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Rationale: Increasing demand for hospital services can lead to overcrowding and delays in treatment, poorer outcomes and a high cost‐burden. The medical ambulatory care service (MACS) provides out of hospital patient care, including diagnostic and therapeutic interventions for patients that require urgent attention, but which can be safely administered in the ambulatory environment. The programme is yet to be rigorously evaluated. Aims/Objectives: The aim of this study is to evaluate the impact of the MACS programme on emergency department (ED) presentations, hospital admissions, length‐of‐stay and health service costs from a health system perspective. Method: We used a single group interrupted time series methodology with a multiple baseline approach to analyse the impact of the MACS clinic on ED presentations, hospital admissions, length‐of‐stay and cost outcomes for general practitioners (GP)‐referred, ED‐referred and ward‐referred patients under two counterfactual scenarios: an increasing trend in health utilization based on preperiod predictions or a stabilization of utilization rates. Results: The time trend of hospital utilization differed after attending MACS for all three referral groups. The time trend for the GP‐referred group declined significantly by 0.36 ED presentations per 100 patients per 30 days [95% confidence interval (CI): −0.52 to −0.2], while inpatient length of stay declined significantly by 1.56 and 3.70 days, respectively, per 100 ED‐referred and ward‐referred patients per 30 days (95% CI: −2.51 to −0.57 and −5.71 to −1.69, respectively). Under two different counterfactual scenarios, the predicted net savings for MACS across three patient groups were $78,685 (95% CI: $54,807−$102,563) and $547,639 (95% CI: $503,990−$591,287) per 100 patients over 18 months. Conclusion: MACS was found to be cost‐effective for GP and ward‐referred groups, but the expected impact for ED‐referred patients is sensitive to assumptions. Expansion of the service for GP‐referred patients is expected to reduce hospitalizations the most and generate the largest net cost savings. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to measure the level of missed nursing care and determine its relationship with nurse staffing and patient safety outcomes in acute care settings in Ethiopia. Background: Missed nursing care in hospitals increases the likelihood of patient adverse events, complications, disability and death. However, little is known about the level of missed nursing care and its impact on patient outcomes in low‐income countries. Methods: An observational study was conducted comprising of a survey of nurses at two time points (n = 74 and 80, respectively) and a medical record review of 517 patients in four units across two hospitals between September 2018 and March 2019. Results: The level of missed nursing care in the study units was very high. The hospital type and hours nurses worked during the last week were significantly associated with missed nursing care. A unit increase in missed nursing care score increased the incidence of adverse patient outcomes by 10%. Conclusion: There was a higher level of missed nursing care in the study units compared with similar studies from high‐income countries. Higher level of missed nursing care was significantly associated with higher incidence of adverse patient safety outcomes. Summary statement: What is already known about this topic? Literature shows nurses working in acute care miss important nursing care activities mainly due to lack of time to perform those nursing care activities. What this paper adds? The level of missed nursing care in the low‐income country acute care units of the study hospitals is very high compared with other settings.Higher levels of missed nursing care were statistically associated with increase adverse patient safety outcomes, whereas lower levels of missed nursing care were statistically associated with improved patient outcomes. The implication of this paper Hospital administrators and nurse managers should work towards reducing missed nursing care through regular monitoring of nursing practice and improved staffing levels.Mechanisms to improve staffing and resource are required to enable nurses enough time to perform all essential nursing care activities for patients. [ABSTRACT FROM AUTHOR]

