Dataset Information

Improved clinical outcomes and efficacy with a nurse-led dysphagia hotline service.

ABSTRACT:

Background

A nurse practitioner-led dysphagia service was introduced to improve appropriateness of investigations.

Objective

To determine the clinical outcomes and efficacy of this service.

Design and patients

A 7-year prospective audit of the first 2000 patients referred for investigation of dysphagia.

Setting

Royal Cornwall Hospitals NHS Trust.

Intervention

An innovative nurse practitioner-led telephone dysphagia hotline (DHL) assessment service for all patients and consultant review following investigation prior to discharge.

Outcomes

Clinical outcomes, service efficiency and cost effectiveness.

Results

2000 patients (median age 70 years, 48% male) were referred in less than 7 years, 1775 being managed fully through the DHL. 67% patients had gastroscopy only, 13% barium swallow only and 8.8% both and 11.2% had no investigation. Reflux was the commonest cause (41.3%), 9% had peptic stricture, 10% malignancy 1.9% pharyngeal pouches and 0.8% achalasia. The did not attend rate was reduced from 3.9% to 1.1% and 151 patients either refused or did not require investigation saving a potential £53 040. Although some patients with pharyngeal pouches had gastroscopy as initial investigation, no complications resulted.

Conclusions

The nurse practitioner-led DHL service has improved efficiency and resulted in a safe prompt service to patients.

SUBMITTER: Murray IA

PROVIDER: S-EPMC5369841 | biostudies-literature | 2013 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Improved clinical outcomes and efficacy with a nurse-led dysphagia hotline service.

Murray Iain Alexander IA Waters Carolyn C Maskell Giles G Despott Edward J EJ Palmer Joanne J Dalton Harry R HR

Frontline gastroenterology 20121214 2

<h4>Background</h4>A nurse practitioner-led dysphagia service was introduced to improve appropriateness of investigations.<h4>Objective</h4>To determine the clinical outcomes and efficacy of this service.<h4>Design and patients</h4>A 7-year prospective audit of the first 2000 patients referred for investigation of dysphagia.<h4>Setting</h4>Royal Cornwall Hospitals NHS Trust.<h4>Intervention</h4>An innovative nurse practitioner-led telephone dysphagia hotline (DHL) assessment service for all pati ...[more]

PMID: 28839709

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Project description:ImportanceMultidisciplinary disease management efforts enable the improvement in lung function among patients with chronic obstructive pulmonary disease (COPD), but there is little evidence of its association with risks of adverse health outcomes and health care service use.ObjectiveTo examine the association between the use of a nurse- and allied health-led primary care clinic for respiratory patients, namely the Nurse and Allied Health Clinic-Respiratory Care (NAHC-Respiratory), and their risks of mortality and morbidity and health care service use.Design, setting, and participantsThis territory-wide, population-based, propensity-matched, retrospective cohort study used data from the electronic health records of all patients who used public health care services in Hong Kong, China, from January 1, 2010, to December 31, 2019. All patients with COPD treated in public outpatient clinics between January 1, 2010, and December 31, 2014, were included. Patients who attended NAHC-Respiratory and usual care only were propensity score-matched at a 1:2 ratio. Data analyses were conducted between August 2023 and April 2024.ExposureAttendance at NAHC-Respiratory.Main outcomes and measuresAll-cause and cause-specific mortality, incidence of COPD complications, and use of emergency department and inpatient services until the end of 2019 were compared between the NAHC-Respiratory and usual care participants using Cox proportional hazard regression, Poisson regression, and log-link gamma regression models after matching.ResultsThis study included 9048 eligible patients after matching, including 3093 in the exposure group (2814 [91.0%] men; mean [SD] age, 69.8 [9.5] years) and 5955 in the reference group (5431 [91.2%] men; mean [SD] age, 69.5 [11.7] years). Compared with patients in the usual care-only group (reference), patients in the exposure group had lower risks of all-cause mortality (hazard ratio [HR], 0.84; 95% CI, 0.78-0.90) as well as pneumonia-caused (HR, 0.85; 95% CI, 0.74-0.97), respiratory-caused (HR, 0.86; 95% CI, 0.77-0.96), and cardiovascular-caused (HR, 0.74; 95% CI, 0.59-0.93) mortality. Exposure was associated with reduced rates of emergency department visits (incidence rate ratio [IRR], 0.92; 95% CI, 0.86-0.98) and hospitalization through emergency department (IRR, 0.89; 95% CI, 0.83-0.95).ConclusionsIn this cohort study, the use of a nurse- and allied health-led clinic in primary care settings was associated with reduced risks of mortality and use of hospital services among patients with COPD. These findings emphasize the important role of health care workers other than physicians in disease management in the primary care setting. The NAHC-Respiratory model and service components can be used to help improve primary care programs to benefit more patients with COPD.

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Dataset Information

Improved clinical outcomes and efficacy with a nurse-led dysphagia hotline service.

Background

Objective

Design and patients

Setting

Intervention

Outcomes

Results

Conclusions

Publications

Improved clinical outcomes and efficacy with a nurse-led dysphagia hotline service.

Similar Datasets

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