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Hundreds of sexual assaults each year on mixed-gender wards

Hundreds of sexual assaults are reported each year on mixed-sex mental health wards in England, HSJ can reveal, highlighting the urgent need for investment to improve facilities.

New figures obtained by HSJ show there have been at least 1,019 reports of sexual assaults between men and woman on mixed wards since April 2017 to October 2019. This compares to just 286 reports of incidents on single-sex mental health wards over the same period.

Of those reports made on mixed-sex wards, 491 were considered serious enough to refer to safeguarding, and 104 were reported to the police.

The level of incidents still being reported suggests patients are not being protected from sexual assault on mixed wards, despite the issue being highlighted by several national reports in recent years.

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Source: HSJ, 7 January 2020

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Artificial intelligence can accurately diagnose brain tumours within minutes

Artificial intelligence can diagnose brain tumours more accurately than a pathologist in a tenth of the time, a study has shown.

The machine-learning technology was marginally more accurate than a traditional diagnosis made by a pathologist, by just 1%, but the results were available in less than 2 minutes and 30 seconds, compared with 20 to 30 minutes by a pathologist.

The study, published in Nature Medicine, demonstrates the speed and accuracy of AI diagnosis for brain surgery, allowing surgeons to detect and remove otherwise undetectable tumour tissue.

Daniel Orringer, an Associate Professor of Neurosurgery at New York University's Grossman School of Medicine and a senior author, said: “As surgeons, we’re limited to acting on what we can see; this technology allows us to see what would otherwise be invisible to improve speed and accuracy in the [operating theatre] and reduce the risk of misdiagnosis."

“With this imaging technology, cancer operations are safer and more effective than ever before.”

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Source: The Independent, 6 January 2020

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Hywel Dda cancels operations after 'critical pressures'

A health board has cancelled planned operations at four of its hospitals "in the interest of patient safety".

Hywel Dda University Health Board made the decision after "an extraordinary weekend" of "critical pressures". On Monday, inpatient operations were cancelled at Bronglais, Glangwili, Prince Philip and Withybush hospitals in mid and west Wales.

The health board said it had contacted the patients affected and outpatient appointments continued as normal. No decisions have been taken yet to cancel more non-emergency operations on Tuesday, it added.

Dr Philip Kloer, the health board's medical director, said the weekend saw hospitals "at a level of escalation not seen before".

"It is in the interest of patient safety that we have postponed planned operations today," he added.

Plaid Cymru's shadow minister for health, Helen Mary Jones, said the decision to cancel operations was "deeply concerning". She said that patients in Wales "deserve so much better".

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Source: BBC News, 6 January 2020

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Myla’s mum left with ‘soul‑destroying sadness’

Mother Natalie Deviren was concerned when her two-year-old daughter Myla  awoke in the night crying with a restlessness and sickness familiar to all parents. Natalie was slightly alarmed, however, because at times her child seemed breathless.

She consulted an online NHS symptom checker. Myla had been vomiting. Her lips were not their normal colour. And her breathing was rapid. The symptom checker recommended a hospital visit, but suggested she check first with NHS 111, the helpline for urgent medical help. To her bitter regret, Natalie followed the advice.

She spoke for 40 minutes to two advisers, but they and their software failed to recognise a life-threatening situation with “red flag” symptoms, including rapid breathing and possible bile in the vomit.

Myla died from an intestinal blockage the next day and could have survived with treatment.

The two calls to NHS 111 before the referral to the out-of-hours service were audited. Both failed the required standards, but Natalie was told that the first adviser and the out-of-hours nurse had since been promoted. She discovered at Myla’s inquest that “action plans” to prevent future deaths had not been fully implemented. The coroner recommended that NHS 111 have a paediatric clinician available at all times.

In her witness statement at her daughter’s inquest in July, Natalie said: “You’re just left with soul-destroying sadness. It is existing with a never-ending ache in your heart. The pure joy she brought to our family is indescribable.”

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Source: The Times, 5 January 2020

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Two-thirds of trusts failing to protect staff from violence

Around two-thirds of NHS providers were found to be breaking laws aimed at protecting staff from violence and aggression, when inspected by the Health and Safety Executive (HSE), information released to HSJ reveals.

The HSE has inspected 37 NHS organisations since April 2018, looking at how they manage risks to staff from violence and aggression, and found 25 of them (67%) were in breach of the law.

