Randomised controlled trial of GP-led in-hospital management of homeless people ('Pathway').

Homeless people have complex problems. GP enhanced care (Pathway) has shown benefits. We performed a randomised, -parallel arm trial at two large inner city hospitals.

Why patients need leaders: introducing a ward safety checklist.

The safety and consistency of the care given to hospital inpatients has recently become a particular political and public concern. The traditional 'ward round' presents an obvious opportunity for systematically and collectively ensuring that proper standards of care are being achieved for individual patients. This paper describes the design and implementation of a 'ward safety checklist' that defines a set of potential risk factors that should be checked on a daily basis, and offers multidisciplinary teams a number of prompts for sharing and clarifying information between themselves, and with the patient, during a round.

Life in the slow lane: making hospitals safer, slowly but surely.

Recognition that serious deficiencies in mutual respect and team work were hampering safe and effective patient care led to the creation of the cultural change initiative described here. We feel this has widespread applicability to other healthcare settings. The After Action Review (AAR) concept was adapted for use in the NHS for the first time as it provides a deceptively simple vehicle to structure healthy blame free team interactions with the aim of improving practice and team behaviours.

Patient safety: culture eats strategy for breakfast.

'One morning recently, a professor conducted a ward round on an elderly medicine ward in a London teaching hospital. The entourage stopped at an 82-year-old man's bed. The elderly patient was confused and so, unfortunately, was the junior doctor who presented the case.

Urine protein estimation in hypertensive pregnancy: which thresholds and laboratory assay best predict clinical outcome?

Objective: To determine what threshold for proteinuria could best predict clinical outcome and whether this threshold could be applied universally to any biochemical assay.

Design: A prospective observational study of hypertensive pregnancies referred for further assessment after in a UK University hospital (n=197). Twenty-four hour urine protein was measured by two different assays [benzethonium chloride assay (BCA) and Bradford assay].

Optimal bedside urinalysis for the detection of proteinuria in hypertensive pregnancy: a study of diagnostic accuracy.

Objective: To compare semi-quantitative visual and automated methods of urine testing with fully quantitative point of care urinalysis for the detection of significant proteinuria (0.3 g/24 hours) in pregnancy complicated by hypertension.

Design: A prospective comparative study.

Emergency care. From zero to hero.

Essex Ambulance Service trust has achieved a rapid transformation, having last year received the country's worst CHI report. The trust transformed itself through new roles, collaborative working and developing its own model for out-of-hours services. Staff have new confidence in the management team, led by young, relatively inexperienced chief executive Anthony Marsh.

Patient initiated home blood pressure recordings are accurate in hypertensive pregnant women.

Objective: We undertook this study to determine the accuracy and reliability of patient initiated blood pressure measurement and recording.

Methods: We recruited 72 women from the antenatal hypertension clinic in a university teaching hospital. All were at high risk for preeclampsia and were asked to measure and record their blood pressure three times per day at home using a validated blood pressure device with an internal memory.