Abstract Background This study set out to achieve three objectives: to test the application of a context assessment tool in an acute hospital in South Australia; to use the tool to compare context in wards that had undergone an evidence implementation process with control wards; and finally to test for relationships between demographic variables (in particular experience) of nurses being studied (n = 422) with the dimensions of context. Methods The Alberta Context Tool (ACT) was administered to all nursing staff on six control and six intervention wards. A total of 217 (62%) were returned (67% from the intervention wards and 56% from control wards). Data were analysed using Stata (v9). The effect of the intervention was analysed using nested (hierarchical) analysis of variance; relationships between nurses' experience and context was examined using canonical correlation analysis. Results Results confirmed the adaptation and fit of the ACT to one acute care setting in South Australia. There was no difference in context scores between control and intervention wards. However, the tool identified significant variation between wards in many of the dimensions of context. Though significant, the relationship between nurses' experience and context was weak, suggesting that at the level of the individual nurse, few factors are related to context. Conclusions Variables operating at the level of the individual showed little relationship with context. However, the study indicated that some dimensions of context (e.g., leadership, culture) vary at the ward level, whereas others (e.g., structural and electronic resources) do not. The ACT also raised a number of interesting speculative hypotheses around the relationship between a measure of context and the capability and capacity of staff to influence it. We propose that context be considered to be dependent on ward- and hospital-level factors. Additionally, questions need to be considered about the unit of measurement of context in studies of knowledge implementation--is individual (micro), ward (meso) or hospital-level (macro) data most appropriate? The preliminary results also raise questions about how best to utilise this instrument in knowledge translation research.

Background: Rapid frailty screening remains problematic in primary care. The diagnostic test accuracy (DTA) of several screening instruments has not been sufficiently established. We evaluated the DTA of several screening instruments against two reference standards: Fried's Frailty Phenotype [FP] and the Adelaide Frailty Index [AFI]), a self-reported questionnaire.Methods: DTA study within three general practices in South Australia. We randomly recruited 243 general practice patients aged 75+ years. Eligible participants were 75+ years, proficient in English and community-dwelling. We excluded those who were receiving palliative care, hospitalized or living in a residential care facility.We calculated sensitivity, specificity, predictive values, likelihood ratios, Youden Index and area under the curve (AUC) for: Edmonton Frail Scale [EFS], FRAIL Scale Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC], Polypharmacy [POLY], PRISMA-7 [P7], Reported Edmonton Frail Scale [REFS], Self-Rated Health [SRH] and Timed Up and Go [TUG]) against FP [3+ criteria] and AFI [>0.21].Results: We obtained valid data for 228 participants, with missing scores for index tests multiply imputed. Frailty prevalence was 17.5% frail, 56.6% prefrail [FP], and 48.7% frail, 29.0% prefrail [AFI]. Of the index tests KC (Se: 85.0% [70.2-94.3]; Sp: 73.4% [66.5-79.6]) and REFS (Se: 87.5% [73.2-95.8]; Sp: 75.5% [68.8-81.5]), both against FP, showed sufficient diagnostic accuracy according to our prespecified criteria.Conclusions: Two screening instruments-the KC and REFS, show the most promise for wider implementation within general practice, enabling a personalized approach to care for older people with frailty. [ABSTRACT FROM AUTHOR]

Against a backdrop of aging populations worldwide, it has become increasingly important to identify frailty screening instruments suitable for community settings. Self‐reported and/or administered instruments might offer significant simplicity and efficiency advantages over clinician‐administered instruments, but their comparative diagnostic test accuracy has yet to be systematically examined. The aim of this systematic review was to determine the diagnostic test accuracy of self‐reported and/or self‐administered frailty screening instruments against two widely accepted frailty reference standards (the frailty phenotype and the Frailty Index) within community‐dwelling older adult populations. We carried out a systematic search of the Embase, CINAHL, MEDLINE, PubMed, Web of Science, PEDro, PsycINFO, ProQuest Dissertations, Open Grey and GreyLit databases up to April 2017 (with an updated search carried out over May–July 2018) to identify studies reporting comparison of self‐reported and/or self‐administered frailty screening instruments against an appropriate reference standard, with a minimum sensitivity threshold of 80% and specificity threshold of 60%. We identified 24 studies that met our selection criteria. Four self‐reported screening instruments across three studies met minimum sensitivity and specificity thresholds. However, in most cases, study design considerations limited the reliability and generalizability of the results. Additionally, meta‐analysis was not carried out, because no more than three studies were available for any of the unique combinations of index tests and reference standards. Although the present study has shown that a number of self‐reported frailty screening instruments reported sensitivity and specificity within a desirable range for community application, additional diagnostic test accuracy studies are required. Geriatr Gerontol Int 2020; 20: 14–24. [ABSTRACT FROM AUTHOR]