It comes amid concern about rising numbers of assaults on NHS and care staff. The HSE has identified that three staff members have been killed by patients or service users in the last five years.

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Source: HSJ, 6 January 2020

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Hospital in bullying claims did not monitor at-risk patients

A hospital accused of bullying its staff is facing new claims that it failed to act on a leading doctor’s warning about a potentially fatal failure to monitor vulnerable patients, the Guardian newspaper can reveal.

Dr Jonathan Boyle, the UK’s top vascular surgeon, had warned West Suffolk NHS trust that patients at risk of dying from burst aneurysms were not being safely monitored. An IT glitch meant that patients were not followed up to see how soon they would need potentially life-saving surgery.

A doctor at the trust, however, says it initially repeatedly refused to take any action, raising further questions about its management.

The trust initially suggested the problem was the result of senior doctors not keeping up with emails, but later accepted its IT systems were at fault. The hospital was forced to recognise that patients were potentially put at risk and took action only after a whistleblower alerted the NHS regulator.

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Source: The Guardian, 5 January 2020

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'Outdated' IT leaves NHS staff with 15 different computer logins

IT systems in the NHS are so outdated that staff have to log in to up to 15 different systems to do their jobs. Doctors can find themselves using different logins for everything from ordering x-rays and getting lab results to accessing A&E records and rotas.

The government in England said it was looking to streamline the systems as part of an IT upgrade. Around £40 million is being set aside to help hospitals and clinics introduce single-system logins in the next year.

Alder Hey in Liverpool is one of a number of hospitals which have already done this, and found it reduced time spent logging in from one minute 45 seconds to just 10 seconds. With almost 5,000 logins per day, it saved over 130 hours of staff time a day, to focus on patient care.

Health Secretary Matt Hancock said it was time to "get the basics right". "It is frankly ridiculous how much time our doctors and nurses waste logging on to multiple systems. Too often outdated technology slows down and frustrates staff."

British Medical Association leader Dr Chaand Nagpaul said logging on to multiple systems did waste time. But he said on its own this move would not solve all the problems, pointing out that many of the IT systems themselves were "antiquated" and needed upgrading.

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Source: BBC News, 4 January 2020

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Surgery patients with deadly sepsis are not getting antibiotics fast enough, NHS audit finds

More than 80% of patients who have signs of a deadly sepsis infection before high-risk surgery are not getting antibiotics fast enough, a major NHS report has warned.

Sepsis kills an estimated 44,000 people in England every year and rapid access to antibiotics within the first hour after diagnosis is vital to halt the infection. However, a review of performance across 179 NHS hospitals has found a majority of patients undergoing emergency bowel surgery are not getting medication early enough. A leak of the bowel can cause sepsis and while antibiotics will help treat the infection, surgery is essential to repair any sepsis-causing leak.

The Royal College of Anaesthetists, which carried out the study for the NHS, said although the number of patients getting surgery in time had improved over the last five years, the numbers receiving antibiotics within an hour had not.

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Source: The Independent, 4 January 2020

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Somerset care home failed to notify health watchdog of deaths

A residential care home failed to notify the health watchdog about the deaths of people they were providing a service to, its report has found.

Kingdom House, in Norton Fitzwarren, run by Butterfields Home Services, was rated "requires improvement". The home cares for people with conditions such as autism. The Care Quality Commission (CQC) said the registered manager and provider lacked knowledge of regulations and how to meet them. Inspectors found the provider failed to notify the CQC about the deaths of people which occurred in the home, as required by Regulation 16 of the Health and Social Care Act 2008.

The report also found people were at "increased risk" because the provider had not ensured staff had the qualifications, competence, skills and experience to provide people with safe care and treatment.

Inspectors did, however, praise the "positive culture" at the home, that is "person-centred", and noted the provider was "passionate about their service and the people they cared for".

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Source: BBC News, 2 January 2020

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Refusing Scottish help a 'grave error' in blood scandal, letter says

Hundreds of people with haemophilia in England and Wales could have avoided infection from HIV and hepatitis if officials had accepted help from Scotland, newly released documents suggest.

A letter dated January 1990 said Scotland’s blood transfusion service could have supplied the NHS in England and Wales with the blood product factor VIII, but officials rejected the offer repeatedly.

Large volumes of factor VIII were imported from the US instead, but it was far more contaminated with the HIV and hepatitis C viruses because US supplies often came from infected prison inmates, sex workers and drug addicts who were paid to give blood but not screened.

