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Background: Hospital at Night (H@N) is a Department of Health (England) driven programme being widely implemented across UK. It aims to redefine how medical cover is provided in hospitals during the out-of-hours period. Aim: To investigate whether the implementation of H@N is associated with significant change in system or clinical outcomes. Design: An observational study for 14 consecutive nights before, and 14 consecutive nights after the implementation of H@N. Data were collected from the Combined surgical and medical Assessment Unit (CAU), the 18 medical/surgical wards (The Ward Arc) and the four High Dependency Units (The Critical Care corridor) within the Royal Infirmary of Edinburgh. Methods: Following an overnight episode of clinical concern, data were gathered on response time, seniority of reviewing staff, patient outcome and the use of Standardized Early Warning Score (SEWS). Results: Two hundred and nine episodes of clinical concern were recorded before the implementation of H@N and 216 episodes afterwards. There was no significant change in response time in the CAU, Ward Arc or Critical Care corridor. However, significant inter-speciality differences in response time were eradicated, particularly in the Critical Care corridor. Following the implementation of H@N, patients were reviewed more frequently by senior medical staff in CAU (28% vs. 4%, P < 0.05) and the Critical Care corridor (50% vs. 22%, P < 0.001). Finally there was a reduction in adverse outcome (defined as unplanned transfer to critical care/cardiac arrest) in the Ward Arc and CAU from 17% to 6% of patients reviewed overnight (P < 0.01). SEWS was more frequently and accurately recorded in CAU. Conclusion: This is the first study that we are aware of directly comparing out-of-hours performance before and after the implementation of H@N. Significant improvements in both patient and system outcomes were observed, with no adverse effects noted. [ABSTRACT FROM AUTHOR]

Thirty-five polished stone axes and shaft-hole implements which had been previously assigned by petrographic (partially destructive) study to Group XVIII (assumed to be from the Whin Sill dolerite source in northern England), were characterised non-destructively using a combination of portable X-ray fluorescence analysis (PXRF) and magnetic susceptibility measurements. All the implements were compared with the Whin Sill, and with other petrologically and/or visually similar rock sources in the north of England and in Scotland, using a database of chemical elements constructed from the published literature, and statistical atypicality testing. Twenty-nine of the implements are good matches for the Whin Sill as expected, but three do not match Whin Sill rocks and may therefore need to be re-assessed as members of Group XVIII. A further three implements have ambiguous characteristics, perhaps as a result of surface weathering. One axe, an axe-hammer and an adze that had not previously been assigned to implement groups were also analysed, as a test of the robustness of the non-destructive methods. All three implements could be distinguished from Group XVIII on the basis of chemical and magnetic characteristics. Most of the distribution of Group XVIII implements is best explained by the opportunistic use of glacial erratics rather than trade from the primary source. Possible alternative sources for the non-Group XVIII implements include the Scottish Old Red Sandstone age lavas, which could also have been obtained as erratics. The chemical and magnetic characteristics established in this paper provide a non-destructive alternative to thin section study of potential Group XVIII artefacts. [Copyright &y& Elsevier]

Background: The ability to secure peripheral intravenous access is regarded as a basic medical skill that is often required for the management of patients admitted to acute medical admission wards. The decision to insert a peripheral intravenous catheter (PIC) is usually taken by relatively inexperienced members of the acute medical team and is primarily based on ‘traditional’ or ‘routine’ practice, rather than on an assessment of need. Furthermore, there appears to be little recognition of the potentially serious adverse events associated with PIC insertion. Method: We conducted a prospective study to evaluate unnecessary PIC insertion in a United Kingdom teaching hospital’s acute medical admissions unit. Results: Of the 338 patients included in the study, 272 (80.5%) received a PIC. Of these, 179 patients (66%) received a PIC that had been used by the post-on-call ward round. Of the 93 patients (34%) with an unused PIC, 30 patients (11%) had been catheterised inappropriately by the study criteria. Conclusions: Despite our use of conservative criteria for PIC insertion, a notable level of inappropriate peripheral intravenous catheterisation was identified. A hypothetical cost-minimisation analysis is presented and a care pathway for best practice proposed. [Copyright &y& Elsevier]