviews to assess pre-existing whiteboard utilisation. Semi-structured interviews with unit managers and clinical practice leaders (n=10), and nurses (n=46) were conducted to determine what information these healthcare providers found important to share with patients. With their consent, semi-structured interviews were conducted with patients and families (n=33) which confirmed that clinician recommendations aligned with the patients’ and families’ perspectives. Input from these three groups identified the need for customised whiteboard content for the following six clinical areas: Inpatient Medicine and Surgery Units (figure 1),4 Intensive Care Unit (ICU), Birthing Unit, Mother and Baby Unit, Neonatal ICU and Children’s Inpatient Unit. Common elements were standardised across all six designs, including the care team, date, room …

We GPs in Hackney had compulsory clinical peer review of our referrals (with payment by results linked to “quality”) imposed on us a few years ago.1 Our referral rates are rising, perhaps more slowly than they otherwise might have done, and cost and quality have not noticeably improved. By preventing some unnecessary referrals and saving money, we might also …

In paediatric wards up and down the country toddlers and children are left for hours on end. Cries …

Many patients with hearing loss find communication in healthcare settings difficult, and this might sometimes affect their care. This article outlines how staff can best communicate with people with hearing loss

Mental health services are still disproportionately failing members of ethnic minority groups, says a report from the UK Care Quality Commission. Its annual survey of people in mental health wards in England and Wales also shows that in 2009 67% of patients (59% of men and 76% of women) were treated on mixed wards, proportions similar to those found in censuses carried out in 2007 and 2008. Additionally, 19% of men and 24% of women had to share mixed sex bathroom facilities during their stay in a psychiatric ward. The commission’s Count Me In report was based on a snapshot of patients on one day: 31 March 2009. It covered NHS and independent mental …

The management of 483 patients presenting with minor head injury to the accident and emergency (AE) departments of two Scottish hospitals was studied prospectively. Such patients comprised 5.7 and 3.9% of the total attendances to each department. Of the 277 patients assessed in the former department, 83 (30%) fulfilled at least one of the currently accepted criteria for recommending admission to hospital and 49 (17.7%) patients were actually admitted. Patients in whom head injury was not the principal reason for admission were excluded from the study. In the same time period the second department dealt with 206 patients with minor head injury, 49 (24%) of whom had criteria for admission. However, significantly fewer, 10 (4.9%) patients, were actually admitted. The major relevant factor when comparing the two departments was the existence in the former of an observation ward. These results support the view that easy access to hospital beds is a major determinant of management in patients presenting with minor head injury to the AE department and may be more influential than clinical findings.

EDITOR—There has been much interest recently in “millennium babies” and the many couples who are attempting to have the first baby born in the new millennium. Validation of the “first baby” requires an accurate clock in the labour room, but this may not always be the case. In …

management of patients improved. Increased research opportu nities and better teaching were other advantages for such specialist centres, but these were offset by loss of continuity of patient care. For this latter reason and also because of a lack of specialist acute dialysis facilities it was decided to treat all cases of acute renal failure in the receiving district general hospital, which did not have a specialist renal unit. We compare results of such management with published results from specialist units.

It is not possible to achieve high bed occupancy in an acute children's ward without serious detriment to the local community. Analysis of a year's admissions shows that `short stays' and high turnover rates must produce low occupancy, and that this represents efficient management.

A survey of five-day wards serving medical and surgical specialties indicated that 30 such units were operating in England in 1979. Six mixed surgical specialty, eight mixed specialty (medicine and surgery), four medical investigation, and 12 single specialty wards had opened since 1969. There was a varied, and often low, use of these wards. Nurse-staffing levels and allocation of operating theatre time also varied considerably. In busy wards nurse-staffing levels were high and access to operating theatre time reasonable. Medical investigation wards showed some of the highest levels of occupancy and throughput. The potential savings and service improvements that can result from five-day wards have yet to be realised on a wide scale.