The death of scores of people with haemophilia and blood transfusion patients and the infection of thousands of others across the UK in the contaminated blood scandal has been described as the worst health disaster to hit the NHS.

The latest document was released under the Freedom of Information Act to campaigner Jason Evans, whose father died in 1993 having contracted hepatitis and HIV. In it, Prof John Cash, a former director of the Scottish Blood Transfusion Service, said the decision not to use Scotland's spare capacity to produce Factor VIII for England was "a grave error of judgement".

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Source: The Guardian, 3 January 2020

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Nurse shortage forces NHS hospital to shut critical-care bed

An NHS hospital in Norwich has had to close four beds in its high dependency unit because it does not have enough nurses to staff them.

Norfolk and Norwich university hospital (NNUH) decided on Monday to temporarily shut the beds in the Gissing ward of its critical care complex.

The beds, which are used for seriously ill patients, have been shut despite flu and other viruses that circulate at this time of year leaving more patients than usual suffering from breathing problems.

Hospital managers told doctors in an email that: “A decision has been made to temporarily close our GHDU beds and reduce to 20 bed capacity on our CCC [critical care complex] from today as the nursing staffing is insufficient to keep Gissing open.”

The closure is another stark illustration of both the lack of staff in the NHS, which in England has around 100,000 vacancies, and the extra strain winter is putting on hospitals.

NHS bosses warned recently that staff shortages were now so widespread that patients’ safety and quality of care are under threat.

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Source: The Guardian, 31 December 2019

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Woman dies after being set on fire during surgery in Romania

A woman has died after being set on fire during surgery in Romania, the country’s health ministry has said, in a case that has cast a spotlight on the ailing Romanian health system.

The patient, who had pancreatic cancer, died on Sunday after suffering burns to 40% of her body when surgeons used an electric scalpel despite her being treated with an alcohol-based disinfectant.

Contact with the flammable disinfectant caused combustion and the patient “ignited like a torch”, Emanuel Ungureanu, a Romanian politician, said.

A nurse threw a bucket of water on the 66-year-old woman to prevent the fire from spreading. The health ministry said it would investigate the “unfortunate incident”, which took place on 22 December.

“The surgeons should have been aware that it is prohibited to use an alcohol-based disinfectant during surgical procedures performed with an electric scalpel,” the Deputy Minister, Horatiu Moldovan, said.

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Source: The Guardian, 30 December 2019

the hub has a number of posts on preventing surgical fires:

 

 

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Woman awarded £8m after doctors left sponge inside her during surgery

A woman has been awarded $10.5 million (£8m) in damages after medical staff left a sponge inside her body.

The sponge – which measured 18-by-18 inches and was left behind during surgery – was inside the woman's body for years before she realised.

It had been left in her body after she underwent heart surgery at a Kentucky hospital in 2011. The bypass surgery is said to have gone wrong, leaving a mess – and as nurses rushed to deal with the problems, the sponge was left inside her body. 

It was not discovered for four years, until she had a CT scan in 2015. In the meantime, the sponge had moved around the woman's body, shifting around her intestines and causing pain as it did so. She had her leg amputated and was left with gastrointestinal issues after the sponge eroded into her intestine.

The patient's lawyers said the case should be a reminder to hospitals to ensure that objects such as needles and other sharp objects, as well as sponges, are removed from patients after surgery.

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Source: The Independent, 1 January 2020

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Supply problems with life-saving IV feed could continue for months, warn NHS bosses

Hundreds of patients have been warned supply problems with the specially made IV feed they need to stay alive is likely to continue for months.

NHS England, which declared a national emergency incident in the summer because of the delays in production of intravenous nutrition, has written to patients warning the problems are far from resolved.

Dozens of patients have been admitted to hospital in the past six months because of the supply shortage, which was sparked in June when the main manufacturer, Calea, based in Runcorn, was hit by overnight restrictions by the Medicines and Healthcare products Regulatory Agency (MHRA).

Since the shortages started the NHS has been forced to fly in feed from other European countries, while some patients have had to switch from their bespoke feed to so-called off-the-shelf bags which don’t contain everything they need in the right quantities. Some hospitals have admitted patients to hospital to make sure they receive what they need because of fears for their health or lack of supplies in the community.

Initially it had been hoped the delays in production would be improved by the end of the year, but in a letter sent to some patients, seen by The Independent, NHS bosses warn patients could be facing many more months of delays.

