Published: 15/01/2004, Volume II4, No. 5888 Page 27

A trial fibrillation: service redesign pays off Replacing an ad hoc referral system with a dedicated service for direct current cardioversion to treat atrial fibrillation could improve clinical outcomes, research suggests. Chesterfield and North Derbyshire Royal Hospital introduced dedicated once-monthly theatre time and staff, and worked to formal protocols on patient selection and preparation.

The move resulted in reduced waiting times (time to perform 35 consecutive cardioversions reduced from 32 to 10 months), far fewer cancellations (from 46 per cent to 3 per cent), more patients discharged in sinus rhythm (60 per cent compared to 30 per cent) and more remaining in sinus rhythm at follow-up (80 per cent compared to 76 per cent). British Journal of Cardiology, 2003; 10: 367-369 (www. bjcardio. co. uk)

Hospital care: NHS can learn from US

NHS patients stay in hospital much longer than US patients under the Kaiser Permanente and Medicare systems, research by the Department of Health shows. NHS bed-day use for the 11 leading causes is threeand-a-half times that of Kaiser's standardised rate, almost twice that of Medicare California's rate and 50 per cent higher than that of Medicare US. British Medical Journal, 2003; 327: 1257 (www. bmj. com)

Meningitis: direct referral for hearing assessment

Direct referral of children who have had meningitis to hearing services by ward staff substantially improves the numbers assessed. The Welsh Hearing Institute found that instigation of direct referrals by paediatric ward staff by telephone before discharge led to 99 per cent of children being tested (93 per cent within six weeks). Previously, there had been no formal guidelines for testing children postmeningitis and just 50 per cent had been assessed (only 31 per cent within eight weeks). Archives of Disease in Childhood, 2003; 88: 976-977 (http: //adc. bmjjournals. com)

Obesity: GP training fails to help

A training programme for primary care staff failed to lead to weight loss in obese patients. Three 90-minute training sessions were delivered by NHS dietitians to staff in 22 general practices. The programme promoted a brief evidence-based approach and included teaching on the clinical benefits of weight loss and effective treatment options.

However, implementation of the taught interventions was low in the trained practices and a year after training, the obese patients at the training practices were on average 1kg heavier than those in control practices. Researchers from the Yorkshire primary care research network concluded: 'Other strategies to manage obesity in primary care urgently need to be considered and evaluated. These might include motivated and dedicated obesity specialists placed at the level of the primary care trust, use of leisure services and use of the commercial weight-loss sector.' British Medical Journal, 2003; 327: 1085 (www. bmj. com)

e-mail consultations: clinicians beware

Two diabetologists from Frimley Park Hospitals trust in Surrey warn fellow clinicians about the dangers of e-mailing information to patients. The two have been told by their trust IT department that emailing is in breach of the Data Protection Act. In a letter to The Lancet, they write: 'Such a breach can only be overcome by encrypting the response so that it can be read only by the patient, or by acquiring written consent from the individual to use this form of communication. An e-mailed enquiry does not, apparently, constitute consent to reply in the same format.' The Lancet, 2003; 362: 1768 (www. thelancet. com)