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Source: The Independent, 1 January 2020

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AI 'outperforms' doctors diagnosing breast cancer

Artificial intelligence is more accurate than doctors in diagnosing breast cancer from mammograms, a study in the journal Nature suggests.

An international team, including researchers from Google Health and Imperial College London, designed and trained a computer model on X-ray images from nearly 29,000 women.

The algorithm outperformed six radiologists in reading mammograms. AI was still as good as two doctors working together.

Unlike humans, AI is tireless. Experts say it could improve detection.

Sara Hiom, director of cancer intelligence and early diagnosis at Cancer Research UK, told the BBC: "This is promising early research which suggests that in future it may be possible to make screening more accurate and efficient, which means less waiting and worrying for patients, and better outcomes."

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Source: BBC News, 2 January 2020

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'Breaking point': fears over lack of intensive care beds for children

Critically ill children are being rushed from one part of England to another because NHS hospitals are running short of intensive care beds in which to treat them, the Guardian has revealed.

An increase in severe breathing problems in children driven by winter viruses and infections, including flu, means some are having to be transferred sometimes many miles from their home area because there are not enough paediatric intensive care (PICU) beds locally.

Specialist doctors who staff the units say the situation is “dangerous and rotten for the families” involved and that staff are firefighting to handle the number of children needing sometimes life-saving care, many of whom are on a ventilator to help them breathe.

In the past few weeks, young patients have been sent from the Midlands to Sheffield, from London to Cambridge, and from one side of the Pennines to the other in order to get them a place in a PICU.

One doctor at a PICU in the Midlands said: “PICU beds are always in high demand. But since winter hit this year, around six weeks ago, the situation feels like we are simply firefighting. Many days I come on shift to find there are no beds in [our] region and the patients referred to us end up in Southampton, Sheffield, Oxford and other centres far away."

“The PICU network is overstretched. There aren’t enough beds, nurses or skilled doctors.”

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Source: The Guardian, 29 December 2019

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Revealed: Dozens of hospitals ignoring NHS safety warnings

Dozens of hospital trusts have failed to act on alerts warning that patients could be harmed on its wards, The Independent newspaper has revealed.

Almost 50 NHS hospitals have missed key deadlines to make changes to keep patients safe – and now could face legal action. One hospital, Birmingham Women’s and Children’s Foundation Trust, has an alert that is more than five years past its deadline date and has still not been resolved.

Now the Care Quality Commission (CQC) has warned it will be inspecting hospitals for their compliance with safety alerts and could take action against hospitals ignoring the deadlines.

National bodies issue safety alerts to hospitals after patient deaths and serious incidents where a solution has been identified and action needs to be taken. Despite the system operating for almost 20 years, the NHS continues to see patient deaths and injuries from known and avoidable mistakes.

NHS national director for safety Aidan Fowler has reorganised the system to send out fewer and simpler alerts with clear actions hospitals need to take, overseen by a new national committee. Last year the CQC made a recommendation to streamline and standardise safety alerts after it investigated why lessons were not being learnt.

Professor Ted Baker, Chief Inspector of hospitals, said: “CQC fully supports the recent introduction of the new national patient safety alerts and we have committed to looking closely at how NHS trusts are implementing these safety alerts as part of our monitoring and inspection activity.”

He stressed: “Failure to take the actions required under these alerts could lead to CQC taking regulatory action.”

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Source: The Independent, 30 December 2019

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Cancer patients pushed to ‘breaking point’ as overstretched nurses struggle with high workload

Cancer patients are being pushed to “breaking point” because of a lack of support from overstretched nurses and carers, a leading charity has warned.

Almost half of specialist cancer nurses have told the Macmillan Cancer Support charity that their high workload was having a negative impact on patient care, while one in five people diagnosed with the disease say the staff responsible for their care have unmanageable demands.

Now the charity says this is affecting patients, with thousands calling its specialist support helpline in distress and worried because they feel they can’t get answers from their health workers.

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Source: The Independent, 31 December 2019

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NHS hospitals to employ safety experts to tackle thousands of avoidable mistakes

Hospitals will be required to employ patient safety specialists from next April as part of efforts by the health service to reduce thousands of avoidable errors every year.

NHS trusts will be told to identify staff who will be designated as the safety specialist for each organisation. These workers, who will get specific training and work as part of a network across the country, will help to tackle a fragmentation in the way safety issues are dealt with in the NHS and ensure nationwide action on key safety risks is coordinated.

The proposals are part of a national patient safety strategy which is aiming to save 928 lives and £98.5m across the NHS, as well as reducing negligence claims by £750m by 2025.

The specialists will be identified from existing staff, with part of the role focused on embedding a so-called “just culture” approach to safety. This means reducing blame, supporting staff who make honest errors and tackling systemic causes of mistakes.

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Source: The Independent, 26 December 2019

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Artificial Intelligence is rushing into patient care

Health products powered by artificial intelligence, or AI, are streaming into our lives, from virtual doctor apps to wearable sensors and drugstore chatbots.

IBM boasted that its AI could “outthink cancer.” Others say computer systems that read X-rays will make radiologists obsolete.

Yet many health industry experts fear AI-based products won’t be able to match the hype. Many doctors and consumer advocates fear that the tech industry, which lives by the mantra “fail fast and fix it later,” is putting patients at risk and that regulators aren’t doing enough to keep consumers safe.

Early experiments in AI provide reason for caution, said Mildred Cho, a professor of pediatrics at Stanford’s Center for Biomedical Ethics.

Systems developed in one hospital often flop when deployed in a different facility, Cho said. Software used in the care of millions of Americans has been shown to discriminate against minorities. And AI systems sometimes learn to make predictions based on factors that have less to do with disease than the brand of MRI machine used, the time a blood test is taken or whether a patient was visited by a chaplain. In one case, AI software incorrectly concluded that people with pneumonia were less likely to die if they had asthma an error that could have led doctors to deprive asthma patients of the extra care they need.

“It’s only a matter of time before something like this leads to a serious health problem,” said Steven Nissen, chairman of cardiology at the Cleveland Clinic.

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Source: Scientific American, 24 December 2019

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China launches new law to protect doctors

China has introduced a new law with the aim of preventing violence against medical workers.

The announcement comes days after a female doctor was stabbed to death at a Beijing hospital.

The law bans any organisation or individual from threatening or harming the personal safety or dignity of medical workers, according to state media.

It will take effect on 1 June next year.

Under the new law, those "disturbing the medical environment, or harming medical workers' safety and dignity" will be given administrative punishments such as detention or a fine. It will also punish people found illegally obtaining, using or disclosing people's private healthcare information.

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Source: BBC News, 29 December 2019

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Harvard researchers find significant clinical impact and cost savings with MedAware's patient safety platform

MedAware, a developer of AI-based patient safety solutions, has announced the publication of a study by The Joint Commission Journal on Quality and Patient Safety, validating both the significant clinical impact and anticipated ROI of MedAware's machine learning-enabled clinical decision support platform designed to prevent medication-related errors and risks.

The study analysed MedAware's clinical relevance and accuracy and estimated the platform's direct cost savings for adverse events potentially prevented in Massachusetts General and Brigham and Women's Hospitals' outpatient clinics. If the system had been operational, the estimated direct cost savings of the avoidable adverse events would have been more than $1.3 million when extrapolating the study's findings to the full patient population.  

Dr David Bates, study co-author, Professor at Harvard Medical School, and Director of the Center for Patient Safety Research & Practice at Brigham and Women's Hospital, said: "Because it is not rule-based, MedAware represents a paradigm shift in medication-related risk mitigation and an innovative approach to improving patient safety."

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Source: CISION PR Newswire, 16 December 2019

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Kindness: an underrated currency

Cultivation of kindness is a valuable part of the business of healthcare, discusses Klaber and Bailey in an Editorial in the BMJ. 

"When we reflect on the past decade, it feels as if we have made a big mistake in healthcare. We have allowed the dominant narrative to be around money, taking the focus, energy, and leadership away from our core purpose of delivering the best care possible. Balancing the books is important, especially in a tax funded system, and we have a duty to drive value for every pound we spend — but money is not the most important thing."

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Source: BMJ, 16 December 2019

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Nurses' strike in Northern Ireland: RCN confirms January strike dates

Nurses in Northern Ireland have announced their plans for further strike action in the new year.

Earlier this month, more than 15,000 nurses took to the picket lines over pay and staffing levels. It was the first time in the 103-year history of the Royal College of Nursing (RCN) that its members had taken such action.

It has announced nurses will strike on 8 January and 10 January 2020, unless a resolution is reached.

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Source: BBC News, 24 December 2019

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